Original Article

European Journal of Clinical Nutrition (2006) 60, 334–341. doi:10.1038/sj.ejcn.1602319; published online 19 October 2005

A dietary exchange of common bread for tailored bread of low glycaemic index and rich in dietary fibre improved insulin economy in young women with impaired glucose tolerance

Guarantor: IME Björck.

Contributors: IMEB, AHF and LCG were responsible for designing the intervention. EMÖ and IMEB were responsible for the development of the low-GI bread products and for determining the GI and II characteristics including the analysis of nutrient composition. AHF was responsible for recruiting the subjects and for performing the IVGTT and euglycaemic–hyperinsulinaemic clamps, including also the blood analyses. IMEB and EMÖ were responsible for the contact with the subjects and management of the diets during the study. IMEB collected the data and AHF and EMÖ evaluated the statistics. IMEB, AHF, LCG and EMÖ took part in the interpretation of the data. EMÖ was responsible for writing and submitting the manuscript. None of the authors had personal or financial conflicts of interest.

E M Östman1, A H Frid2, L C Groop2 and I M E Björck1

  1. 1Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Center for Chemistry and Chemical Engineering, Lund University, Lund, Sweden
  2. 2Clinic of Endocrinology, University Hospital MAS, Malmö, Sweden

Correspondence: Dr EM Östman, Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Center for Chemistry and Chemical Engineering, Lund University, PO Box 124, SE-221 00 Lund, Sweden. E-mail: elin.ostman@inl.lth.se

Received 5 May 2005; Revised 23 August 2005; Accepted 7 September 2005; Published online 19 October 2005.

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Abstract

Objective:

 

To study the possibility of improving blood lipids, glucose tolerance and insulin sensitivity in women with impaired glucose tolerance and a history of gestational diabetes by merely changing the glycaemic index (GI) and dietary fibre (DF) content of their bread.

Design:

 

Randomized crossover study where test subjects were given either low GI/high DF or high GI/low DF bread products during two consecutive 3-week periods, separated by a 3-week washout period. An intravenous glucose tolerance test followed by a euglycaemic–hyperinsulinaemic clamp was performed on days 1 and 21 in both the high- and low-GI periods, to assess insulin secretion and insulin sensitivity. Blood samples were also collected on days 1 and 21 for analysis of fasting levels of glucose, insulin, HDL-cholesterol and triacylglycerols (TG).

Setting:

 

Lund University, Sweden.

Subjects:

 

Seven women with impaired glucose tolerance.

Results:

 

The study shows that a modest dietary modification, confined to a lowering of the GI character and increasing cereal DF of the bread products, improved insulin economy as judged from the fact that all women lowered their insulin responses to the intravenous glucose challenge on average by 35% (0–60 min), in the absence of effect on glycaemia. No changes were found in fasting levels of glucose, insulin, HDL-cholesterol or TG.

Conclusion:

 

It is concluded that a combination of low GI and a high content of cereal DF has a beneficial effect on insulin economy in women at risk of developing type II diabetes. This is in accordance with epidemiological data, suggesting that a low dietary GI and/or increased intake of whole grain prevent against development of type II diabetes.

Sponsorship:

 

Supported by grants from Cerealia Research Foundation.

Keywords:

glycaemic index, impaired glucose tolerance, euglycaemic–hyperinsulinaemic clamp, gestational diabetes, insulin resistance, dietary fibre

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