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Scarr D, Lovblom E, Ye H, Liu H, Bakhsh A, Verhoeff NJ, Wolever TMS, Lawler PR, Sharma K, Cherney DZI, Perkins BA. Ketone production and excretion even during mild hyperglycemia and the impact of sodium-glucose co-transporter inhibition in type 1 diabetes. Diabetes Res Clin Pract 2024; 207:111031. [PMID: 38036220 DOI: 10.1016/j.diabres.2023.111031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
AIMS We aimed to determine if ketone production and excretion are increased even at mild fasting hyperglycemia in type 1 diabetes (T1D) and if these are modified by ketoacidosis risk factors, including sodium-glucose co-transporter inhibition (SGLTi) and female sex. METHODS In secondary analysis of an 8-week single-arm open-label trial of empagliflozin (NCT01392560) we evaluated ketone concentrations during extended fasting and clamped euglycemia (4-6 mmol/L) and mild hyperglycemia (9-11 mmol/L) prior to and after treatment. Plasma and urine beta-hydroxybutyrate (BHB) concentrations and fractional excretion were analyzed by metabolomic analysis. RESULTS Forty participants (50 % female), aged 24 ± 5 years, HbA1c 8.0 ± 0.9 % (64 ± 0.08 mmol/mol) with T1D duration of 17.5 ± 7 years, were studied. Increased BHB production even during mild hyperglycemia (median urine 6.3[3.5-13.6] vs. 3.5[2.2-7.0] µmol/mmol creatinine during euglycemia, p < 0.001) was compensated by increased fractional excretion (0.9 % [0.3-1.6] vs. 0.4 % [0.2-0.9], p < 0.001). SGLTi increased production and attenuated the increased BHB fractional excretion (decreased to 0.3 % during mild hyperglycemia, p < 0.001), resulting in higher plasma concentrations (increased to 0.21 [0.05-0.40] mmol/L, p < 0.001), particularly in females (interaction p < 0.001). CONCLUSIONS Even mild hyperglycemia is associated with greater ketone production, compensated by urinary excretion, in T1D. However, SGLTi exaggerates production and partially reduces compensatory excretion, particularly in women.
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Affiliation(s)
- Daniel Scarr
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Erik Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hongping Ye
- Center for Renal Precision Medicine, Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - Hongyan Liu
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abdulmohsen Bakhsh
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Kidney & Pancreas Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natasha J Verhoeff
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patrick R Lawler
- McGill University Health Centre, Montreal, Canada; The Peter Munk Cardiac Centre at University Health Network, University of Toronto, Canada
| | - Kumar Sharma
- Center for Renal Precision Medicine, Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ramdath DD, Renwick S, Hawke A, Ramdath DG, Wolever TMS. Minimal Effective Dose of Beans Required to Elicit a Significantly Lower Glycemic Response Than Commonly Consumed Starchy Foods: Predictions Based on In Vitro Digestion and Carbohydrate Analysis. Nutrients 2023; 15:4495. [PMID: 37960148 PMCID: PMC10649573 DOI: 10.3390/nu15214495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Beans elicit lower glycemic responses (GRs) than other starchy foods, but the minimum effective dose (MED) to reduce GR is unknown. We sought to determine the MED of beans compared to common starchy foods. Overnight-fasted healthy volunteers consumed ¼c (phase 1, n = 24) or ½c (phase 2, n = 18) of black, cranberry, great northern, kidney, navy and pinto beans and corn, rice, pasta and potato (controls), with blood glucose measured before and for 2 h after eating. GRs (incremental areas under the curves, iAUCs) after beans were consumed were compared to those of controls by ANOVA followed by Dunnett's test. To qualify for MED, beans had to elicit an effective reduction in GR, defined as a statistically significant reduction in iAUC of ≥20% (i.e., a relative glycemic response, RGR, ≤80). Outcomes from in vitro digestion were compared with in vivo RGR. Both doses of all six beans effectively reduced GR versus all four starchy controls, except for ¼c and ½c cranberry and pinto vs. corn, ¼c great northern and navy vs. corn and ¼c navy and pinto vs. potato. MED criteria were met for 18 comparisons of the ¼c servings, with four of the remaining six met by the ½c servings. The overall mean ± SEM RGR vs. controls was similar for the ¼c and ½c servings: 53 ± 4% and 56 ± 3%, respectively. By multiple regression analysis, RGR = 23.3 × RDS + 8.3 × SDS - 20.1 × RS + 39.5 × AS - 108.2 (rapidly digested starch, p < 0.001; slowly digested starch, p = 0.054; resistant starch, p = 0.18; available sugars, p = 0.005; model r = 0.98, p = 0.001). RGR correlated with in vitro glucose release (r = 0.92, p < 0.001). The MED of beans is ¼ cup. For n = 30 comparisons (n = 24 beans vs. controls, n = 6 controls vs. each other), an effective reduction in GR was predicted from in vitro carbohydrate analysis with 86% sensitivity and 100% specificity.
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Affiliation(s)
- D. Dan Ramdath
- Guelph Research and Development Centre, Agriculture and Agri Food Canada, Guelph, ON N1G 5C9, Canada; (S.R.); (A.H.); (D.G.R.)
| | - Simone Renwick
- Guelph Research and Development Centre, Agriculture and Agri Food Canada, Guelph, ON N1G 5C9, Canada; (S.R.); (A.H.); (D.G.R.)
| | - Aileen Hawke
- Guelph Research and Development Centre, Agriculture and Agri Food Canada, Guelph, ON N1G 5C9, Canada; (S.R.); (A.H.); (D.G.R.)
| | - Davin G. Ramdath
- Guelph Research and Development Centre, Agriculture and Agri Food Canada, Guelph, ON N1G 5C9, Canada; (S.R.); (A.H.); (D.G.R.)
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Wolever TMS, Maningat CC, Seib PA, Campbell JE, Jenkins AL. Cross-linked phosphorylated RS4 wheat starch reduces glucose and insulin responses after 3 days of pre-feeding in healthy adults: an acute, double-blind, randomized controlled clinical trial. Int J Food Sci Nutr 2023; 74:621-629. [PMID: 37475127 DOI: 10.1080/09637486.2023.2236809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
When this project was designed, there was no evidence that adding resistant starch to available carbohydrate (avCHO) reduced glycaemic and insulinaemic responses (GIR). We compared GIR elicited by a cookie containing cross-linked phosphorylated RS4 wheat starch (Fibersym®) (RS4XL) versus an avCHO-matched control-cookie (CC) after n = 15 adults had consumed RS4XL or CC daily for 3-days using a double-blind, randomised, cross-over design. The difference in glucose iAUC over 0-2 h (primary endpoint) (mmol × min/L) after RS4XL, (mean ± SEM) 106 ± 16, versus CC, 124 ± 16, was not significant (p = 0.087). However, RS4XL reduced 0-90 min glucose iAUC (72 ± 9 vs 87 ± 9, p = 0.022), peak glucose concentration (6.05 ± 0.36 vs 6.57 ± 0.31 mmol/L, p = 0.017) and 0-2 h insulin iAUC (189 ± 21 vs 246 ± 24 nmol × h/L, p = 0.020). These results show that RS4XL reduced postprandial glycaemic and insulinaemic responses when added to avCHO, but do not prove that the products of its colonic fermentation are required for this effect.
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Affiliation(s)
- Thomas M S Wolever
- INQUIS Clinical Research Ltd. (Formerly Glycemic Index Laboratories), Toronto, Ontario, Canada
| | | | - Paul A Seib
- Kansas State University, Manhattan, Kansas, USA
| | - Janice E Campbell
- INQUIS Clinical Research Ltd. (Formerly Glycemic Index Laboratories), Toronto, Ontario, Canada
| | - Alexandra L Jenkins
- INQUIS Clinical Research Ltd. (Formerly Glycemic Index Laboratories), Toronto, Ontario, Canada
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Liu Q, Chiavaroli L, Ayoub-Charette S, Ahmed A, Khan TA, Au-Yeung F, Lee D, Cheung A, Zurbau A, Choo VL, Mejia SB, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials. PLoS One 2023; 18:e0264802. [PMID: 37582096 PMCID: PMC10427023 DOI: 10.1371/journal.pone.0264802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/30/2023] [Indexed: 08/17/2023] Open
Abstract
Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.
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Affiliation(s)
- Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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Lee D, Chiavaroli L, Ayoub-Charette S, Khan TA, Zurbau A, Au-Yeung F, Cheung A, Liu Q, Qi X, Ahmed A, Choo VL, Blanco Mejia S, Malik VS, El-Sohemy A, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials. Nutrients 2022; 14:nu14142846. [PMID: 35889803 PMCID: PMC9325155 DOI: 10.3390/nu14142846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.
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Affiliation(s)
- Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Xinye Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
- Correspondence: ; Tel.: +1-416-867-3732
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Doma KM, Dolinar KF, Dan Ramdath D, Wolever TMS, Duncan AM. Canned Beans Decrease Serum Total and LDL Cholesterol in Adults with Elevated LDL Cholesterol in a 4-wk Multicenter, Randomized, Crossover Study. J Nutr 2021; 151:3701-3709. [PMID: 34642756 DOI: 10.1093/jn/nxab323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Practical risk reduction strategies are needed to address cardiovascular disease. Beans can decrease LDL cholesterol; however, research into different daily amounts and varieties is warranted. OBJECTIVES To examine the effects of canned beans (daily rotation of black, navy, pinto, dark red kidney, white kidney) in 1-cup (1CB, 180 g) and ½-cup (½CB, 90 g) daily amounts compared with a 1-cup white rice (WR) control on serum lipid and glycemic biomarkers in adults with elevated LDL cholesterol. METHODS Adults [n = 73, mean ± SD age: 48.1 ± 14.2 y; BMI (in kg/m2): 25.9 ± 4.22; fasting serum LDL cholesterol: 3.0-5.0 mmol/L] consumed 1CB, ½CB, and WR for 4-wk treatment periods separated by ≥4-wk washouts in a multicenter, randomized, crossover study. Fasting serum LDL cholesterol (primary outcome) and other lipids and glycemic biomarkers (secondary outcomes) were measured on study days 1 and 29 of each treatment period with study day 29 values compared using repeated-measures ANCOVA, including study day 1 values as covariates. RESULTS Treatment completion was n = 66 for 1CB, n = 68 for ½CB, and n = 64 for WR. Total cholesterol on study day 29 was lower for 1CB (P = 0.04) but not ½CB (P = 0.77) compared with WR (-5.46%, -2.74%, -0.65% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.17). LDL cholesterol on study day 29 was also lower for 1CB (P = 0.002) but not ½CB (P = 0.30) compared with WR (-8.08%, -3.84%, +0.49% changes from study day 1, respectively) and did not differ between 1CB and ½CB (P = 0.11). Other lipids and glycemic biomarkers did not differ among treatments. CONCLUSIONS Consumption of 1 cup (180 g) of canned beans of multiple varieties decreased total and LDL cholesterol in adults with elevated LDL cholesterol, supporting a practical strategy for cardiovascular disease risk reduction. This trial was registered at clinicaltrials.gov as NCT03830970.
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Affiliation(s)
- Katarina M Doma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Karen F Dolinar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - D Dan Ramdath
- Guelph Research and Development Centre, Agriculture and Agri-Food Canada, Guelph, Ontario, Canada
| | | | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Wolever TMS, El-Sohemy A, Ezatagha A, Zurbau A, Jenkins AL. Neither low salivary amylase activity, cooling cooked white rice, nor single nucleotide polymorphisms in starch-digesting enzymes reduce glycemic index or starch digestibility: a randomized, crossover trial in healthy adults. Am J Clin Nutr 2021; 114:1633-1645. [PMID: 34293081 DOI: 10.1093/ajcn/nqab228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It was suggested that low salivary-amylase activity (SAA) and cooling or stir-frying cooked starch decreases its digestibility and glycemic index. OBJECTIVE We determined the effects of SAA, cooling, and single-nucleotide polymorphisms (SNPs) in the salivary amylase (AMY1), pancreatic amylase (AMY2A, AMY2B), maltase-glucoamylase (MGAM), and sucrase-isomaltase (SI) genes on starch digestibility and glycemic index of cooked polished rice. METHODS Healthy subjects [pilot, n = 12; main, n = 20 with low-SAA (<50 U/mL), and n = 20 with high-SAA (>105 U/mL)] consumed test meals containing 25 g (pilot) or 50 g (main) available carbohydrate at a contract research organization using open-label (pilot) or assessor-blinded (main), randomized, crossover, Latin-square designs (trial registration: NCT03667963). Pilot-trial test meals were dextrose, freshly cooked polished rice, cooked rice cooled overnight, stir-fried hot rice, or stir-fried cold rice. Main-trial test meals were dextrose, dextrose plus 10 g lactulose, plain hot rice, or plain cold rice. In both trials, blood glucose was measured fasting and at intervals over 2 h. In the main trial, breath hydrogen was measured fasting and hourly for 6 h to estimate in vivo starch digestibility. Data were analyzed by repeated-measures ANOVA for the main effects of temperature and stir-frying (pilot trial) or the main effects of SAA and temperature (main trial) and their interactions. Effects of 24 single nucleotide polymorphisms (SNPs) were assessed separately. Means were considered to be equivalent if the 95% CI of the differences were within ±20% of the comparator mean for glucose response/glycemic index or ±7% for digestibility. RESULTS Pilot: neither temperature nor stir-frying significantly affected glucose incremental AUC (primary endpoint, n = 12). Main: mean ± SEM glycemic index (primary endpoint, n = 40) was equivalent for low-SAA compared with high-SAA (73 ± 3 vs. 75 ± 4) and cold rice compared with hot rice (75 ± 3 vs. 70 ± 3). Estimated starch digestibility (n = 39) was equivalent for low-SAA compared with high-SAA (95% ± 1% vs. 92% ± 1%) and hot rice compared with cold rice (94% ± 1% vs. 93% ± 1%). No meaningful associations were observed between genotypes and starch digestibility or glycemic index for any of the SNPs. CONCLUSIONS The results do not support the hypotheses that low-SAA, cooling, and common genetic variations in starch-digesting enzymes affect the glycemic index or in vivo carbohydrate digestibility of cooked polished rice. This trial was registered at clinicaltrials.gov as NCT03667963.
