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Introduction The glycaemic index (GI) is a concept for classification of foods rich in carbohydrates according to their effect on the postprandial blood glucose (B-glucose) response. Since the introduction of [...], Objective: To investigate if the improved glucose tolerance previously observed at breakfast following an evening meal with boiled barley kernels derives from colonic events related to the fermentation of the elevated amounts of indigestible carbohydrates present and/or from the low-GI features. Subjects/Methods: Twenty healthy volunteers aged 19-30 years. Design: High-GI white wheat bread (WWB), WWB + barley dietary fibre (DF) corresponding to the DF content of barley kernels, low-GI spaghetti + barley DF, spaghetti + double amounts of barley DF (2*DF), spaghetti + oat DF, or whole grain barley flour porridge, were provided as late evening meals. At a subsequent standardised WWB breakfast, B-glucose, s-insulin, p-SCFA, p-FFA, and breath hydrogen ([H.sub.2]) were measured. Results: The B-glucose response (incremental areas under the curves (IAUC) 0-120 min and total areas under the curves 0-180 min) to the standardized breakfast was significantly lower after consuming spaghetti + 2*DF in the evening compared with barley porridge (P = 0.012). The spaghetti + 2*DF meal also resulted in the highest breath [H.sub.2] excretion (P < 0.02). The glucose IAUC (0-120 min) after the standardized breakfast was positively correlated to fasting p-FFA (r = 0.29, P < 0.02), and the total glucose area (0-180 min) was negatively correlated to the p-propionate level (0-30 min) (r = -0.24, P < 0.02). Conclusions: The prolonged digestive and absorptive phase per se, like with a low-glycaemic index (GI) spaghetti evening meal, did not induce overnight benefits on glucose tolerance. Addition of barley DF in high amounts (2*DF) was required to improve overnight glucose tolerance. The correlations observed between glycaemia and p-propionate implicate colonic fermentation as a modulator of glucose tolerance through a mechanism leading to suppressed free fatty acids levels. It is proposed that the overnight benefits on glucose tolerance previously reported for boiled barley kernels is mediated through colonic fermentation of the prebiotic carbohydrates present in this product. doi:10.1038/sj.ejcn.1602784; published online 23 May 2007 Keywords: glycaemic index; glucose tolerance; second-meal effect; colonic fermentation; dietary fibre, resistant starch

Author(s): M Leeman [1]; E Ãstman [1]; I Björck [1] Introduction The role of glycaemic index (GI) on satiety sensation and weight maintenance has been the subject of a number [...]

Author(s): A Nilsson [1]; Y Granfeldt [1]; E Ãstman [1]; T Preston [2]; I Björck [1] Introduction The glycaemic index (GI) is a concept used to classify carbohydrate-rich foods according [...]

Author(s): E M Ãstman [1]; A H Frid [2]; L C Groop [2]; I M E Björck [1] Introduction It is well known that low glycaemic index (GI) starchy foods [...]

Author(s): M Leeman [1]; E Ãstman [1]; I Björck [1] Introduction Today we see a worldwide increase in the prevalence of diseases linked to insulin resistance. Although sedentary lifestyle play [...]

Author(s): E Ãstman [1]; Y Granfeldt [1]; L Persson [1]; I Björck [1] Introduction Today, we see a rapid increase in obesity and diseases related to the insulin resistance syndrome [...]

Abstract Background Dairy proteins, in particular the whey fraction, exert insulinogenic properties and facilitate glycemic regulation through a mechanism involving elevation of certain plasma amino acids, and stimulation of incretins. Human milk is rich in whey protein and has not been investigated in this respect. Method Nine healthy volunteers were served test meals consisting of human milk, bovine milk, reconstituted bovine whey- or casein protein in random order. All test meals contributed with 25g intrinsic or added lactose, and a white wheat bread (WWB) meal was used as reference, providing 25g starch. Post-prandial levels in plasma of glucose, insulin, incretins and amino acids were investigated at time intervals for up to 2 h. Results All test meals elicited lower postprandial blood glucose responses, expressed as iAUC 0–120 min compared with the WWB (P Conclusion This study shows that the glycemic response was significantly lower following all milk/milk protein based test meals, in comparison with WWB. The effect appears to originate from the protein fraction and early phase plasma amino acids and incretins were involved in the insulin secretion. Despite its lower protein content, the human milk was a potent GLP-1 secretagogue and showed insulinogenic properties similar to that seen with reconstituted bovine whey-protein, possibly due to the comparatively high proportion of whey in human milk.

