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ABSTRACT disease (1, 5), and the metabolic syndrome (6). Similar preven-
Background: Frequent hyperglycemic episodes are increasingly tive effects have also been observed with foods rich in whole
being associated with an increased risk of type 2 diabetes and car- grains (7, 8); therefore, it could be hypothesized that low-GI
diovascular disease. foods that are additionally rich in whole-grain constituents could
Am J Clin Nutr 2008;87:645–54. Printed in USA. © 2008 American Society for Nutrition 645
646 NILSSON ET AL
21, 22). However, in the evening meal to breakfast scenario, Malmö, Sweden. The amount of barley DF added to the WWB
other properties of the low-GI foods, such as the specific amount meal was intended to correspond to the total DF content naturally
or type of indigestible carbohydrates, might contribute to the occurring in an equivalent starch portion of boiled barley kernels.
improvement in glucose tolerance (24 –26). Colonic fermenta- The size of the test meals corresponded to 50 g available starch
tion of indigestible carbohydrates [dietary fiber (DF) and resis- (calculated by subtracting RS from total starch). The portion
tant starch (RS)] results in the formation of colonic metabolites, sizes and contents of available starch, RS, and DF (soluble and
particularly short-chain fatty acids (mainly acetic, propionic, and insoluble) are shown in Table 1. The wheat, rye, and barley
butyric acids) (27, 28). The colonic metabolites may enter the kernels were boiled for 30, 35, and 23 min, respectively, in 110
circulation, and it has been suggested that certain short-chain mL water. The oat kernels were boiled for 18 min in 100 mL
fatty acids produced during colonic fermentation may exert sys- water. Salt (0.5 g) was added to the boiling water. All water was
temic effects, including benefits on glucose metabolism (24, 25, absorbed into the kernels when cooked. The whole-grain barley
29, 30). flour used for the porridge was suspended in 400 mL water (with
The purpose of the present study was to investigate the effects 0.5 g salt) and then cooked in a microwave oven for 5 min (600
of some cereal-based test meals that varied in GI features and W) with 2 intermittent breaks for stirring. The products were
content of indigestible carbohydrates (DF and RS) on acute post- served immediately after preparation. The WWB was baked
prandial glucose tolerance as well as on glucose tolerance at according to a standardized procedure (31) in a home baking
subsequent standardized meals. The postprandial glycemia at machine (Severin model no. BM 3983; Severin Svenaka AB,
subsequent meals was related to the magnitude of colonic fer- Djursholm, Sweden). After cooling, the crust was removed and
TABLE 1
Portion sizes and contents of available starch, dietary fiber (DF; soluble and insoluble), and resistant starch (RS) in the test products and meals1
DF
% mmol 䡠 min/L
WWB 100 a
145.4 앐 22.4 192.5 앐 28.9 360.6 앐 36.3 698.5 앐 70.7a
Barley porridge 112 앐 25a 134.6 앐 20.6 157.0 앐 17.8 366.9 앐 23.9 658.5 앐 41.8a,b
WWB ѿ barley DF 93 앐 15a,b 116.0 앐 14.8 156.2 앐 21.9 379.7 앐 17.6 651.9 앐 42.0a,b
Oat kernels 85 앐 13a,b 105.0 앐 15.1 137.1 앐 17.0 372.6 앐 34.7 614.7 앐 49.3a,b,c
Wheat kernels 79 앐 13a,b 100.4 앐 17.5 127.4 앐 14.2 361.0 앐 33.5 588.8 앐 40.5a,b,c
Rye kernels 73 앐 19b 80.6 앐 11.3 130.7 앐 21.2 345.8 앐 36.0 557.1 앐 58.2b,c
Barley kernels 49 앐 7b 68.2 앐 11.8 107.7 앐 14.4 309.6 앐 25.6 485.5 앐 40.1c
1
All values are x 앐 SEM; n ҃ 12 healthy subjects. WWB, white-wheat bread; DF, dietary fiber. Significant effects of treatment (type of breakfast) (P 쏝
0.001) and of time (P 쏝 0.0001) were found along the test day, whereas no treatment ҂ time interaction was seen. Means in a column not sharing the same
superscript letter are significantly different, P 쏝 0.05 (ANOVA followed by Tukey’s test).
during the test day were also lower after the barley kernel break- kernel breakfast. The barley or rye kernel breakfasts resulted in
fast than after the breakfasts consisting of whole-grain barley significantly lower blood glucose peaks (1.5 앐 0.2 mmol/L and
porridge or WWBѿbarley DF (P 쏝 0.01). In addition, a signif- 1.6 앐 0.2 mmol/L, respectively, based on individual peak incre-
icant effect of time on blood glucose IAUCs (0 –120 min) was ment) than did breakfasts of WWB (3.2 앐 0.4 mmol/L; P 쏝
seen throughout the test day; that is, the blood glucose IAUCs 0.0001), whole-grain barley porridge (2.9 앐 0.3 mmol/L, barley/
increased significantly during the day (P 쏝 0.0001). Conse- rye; P 쏝 0.001 and P 쏝 0.01, respectively), or oat kernels (2.7 앐
quently, the mean blood glucose IAUCs (0 –120 min) after the 0.2 mmol/L, barley/rye; P 쏝 0.01 and P 쏝 0.05, respectively).