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Affiliation(s)
- Thomas M S Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,INQUIS Clinical Research, Ltd (formerly GI Labs), Toronto, Ontario, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adish Ezatagha
- INQUIS Clinical Research, Ltd (formerly GI Labs), Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,INQUIS Clinical Research, Ltd (formerly GI Labs), Toronto, Ontario, Canada
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Chiavaroli L, Lee D, Ahmed A, Cheung A, Khan TA, Blanco S, Mejia, Mirrahimi A, Jenkins DJA, Livesey G, Wolever TMS, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 2021; 374:n1651. [PMID: 34348965 PMCID: PMC8336013 DOI: 10.1136/bmj.n1651] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Library searched up to 13 May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. OUTCOME AND MEASURES The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI (body mass index), waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. RESULTS 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. CONCLUSIONS This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, blood pressure, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. STUDY REGISTRATION ClinicalTrials.gov NCT04045938.
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Sonia Blanco
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- Independent Nutrition Logic, Wymondham, UK
- INQUIS Clinical Research, Toronto, ON, Canada
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | | | - Thomas M S Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- INQUIS Clinical Research, Toronto, ON, Canada
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
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Wolever TMS, Rahn M, Dioum EH, Jenkins AL, Ezatagha A, Campbell JE, Chu Y. Effect of Oat β-Glucan on Affective and Physical Feeling States in Healthy Adults: Evidence for Reduced Headache, Fatigue, Anxiety and Limb/Joint Pains. Nutrients 2021; 13:1534. [PMID: 34062937 PMCID: PMC8147290 DOI: 10.3390/nu13051534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 01/07/2023] Open
Abstract
The gastrointestinal (GI) side-effects of dietary fibers are recognized, but less is known about their effects on non-GI symptoms. We assessed non-GI symptoms in a trial of the LDL-cholesterol lowering effect of oat β-glucan (OBG). Participants (n = 207) with borderline high LDL-cholesterol were randomized to an OBG (1 g OBG, n = 104, n = 96 analyzed) or Control (n = 103, n = 95 analyzed) beverage 3-times daily for 4 weeks. At screening, baseline, 2 weeks and 4 weeks participants rated the severity of 16 non-GI symptoms as none, mild, moderate or severe. The occurrence and severity (more or less severe than pre-treatment) were compared using chi-squared and Fisher's exact test, respectively. During OBG treatment, the occurrence of exhaustion and fatigue decreased versus baseline (p < 0.05). The severity of headache (2 weeks, p = 0.032), anxiety (2 weeks p = 0.059) and feeling cold (4 weeks, p = 0.040) were less on OBG than Control. The severity of fatigue and hot flashes at 4 weeks, limb/joint pain at 2 weeks and difficulty concentrating at both times decreased on OBG versus baseline. High serum c-reactive-protein and changes in c-reactive-protein, oxidized-LDL, and GI-symptom severity were associated with the occurrence and severity of several non-GI symptoms. These data provide preliminary, hypothesis-generating evidence that OBG may reduce several non-GI symptoms in healthy adults.
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Affiliation(s)
- Thomas M. S. Wolever
- Formerly GI Labs, INQUIS Clinical Research, Ltd., Toronto, ON M5C 2N8, Canada; (A.L.J.); (A.E.); (J.E.C.)
| | - Maike Rahn
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA; (M.R.); (E.H.D.); (Y.C.)
| | - El Hadji Dioum
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA; (M.R.); (E.H.D.); (Y.C.)
| | - Alexandra L. Jenkins
- Formerly GI Labs, INQUIS Clinical Research, Ltd., Toronto, ON M5C 2N8, Canada; (A.L.J.); (A.E.); (J.E.C.)
| | - Adish Ezatagha
- Formerly GI Labs, INQUIS Clinical Research, Ltd., Toronto, ON M5C 2N8, Canada; (A.L.J.); (A.E.); (J.E.C.)
| | - Janice E. Campbell
- Formerly GI Labs, INQUIS Clinical Research, Ltd., Toronto, ON M5C 2N8, Canada; (A.L.J.); (A.E.); (J.E.C.)
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA; (M.R.); (E.H.D.); (Y.C.)
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Lewis EJH, Lovblom LE, Cisbani G, Chen DK, Bazinet RP, Wolever TMS, Perkins BA, Bril V. Baseline omega-3 level is associated with nerve regeneration following 12-months of omega-3 nutrition therapy in patients with type 1 diabetes. J Diabetes Complications 2021; 35:107798. [PMID: 33309385 DOI: 10.1016/j.jdiacomp.2020.107798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022]
Abstract
AIM Omega-3 (n-3) polyunsaturated fatty-acids are essential for the development and maintenance of nerve function, but the relationship of plasma n-3 to the presence of diabetic distal-symmetric-polyneuropathy (DSP) and the effect of n-3 therapy on plasma levels and small nerve fibre morphology in T1D are unknown. METHODS Participants with T1D (n = 40, 53% female, aged (mean ± SD) 48 ± 14 years, BMI 28.1 ± 5.8 kg/m2, diabetes duration 27 ± 18 years), 23 of whom had DSP, took seal-oil (10 mL/day; 750 mg eicosapentaenoic acid (EPA), 560 mg docosapentaenoic acid (DPAn-3), and 1020 mg docosahexaenoic acid (DHA)) for 12-months in a single-arm open-label study. The improvement in corneal nerve fibre length (CNFL) (primary outcome) was previously reported. In this secondary analysis, plasma n-3s were measured at baseline, 4, 8 and 12-months. RESULTS At baseline, participants with DSP had lower DHA than those without (1.73 ± 0.89 vs. 2.27 ± 0.70%, p = 0.049). Twelve-months seal-oil therapy increased mean plasma EPA by 185%, DPA by 29%, DHA by 79% (p < 0.001) and CNFL by 29% (p = 0.001). Change in CNFL was positively associated with higher baseline total n-3 (Spearman's correlation coefficient r = 0.41, p = 0.013), DPA (r = 0.33, p = 0.047) and DHA (r = 0.42, p = 0.012). CONCLUSION In conclusion, low plasma DHA was associated with prevalent DSP, n-3 therapy increased blood n-3 levels and higher baseline n-3s were associated with greater nerve regeneration.
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Affiliation(s)
- Evan J H Lewis
- Lunenfeld-Tanenbaum Research Institute, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Giulia Cisbani
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel K Chen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Richard P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Disorders, Division of Neurology, University Health Network, University of Toronto, Toronto, Canada
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11
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Zurbau A, Noronha JC, Khan TA, Sievenpiper JL, Wolever TMS. The effect of oat β-glucan on postprandial blood glucose and insulin responses: a systematic review and meta-analysis. Eur J Clin Nutr 2021; 75:1540-1554. [PMID: 33608654 PMCID: PMC8563417 DOI: 10.1038/s41430-021-00875-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 12/26/2022]
Abstract
To determine the effect of oat β‑glucan (OBG) on acute glucose and insulin responses and identify significant effect modifiers we searched the MEDLINE, EMBASE, and Cochrane databases through October 27, 2020 for acute, crossover, controlled feeding trials investigating the effect of adding OBG (concentrate or oat-bran) to carbohydrate-containing test-meals compared to comparable or different carbohydrate-matched control-meals in humans regardless of health status. The primary outcome was glucose incremental area-under-the-curve (iAUC). Secondary outcomes were insulin iAUC, and glucose and insulin incremental peak-rise (iPeak). Two reviewers extracted the data and assessed risk-of-bias and certainty-of-evidence (GRADE). Data were pooled using generic inverse-variance with random-effects model and expressed as ratio-of-means with [95% CIs]. We included 103 trial comparisons (N = 538). OBG reduced glucose iAUC and iPeak by 23% (0.77 [0.74, 0.81]) and 28% (0.72 [0.64, 0.76]) and insulin by 22% (0.78 [0.72, 0.85]) and 24% (0.76 [0.65, 0.88]), respectively. Dose, molecular-weight, and comparator were significant effect modifiers of glucose iAUC and iPeak. Significant linear dose-response relationships were observed for all outcomes. OBG molecular-weight >300 kg/mol significantly reduced glucose iAUC and iPeak, whereas molecular-weight <300 kg/mol did not. Reductions in glucose iAUC (27 vs 20%, p = 0.03) and iPeak (39 vs 25%, p < 0.01) were significantly larger with different vs comparable control-meals. Outcomes were similar in participants with and without diabetes. All outcomes had high certainty-of-evidence. In conclusion, current evidence indicates that adding OBG to carbohydrate-containing meals reduces glycaemic and insulinaemic responses. However, the magnitude of glucose reduction depends on OBG dose, molecular-weight, and the comparator.
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Affiliation(s)
- Andreea Zurbau
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jarvis C Noronha
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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12
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Augustin LSA, Aas AM, Astrup A, Atkinson FS, Baer-Sinnott S, Barclay AW, Brand-Miller JC, Brighenti F, Bullo M, Buyken AE, Ceriello A, Ellis PR, Ha MA, Henry JC, Kendall CWC, La Vecchia C, Liu S, Livesey G, Poli A, Salas-Salvadó J, Riccardi G, Riserus U, Rizkalla SW, Sievenpiper JL, Trichopoulou A, Usic K, Wolever TMS, Willett WC, Jenkins DJA. Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC). Nutrients 2020; 12:nu12092553. [PMID: 32846882 PMCID: PMC7551906 DOI: 10.3390/nu12092553] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023] Open
Abstract
Dietary fibre is a generic term describing non-absorbed plant carbohydrates and small amounts of associated non-carbohydrate components. The main contributors of fibre to the diet are the cell walls of plant tissues, which are supramolecular polymer networks containing variable proportions of cellulose, hemicelluloses, pectic substances, and non-carbohydrate components, such as lignin. Other contributors of fibre are the intracellular storage oligosaccharides, such as fructans. A distinction needs to be made between intrinsic sources of dietary fibre and purified forms of fibre, given that the three-dimensional matrix of the plant cell wall confers benefits beyond fibre isolates. Movement through the digestive tract modifies the cell wall structure and may affect the interactions with the colonic microbes (e.g., small intestinally non-absorbed carbohydrates are broken down by bacteria to short-chain fatty acids, absorbed by colonocytes). These aspects, combined with the fibre associated components (e.g., micronutrients, polyphenols, phytosterols, and phytoestrogens), may contribute to the health outcomes seen with the consumption of dietary fibre. Therefore, where possible, processing should minimise the degradation of the plant cell wall structures to preserve some of its benefits. Food labelling should include dietary fibre values and distinguish between intrinsic and added fibre. Labelling may also help achieve the recommended intake of 14 g/1000 kcal/day.
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Affiliation(s)
- Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS-“Fondazione G. Pascale”, 80131 Napoli, Italy
- Correspondence:
| | - Anne-Marie Aas
- Section of Nutrition and Dietetics, Division of Medicine, Department of Clinical Service, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Arnie Astrup
- Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Fiona S. Atkinson
- School of Life and Environmental Sciences, The University of Sydney, 2006 Sydney, Australia; (F.S.A.); (J.C.B.-M.)
- Charles Perkins Centre, The University of Sydney, 2006 Sydney, Australia
| | | | | | - Jennie C. Brand-Miller
- School of Life and Environmental Sciences, The University of Sydney, 2006 Sydney, Australia; (F.S.A.); (J.C.B.-M.)
- Charles Perkins Centre, The University of Sydney, 2006 Sydney, Australia
| | - Furio Brighenti
- Department of Food and Drug, University of Parma, 43120 Parma, Italy;
| | - Monica Bullo
- Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.); (J.S.-S.)
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Anette E. Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany;
| | - Antonio Ceriello
- IRCCS MultiMedica, Diabetes Department, Sesto San Giovanni, 20099 Milan, Italy;
| | - Peter R. Ellis
- Biopolymers Group, Departments of Biochemistry and Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK;
| | - Marie-Ann Ha
- Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK;
| | - Jeyakumar C. Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore 637551, Singapore;
| | - Cyril W. C. Kendall
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.W.C.K.); (J.L.S.); (T.M.S.W.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy;
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA;
| | - Geoffrey Livesey
- Independent Nutrition Logic Ltd., 21 Bellrope Lane, Wymondham NR180QX, UK;
| | - Andrea Poli
- Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy;
| | - Jordi Salas-Salvadó
- Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.); (J.S.-S.)
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili (IISPV), 43201 Reus, Spain
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy;
| | - Ulf Riserus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, 751 22 Uppsala, Sweden;
| | - Salwa W. Rizkalla
- Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France;
| | - John L. Sievenpiper
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.W.C.K.); (J.L.S.); (T.M.S.W.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | | | - Kathy Usic
- Glycemic Index Foundation, 2037 Sydney, Australia;
| | - Thomas M. S. Wolever
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.W.C.K.); (J.L.S.); (T.M.S.W.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Walter C. Willett
- Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA;
| | - David J. A. Jenkins
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (C.W.C.K.); (J.L.S.); (T.M.S.W.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
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13
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M. Grant S, J. Glenn A, M. S. Wolever T, G. Josse R, L. O’Connor D, Thompson A, D. Noseworthy R, Seider M, Sobie M, Bhatti G, Cavanagh J, Jones E, B. Darling P. Evaluation of Glycemic Index Education in People Living with Type 2 Diabetes: Participant Satisfaction, Knowledge Uptake, and Application. Nutrients 2020; 12:E2416. [PMID: 32806563 PMCID: PMC7469042 DOI: 10.3390/nu12082416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
The glycemic index (GI) has been included in the Canadian clinical practice guidelines for type 2 diabetes (T2D) management since 2003, and even longer in other parts of the world (e.g., Australia). Despite this, dietitians have reported that GI is "too difficult for patients to understand and apply." They have called for diverse GI-utility data and evidence-informed education materials. To address these concerns, we developed and evaluated a GI education workshop and supporting materials, using the Kirkpatrick Model, for a T2D population. Participants (n = 29) with T2D attended a dietitian-facilitated workshop and received education materials. A mixed-form questionnaire (GIQ) and 3-day-diet-record were used to capture patient demographics, satisfaction, knowledge, and application, prior to and immediately after the workshop, 1-week, and 4-weeks post-education. Dietary GI was significantly lower at 1 and 4 weeks post-education (mean ± SEM; both 54 ± 1), compared to pre-education (58 ± 1; p ≤ 0.001). Participants (28/29) were satisfied with the intervention. The GI knowledge score was significantly higher post-education at baseline (83.5 ± 3.4%; p ≤ 0.001), week one (87.5 ± 2.6%; p = 0.035), and week four (87.6 ± 3.8%; p = 0.011) when compared to pre-education (53.6 ± 5.1%). A significant reduction in dietary GI was achieved by participants living with T2D, after completing the workshop, and they were able to acquire and apply GI knowledge in a relatively short period.