Abstract Background Whey protein increases postprandial serum insulin levels. This has been associated with increased serum levels of leucine, isoleucine, valine, lysine, threonine and the incretin hormone glucose-dependent insulinotropic polypeptide (GIP). We have examined the effects of these putative mediators of whey’s action on insulin secretion from isolated mouse Langerhans islets. Methods Mouse pancreatic islets were incubated with serum drawn from healthy individuals after ingestion of carbohydrate equivalent meals of whey protein (whey serum), or white wheat bread (control serum). In addition the effect of individual amino acid combinations on insulin secretion was also tested. Furthermore, the stimulatory effects of whey serum on insulin secretion was tested in vitro in the absence and presence of a GIP receptor antagonist ((Pro(3))GIP[mPEG]). Results Postprandial amino acids, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) responses were higher after whey compared to white wheat bread. A stimulatory effect on insulin release from isolated islets was observed with serum after whey obtained at 15 min (+87%, P < 0.05) and 30 min (+139%, P < 0.05) postprandially, compared with control serum. The combination of isoleucine, leucine, valine, lysine and threonine exerted strong stimulatory effect on insulin secretion (+270%, P < 0.05), which was further augmented by GIP (+558% compared to that produced by glucose, P < 0.05). The stimulatory action of whey on insulin secretion was reduced by the GIP-receptor antagonist (Pro(3))GIP[mPEG]) at both 15 and 30 min (−56% and −59%, P < 0.05). Conclusions Compared with white wheat bread meal, whey causes an increase of postprandial insulin, plasma amino acids, GIP and GLP-1 responses. The in vitro data suggest that whey protein exerts its insulinogenic effect by preferential elevation of the plasma concentrations of certain amino acids, GIP and GLP-1.

Abstract Background Rye products have been demonstrated to lower the acute insulin demand, induce a low and prolonged blood glucose response (high Glycemic Profile, GP) and reduce subclinical inflammation. These products may therefore contribute to a lowered risk of obesity, type 2 diabetes and cardio vascular disease. The objective of the present paper was to evaluate the mechanism for a reduced postprandial insulin demand with rye products, and to explore possible appetite regulating properties. Methods 10 healthy subjects were served breakfast meals (50 g of available starch) with endosperm- or whole grain rye breads, with and without lactic acid, boiled whole grain rye- (RK) or wheat (WK) kernels, or white wheat bread reference (WWB) in random order in a cross-over design. Plasma concentrations of glucose, ghrelin, serum insulin, free fatty acids, adiponectin, breath hydrogen excretion (H2), and subjective satiety was evaluated during the postprandial phase. 270 min after the breakfast, an ad lib lunch buffet was served and the voluntary energy intake (EI) was registered. Results All rye products and WK induced lower insulinemic indices (II) than WWB. A lower incremental insulin peak following breakfast correlated with a lower EI at lunch (r = 0.38). A low II was related to improved satiety in the early postprandial phase (fullness AUC 0-60 min, r = -0.36). RK induced a higher GP compared to WWB and WK. A higher GP was related to a lowered desire to eat before lunch (AUC 210-270) and to a lower concentration of ghrelin in the late postprandial phase after breakfast (270 min), r = -0.29 and -0.29), which in turn was related to a lower voluntary EI (r = 0.43 and 0.33). The RK breakfast improved satiety in the early postprandial phase (0-60 min) compared to WWB, and induced a lower EI at lunch (-16%). A high content of indigestible carbohydrates in the breakfast products was related to improved satiety (0-60 min, r = 0.68 for fullness), and a higher breath H2 in the late postprandial phase (120-270 and 270-390 min, r = 0.46 and 0.70). High H2 (AUC 120-270 min) also correlated with lower EI (r = -0.34). Conclusions Rye products, rich in indigestible carbohydrates, induce colonic fermentation already post the breakfast meal, and lowers acute insulin responses. A high excretion of breath H2 also correlated with a higher GP. Especially, rye kernels induced a high GP which was associated with a 16% lowering of energy intake at a subsequent lunch meal. The bulking effect of rye fiber, colonically derived fermentation metabolites, a high GP and a low insulin response possibly all contributes to the benefits on glucose- and appetite regulation seen in an acute and semi-acute perspective.