dinner (356.6 앐 11.3 mmol 䡠 min/L) were significantly larger (P The breakfast consisting of whole-grain barley flour porridge
쏝 0.0001) than both the mean blood glucose IAUCs after break- resulted in the fastest rise in blood glucose concentration after
fast (107.7 앐 6.7 mmol 䡠 min/L) and those after lunch (144.1 앐 breakfast. Consequently, the blood glucose increment at 15 min
7.8). The blood glucose IAUCs after lunch were also signifi- was significantly higher after the whole-grain barley porridge
cantly higher than those after the breakfast (P 쏝 0.01). breakfast than after a breakfast of boiled barley kernels or
A significant treatment effect (P 쏝 0.0001) and a significant WWBѿbarley DF (P 쏝 0.01). The breakfast with WWBѿbarley
interaction (treatment ҂ time, P 쏝 0.001) were found after the DF showed a delay in the mean blood glucose peak (Figure 4).
breakfast meal (0 –120 min) (Figure 4). The lowest postprandial Moreover, the drop in blood glucose concentrations in the later
blood glucose increments were achieved after a barley or rye postprandial phase (90 –120 min after the breakfast) was less
steep after the consumption of WWBѿbarley DF. Consequently,
the blood glucose increment remained higher at 120 min after the
WWBѿbarley DF breakfast than after the WWB, barley kernel,
and barley porridge (P 쏝 0.05).
In the postprandial period after the standardized lunch with the
highest blood glucose increments, that is, 30 – 60 min after the
standardized lunch, a breakfast of barley kernels resulted in sig-
nificantly lower blood glucose increments than did the WWB (30
min, P 쏝 0.001; 45 min, P 쏝 0.05; 60 min, P ҃ 0.001) (Figure
5). At 30 min after the start of the standardized lunch, a barley
kernel breakfast also resulted in lower blood glucose increments
than did breakfasts consisting of whole-grain barley porridge or
WWBѿbarley DF (P 쏝 0.05). At 60 min after the start of the
lunch, all the kernel-based breakfasts resulted in lower blood
glucose increments than did a breakfast of WWB (P 쏝 0.05). The
blood glucose IAUCs (0 –120 min) after the standardized lunch
were positively correlated with the blood glucose IAUCs (0 –120
min) after the cereal test breakfast (r ҃ 0.30, P 쏝 0.05).
FIGURE 4. Mean acute incremental blood glucose changes (⌬) after the No significant effects of the type of breakfast consumed were
different cereal breakfasts. A significant treatment (type of breakfast) effect seen after the standardized dinner meals, at 9.5–11.5 h after the
(P 쏝 0.001) and a significant interaction (treatment ҂ time, P 쏝 0.0001) were test breakfasts (Figure 6). However, the cumulative postprandial
found over the test period. At a given point in time, values not sharing the
same letters are significantly different, P 쏝 0.05 (ANOVA followed by
glucose IAUCs (0 –120 min) over the entire test period (breakfast
Tukey’s test). n ҃ 12 healthy subjects. WWB, white-wheat bread; DF, ѿ lunch ѿ dinner) were significantly lower after the barley
dietary fiber. kernel or the rye kernel breakfasts than after the WWB breakfast
650 NILSSON ET AL
Series 2 (test evening meal series): overnight perspective Comparisons between series 1 and series 2
Postprandial blood glucose increments after a standardized The blood glucose response (0 –120 min IAUCs) at a stan-
breakfast after different cereal-based evening meals dardized WWB meal was significantly higher at 9.5 h after the
test breakfasts than the corresponding area obtained at 9.5 h after
A significant treatment effect of the preceding evening test the various test evening meals (Figure 11). That is, the blood
meal was noted in blood glucose increments in the 45– 60-min glucose response was higher in the evening than in the morning
postprandial period after the standardized breakfast (Figure 9). (P 쏝 0.0001). There were, however, no corresponding differ-
At 45 min after the start of the standardized breakfast, the blood ences in mean hydrogen concentrations at 9.5–11.5 h after the
glucose increment was significantly lower after an evening meal test meals depending on whether the test period was from
with barley kernels than after both an evening meal of WWB (P evening meal to breakfast or from breakfast to evening meal
쏝 0.01) and of WWBѿbarley DF (P 쏝 0.05). When expressed (Figure 12).
as IAUCs (0 –120 min), the postprandial blood glucose response
after the standardized breakfast was lower after an evening meal
of barley kernels than after a corresponding evening meal of
WWB (IAUCs of 80.9 앐 12.4 and 121.6 앐 10.7 mmol 䡠 min/L,
respectively; P 쏝 0.05). There were no significant differences (P
҃ 0.06) in the 0 –120-min blood glucose IAUCs at breakfast after
FIGURE 9. Mean blood glucose incremental changes (⌬) after a stan- FIGURE 10. Mean breath hydrogen concentrations after a standardized
dardized breakfast, 9.5–11.5 h after different test evening meals. At a given breakfast, 9.5 h after different test evening meals. A significant treatment
point in time, values not sharing the same letter are significantly different, P (type of breakfast) effect (P 쏝 0.001, Tukey’s test) was found, whereas no
쏝 0.05 (ANOVA followed by Tukey’s test). n ҃ 12 healthy subjects. WWB, treatment ҂ time interaction was seen along the test period. n ҃ 12 healthy
white-wheat bread; DF, dietary fiber. subjects. WWB, white-wheat bread; DF, dietary fiber.
652 NILSSON ET AL
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