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Affiliation(s)
- Shannan M. Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS B3M 2J6, Canada
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Andrea J. Glenn
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
| | - Robert G. Josse
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, 61 Queen St. E, Toronto, ON M5C 2T2, Canada
| | - Deborah L. O’Connor
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Physiology and Experimental Medicine Program, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Alexandra Thompson
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Rebecca D. Noseworthy
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Maxine Seider
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, 61 Queen Street E, Toronto, ON M5C 2T2, Canada
| | - Melissa Sobie
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Gurita Bhatti
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Julianne Cavanagh
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Emily Jones
- Nutrition Department, St Michael’s Hospital, 61 queen St. E, Toronto, ON M5B 1W8, Canada; (M.S.); (G.B.); (J.C.); (E.J.)
| | - Pauline B. Darling
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (A.J.G.); (T.M.S.W.); (R.G.J.); (D.L.O.); (A.T.); (R.D.N.); (M.S.); (P.B.D.)
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 7K4, Canada
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14
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Wolever TMS, Mattila O, Rosa-Sibakov N, Tosh SM, Jenkins AL, Ezatagha A, Duss R, Steinert RE. Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans. Nutrients 2020; 12:nu12082275. [PMID: 32751269 PMCID: PMC7469033 DOI: 10.3390/nu12082275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
To see if the molecular weight (MW) and viscosity of oat β-glucan (OBG) when taken before eating determine its effect on postprandial glycemic responses (PPRG), healthy overnight-fasted subjects (n = 16) were studied on eight separate occasions. Subjects consumed 200 mL water alone (Control) or with 4 g OBG varying in MW and viscosity followed, 2-3 min later, by 113 g white-bread. Blood was taken fasting and at 15, 30, 45, 60, 90, and 120 min after starting to eat. None of the OBG treatments differed significantly from the Control for the a-priori primary endpoint of glucose peak-rise or secondary endpoint of incremental area-under-the-curve (iAUC) over 0-120 min. However, significant differences from the Control were seen for glucose iAUC over 0-45 min and time to peak (TTP) glucose. Lower log(MW) and log(viscosity) were associated with higher iAUC 0-45 (p < 0.001) and shorter TTP (p < 0.001). We conclude that when 4 g OBG is taken as a preload, reducing MW does not affect glucose peak rise or iAUC0-120, but rather accelerates the rise in blood glucose and reduces the time it takes glucose to reach the peak. However, this is based on post-hoc calculation of iAUC0-45 and TTP and needs to be confirmed in a subsequent study.
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Affiliation(s)
- Thomas M. S. Wolever
- INQUIS Clinical Research, Ltd. (formerly GI Labs), Toronto, ON M5C 2N8, Canada; (T.M.S.W.); (A.L.J.); (A.E.)
| | - Outi Mattila
- VTT Technical Research Centre of Finland Ltd., 1000 Espoo, Finland; (O.M.); (N.R.-S.)
| | - Natalia Rosa-Sibakov
- VTT Technical Research Centre of Finland Ltd., 1000 Espoo, Finland; (O.M.); (N.R.-S.)
| | - Susan M. Tosh
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Alexandra L. Jenkins
- INQUIS Clinical Research, Ltd. (formerly GI Labs), Toronto, ON M5C 2N8, Canada; (T.M.S.W.); (A.L.J.); (A.E.)
| | - Adish Ezatagha
- INQUIS Clinical Research, Ltd. (formerly GI Labs), Toronto, ON M5C 2N8, Canada; (T.M.S.W.); (A.L.J.); (A.E.)
| | - Ruedi Duss
- DSM Nutritional Products Ltd., R&D Human Nutrition and Health, 4002 Basel, Switzerland;
| | - Robert E. Steinert
- DSM Nutritional Products Ltd., R&D Human Nutrition and Health, 4002 Basel, Switzerland;
- Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zürich, 8091 Zürich, Switzerland
- Correspondence:
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15
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Shah P, Jenkins A, Ezatagha A, Campbell J, Zurbau A, Wolever TMS, Bhaduri A, Mullick A. Comparison of the Acute Glycemic and Insulinemic Response of Fossence™, a Short Chain Fructo-Oligosaccharide, Taken Alone, Added or Substituted into a Carbohydrate Load. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa052_043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To explore the physiological response to ingestion of FossenceTM, a short chain fructo-oligosaccharide, when taken alone or when added or substituted into a carbohydrate load.
Methods
In a randomized, controlled, cross-over design, 25 healthy subjects completed three phases (phase 1: 13M:12F; 41 ± 14y; 24.4 ± 2.2 kg/m²; phase 2: 13M:12F; 40 ± 14y; 24.5 ± 2.4 kg/m²; phase 3: 13M:12F; 41 ± 14y; 24.3 ± 2.6 kg/m²; Mean ± SD). On separate days, each subject received in Phase 1: 10 g FossenceTM(10FOS), 10 g Dextrose (10Dex) or a water control (Control); Phase 2: 50 g Dextrose alone (50Dex), Dextrose with 15 g FossenceTM(50Dex + 15FOS), 35 g Dextrose alone (35Dex) or Dextrose with 15 g FossenceTM(35Dex + 15FOS); and Phase 3 received: 50 g available carbohydrate (avCHO) from white bread alone (50WB) or with 15 g FossenceTM(50WB + 15FOS), 35 g avCHO from white bread alone (35WB) or with 15 g FossenceTM(35WB + 15FOS). Blood samples were collected at fasting and over 2 hours after the start of the test meal and analyzed for glucose and insulin levels. The primary endpoint was differences in glucose IAUC. (ClinicalTrials.gov: NCT03755232).
Results
Phase 1: The glucose IAUC was significantly lower after 10FOS and Control compared to 10Dex (P < 0.0001). Similarly, the insulin IAUC was significantly lower after Control and 10FOS compared to 10Dex (P < 0.0001). Phase 2: The glucose IAUC was significantly lower after 35Dex and 35Dex + 15FOS compared to 50Dex (P < 0.0001). Insulin IAUC was significantly lower after 35Dex compared to 50Dex and 50Dex + 15FOS, the IAUC of 35Dex + 15FOS was significantly lower than 50Dex (P < 0.0003). Phase 3: The glucose IAUC was significantly lower after 35WB and 35WB + 15FOS compared to 50WB and 50WB + 15FOS (P < 0.00001). Insulin IAUC was significantly lower after 35WB and 35WB + 15FOS compared to 50WB and 50WB + 15FOS (P < 0.00001).
Conclusions
These studies demonstrate that FossenceTM, when consumed alone, does not increase postprandial glucose and insulin levels, indicating it is resistant to breakdown. When added to a carbohydrate load, no increase in postprandial glucose or insulin levels is observed while substitution of 30% of glycemic carbohydrate by FossenceTMsignificantly decreased postprandial glucose and insulin levels. FossenceTM, being sweet to taste, may be advised to individuals on restricted sugar intake.
Funding Sources
Tata Chemicals Ltd, India.
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16
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Wolever TMS, Tosh SM, Spruill SE, Jenkins AL, Ezatagha A, Duss R, Johnson J, Chu Y, Steinert RE. Increasing oat β-glucan viscosity in a breakfast meal slows gastric emptying and reduces glycemic and insulinemic responses but has no effect on appetite, food intake, or plasma ghrelin and PYY responses in healthy humans: a randomized, placebo-controlled, crossover trial. Am J Clin Nutr 2020; 111:319-328. [PMID: 31828287 DOI: 10.1093/ajcn/nqz285] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/24/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The viscosity of oat β-glucan (OBG) determines its effect on serum cholesterol and glycemic responses, but whether OBG viscosity affects gastric emptying, appetite, and ad libitum food intake is unknown. OBJECTIVES We aimed to determine the effect of altering the amount or molecular weight (MW) and, hence, viscosity of OBG in a breakfast meal on the primary endpoint of food intake at a subsequent meal. METHODS Overnight-fasted males (n = 16) and nonpregnant females (n = 12) without diabetes, aged 18-60 y, with BMI 20.0-30.0 kg/m² who were unrestrained eaters participated in a double-blind, randomized, crossover study at a contract research organization. Participants consumed, in random order, breakfast meals equivalent in weight, energy, and macronutrients consisting of white-bread, butter, jam, and 2% milk plus hot cereal [Cream of Rice (CR), or instant-oatmeal plus either 3 g oat-bran (2gOBG), 10 g oat-bran (4gOBG), or 10 g oat-bran plus β-glucanase (4gloMW) to reduce OBG MW and viscosity compared with 4gOBG]. Gastric emptying, subjective appetite, and glucose, insulin, ghrelin, and peptide tyrosine tyrosine (PYY) responses were assessed for 3 h and then subjects were offered an ad libitum lunch (water and pizza). RESULTS Pizza intakes (n = 28) after CR, 2gOBG, 4gOBG, and 4gloMW (mean ± SEM: 887 ± 64, 831 ± 61, 834 ± 78, and 847 ± 68 kcal, respectively) were similar (nonsignificant). Compared with CR, 4gOBG significantly reduced glucose (78 ± 10 compared with 135 ± 15 mmol × min/L) and insulin (14.0 ± 1.6 compared with 26.8 ± 3.5 nmol × min/L) incremental area-under-the-curve and delayed gastric-emptying half-time (geometric mean: 285; 95% CI: 184, 442, compared with geometric mean: 105; 95% CI: 95, 117 min), effects not seen after 4gloMW. Subjective appetite, PYY, and ghrelin responses after 2gOBG, 4gOBG, and 4gloMW were similar to those after CR. CONCLUSIONS The results demonstrate that OBG viscosity determines its effect on postprandial glucose, insulin, and gastric emptying. However, we were unable to demonstrate a significant effect of OBG on appetite or food intake, regardless of its viscosity.This trial was registered at clinicaltrials.gov as NCT03490851.
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Affiliation(s)
- Thomas M S Wolever
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Susan M Tosh
- School of Nutrition Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Adish Ezatagha
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Ruedi Duss
- R&D Human Nutrition and Health, DSM Nutritional Products Ltd., Basel, Switzerland
| | - Jodee Johnson
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL, USA
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL, USA
| | - Robert E Steinert
- R&D Human Nutrition and Health, DSM Nutritional Products Ltd., Basel, Switzerland
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17
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Soares MJ, Müller MJ, Wolever TMS. Response to Letter from Bero et al. Eur J Clin Nutr 2019; 74:353-354. [PMID: 31822821 DOI: 10.1038/s41430-019-0546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/09/2022]
Affiliation(s)
- M J Soares
- School of Public Health, Curtin University, Kent Street, Perth, Western Australia, Australia.
| | - M J Müller
- Institute of Human Nutrition & Food Science, Christian Albrechts Universität, Kiel, Germany
| | - T M S Wolever
- Department of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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18
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Khan TA, Tayyiba M, Agarwal A, Mejia SB, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Relation of Total Sugars, Sucrose, Fructose, and Added Sugars With the Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies. Mayo Clin Proc 2019; 94:2399-2414. [PMID: 31806098 DOI: 10.1016/j.mayocp.2019.05.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the association of total and added fructose-containing sugars on cardiovascular (CVD) incidence and mortality. METHODS MEDLINE, EMBASE and Cochrane Library were searched from January 1, 1980, to July 31, 2018. Prospective cohort studies assessing the association of reported intakes of total, sucrose, fructose and added sugars with CVD incidence and mortality in individuals free from disease at baseline were included. Risk estimates were pooled using the inverse variance method, and dose-response analysis was modeled. RESULTS Eligibility criteria were met by 24 prospective cohort comparisons (624,128 unique individuals; 11,856 CVD incidence cases and 12,224 CVD mortality cases). Total sugars, sucrose, and fructose were not associated with CVD incidence. Total sugars (risk ratio, 1.09 [95% confidence interval, 1.02 to 1.17]) and fructose (1.08 [1.01 to 1.15]) showed a harmful association for CVD mortality, there was no association for added sugars and a beneficial association for sucrose (0.94 [0.89 to 0.99]). Dose-response analyses showed a beneficial linear dose-response gradient for sucrose and nonlinear dose-response thresholds for harm for total sugars (133 grams, 26% energy), fructose (58 grams, 11% energy) and added sugars (65 grams, 13% energy) in relation to CVD mortality (P<.05). The certainty of the evidence using GRADE was very low for CVD incidence and low for CVD mortality for all sugar types. CONCLUSION Current evidence supports a threshold of harm for intakes of total sugars, added sugars, and fructose at higher exposures and lack of harm for sucrose independent of food form for CVD mortality. Further research of different food sources of sugars is needed to define better the relationship between sugars and CVD. REGISTRATION: clinicaltrials.gov, NCT01608620.