Abstract Background Rye products have previously been shown to induce comparatively low post-prandial insulin responses; irrespectively of their glycaemic indices (GI). However, the mechanism behind this lowered insulin demand remains unknown. An improved insulin economy might contribute to the benefits seen in epidemiological studies with whole grain diets on metabolic risk factors and weight regulation. The objective of this study was to explore the mechanism for a reduced post-prandial insulin demand with rye products. Methods 12 healthy subjects were given flour based rye products made from endosperm, whole grain or bran, produced with different methods (baking, simulated sour-dough baking and boiling) as breakfasts in random order in a cross-over design. White wheat bread (WWB) was used as a reference. Blood glucose, serum insulin, plasma ghrelin and subjective satiety were measured during 180 minutes. To evaluate the course of post-meal glycaemia, a measure of the glycaemic profile (GP) was introduced defined as the duration for the incremental post-prandial blood glucose response divided with the blood glucose incremental peak (min/mM). Results The study shows that whole grain rye breads and endosperm rye products induced significantly (p < 0.05) lower insulinaemic indices (II's) than WWB. Rye bran bread (RBB) produced significantly higher II compared with all the other rye products. Furthermore, the acute insulin response showed better correlations with the GP than with the GI of the products. The endosperm rye bread and the whole grain rye bread with lactic acid induced a significantly higher GP than RBB, WWB, white wheat- and whole grain rye porridge, respectively. A low insulin incremental peak was associated with less severe late post-prandial hypoglycaemia (r = 0.38, p < 0.001), and hypoglycaemia was negatively correlated to subjective satiety at 180 min (r = -0.28, p < 0.05). A low insulin incremental peak was also associated with a milder recovery of plasma ghrelin in the late post-prandial phase (180 min, r = 0.34, p < 0.01). Conclusion Our study shows that endosperm and wholegrain rye products induce low acute insulinaemic responses and improved glycaemic profiles. The results also suggest that the rye products possess beneficial appetite regulating properties. Further studies are needed to identify the unknown property or bioactive component(s) responsible for these beneficial metabolic features of rye.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants continue to emerge, and effective tracking requires rapid return of results. Surveillance of variants is typically performed by whole genome sequencing (WGS), which can be financially prohibitive and requires specialized equipment and bioinformatic expertise. Genotyping approaches are rapid methods for monitoring SARS-CoV-2 variants but require continuous adaptation. Fragment analysis may represent an approach for improved SARS-CoV-2 variant detection., Methods: A multiplex fragment analysis approach (CoVarScan) was validated using PCR targeting variants by size and fluorescent color. Eight SARS-CoV-2 mutational hot spots in variants of concern (VOCs) were targeted. Three primer pairs (recurrently deleted region [RDR] 1, RDR2, and RDR3-4) flank RDRs in the S-gene. Three allele-specific primers target recurrent spike receptor binding domain mutants. Lastly, 2 primer pairs target recurrent deletions or insertions in ORF1A and ORF8. Fragments were resolved and analyzed by capillary electrophoresis (ABI 3730XL), and mutational signatures were compared to WGS results., Results: We validated CoVarScan using 3544 clinical respiratory specimens. The assay exhibited 96% sensitivity and 99% specificity compared to WGS. The limit of detection for the core targets (RDR1, RDR2, and ORF1A) was 5 copies/reaction. Variants were identified in 95% of samples with cycle threshold (CT) <30 and 75% of samples with a CT 34 to 35. Assay design was frozen April 2021, but all subsequent VOCs have been detected including Delta (n = 2820), Mu, (n = 6), Lambda (n = 6), and Omicron (n = 309). Genotyping results are available in as little as 4 h., Conclusions: Multiplex fragment analysis is adaptable and rapid and has similar accuracy to WGS to classify SARS-CoV-2 variants., (© American Association for Clinical Chemistry 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The Bio-Rad SARS-CoV-2 ddPCR Kit (Bio-Rad Laboratories) was the first droplet digital polymerase chain reaction (ddPCR) assay to receive Food and Drug Administration (FDA) Emergency Use Authorization approval, but it has not been evaluated clinically. We describe the performance of ddPCR-in particular, its ability to confirm weak-positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results., Methods: We clinically validated the Bio-Rad Triplex Probe ddPCR Assay. The limit of detection was determined by using serial dilutions of SARS-CoV-2 RNA in an artificial viral envelope. The ddPCR assay was performed according to the manufacturer's specifications on specimens confirmed to be positive (n = 48) or negative (n = 30) by an FDA-validated reverse transcription-polymerase chain reaction assay on the m2000 RealTime system (Abbott). Ten borderline positive cases were also evaluated., Results: The limit of detection was 50 copies/mL (19 of 20 positive). Forty-seven specimens spanning a range of quantification cycles (2.9-25.9 cycle numbers) were positive by this assay (47 of 48; 97.9% positive precent agreement), and 30 negative samples were confirmed as negative (30 of 30; 100% negative percent agreement). Nine of 10 borderline cases were positive when tested in triplicate., Conclusions: The ddPCR of SARS-CoV-2 is an accurate method, with superior sensitivity for viral RNA detection. It could provide definitive evaluation of borderline positive cases or suspected false-negative cases., (© American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background/objectives: Whey proteins have insulinogenic properties and the effect appears to be mediated from a postprandial plasma amino-acid (AA) response. The aim was to study the possible dose-response relationship between whey intake and glycaemic-, insulinaemic- and plasma AA responses., Subjects/methods: Twelve healthy volunteers participated in the study. They were provided three whey protein drinks, containing 4.5, 9 or 18 g protein as breakfast meals in random order. All meals contained 25 g available carbohydrates (glucose). The same amount of glucose in water was used as reference., Results: Linear dose-response relations were found between whey protein intake and postprandial glycaemia, insulinaemia and plasma AAs. The two highest doses, 18 g and 9 g, significantly reduced postprandial glycaemia (incremental area under the curve (iAUC) 0-120 min; P ≤ 0.05). The 18 g dose significantly increased the insulin response (iAUC 0-120 min; P ≤ 0.05). All measured plasma AAs (15 in total), except glutamic acid, responded in a dose-dependent way, and the 9 and 18 g doses resulted in significantly higher plasma levels of AAs compared with the reference., Conclusions: Whey protein affects glycaemia, insulinaemia and plasma AAs to a glucose load in a dose-dependent manner. Comparatively low doses of whey protein (9 g) reduced postprandial glycaemia significantly when added to a carbohydrate-rich meal.