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Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mobushra Tayyiba
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
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19
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Fisher JM, Wolever TMS, Campbell JE, Ezatagha A, Noronha JC, Jenkins AL. Effect of a Snack Bar Optimized to Reduce Alcohol Bioavailability: A Randomized Controlled Clinical Trial in Healthy Individuals. J Med Food 2019; 23:432-439. [PMID: 31755823 PMCID: PMC7185312 DOI: 10.1089/jmf.2019.0228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Alcohol intoxication impairs judgment and reaction times and the level of blood alcohol concentration (BAC) is highly correlated with accidents and injury. We hypothesized that a food optimized to delay gastric emptying, a reduced alcohol bioavailability bar (RABB), would decrease postprandial BAC and alcohol bioavailability with greater caloric-efficiency than control foods. Therefore, we evaluated the RABB in a randomized, crossover trial in 21 overnight fasted healthy adults (10 male, 11 female). Just before consuming a moderate dose of alcohol (0.3-0.35 g/kg body weight), participants ate either (1) no food (NF, 0 kcal), (2) the RABB (210 kcal), (3) a savory snack mix (SSM, 210 kcal), or (4) a multicomponent meal (MCM, 635 kcal) and their BAC was measured over 90 minutes using a breathalyzer, the primary endpoint being peak BAC (pBAC). pBACs were analyzed by repeated measures analysis of variance (ANOVA) (F = 107.5, P < .0001) with the differences between means assessed using Tukey's honestly significant difference test. The pBAC of each group was different (P < .001) from all other groups (NF = 0.064 ± 0.003, SSM = 0.047 ± 0.002, RABB = 0.031 ± 0.002, MCM = 0.020 ± 0.002%; mean ± standard error of the mean). Furthermore, the bioavailability of alcohol over 90 minutes (BA90) was reduced compared to the NF group by similar margins (SSM = 22.0 ± 2.2, RABB = 45.0 ± 3.8, MCM = 67.9 ± 3.1%) with the mean BA90 of each group different from all other groups (P < .001). Compared to the NF condition, the average reduction of pBAC per 100 calories of food consumed was higher for the RABB (24.0%) than either the SSM (11.8%) or the MCM (10.7%). This study demonstrates that the RABB can reduce both pBAC and alcohol bioavailability with high caloric-efficiency.
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Affiliation(s)
| | | | | | - Adish Ezatagha
- INQUIS Clinical Research, Ltd., Toronto, Ontario, Canada
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20
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Livesey G, Taylor R, Livesey HF, Buyken AE, Jenkins DJA, Augustin LSA, Sievenpiper JL, Barclay AW, Liu S, Wolever TMS, Willett WC, Brighenti F, Salas-Salvadó J, Björck I, Rizkalla SW, Riccardi G, Vecchia CL, Ceriello A, Trichopoulou A, Poli A, Astrup A, Kendall CWC, Ha MA, Baer-Sinnott S, Brand-Miller JC. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: Assessment of Causal Relations. Nutrients 2019; 11:nu11061436. [PMID: 31242690 PMCID: PMC6628270 DOI: 10.3390/nu11061436] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neither dietary fiber nor cereal fiber nor wholegrain were found to be reliable or effective surrogate measures of GI or GL. Finally, our cost–benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sufficient to consider inclusion of GI and GL in food and nutrient-based recommendations.
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Affiliation(s)
- Geoffrey Livesey
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Richard Taylor
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Helen F Livesey
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Anette E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany.
| | - David J A Jenkins
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Livia S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Epidemiology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Napoli, Italy.
| | - John L Sievenpiper
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Alan W Barclay
- Glycemic Index Foundation, 26 Arundel St, Glebe, Sydney NSW 2037, Australia.
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA.
| | - Thomas M S Wolever
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA.
| | - Furio Brighenti
- Department of Food and Drug, University of Parma, 43120 Parma, Italy.
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, 43201 Reus, Spain.
- Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 27400 Madrid, Spain.
| | - Inger Björck
- Retired from Food for Health Science Centre, Antidiabetic Food Centre, Lund University, S-221 00 Lund, Sweden.
| | - Salwa W Rizkalla
- Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy.
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy.
| | - Antonio Ceriello
- IRCCS MultiMedica, Diabetes Department, Sesto San Giovanni, 20099 Milan, Italy.
| | | | - Andrea Poli
- Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy.
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark.
| | - Cyril W C Kendall
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada.
| | - Marie-Ann Ha
- Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK.
| | | | - Jennie C Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney NSW 2006, Australia.
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Wolever TMS, Jenkins AL, Yang J, Nisbet M, Johnson J, Chu Y, Pan Y. An Optimized, Slowly Digested Savory Cluster Reduced Postprandial Glucose and Insulin Responses in Healthy Human Subjects. Curr Dev Nutr 2019; 3:nzz006. [PMID: 30882061 PMCID: PMC6411418 DOI: 10.1093/cdn/nzz006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/19/2018] [Accepted: 01/14/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Slowly digested carbohydrates are perceived as beneficial by some consumers, and various regulatory bodies have published specific criteria defining lower postprandial glycemic response. We developed an optimized savory cluster snack containing slowly digested starch. OBJECTIVE We compared the glucose and insulin responses elicited by the optimized (test-) cluster, a control-cluster, and an available-carbohydrate-matched portion of white bread in healthy individuals. The primary outcome was blood-glucose peak rise.We tested healthy individuals (n = 25) on 3 occasions using a randomized crossover design. On each occasion, the participants provided fasting blood samples and then consumed 1 serving of test-cluster, control-cluster, or white bread. We then measured the participants' blood-glucose and serum-insulin concentrations over the next 4 h. RESULTS The test-cluster elicited a significantly lower blood-glucose peak rise (mean ± SEM: 1.24 ± 0.09 mmol/L) and incremental area under the curve (iAUC; 67 ± 8 mmol × min/L) than the control-cluster (2.27 ± 0.13 mmol/L and 117 ± 10 mmol × min/L, respectively) and white bread (2.27 ± 0.16 mmol/L and 114 ± 9 mmol × min/L, respectively). The serum-insulin peak rise and iAUC elicited by the test-cluster (128 ± 13 pmol/L and 6.10 ± 0.73 nmol × min/L, respectively) and white bread (141 ± 20 pmol/L and 6.47 ± 1.11 nmol × min/L, respectively) were significantly lower than those elicited by the control-cluster (205 ± 26 pmol/L and 9.60 ± 1.31 nmol × min/L, respectively). CONCLUSION The test-cluster elicited lower glucose and insulin responses than the control-cluster. The results support the hypothesis that the carbohydrates in the test-cluster are digested and absorbed slowly in vivo.
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Affiliation(s)
| | | | - Jun Yang
- Analytical Sciences, PepsiCo R&D, Plano, TX
| | | | | | - YiFang Chu
- Nutrition Sciences, PepsiCo R&D, Barrington, IL
| | - Yang Pan
- Nutrition Sciences, PepsiCo R&D, Plano, TX
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22
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Choo VL, Viguiliouk E, Blanco Mejia S, Cozma AI, Khan TA, Ha V, Wolever TMS, Leiter LA, Vuksan V, Kendall CWC, de Souza RJ, Jenkins DJA, Sievenpiper JL. Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies. BMJ 2018; 363:k4644. [PMID: 30463844 PMCID: PMC6247175 DOI: 10.1136/bmj.k4644] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the effect of different food sources of fructose-containing sugars on glycaemic control at different levels of energy control. DESIGN Systematic review and meta-analysis of controlled intervention studies. DATA SOURCES Medine, Embase, and the Cochrane Library up to 25 April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Controlled intervention studies of at least seven days' duration and assessing the effect of different food sources of fructose-containing sugars on glycaemic control in people with and without diabetes were included. Four study designs were prespecified on the basis of energy control: substitution studies (sugars in energy matched comparisons with other macronutrients), addition studies (excess energy from sugars added to diets), subtraction studies (energy from sugars subtracted from diets), and ad libitum studies (sugars freely replaced by other macronutrients without control for energy). Outcomes were glycated haemoglobin (HbA1c), fasting blood glucose, and fasting blood glucose insulin. DATA EXTRACTION AND SYNTHESIS Four independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by random effects models and overall certainty of the evidence assessed by the GRADE approach (grading of recommendations assessment, development, and evaluation). RESULTS 155 study comparisons (n=5086) were included. Total fructose-containing sugars had no harmful effect on any outcome in substitution or subtraction studies, with a decrease seen in HbA1c in substitution studies (mean difference -0.22% (95% confidence interval to -0.35% to -0.08%), -25.9 mmol/mol (-27.3 to -24.4)), but a harmful effect was seen on fasting insulin in addition studies (4.68 pmol/L (1.40 to 7.96)) and ad libitum studies (7.24 pmol/L (0.47 to 14.00)). There was interaction by food source, with specific food sources showing beneficial effects (fruit and fruit juice) or harmful effects (sweetened milk and mixed sources) in substitution studies and harmful effects (sugars-sweetened beverages and fruit juice) in addition studies on at least one outcome. Most of the evidence was low quality. CONCLUSIONS Energy control and food source appear to mediate the effect of fructose-containing sugars on glycaemic control. Although most food sources of these sugars (especially fruit) do not have a harmful effect in energy matched substitutions with other macronutrients, several food sources of fructose-containing sugars (especially sugars-sweetened beverages) adding excess energy to diets have harmful effects. However, certainty in these estimates is low, and more high quality randomised controlled trials are needed. STUDY REGISTRATION Clinicaltrials.gov (NCT02716870).
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Affiliation(s)
- Vivian L Choo
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adrian I Cozma
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Undergraduate Medical Education, School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas M S Wolever
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Lawrence A Leiter
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Vladimir Vuksan
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Russell J de Souza
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - David J A Jenkins
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
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23
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Noronha JC, Braunstein CR, Glenn AJ, Khan TA, Viguiliouk E, Noseworthy R, Blanco Mejia S, Kendall CWC, Wolever TMS, Leiter LA, Sievenpiper JL. The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double-blind, randomized, controlled, acute feeding, equivalence trial. Diabetes Obes Metab 2018; 20:2361-2370. [PMID: 29797503 PMCID: PMC6175314 DOI: 10.1111/dom.13374] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023]
Abstract
AIM To assess and compare the effect of small doses of fructose and allulose on postprandial blood glucose regulation in type 2 diabetes. METHODS A double-blind, multiple-crossover, randomized, controlled, acute feeding, equivalence trial in 24 participants with type 2 diabetes was conducted. Each participant was randomly assigned six treatments separated by >1-week washouts. Treatments consisted of fructose or allulose at 0 g (control), 5 g or 10 g added to a 75-g glucose solution. A standard 75-g oral glucose tolerance test protocol was followed with blood samples at -30, 0, 30, 60, 90 and 120 minutes. The primary outcome measure was plasma glucose incremental area under the curve (iAUC). RESULTS Allulose significantly reduced plasma glucose iAUC by 8% at 10 g compared with 0 g (717.4 ± 38.3 vs. 777.5 ± 39.9 mmol × min/L, P = 0.015) with a linear dose response gradient between the reduction in plasma glucose iAUC and dose (P = 0.016). Allulose also significantly reduced several related secondary and exploratory outcome measures at 5 g (plasma glucose absolute mean and total AUC) and 10 g (plasma glucose absolute mean, absolute and incremental maximum concentration [Cmax ], and total AUC) (P < .0125). There was no effect of fructose at any dose. Although allulose showed statistically significant reductions in plasma glucose iAUC compared with fructose at 5 g, 10 g and pooled doses, these reductions were within the pre-specified equivalence margins of ±20%. CONCLUSION Allulose, but not fructose, led to modest reductions in the postprandial blood glucose response to oral glucose in individuals with type 2 diabetes. There is a need for long-term randomized trials to confirm the sustainability of these improvements.
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Catherine R. Braunstein
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andrea J. Glenn
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Tauseef A. Khan
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Rebecca Noseworthy
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Cyril W. C. Kendall
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonCanada
| | - Thomas M. S. Wolever
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - Lawrence A. Leiter
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
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24
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Zurbau A, Jenkins AL, Jovanovski E, Au-Yeung F, Bateman EA, Brissette C, Wolever TMS, Hanna A, Vuksan V. Acute effect of equicaloric meals varying in glycemic index and glycemic load on arterial stiffness and glycemia in healthy adults: a randomized crossover trial. Eur J Clin Nutr 2018; 73:79-85. [PMID: 29777241 DOI: 10.1038/s41430-018-0182-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Dietary carbohydrate quality and quantity fluctuate but it is unknown which attribute takes precedence in vascular health preservation. We investigated all four permutations of glycemic index (GI) and glycemic load (GL) on acute vascular and glycemic responses. SUBJECTS/METHODS Twenty-one healthy adults were screened for this crossover trial. Seventeen (8 M:9 F; 26.7 ± 12.3 y; BMI 22.2 ± 2.8 kg/m2) entered randomization and completed the study, receiving four isocaloric meals, varying in GI and GL, in random order at least 3 days apart. The four meals included either chickpeas (GI = 28, GL = 14, 50 g available carbohydrates (CHO)), a small potato portion (GI = 85, GL = 14, CHO = 17 g), pasta (GI = 45, GL = 42, CHO = 94 g) or a large potato portion (GI = 85, GL = 42, CHO = 50 g) as the source of carbohydrate. Augmentation index (AIx) and central and peripheral blood pressure were measured fasting, 1, 2, 3, and 4 h post-consumption. Capillary blood glucose was analyzed fasting, 15, 30, 45, 60, 90, 120, 180, and 240 min. RESULTS A reduction in AIx from baseline was observed 4 h following the chickpeas (low GI-low GL) (p = 0.046). The incremental area under blood glucose curves were significantly higher 2 h post-consumption following high compared with low GL meals (p < 0.001). Despite doubling carbohydrates, there was no difference in glycemic response between the large potato (high GI-high GL) and the pasta (low GI-high GL) meals. No significant differences in AIx or blood pressure were seen between meals. CONCLUSIONS Low GI, low-carbohydrate meals may support a healthy vascular tone. Varying meal GI and GL results in different glycemic profiles, which are not necessarily predicted by carbohydrate content. Further investigations on cardiometabolic profiles to meals varying in GI and GL are warranted.
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Affiliation(s)
- Andreea Zurbau
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alexandra L Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Elena Jovanovski
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fei Au-Yeung
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emma A Bateman
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Christy Brissette
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Thomas M S Wolever
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology, St. Michael's Hospital, Toronto, ON, Canada
| | - Amir Hanna
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology, St. Michael's Hospital, Toronto, ON, Canada
| | - Vladimir Vuksan
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada. .,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. .,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Endocrinology, St. Michael's Hospital, Toronto, ON, Canada.
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25
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Wolever TMS, Jenkins AL, Prudence K, Johnson J, Duss R, Chu Y, Steinert RE. Effect of adding oat bran to instant oatmeal on glycaemic response in humans - a study to establish the minimum effective dose of oat β-glucan. Food Funct 2018; 9:1692-1700. [PMID: 29480316 DOI: 10.1039/c7fo01768e] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Reducing the glycaemic response to carbohydrate-containing foods may have desirable physiological effects for many people. Here, we aimed to determine the minimum amount of oat β-glucan from oat-bran which, when added to instant-oatmeal, would reduce the glycaemic response by 20% compared to a β-glucan-free cereal. Therefore, the glycaemic responses elicited by one serving (27 g) instant-oatmeal plus 247 g 2% milk (IO, 28 g available-carbohydrate, 1.2 g β-glucan) or IO plus 0.2, 0.4, 0.8 or 1.6 g oat β-glucan (OBG) from oat-bran, or an available-carbohydrate matched portion of cream of rice (CR) plus milk were measured over 2 h in n = 40 subjects using a randomized, cross-over design. The primary endpoint was incremental area under the curve (iAUC). The secondary endpoint was glucose peak-rise. The results showed that grams OBG consumed were significantly correlated with mean iAUC (p = 0.009) and with mean glucose peak-rise (p = 0.002). Each gram of OBG reduced iAUC by 7% and peak-rise by 15%. Thus, to achieve a ≥20% reduction in iAUC relative to CR, 1.6 g OBG had to be added to IO (74 ± 7 vs. 93 ± 6 mmol min L-1, p < 0.05), but, to achieve a 20% reduction in peak-rise, only 0.4 g OBG was required (2.00 ± 0.1 vs. 2.40 ± 0.1 mmol, p < 0.05). We conclude that adding OBG to IO flattened postprandial glycaemic responses in a dose-dependent fashion; 1.6 g OBG was required to reduce iAUC by ≥20% versus CR, but a 20% reduction in peak-rise required only 0.4 g. The greater effect of OGB on peak-rise than iAUC presumably reflects the way viscous dietary fibres modulate glucose absorption kinetics.
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Affiliation(s)
| | | | - Kevin Prudence
- DSM Nutritional Products Ltd., R&D Human Nutrition and Health, Basel, Switzerland
| | - Jodee Johnson
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA
| | - Ruedi Duss
- DSM Nutritional Products Ltd., R&D Human Nutrition and Health, Basel, Switzerland
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA
| | - Robert E Steinert
- DSM Nutritional Products Ltd., R&D Human Nutrition and Health, Basel, Switzerland and Department of Surgery, Division of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland
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26
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Tsilas CS, de Souza RJ, Mejia SB, Mirrahimi A, Cozma AI, Jayalath VH, Ha V, Tawfik R, Di Buono M, Jenkins AL, Leiter LA, Wolever TMS, Beyene J, Khan T, Kendall CWC, Jenkins DJA, Sievenpiper JL. Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. CMAJ 2017; 189:E711-E720. [PMID: 28536126 DOI: 10.1503/cmaj.160706] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverages are associated with type 2 diabetes. To assess whether this association holds for the fructose-containing sugars they contain, we conducted a systematic review and meta-analysis of prospective cohort studies. METHODS We searched MEDLINE, Embase, CINAHL and the Cochrane Library (through June 2016). We included prospective cohort studies that assessed the relation of fructose-containing sugars with incident type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. We pooled risk ratios (RRs) using random effects meta-analyses. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Fiffeen prospective cohort studies (251 261 unique participants, 16 416 cases) met the eligibility criteria, comparing the highest intake (median 137, 35.2 and 78 g/d) with the lowest intake (median 65, 9.7 and 25.8 g/d) of total sugars, fructose and sucrose, respectively. Although there was no association of total sugars (RR 0.91, 95% confidence interval [CI] 0.76-1.09) or fructose (RR 1.04, 95% CI 0.84-1.29) with type 2 diabetes, sucrose was associated with a decreased risk of type 2 diabetes (RR 0.89, 95% CI 0.80-0.98). Our confidence in the estimates was limited by evidence of serious inconsistency between studies for total sugars and fructose, and serious imprecision in the pooled estimates for all 3 sugar categories. INTERPRETATION Current evidence does not allow us to conclude that fructose-containing sugars independent of food form are associated with increased risk of type 2 diabetes. Further research is likely to affect our estimates. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01608620.
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Affiliation(s)
- Christine S Tsilas
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Arash Mirrahimi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Adrian I Cozma
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Viranda H Jayalath
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Vanessa Ha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Reem Tawfik
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Marco Di Buono
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Alexandra L Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Thomas M S Wolever
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Joseph Beyene
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Tauseef Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - David J A Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit (Tsilas, de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Tawfik, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sievenpiper), Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ont.; Division of Food and Nutritional Sciences (Tsilas), Brescia University College at Western University, London, Ont.; Department of Nutritional Sciences (de Souza, Blanco Mejia, Mirrahimi, Cozma, Jayalath, Ha, Di Buono, A. Jenkins, Leiter, Wolever, Khan, Kendall, D. Jenkins, Sieven-piper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (de Souza, Ha, Beyene), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; School of Medicine (Mirrahimi), Faculty of Health Sciences, Queen's University, Kingston, Ont.; MD Program (Cozma, Jayalath), Faculty of Medicine University of Toronto, Toronto, Ont.; Department of Medicine (Leiter, Wolever, D. Jenkins, Sievenpiper), Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Psychology (Tawfik), Faculty of Arts, University of Waterloo, Waterloo, Ont.; American Heart Association (Di Buono), Dallas, Tex.; Division of Endocrinology and Metabolism (Leiter, Wolever, D. Jenkins, Sievenpiper); Li Ka Shing Knowledge Institute (Leiter, Wolever, D. Jenkins, Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Dalla Lana School of Public Health (Beyene), Faculty of Medicine, University of Toronto, Toronto, Ont.; College of Pharmacy and Nutrition (Kendall), University of Saskatchewan, Saskatoon, Sask.
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Lewis EJH, Perkins BA, Lovblom LE, Bazinet RP, Wolever TMS, Bril V. Effect of omega-3 supplementation on neuropathy in type 1 diabetes: A 12-month pilot trial. Neurology 2017; 88:2294-2301. [PMID: 28515269 DOI: 10.1212/wnl.0000000000004033] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/21/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To test the hypothesis that 12 months of seal oil omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation will stop the known progression of diabetic sensorimotor polyneuropathy (DSP) in type 1 diabetes mellitus (T1DM). METHODS Individuals with T1DM and evidence of DSP as determined by a Toronto Clinical Neuropathy Score ≥1 were recruited to participate in a single-arm, open-label trial of seal oil ω-3 PUFA supplementation (10 mL·d-1; 750 mg eicosapentaenoic acid, 560 mg docosapentaenoic acid, and 1,020 mg docosahexaenoic acid) for 1 year. The primary outcome was the 1-year change in corneal nerve fiber length (CNFL) measured by in vivo corneal confocal microscopy, with sensory and nerve conduction measures as secondary outcomes. RESULTS Forty participants (53% female), aged 48 ± 14 years, body mass index 28.1 ± 5.8 with diabetes duration of 27 ± 18 years, were enrolled. At baseline, 23 participants had clinical DSP and 17 did not. Baseline CNFL was 8.3 ± 2.9 mm/mm2 and increased 29% to 10.1 ± 3.7 mm/mm2 (p = 0.002) after 12 months of supplementation. There was no change in nerve conduction or sensory function. CONCLUSIONS Twelve months of ω-3 supplementation was associated with increase in CNFL in T1DM. CLINICALTRIALSGOVIDENTIFIER NCT02034266. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with T1DM and evidence of DSP, 12 months of seal oil omega-3 supplementation increases CNFL.
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Affiliation(s)
- Evan J H Lewis
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada.
| | - Bruce A Perkins
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada
| | - Leif E Lovblom
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada
| | - Richard P Bazinet
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada
| | - Thomas M S Wolever
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada
| | - Vera Bril
- From the Department of Nutritional Sciences (E.J.H.L., R.P.B., T.M.S.W.), Faculty of Medicine, University of Toronto; Leadership Sinai Centre for Diabetes (B.A.P., L.E.L.), Mount Sinai Hospital, Toronto; and Ellen and Martin Prosserman Centre for Neuromuscular Diseases (V.B.), Division of Neurology, University Health Network, Toronto, Canada
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Lewis EJH, Perkins BA, Lovblom LE, Bazinet RP, Wolever TMS, Bril V. Using in vivo corneal confocal microscopy to identify diabetic sensorimotor polyneuropathy risk profiles in patients with type 1 diabetes. BMJ Open Diabetes Res Care 2017; 5:e000251. [PMID: 28243447 PMCID: PMC5316911 DOI: 10.1136/bmjdrc-2016-000251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 11/21/2016] [Accepted: 12/13/2016] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Diabetic sensorimotor peripheral neuropathy (DSP) is the most prevalent complication in diabetes mellitus. Identifying DSP risk is essential for intervening early in the natural history of the disease. Small nerve fibers are affected earliest in the disease progression and evidence of this damage can be identified using in vivo corneal confocal microscopy (IVCCM). RESEARCH DESIGN AND METHODS We applied IVCCM to a cohort of 40 patients with type 1 diabetes to identify their DSP risk profile. We measured standard IVCCM parameters including corneal nerve fiber length (CNFL), and performed nerve conduction studies and quantitative sensory testing. RESULTS 40 patients (53% female), with a mean age of 48±14, BMI 28.1±5.8, and diabetes duration of 27±18 years were enrolled between March 2014 and June 2015. Mean IVCCM CNFL was 12.0±5.2 mm/mm2 (normal ≥15 mm/mm2). Ten patients (26%) without DSP were identified as being at risk of future DSP with mean CNFL 11.0±2.1 mm/mm2. Six patients (15%) were at low risk of future DSP with mean CNFL 19.0±4.6 mm/mm2, while 23 (59%) had established DSP with mean CNFL 10.5±4.5 mm/mm2. CONCLUSIONS IVCCM can be used successfully to identify the risk profile for DSP in patients with type 1 diabetes. This methodology may prove useful to classify patients for DSP intervention clinical trials.
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Affiliation(s)
- Evan J H Lewis
- Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Bruce A Perkins
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada
| | - Lief E Lovblom
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital , Toronto, Ontario , Canada
| | - Richard P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Vera Bril
- Division of Neurology , Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital , Toronto, Ontario , Canada
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Ramdath DD, Liu Q, Donner E, Hawke A, Kalinga D, Winberg J, Wolever TMS. Investigating the relationship between lentil carbohydrate fractions and in vivo postprandial blood glucose response by use of the natural variation in starch fractions among 20 lentil varieties. Food Funct 2017; 8:3783-3791. [DOI: 10.1039/c7fo00972k] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Using human studies we confirm that lentils lower blood glucose response, which is correlated to the rapidly digestible starch and resistant starch content.
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Affiliation(s)
- D. Dan Ramdath
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
| | - Qiang Liu
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
| | - Elizabeth Donner
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
| | - Aileen Hawke
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
| | - Danusha Kalinga
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
| | - Jordan Winberg
- Guelph Research and Development Centre
- Agriculture and Agri-Food Canada
- Guelph
- Canada
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Moreira-Lucas TS, Duncan AM, Rabasa-Lhoret R, Vieth R, Gibbs AL, Badawi A, Wolever TMS. Effect of vitamin D supplementation on oral glucose tolerance in individuals with low vitamin D status and increased risk for developing type 2 diabetes (EVIDENCE): A double-blind, randomized, placebo-controlled clinical trial. Diabetes Obes Metab 2017; 19:133-141. [PMID: 27717236 DOI: 10.1111/dom.12794] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 01/21/2023]
Abstract
AIMS Low serum 25-hydroxyvitamin-D (25(OH)D) concentrations are associated with insulin resistance, β-cell dysfunction and type 2 diabetes. We conducted a 24-week double-blind, randomized, placebo-controlled trial to examine the effect of 28 000 IU of vitamin D3 once weekly on plasma glucose after a 2 hour-75 g oral glucose tolerance test (2hrPC glucose), insulin sensitivity and β-cell function. STUDY DESIGN AND METHODS A total of 71 participants with serum 25(OH)D ≤65 nmol/L, impaired fasting glucose and elevated glycated hemoglobin were randomly assigned to receive 28 000 IU of vitamin D3 (VitD; n = 35) or placebo (n = 36) in cheese once weekly for 24 weeks. The primary outcome was the change in 2hPC glucose. Secondary outcomes were fasting glucose, fasting and postprandial insulin, indices of insulin sensitivity and β-cell function, glycated hemoglobin and lipid profile. Participants underwent an oral glucose tolerance test to determine 2hPC glucose. RESULTS Mean baseline serum 25(OH)D was 48.1 and 47.6 nmol/L in the VitD and placebo groups, respectively. Serum 25(OH)D significantly increased to 98.7 nmol/L (51 nmol/L increase; P < .0001) in the VitD group. No significant differences in fasting ( P = .42) or 2hPC glucose ( P = .55) or other indices of glucose metabolism, including β-cell function and insulin sensitivity, were observed between groups. A subgroup analysis of individuals with 25(OH)D < 50 nmol/L and prediabetes did not change these results. The VitD group exhibited a significant reduction in LDL cholesterol (-0.27 vs 0.01 mmol/L, P = .03). CONCLUSION Weekly doses of vitamin D3 in individuals with suboptimal vitamin D levels who were at risk for type 2 diabetes did not improve oral glucose tolerance or markers of glycaemic status.