Background: Previous studies indicate that elevated amylose content in products from rice, corn, and barley induce lower postprandial glycaemic responses and higher levels of resistant starch (RS). Consumption of slowly digestible carbohydrates and RS has been associated with health benefits such as decreased risk of diabetes and cardiovascular disease., Objective: To evaluate the postprandial glucose and insulin responses in vivo to bread products based on a novel wheat genotype with elevated amylose content (38%)., Design: Bread was baked from a unique wheat genotype with elevated amylose content, using baking conditions known to promote amylose retrogradation. Included test products were bread based on whole grain wheat with elevated amylose content (EAW), EAW with added lactic acid (EAW-la), and ordinary whole grain wheat bread (WGW). All test breads were baked at pumpernickel conditions (20 hours, 120°C). A conventionally baked white wheat bread (REF) was used as reference. Resistant starch (RS) content was measured in vitro and postprandial glucose and insulin responses were tested in 14 healthy subjects., Results: The results showed a significantly higher RS content (on total starch basis) in breads based on EAW than in WGW (p<0.001). Lactic acid further increased RS (p<0.001) compared with both WGW and EAW. Breads baked with EAW induced lower postprandial glucose response than REF during the first 120 min (p<0.05), but there were no significant differences in insulin responses. Increased RS content per test portion was correlated to a reduced glycaemic index (GI) (r=-0.571, p<0.001)., Conclusions: This study indicates that wheat with elevated amylose content may be preferable to other wheat genotypes considering RS formation. Further research is needed to test the hypothesis that bread with elevated amylose content can improve postprandial glycaemic response.

Aim: Clinical studies have suggested a role for dietary glycaemic index (GI) in body weight regulation and diabetes risk. Here, we investigated the long-term metabolic effects of low and high glycaemic diets using the C57BL/6J mouse model., Methods: Female C57BL/6J mice were fed low or high glycaemic starch in either low-fat or medium-fat diets for 22 weeks. Oral and intravenous glucose tolerance tests were performed to investigate the effect of the experimental diets on glucose tolerance and insulin resistance., Results: In this study, a high glycaemic diet resulted in impaired oral glucose tolerance compared to a low glycaemic diet. This effect was more pronounced in the group fed a medium-fat diet, suggesting that a lower dietary fat content ameliorates the negative effect of a high glycaemic diet. No effect on body weight or body fat content was observed in either a low-fat diet or a medium-fat diet. Static incubation of isolated islets did not show any differences in basal (3.3 mM glucose) or glucose-stimulated (8.6 and 16.7 mM glucose) insulin secretion between mice fed a low or high glycaemic diet., Conclusion: Together, our data suggest that the impaired glucose tolerance seen after a high glycaemic diet is not explained by altered β-cell function., (© 2010 Blackwell Publishing Ltd.)

Monodisperse short-chain amorphous or semicrystalline amylose-glycerol monostearate (GMS) complexes, or, as a reference, pure GMS, were added to starch dispersions which were gelatinized and allowed to cool. The largest impacts on rheological properties were observed when GMS or amorphous GMS complexes were added. The controlled release of the short amylose chains of the latter induced double helix and, thus, network formation, resulting in higher viscosity readings. As the lipid is set free after starch gelatinization, it is assumed that it complexes with amylose leached outside the granule, whereas additional pure GMS can probably to a greater extent complex inside the granule. Semicrystalline complexes could be considered as inert mass in the starch systems as their melting temperature exceeded the temperature reached during the experiment. The additives also impacted starch's sensitivity to enzymatic degradation. GMS addition reduced the resistant starch (RS) content of the gels and increased their hydrolysis index (HI). Added amorphous or semicrystalline complexes, on the other hand, yielded gels with a higher RS content and a lower HI. Addition of amylose-lipid complexes to starch suspensions impacts starch gel characteristics and decreases its digestion rate, possibly by releasing short amylose chains in a controlled way that then participate in amylose crystallization and, hence, RS formation.

Objective: A diet rich in whole grain cereals is suggested to protect against type 2 diabetes and facilitate body weight regulation. However, little is known about the impact of different cereals and the underlying mechanisms. The objective of this study was to compare the long-term metabolic effects of diets supplemented with whole grain wheat or whole grain rye in the C57BL/6J mouse., Methods: Mice were fed the whole grain supplements in a low-fat background diet for 22 wk. Oral and intravenous glucose tolerance tests were performed during the study and in vitro insulin secretion assays were performed at the end of the study. Body weight, energy intake, body fat content, and plasma parameters were measured during the study., Results: A dietary supplement of whole grain rye suppressed body weight gain and resulted in significantly decreased adiposity, plasma leptin, total plasma cholesterol, and triacylglycerols compared with a supplement of whole grain wheat. Also, a slight improvement in insulin sensitivity was observed in the rye group compared with the wheat group. The decreases in body weight and adiposity were observed in the absence of differences in energy intake., Conclusion: Long-term administration of whole grain rye evokes a different metabolic profile compared with whole grain wheat in the C57BL/6J mouse, the primary difference being that whole grain rye reduces body weight and adiposity compared with whole grain wheat. In addition, whole grain rye slightly improves insulin sensitivity and lowers total plasma cholesterol., (2010 Elsevier Inc. All rights reserved.)