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Affiliation(s)
| | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal & Nutrition Department, Université de Montréal, Montreal, Canada
| | - Reinhold Vieth
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Alison L Gibbs
- Department of Statistical Sciences, University of Toronto, Toronto, Canada
| | - Alaa Badawi
- Public Health Risk Science Division, Public Health Agency of Canada, Toronto, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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Rahat-Rozenbloom S, Fernandes J, Cheng J, Wolever TMS. Acute increases in serum colonic short-chain fatty acids elicited by inulin do not increase GLP-1 or PYY responses but may reduce ghrelin in lean and overweight humans. Eur J Clin Nutr 2016; 71:953-958. [PMID: 27966574 PMCID: PMC5423780 DOI: 10.1038/ejcn.2016.249] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/19/2016] [Accepted: 10/26/2016] [Indexed: 12/21/2022]
Abstract
Background Colonic fermentation of dietary-fibre to short-chain-fatty-acids (SCFA) influences appetite hormone secretion in animals, but SCFA production is excessive in obese animals. This suggests there may be resistance to the effect of SCFA on appetite-hormones in obesity. Objectives to determine the effects of inulin (IN) and resistant-starch (RS) on postprandial SCFA, and gut hormone (GLP-1, PYY, and ghrelin) responses in healthy overweight/obese (OWO) vs lean (LN) humans. Methods Overnight fasted participants (13 OWO, 12 LN) consumed 300mL water containing 75g glucose (GLU) as Control, or 75g glucose plus 24g IN, or 28.2g RS using a randomized, single-blind, cross-over design. Blood for appetite-hormones and SCFA was collected at intervals over 6h. A standard lunch was served 4h after the test drink. Results Relative to GLU, IN, but not RS, significantly increased SCFA AUC from 4–6h (AUC4-6). Neither IN nor RS affected GLP-1 or PYY-AUC4-6. Although neither IN nor RS reduced ghrelin-AUC4-6 compared to GLU, ghrelin at 6h after IN was significantly lower than that after GLU (p<0.05). After IN, relative to GLU, the changes in SCFA-AUC4-6 were negatively related to the changes in ghrelin-AUC4-6 (p=0.017). SCFA and hormone responses did not differ significantly between LN and OWO. Conclusions Acute increases in colonic SCFA do not affect GLP-1 or PYY responses in LN or OWO subjects, but may reduce ghrelin. The results do not support the hypothesis that SCFA acutely stimulate PYY and GLP-1 secretion; however, a longer adaptation to increased colonic fermentation or a larger sample size may yield different results.
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Affiliation(s)
- S Rahat-Rozenbloom
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Fernandes
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Cheng
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Charlton East, Hamilton, Ontario, Canada
| | - T M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, and Division of Endocrinology and Metabolism and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Wolever TMS, Chiasson JL, Josse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA. Effects of Changing the Amount and Source of Dietary Carbohydrates on Symptoms and Dietary Satisfaction Over a 1-Year Period in Subjects with Type 2 Diabetes: Canadian Trial of Carbohydrates in Diabetes (CCD). Can J Diabetes 2016; 41:164-176. [PMID: 27884550 DOI: 10.1016/j.jcjd.2016.08.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the long-term effects of changing the amount or source of dietary carbohydrate on quality of life (QOL), symptoms and dietary satisfaction in people with type 2 diabetes. METHODS Subjects with diabetes treated by diet alone (n=162) were randomly assigned to high-carbohydrate/high-glycemic-index (HGI) diets; high-carbohydrate/low-glycemic-index (LGI) diets; or lower-carbohydrate/high-monounsaturated-fat (LC) diets for 1 year. We measured QOL at baseline and at study's end, and we measured symptoms and dietary satisfaction quarterly. RESULTS The HGI, LGI and LC diets contained, respectively, 47±1, 52±1 and 40±1% energy carbohydrate; 30±1, 27±1 and 40±1% fat with GI 64±0.4, 55±0.4 and 59±0.4. Significantly more participants reported increased flatulence on LGI than on LC and HGI diets at 3 months (41%, 19%, 14%; p<0.05), but not at 12 months (29%, 17%, 17%; ns). Abdominal distension was more severe (46% vs. 14%, 19%; p<0.05), and headache less severe (8% vs. 22%, 23%; p<0.05) on LGI than on both other diets. Increased appetite was more severe on LC (33%) than on HGI diets (14%, p<0.05). Joint/limb pains were less severe on LGI (16%) than HGI (28%) diets. LC elicited more severe gloomy thoughts (23%) than LGI (4%; p<0.05) but greater dietary-satisfaction (70%; p<0.05) than LGI (40%) and HGI (48%) diets. For all diets, glycated hemoglobin (A1C) levels increased less in those who gained less weight, had less increased appetite and were more satisfied with the enjoyment obtained from eating. CONCLUSIONS Each diet elicited increased severity of 1 or more symptoms than the other diets. Although overall dietary satisfaction was greater on the 40% carbohydrate diet than on the 50% carbohydrate diet, the LGI diet was no less satisfying than the HGI diet. Changes in appetite and dietary satisfaction may influence body weight and glycemic control, or vice-versa.
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Affiliation(s)
- Thomas M S Wolever
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Jean-Louis Chiasson
- Research Center (CHUM) Hôtel-Dieu de Montréal, University of Montréal, Montréal, Québec, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Pierre Maheux
- Department of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Rémi Rabasa-Lhoret
- IRCM (Institut de Recherches Cliniques de Montréal), Montréal, Québec, Canada
| | - N Wilson Rodger
- Department of Medicine, St. Joseph's Health Centre, Western University, London, Ontario, Canada
| | - Edmond A Ryan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Jamnik J, Rehman S, Blanco Mejia S, de Souza RJ, Khan TA, Leiter LA, Wolever TMS, Kendall CWC, Jenkins DJA, Sievenpiper JL. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 2016; 6:e013191. [PMID: 27697882 PMCID: PMC5073537 DOI: 10.1136/bmjopen-2016-013191] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prevalence of hyperuricemia and gout has increased in recent decades. The role of dietary fructose in the development of these conditions remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of prospective cohort studies investigating the association fructose consumption with incident gout and hyperuricemia. DESIGN MEDLINE, EMBASE and the Cochrane Library were searched (through September 2015). We included prospective cohort studies that assessed fructose consumption and incident gout or hyperuricemia. 2 independent reviewers extracted relevant data and assessed study quality using the Newcastle-Ottawa Scale. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS 2 studies involving 125 299 participants and 1533 cases of incident gout assessed the association between fructose consumption and incident gout over an average of 17 years of follow-up. No eligible studies assessed incident hyperuricemia as an outcome. Fructose consumption was associated with an increase in the risk of gout (RR=1.62, 95% CI 1.28 to 2.03, p<0.0001) with no evidence of interstudy heterogeneity (I2=0%, p=0.33) when comparing the highest (>11.8% to >11.9% total energy) and lowest (<6.9% to <7.5% total energy) quantiles of consumption. LIMITATIONS Despite a dose-response gradient, the overall quality of evidence as assessed by GRADE was low, due to indirectness. There were only two prospective cohort studies involving predominantly white health professionals that assessed incident gout, and none assessed hyperuricemia. CONCLUSIONS Fructose consumption was associated with an increased risk of developing gout in predominantly white health professionals. More prospective studies are necessary to understand better the role of fructose and its food sources in the development of gout and hyperuricemia. PROTOCOL REGISTRATION NUMBER NCT01608620.
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Affiliation(s)
- Joseph Jamnik
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Rehman
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Wolever TMS, van Klinken BJW, Spruill SE, Jenkins AL, Chu Y, Harkness L. Effect of serving size and addition of sugar on the glycemic response elicited by oatmeal: A randomized, cross-over study. Clin Nutr ESPEN 2016; 16:48-54. [PMID: 28531455 DOI: 10.1016/j.clnesp.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/13/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS We aimed to determine the impact of serving size and addition of sucrose on the glycemic response elicited by oatmeal. METHODS We studied 38 healthy subjects (mean ± SD age 40 ± 12 yr, BMI 26.4 ± 3.6 kg/m2) on 8 separate days using a randomized, cross-over design. Capillary blood-glucose responses over 2hr after consuming 30, 40 and 60 g Classic Quaker Quick Oats (18, 24 and 36 g available-carbohydrate [avCHO], respectively) and 30 g Oats plus 9 g sucrose (27 g avCHO) were compared with those after avCHO-matched servings of Cream of Rice cereal (Control) (22, 29, 44 and 33 g cereal, respectively). Blood-glucose incremental area under the curve (iAUC), peak-rise, rate-of-decline, time-to-peak and time-to-baseline were calculated. RESULTS As serving size increased, iAUC, peak-rise, rate-of-decline and time-to-baseline increased significantly for both cereals, but the rate of increase was significantly greater for Control than for Oats. Time-to-peak increased significantly with serving size only for Oats. Compared to avCHO-matched servings of Control, mean (95%CI) iAUC, peak-rise and rate-of-decline, respectively were 22 (16, 27)%, 22 (19, 26)% and 23 (18, 27)% lower after consuming Oats without sucrose and 26 (18, 34)%, 14 (9, 20)% and 16 (9, 24)% lower after consuming Oats plus sucrose. CONCLUSIONS Oatmeal elicited a significantly lower glycemic response than avCHO-matched servings of Cream of Rice, even when sucrose was added to the oatmeal. Measures of glycemic response tended to increase with increased serving size; although the pattern of change varied between cereal types. These results suggest that oatmeal may be a good choice for minimizing postprandial glycemia. CLINICAL TRIAL REGISTRY ClinicalTrials.gov (NCT02506972).
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Affiliation(s)
- Thomas M S Wolever
- Glycemic Index Laboratories, Inc., 20 Victoria St., 3rd Floor, Toronto, Ontario M5C 2N8, Canada.
| | | | - Susan E Spruill
- Applied Statistics and Consulting, 1205 Chestnut Mountain Rd., Spruce Pine, NC 28277, USA.
| | - Alexandra L Jenkins
- Glycemic Index Laboratories, Inc., 20 Victoria St., 3rd Floor, Toronto, Ontario M5C 2N8, Canada.
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA.
| | - Laura Harkness
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition, Barrington, IL 60010, USA.
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Steinert RE, Raederstorff D, Wolever TMS. Effect of Consuming Oat Bran Mixed in Water before a Meal on Glycemic Responses in Healthy Humans-A Pilot Study. Nutrients 2016; 8:nu8090524. [PMID: 27571099 PMCID: PMC5037511 DOI: 10.3390/nu8090524] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 01/24/2023] Open
Abstract
Background: Viscous dietary fibers including oat β-glucan are one of the most effective classes of functional food ingredients for reducing postprandial blood glucose. The mechanism of action is thought to be via an increase in viscosity of the stomach contents that delays gastric emptying and reduces mixing of food with digestive enzymes, which, in turn, retards glucose absorption. Previous studies suggest that taking viscous fibers separate from a meal may not be effective in reducing postprandial glycemia. Methods: We aimed to re-assess the effect of consuming a preload of a commercially available oat-bran (4.5, 13.6 or 27.3 g) containing 22% of high molecular weight oat β-glucan (O22 (OatWell®22)) mixed in water before a test-meal of white bread on glycemic responses in 10 healthy humans. Results: We found a significant effect of dose on blood glucose area under the curve (AUC) (p = 0.006) with AUC after 27.3 g of O22 being significantly lower than white bread only. Linear regression analysis showed that each gram of oat β-glucan reduced glucose AUC by 4.35% ± 1.20% (r = 0.507, p = 0.0008, n = 40) and peak rise by 6.57% ± 1.49% (r = 0.582, p < 0.0001). Conclusion: These data suggest the use of oat bran as nutritional preload strategy in the management of postprandial glycemia.
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Affiliation(s)
- Robert E Steinert
- DSM Nutritional Products Ltd., R & D Human Nutrition and Health, Basel 4057, Switzerland.
| | - Daniel Raederstorff
- DSM Nutritional Products Ltd., R & D Human Nutrition and Health, Basel 4057, Switzerland.
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Reeds J, Mansuri S, Mamakeesick M, Harris SB, Zinman B, Gittelsohn J, Wolever TMS, Connelly PW, Hanley A. Dietary Patterns and Type 2 Diabetes Mellitus in a First Nations Community. Can J Diabetes 2016; 40:304-10. [PMID: 27374251 DOI: 10.1016/j.jcjd.2016.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus is a growing concern worldwide, particularly in Indigenous communities, which have undergone a marked nutrition transition characterized by reduced intakes of traditional foods and increased intakes of market foods. Few studies have assessed the relationships between differing dietary patterns and risk for type 2 diabetes in Indigenous communities in Canada. The objective of the study was to characterize dietary patterns using factor analysis (FA) and to relate these patterns to the incidence of type 2 diabetes after 10 years of follow up in a First Nations community in Ontario, Canada. METHODS We conducted a prospective analysis of 492 participants in the SLHDP who did not have diabetes at baseline (1993 to 1995) and were followed for 10 years. A food-frequency questionnaire was administered, and FA was used to identify patterns of food consumption. Multivariate logistic regression analyses determined associations of food patterns with incident type 2 diabetes, adjusting for sociodemographic and lifestyle confounders. RESULTS At follow up, 86 participants had developed incident type 2 diabetes. FA revealed 3 prominent dietary patterns: Balanced Market Foods, Beef and Processed Foods and Traditional Foods. After adjustment for age, sex, waist circumference, interleukin-6 and adiponectin, the Beef and Processed Foods pattern was associated with increased risk for incident type 2 diabetes (OR=1.38; 95% CI 1.02, 1.86). In contrast, the Balanced Market Foods and Traditional Foods Patterns were not significantly associated with type 2 diabetes. CONCLUSIONS Dietary interventions should encourage reduced consumption of unhealthful market foods, in combination with improvements in local food environments so as to increase access to healthful foods and reduce food insecurity in Indigenous communities.
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Affiliation(s)
- Jacqueline Reeds
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sudaba Mansuri
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mary Mamakeesick
- Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bernard Zinman
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Joel Gittelsohn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas M S Wolever
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Phillip W Connelly
- Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anthony Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada.
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Chiavaroli L, de Souza RJ, Ha V, Cozma AI, Mirrahimi A, Wang DD, Yu M, Carleton AJ, Di Buono M, Jenkins AL, Leiter LA, Wolever TMS, Beyene J, Kendall CWC, Jenkins DJA, Sievenpiper JL. Effect of Fructose on Established Lipid Targets: A Systematic Review and Meta-Analysis of Controlled Feeding Trials. J Am Heart Assoc 2015; 4:e001700. [PMID: 26358358 PMCID: PMC4599489 DOI: 10.1161/jaha.114.001700] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Debate over the role of fructose in mediating cardiovascular risk remains active. To update the evidence on the effect of fructose on established therapeutic lipid targets for cardiovascular disease (low-density lipoprotein cholesterol [LDL]-C, apolipoprotein B, non-high-density lipoprotein cholesterol [HDL-C]), and metabolic syndrome (triglycerides and HDL-C), we conducted a systematic review and meta-analysis of controlled feeding trials. Methods and Results MEDLINE, EMBASE, CINHAL, and the Cochrane Library were searched through July 7, 2015 for controlled feeding trials with follow-up ≥7 days, which investigated the effect of oral fructose compared to a control carbohydrate on lipids (LDL-C, apolipoprotein B, non-HDL-C, triglycerides, and HDL-C) in participants of all health backgrounds. Two independent reviewers extracted relevant data. Data were pooled using random effects models and expressed as mean difference with 95% CI. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Eligibility criteria were met by 51 isocaloric trials (n=943), in which fructose was provided in isocaloric exchange for other carbohydrates, and 8 hypercaloric trials (n=125), in which fructose supplemented control diets with excess calories compared to the control diets alone without the excess calories. Fructose had no effect on LDL-C, non-HDL-C, apolipoprotein B, triglycerides, or HDL-C in isocaloric trials. However, in hypercaloric trials, fructose increased apolipoprotein B (n=2 trials; mean difference = 0.18 mmol/L; 95% CI: 0.05, 0.30; P=0.005) and triglycerides (n=8 trials; mean difference = 0.26 mmol/L; 95% CI: 0.11, 0.41; P<0.001). The study is limited by small sample sizes, limited follow-up, and low quality scores of the included trials. Conclusions Pooled analyses showed that fructose only had an adverse effect on established lipid targets when added to existing diets so as to provide excess calories (+21% to 35% energy). When isocalorically exchanged for other carbohydrates, fructose had no adverse effects on blood lipids. More trials that are larger, longer, and higher quality are required. Clinical Trials Registration URL: https://www.clinicaltrials.gov/. Unique Identifier: NCT01363791.
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Affiliation(s)
- Laura Chiavaroli
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster UniversityHamilton, ON, Canada
| | - Vanessa Ha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster UniversityHamilton, ON, Canada
| | - Adrian I Cozma
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
| | - Arash Mirrahimi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- School of Medicine, Faculty of Health Sciences, Queen’s UniversityKingston, ON, Canada
| | - David D Wang
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
| | - Matthew Yu
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- School of Dentistry, University of MinnesotaMinneapolis, MN
| | - Amanda J Carleton
- Department of Undergraduate Medical Education (MD Program), Faculty of Medicine, University of TorontoON, Canada
| | - Marco Di Buono
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- Heart and Stroke Foundation of OntarioToronto, ON, Canada
- American Heart AssociationDallas, TX
| | - Alexandra L Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Division of Endocrinology, St. Michael’s HospitalToronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- Department of Medicine, Faculty of Medicine, University of TorontoON, Canada
| | - Thomas M S Wolever
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Division of Endocrinology, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- Department of Medicine, Faculty of Medicine, University of TorontoON, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster UniversityHamilton, ON, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- College of Pharmacy and Nutrition, University of SaskatchewanSaskatoon, SK, Canada
| | - David J A Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Division of Endocrinology, St. Michael’s HospitalToronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- Department of Medicine, Faculty of Medicine, University of TorontoON, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s HospitalToronto, ON, Canada
- Division of Endocrinology, St. Michael’s HospitalToronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s HospitalToronto, ON, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of TorontoON, Canada
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster UniversityHamilton, ON, Canada
- Correspondence to: John L. Sievenpiper, MD, PhD, FRCPC, Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, #6137-61 Queen St E, Toronto, ON, Canada M5C 2T2. E-mail:
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Augustin LSA, Kendall CWC, Jenkins DJA, Willett WC, Astrup A, Barclay AW, Björck I, Brand-Miller JC, Brighenti F, Buyken AE, Ceriello A, La Vecchia C, Livesey G, Liu S, Riccardi G, Rizkalla SW, Sievenpiper JL, Trichopoulou A, Wolever TMS, Baer-Sinnott S, Poli A. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015; 25:795-815. [PMID: 26160327 DOI: 10.1016/j.numecd.2015.05.005] [Citation(s) in RCA: 377] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.
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Affiliation(s)
- L S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
| | - C W C Kendall
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada; University of Saskatchewan, Saskatoon, Canada
| | - D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - W C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, USA
| | - A Astrup
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - A W Barclay
- Glycemic Index Foundation, Sydney, Australia
| | - I Björck
- Food for Health Science Centre, Lund University, Lund, Sweden
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - F Brighenti
- Department of Food Sciences, University of Parma, Parma, Italy
| | - A E Buyken
- Department of Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Ceriello
- Institut d' Investigación Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - G Livesey
- Independent Nutrition Logic, Wymondham, UK
| | - S Liu
- Department of Epidemiology and Medicine, Brown University, Providence, USA
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - S W Rizkalla
- Institute Cardiometabolism and Nutrition (ICAN), University Pierre et Marie Curie, Pitié Salpêtrière Hospital, Paris, France; National Institute of Health and Medical Research (INSERM), University Pierre et Marie Curie and Pitié Salpêtrière Hospital, Paris, France
| | - J L Sievenpiper
- Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - T M S Wolever
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | | | - A Poli
- Nutrition Foundation of Italy, Milan, Italy
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Lewis EJH, Radonic PW, Wolever TMS, Wells GD. 21 days of mammalian omega-3 fatty acid supplementation improves aspects of neuromuscular function and performance in male athletes compared to olive oil placebo. J Int Soc Sports Nutr 2015; 12:28. [PMID: 26085822 PMCID: PMC4470064 DOI: 10.1186/s12970-015-0089-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022] Open
Abstract
Background Omega-3 polyunsaturated fatty acids (N-3) are essential nutrients for human health and integral components of neural tissues. There is evidence that N-3 supplementation may benefit exercise performance, however, no study has investigated the ergogenic potential of N-3 supplementation. Our objective was to determine the effect of short-term N-3 supplementation on neuromuscular-function and physical-performance in well-trained athletes. Methods Male athletes (n = 30), 25 years (SD 4.6), training 17 h.wk−1 (SD 5) completed this randomized, placebo-controlled, parallel-design study. At baseline a blood sample was collected, maximal voluntary isometric contractions (MVC) with electromyography (EMG) recordings were measured, and participants underwent various performance tests including a Wingate test and 250 kJ time trial (TT) followed by repeated MVC and EMG measurement. Participants were then randomly assigned to receive N-3 (5 ml seal oil, 375 mg EPA, 230 mg DPA, 510 mg DHA) or placebo (5 ml olive oil) for 21-days after which baseline testing was repeated. The magnitude-based inference approach was used to estimate the probability that N-3 had a beneficial effect on neuromuscular-function and performance of at least ±1 %. Data are shown as mean ± 90 % confidence-interval. Results Plasma EPA was higher on N-3 than placebo (p = 0.004) but the increases in DPA and DHA were not significant (p = 0.087, p = 0.058). N-3 supplementation had an unclear effect on MVC force (4.1 ± 6.6 %) but increased vastus lateralis EMG by 20 ± 18 % vs placebo (very likely beneficial). N-3 supplementation reduced Wingate percent power drop by 4.76 ± 3.4 % vs placebo (very likely beneficial), but the difference in TT performance was unclear (−1.9 ± 4.8 %). Conclusion Our data indicates N-3 PUFA supplementation improved peripheral neuromuscular function and aspects of fatigue with an unclear effect on central neuromuscular function. Clinical trial registration NCT0201433.
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Affiliation(s)
- Evan J H Lewis
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 150 College St., M5S 3E2 Toronto, Ontario Canada
| | - Peter W Radonic
- Faculty of Kinesiology & Physical Education, University of Toronto, 100 Devonshire Place, M5S 2C9 Toronto, Ontario Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 150 College St., M5S 3E2 Toronto, Ontario Canada
| | - Greg D Wells
- Faculty of Kinesiology & Physical Education, University of Toronto, 100 Devonshire Place, M5S 2C9 Toronto, Ontario Canada ; Department of Physiology and Experimental Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, Ontario Canada
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Affiliation(s)
- T M S Wolever
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [2] Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit of the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada [3] Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada [4] Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - J L Sievenpiper
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [2] Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit of the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada [3] Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada [4] Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Rahat-Rozenbloom S, Fernandes J, Gloor GB, Wolever TMS. Evidence for greater production of colonic short-chain fatty acids in overweight than lean humans. Int J Obes (Lond) 2014; 38:1525-31. [PMID: 24642959 PMCID: PMC3970979 DOI: 10.1038/ijo.2014.46] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Short-chain fatty acids (SCFA) are produced by colonic microbiota from dietary carbohydrates and proteins that reach the colon. It has been suggested that SCFA may promote obesity via increased colonic energy availability. Recent studies suggest obese humans have higher faecal SCFA than lean, but it is unclear whether this difference is due to increased SCFA production or reduced absorption. OBJECTIVES To compare rectal SCFA absorption, dietary intake and faecal microbial profile in lean (LN) versus overweight and obese (OWO) individuals. DESIGN Eleven LN and eleven OWO individuals completed a 3-day diet record, provided a fresh faecal sample and had SCFA absorption measured using the rectal dialysis bag method. The procedures were repeated after 2 weeks. RESULTS Age-adjusted faecal SCFA concentration was significantly higher in OWO than LN individuals (81.3±7.4 vs 64.1±10.4 mmol kg(-1), P=0.023). SCFA absorption (24.4±0.8% vs 24.7±1.2%, respectively, P=0.787) and dietary intakes were similar between the groups, except for a higher fat intake in OWO individuals. However, fat intake did not correlate with SCFAs or bacterial abundance. OWO individuals had higher relative Firmicutes abundance (83.1±4.1 vs 69.5±5.8%, respectively, P=0.008) and a higher Firmicutes:Bacteriodetes ratio (P=0.023) than LN individuals. There was a positive correlation between Firmicutes and faecal SCFA within the whole group (r=0.507, P=0.044), with a stronger correlation after adjusting for available carbohydrate (r=0.615, P=0.005). CONCLUSIONS The higher faecal SCFA in OWO individuals is not because of differences in SCFA absorption or diet. Our results are consistent with the hypothesis that OWO individuals produce more colonic SCFA than LN individuals because of differences in colonic microbiota. However, further studies are needed to prove this.
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Affiliation(s)
- S Rahat-Rozenbloom
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - J Fernandes
- Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - G B Gloor
- Department of Biochemistry, The University of Western Ontario, London, Ontario, Canada
| | - T M S Wolever
- 1] Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Clinical Nutrition and Risk Factor Modification Centre, and Division of Endocrinology and Metabolism and Li Ka Shing Knowledge Institute, St Michael's Hospital Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Health claims regarding the cholesterol-lowering effect of soluble fiber from oat products, approved by food standards agencies worldwide, are based on a diet containing ≥3 g/d of oat β-glucan (OBG). Given the number of recently published randomized controlled trials (RCTs), it is important to update the findings of previous meta-analyses. OBJECTIVE The objective was to quantify the effect of ≥3 g OBG/d on serum cholesterol concentrations in humans and investigate potential effect modifiers. DESIGN A meta-analysis was performed on 28 RCTs comparing ≥3 g OBG/d with an appropriate control. Systematic searches were undertaken in PubMed, AGRICOLA, and Scopus between 1 January 1966 and 6 June 2013, plus in-house study reports at CreaNutrition AG. Studies were assessed with regard to inclusion/exclusion criteria, and data were extracted from included studies by reviewers working independently in pairs, reconciling differences by consensus. Estimates of the mean reduction in serum cholesterol from baseline between the OBG and control diets were analyzed by using random-effects meta-analysis models and meta-regression. RESULTS OBG in doses of ≥3 g/d reduced low-density lipoprotein (LDL) and total cholesterol relative to control by 0.25 mmol/L (95% CI: 0.20, 0.30; P < 0.0001) and 0.30 mmol/L (95% CI: 0.24, 0.35; P < 0.0001), respectively, with some indication of heterogeneity (P = 0.13 and P = 0.067). There was no significant effect of OBG on high-density lipoprotein (HDL) cholesterol or triglycerides and no evidence that dose (range across trials: 3.0-12.4 g/d) or duration of treatment (range: 2-12 wk) influenced the results. LDL cholesterol lowering was significantly greater with higher baseline LDL cholesterol. There was a significantly greater effect for both LDL and total cholesterol in subjects with diabetes compared with those without (although based on few studies). CONCLUSIONS Adding ≥3 g OBG/d to the diet reduces LDL and total cholesterol by 0.25 mmol/L and 0.30 mmol/L, respectively, without changing HDL cholesterol or triglycerides.