Background: Foods with a low glycemic index are increasingly being acknowledged as beneficial for individuals with disorders related to the insulin resistance syndrome. The presence of certain salts of organic acids has been shown to lower the glycemic index of bread products and one of the suggested mechanisms is a lowered gastric emptying rate (GER). One obvious pitfall with many of the common techniques for GER measurement is that the food structure, and hence the gastric release of nutrients, may be affected by enclosure of the marker for gastric emptying, eg, paracetamol. Ultrasonography is a noninvasive method for which the above pitfall is to a large extent avoided., Objective: The main objective was to evaluate the use of ultrasonography to determine whether the lowered glycemic and insulinemic responses to bread ingestion after the addition of sodium propionate are explained by a specific effect of propionate on the GER., Design: The effect of sodium propionate in bread was evaluated in 9 healthy volunteers. Barley bread products, with or without added sodium propionate, were ingested as breakfast after an overnight fast. The GER was monitored for 2 h by ultrasonography; during this period, capillary blood was withdrawn repeatedly for measurement of blood glucose and insulin., Results: The GER of the barley bread decreased markedly after the addition of sodium propionate and was accompanied by lowered glycemic and insulinemic responses., Conclusion: The lowered glycemic response to ingestion of bread with added sodium propionate appears to be related to a lowered GER.

Background: Foods with a low glycemic index are increasingly being acknowledged as beneficial in relation to the insulin resistance syndrome. Certain organic acids can lower the glycemic index of bread products. However, the possible effect of acids in fermented milk products on the glycemic index and on insulinemic characteristics has not been addressed. The metabolic effects of fermented milk or pickled products used as additives to mixed meals have also not been addressed., Objectives: One objective was to characterize the glycemic and insulinemic responses after intake of regular or fermented milk products (study 1). In addition, the acute metabolic effect of fermented milk (yogurt) and pickled cucumber as supplements to a traditional breakfast based on a high-glycemic index bread was evaluated (study 2)., Design: Ten healthy volunteers were served different breakfast meals after an overnight fast. Capillary blood samples were collected before and during 2 (study 1) or 3 (study 2) h after the meal. White-wheat bread was used as a reference meal in both studies., Results: The lactic acid in the fermented milk products did not lower the glycemic and insulinemic indexes. Despite low glycemic indexes of 15-30, all of the milk products produced high insulinemic indexes of 90-98, which were not significantly different from the insulinemic index of the reference bread. Addition of fermented milk (yogurt) and pickled cucumber to a breakfast with a high-glycemic index bread significantly lowered postprandial glycemia and insulinemia compared with the reference meal. In contrast, addition of regular milk and fresh cucumber had no favorable effect on the metabolic responses., Conclusions: Milk products appear insulinotropic as judged from 3-fold to 6-fold higher insulinemic indexes than expected from the corresponding glycemic indexes. The presence of organic acids may counteract the insulinotropic effect of milk in mixed meals.

Accumulating data indicate that a diet characterized by low glycaemic-index (GI) foods not only improves certain metabolic ramifications of insulin resistance, but also reduces insulin resistance per se. Epidemiological data also suggest a protective role against development of non-insulin-dependent diabetes mellitus and cardiovascular disease. A major disadvantage in this connection is the shortage of low-GI foods, and many common starchy staple foods, such as bread products, breakfast cereals and potato products, have a high GI. Studies in our laboratory show that it is possible to significantly lower the GI of starchy foods, for example by choice of raw material and/or by optimizing the processing conditions. Such low-GI foods may or may not influence glucose tolerance at a subsequent meal. Consequently, certain low-GI breakfasts capable of maintaining a net increment in blood glucose and insulin at the time of the next meal significantly reduced post-prandial glycaemia and insulinaemia following a standardized lunch meal, whereas others had no 'second-meal' impact. These results imply that certain low-GI foods may be more efficient in modulating metabolism in the long term. Although the literature supports a linear correlation between the GI and insulinaemic index (II) of foods, this is not always the case. Consequently, milk products elicited elevated IIs, indistinguishable from a white bread reference meal, despite GIs in the lower range. This inconsistent behaviour of milk products has not been acknowledged, and potential metabolic consequences remain to be elucidated.