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Affiliation(s)
- Anne Whitehead
- From the Medical & Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (AW); the School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia (EJB); Agriculture and Agri-Food Canada, Guelph, Canada (ST); and the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (TMSW)
| | - Eleanor J Beck
- From the Medical & Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (AW); the School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia (EJB); Agriculture and Agri-Food Canada, Guelph, Canada (ST); and the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (TMSW)
| | - Susan Tosh
- From the Medical & Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (AW); the School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia (EJB); Agriculture and Agri-Food Canada, Guelph, Canada (ST); and the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (TMSW)
| | - Thomas M S Wolever
- From the Medical & Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom (AW); the School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia (EJB); Agriculture and Agri-Food Canada, Guelph, Canada (ST); and the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (TMSW)
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Belcheva A, Irrazabal T, Robertson SJ, Streutker C, Maughan H, Rubino S, Moriyama EH, Copeland JK, Surendra A, Kumar S, Green B, Geddes K, Pezo RC, Navarre WW, Milosevic M, Wilson BC, Girardin SE, Wolever TMS, Edelmann W, Guttman DS, Philpott DJ, Martin A. Gut microbial metabolism drives transformation of MSH2-deficient colon epithelial cells. Cell 2014; 158:288-299. [PMID: 25036629 DOI: 10.1016/j.cell.2014.04.051] [Citation(s) in RCA: 323] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/24/2014] [Accepted: 04/28/2014] [Indexed: 02/08/2023]
Abstract
The etiology of colorectal cancer (CRC) has been linked to deficiencies in mismatch repair and adenomatous polyposis coli (APC) proteins, diet, inflammatory processes, and gut microbiota. However, the mechanism through which the microbiota synergizes with these etiologic factors to promote CRC is not clear. We report that altering the microbiota composition reduces CRC in APC(Min/+)MSH2(-/-) mice, and that a diet reduced in carbohydrates phenocopies this effect. Gut microbes did not induce CRC in these mice through an inflammatory response or the production of DNA mutagens but rather by providing carbohydrate-derived metabolites such as butyrate that fuel hyperproliferation of MSH2(-/-) colon epithelial cells. Further, we provide evidence that the mismatch repair pathway has a role in regulating β-catenin activity and modulating the differentiation of transit-amplifying cells in the colon. These data thereby provide an explanation for the interaction between microbiota, diet, and mismatch repair deficiency in CRC induction. PAPERCLIP:
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Affiliation(s)
- Antoaneta Belcheva
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Thergiory Irrazabal
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Susan J Robertson
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Catherine Streutker
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | | | - Stephen Rubino
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Eduardo H Moriyama
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON M5G 1L7, Canada
| | - Julia K Copeland
- Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON M5S 3B2, Canada
| | - Anu Surendra
- Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON M5S 3B2, Canada
| | - Sachin Kumar
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Blerta Green
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Kaoru Geddes
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Rossanna C Pezo
- Department of Medical Oncology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - William W Navarre
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Michael Milosevic
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada
| | - Brian C Wilson
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON M5G 1L7, Canada
| | - Stephen E Girardin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Winfried Edelmann
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David S Guttman
- Centre for the Analysis of Genome Evolution & Function, University of Toronto, Toronto, ON M5S 3B2, Canada
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Alberto Martin
- Department of Immunology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Jayalath VH, Sievenpiper JL, de Souza RJ, Ha V, Mirrahimi A, Santaren ID, Blanco Mejia S, Di Buono M, Jenkins AL, Leiter LA, Wolever TMS, Beyene J, Kendall CWC, Jenkins DJA. Total fructose intake and risk of hypertension: a systematic review and meta-analysis of prospective cohorts. J Am Coll Nutr 2014; 33:328-39. [PMID: 25144126 PMCID: PMC4261182 DOI: 10.1080/07315724.2014.916237] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although most controlled feeding trials have failed to show an adverse effect of fructose on blood pressure, concerns continue to be raised regarding the role of fructose in hypertension. To quantify the association between fructose-containing sugar (high-fructose corn syrup, sucrose, and fructose) intake and incident hypertension, a systematic review and meta-analysis of prospective cohort studies was undertaken. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Library (through February 5, 2014) were searched for relevant studies. Two independent reviewers reviewed and extracted relevant data. Risk estimates were aggregated comparing the lowest (reference) quintile with highest quintile of intake using inverse variance random effect models and expressed as risk ratios (RR) with 95% confidence intervals (CIs). Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I(2) statistic). The Newcastle-Ottawa Scale assessed study quality. Clinicaltrials.gov NCT01608620. RESULTS Eligibility criteria were met by 3 prospective cohorts (n = 37,375 men and 185,855 women) with 58,162 cases of hypertension observed over 2,502,357 person-years of follow-up. Median fructose intake was 5.7-6.0% total energy in the lowest quintile and 13.9-14.3% total energy in the highest quintile. Fructose intake was not associated with incident hypertension (RR = 1.02, 95% CI, 0.99-1.04), with no evidence of heterogeneity (I(2) = 0%, p = 0.59). Spline curve modeling showed a U-shaped relationship with a negative association at intakes ≤50th percentile (∼10% total energy) and a positive association at higher intakes. CONCLUSIONS Total fructose intake was not associated with an increased risk of hypertension in 3 large prospective cohorts of U.S. men and women.
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Affiliation(s)
- Viranda H Jayalath
- a Toronto 3D Knowledge Synthesis and Clinical Trials Unit , Clinical Nutrition and Risk Factor Modification Center , Toronto , Ontario , CANADA
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Priyadarshini M, Thomas A, Reisetter AC, Scholtens DM, Wolever TMS, Josefson JL, Layden BT. Maternal short-chain fatty acids are associated with metabolic parameters in mothers and newborns. Transl Res 2014; 164:153-7. [PMID: 24530607 PMCID: PMC4156825 DOI: 10.1016/j.trsl.2014.01.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 12/14/2022]
Abstract
During the course of pregnancy, dynamic remodeling of the gut microbiota occurs and contributes to maternal metabolic changes through an undefined mechanism. Because short chain fatty acids (SCFAs) are a major product of gut microbiome fermentation, we investigated whether serum SCFA levels during pregnancy are related to key metabolic parameters in mothers and newborns. In this prospective study, 20 pregnant women without gestational diabetes were evaluated at 36-38 weeks of gestation, and their newborns were assessed after parturition. In this cohort, which included normal (n = 10) and obese (n = 10) subjects based on prepregnancy body mass index, serum levels of SCFAs (acetate, propionate, and butyrate), maternal adipokines, maternal glucose, and C-peptide were measured at 36-38 weeks of gestation. Maternal weight gain and newborn anthropometrics were also determined. Data were analyzed using linear regression to test for associations, adjusting for prepregnancy obesity. In this cohort, serum acetate levels were associated with maternal weight gain and maternal adiponectin levels. In addition, serum propionate correlated negatively with maternal leptin levels, newborn length, and body weight. Taken together, this study observed that novel relationships exist among maternal SCFA levels and multiple interrelated maternal/newborn metabolic parameters.
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Affiliation(s)
- Medha Priyadarshini
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexandra Thomas
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anna C Reisetter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Thomas M S Wolever
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Jami L Josefson
- Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian T Layden
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Jesse Brown Veterans Affairs Medical Center, Chicago, IL.
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Fernandes J, Vogt J, Wolever TMS. Kinetic model of acetate metabolism in healthy and hyperinsulinaemic humans. Eur J Clin Nutr 2014; 68:1067-71. [PMID: 25052228 PMCID: PMC4500642 DOI: 10.1038/ejcn.2014.136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 05/27/2014] [Accepted: 06/08/2014] [Indexed: 12/31/2022]
Abstract
Background/objectives The short chain fatty acid acetate (AC), may play a role in increasing insulin sensitivity, thus lowering risk for obesity and type 2 diabetes mellitus. It is unclear if AC kinetics is similar in normal and hyperinsulinaemic participants. Therefore, we studied AC absorption from the distal colon in participants with normal (<40 pmol/L, NI) and high (≥40 pmol/L, HI) plasma-insulin. This work was part of a series of studies conceived to compute a kinetic model for acetate. Kinetic parameters such as estimates of rate of entry into peripheral blood, hepatic uptake and endogenous/exogenous production were compared in the groups. Subjects/methods Overnight fasted NI (n = 9) and HI (n = 8) participants were given rectal infusions containing sodium acetate (90 mmol/L). The solutions were retained for 40 min, then voided for AC measurement. Total amount of AC infused was 27 mmols. Results Acetate absorption from the distal colon (279±103 vs 322±91 μmol/min, P = 0.76) and hepatic uptake of AC (155±101 vs 146±85 μmol/min, P = 0.94) were similar in the groups. Endogenous and exogenous AC production was significantly higher in NI than HI participants. Plasma AC was inversely proportional to plasma insulin concentrations in the entire cohort (y=k/x, where k = 1813). Conclusions There was low power to detect differences in AC absorption rate and hepatic AC uptake in NI vs HI. The rate of entry of AC into peripheral blood was similar in NI and HI participants. However, hyperinsulinaemia may alter endogenous and exogenous AC metabolism.
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Affiliation(s)
- J Fernandes
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - J Vogt
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - T M S Wolever
- 1] Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Clinical Nutrition and Risk Factor Modification Centre and Division of Endocrinology and Metabolism and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Fernandes J, Su W, Rahat-Rozenbloom S, Wolever TMS, Comelli EM. Adiposity, gut microbiota and faecal short chain fatty acids are linked in adult humans. Nutr Diabetes 2014; 4:e121. [PMID: 24979150 PMCID: PMC4079931 DOI: 10.1038/nutd.2014.23] [Citation(s) in RCA: 401] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES High dietary fibre intakes may protect against obesity by influencing colonic fermentation and the colonic microbiota. Though, recent studies suggest that increased colonic fermentation contributes to adiposity. Diet influences the composition of the gut microbiota. Previous research has not evaluated dietary intakes, body mass index (BMI), faecal microbiota and short chain fatty acid (SCFA) in the same cohort. Our objectives were to compare dietary intakes, faecal SCFA concentrations and gut microbial profiles in healthy lean (LN, BMI⩽25) and overweight or obese (OWOB, BMI>25) participants. DESIGN We collected demographic information, 3-day diet records, physical activity questionnaires and breath and faecal samples from 94 participants of whom 52 were LN and 42 OWOB. RESULTS Dietary intakes and physical activity levels did not differ significantly between groups. OWOB participants had higher faecal acetate (P=0.05), propionate (P=0.03), butyrate (P=0.05), valerate (P=0.03) and total short chain fatty acid (SCFA; P=0.02) concentrations than LN. No significant differences in Firmicutes to Bacteroides/Prevotella (F:B) ratio was observed between groups. However, in the entire cohort, Bacteroides/Prevotella counts were negatively correlated with faecal total SCFA (r=-0.32, P=0.002) and F:B ratio was positively correlated with faecal total SCFA (r=0.42, P<0.0001). Principal component analysis identified distinct gut microbiota and SCFA-F:B ratio components, which together accounted for 59% of the variation. F:B ratio loaded with the SCFA and not with the microbiota suggesting that SCFA and F:B ratio vary together and may be interrelated. CONCLUSIONS The results support the hypothesis that colonic fermentation patterns may be altered, leading to different faecal SCFA concentrations in OWOB compared with LN humans. More in-depth studies looking at the metabolic fate of SCFA produced in LN and OWOB participants are needed in order to determine the role of SCFA in obesity.
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Affiliation(s)
- J Fernandes
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - W Su
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Rahat-Rozenbloom
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - T M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Clinical Nutrition and Risk Factor Modification Centre, and Division of Endocrinology and Metabolism and Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Toronto, Ontario, Canada
| | - E M Comelli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chiu S, Sievenpiper JL, de Souza RJ, Cozma AI, Mirrahimi A, Carleton AJ, Ha V, Di Buono M, Jenkins AL, Leiter LA, Wolever TMS, Don-Wauchope AC, Beyene J, Kendall CWC, Jenkins DJA. Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr 2014; 68:416-23. [PMID: 24569542 PMCID: PMC3975811 DOI: 10.1038/ejcn.2014.8] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 10/12/2013] [Accepted: 11/12/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES In the absence of consistent clinical evidence, there are concerns that fructose contributes to non-alcoholic fatty liver disease (NAFLD). To determine the effect of fructose on markers of NAFLD, we conducted a systematic review and meta-analysis of controlled feeding trials. SUBJECTS/METHODS We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library (through 3 September 2013). We included relevant trials that involved a follow-up of ≥ 7 days. Two reviewers independently extracted relevant data. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean difference (SMD) for intrahepatocellular lipids (IHCL) and mean difference (MD) for alanine aminotransferase (ALT). Inter-study heterogeneity was assessed (Cochran Q statistic) and quantified (I(2) statistic). RESULTS Eligibility criteria were met by eight reports containing 13 trials in 260 healthy participants: seven isocaloric trials, in which fructose was exchanged isocalorically for other carbohydrates, and six hypercaloric trials, in which the diet was supplemented with excess energy (+21-35% energy) from high-dose fructose (+104-220 g/day). Although there was no effect of fructose in isocaloric trials, fructose in hypercaloric trials increased both IHCL (SMD=0.45 (95% confidence interval (CI): 0.18, 0.72)) and ALT (MD=4.94 U/l (95% CI: 0.03, 9.85)). LIMITATIONS Few trials were available for inclusion, most of which were small, short (≤ 4 weeks), and of poor quality. CONCLUSIONS Isocaloric exchange of fructose for other carbohydrates does not induce NAFLD changes in healthy participants. Fructose providing excess energy at extreme doses, however, does raise IHCL and ALT, an effect that may be more attributable to excess energy than fructose. Larger, longer and higher-quality trials of the effect of fructose on histopathological NAFLD changes are required.
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Affiliation(s)
- S Chiu
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Department of Human Biology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - J L Sievenpiper
- 1] Department of Pathology and Molecular Medicine, Faculty of Health Sciences, Hamilton, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - R J de Souza
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - A I Cozma
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - A Mirrahimi
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - A J Carleton
- 1] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [2] Department of Undergraduate Medical Education (MD Program), Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - V Ha
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - M Di Buono
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Heart and Stroke Foundation of Ontario, Toronto, ON, Canada [3] American Heart Association, Dallas, TX, USA
| | - A L Jenkins
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - L A Leiter
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada [4] Division of Endocrinology, St Michael's Hospital, Toronto, ON, Canada [5] Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - T M S Wolever
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada [4] Division of Endocrinology, St Michael's Hospital, Toronto, ON, Canada [5] Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A C Don-Wauchope
- 1] Department of Pathology and Molecular Medicine, Faculty of Health Sciences, Hamilton, ON, Canada [2] Division of Clinical Chemistry and Immunology, Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada
| | - J Beyene
- 1] Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada [2] The Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [3] Child Health Evaluative Sciences (CHES), The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - C W C Kendall
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - D J A Jenkins
- 1] Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada [2] Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada [3] Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada [4] Division of Endocrinology, St Michael's Hospital, Toronto, ON, Canada [5] Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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