Acute effect of low and high glycemic index meals on post- prandial glycemia and insulin responses in patients with type 2 diabetes mellitus

Introduction:Post-prandial hyperglycemia is an important independent risk factor in the development of cardiovascular disease in diabetes. This randomised cross-over study was conducted to compare the post-prandial glycemic and insulin responses to both high and low glycemic index (GI) meals in patients with type 2 diabetes (T2DM). Methods:A total of 41 patients with established T2DM (16 males, 25 females, Age= 55 + 10 years and BMI= 27 + 4 kg/m2) were randomly given either a High GI or a Low GI meal in a cross-over manner. Both test meals were separated by one week washout periods. The meals contained almost the same amount of energy and macronutrients with the exception of the GI values(High GI=70 vs Low GI= 36). Venous blood was taken through an indwelling catheter periodically at 0, 30, 60, 90, 120, 150 and 180 minutes respectively. The incremental area under the curve (iAUC) was used to calculate the post-prandial glycemia and insulin excursion over the 3-hour period. Results: The low GI meal induced lower glycemic responses at times 30, 60, 90 and 120 minutes (mean+SE; low GI=8.1+0.4, 9.1+0.4, 8.9+0.4 and 8.5 +0.4mmol/l vs high GI= 9.1+0.4, 10.7+0.4, 11.0+0.5 and 9.7 +0.5 mmol/l) and reduced the insulin levels at time 60, 90, 120 and 150 minutes (mean+SE; low GI= 17.1+1.7, 21.1+2.0, 20.4+1.7,18.5+1.8 vs high GI= 25.0+2.5, 31.2+2.9, 29.8 +3.0 and 23.0+2.3 μIU/ml)(p<0.05). The area under the glycemic (mean+SE; low GI= 215.93 + 15.9 mmol.L/minute vs high GI= 419.52 + 32.7 mmol.L/minute) and insulin (mean +SE; low GI= 1439.76 + 226 vs high GI= 2372.76 + 317μ IU.ml/min) curves were lower after the low GI than high GI meal respectively (p<0.05).Conclusion: The low GI meal has the ability to reduce the post-prandial hyperglycemia as well insulin responses in type 2 diabetes patients

Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus.

This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM). Asian patients with T2DM (N  =  104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record. At week 12, both groups achieved the recommendations for carbohydrate (52 ± 4% and 54 ± 4% of energy) and fat (30 ± 4% and 28 ± 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A(1c) level at week 12 for patients in the lowest GI/GL quartile (Δ  =  -0.7 ± 0.1%) compared with those in the highest GI/GL quartile (Δ  =  -0.1 ± 0.2%). These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM

Association of body weight status and socio-demographic factors with food habits among preschool children in Peninsular Malaysia

Introduction: Changes in children's food habits are largely attributed to changes in the family and social environment. This cross-sectional study was carried out to determine the association of socio-demographic factors with food habits among preschool children in Peninsular Malaysia. Methods: A total of 1,933 preschool children aged 4-6 years old participated in the study. Parents or guardians were interviewed on the socio-demographic characteristics and food habits of their children. Height and weight of the preschoolers were measured; BMI-for-age, weight-for-age and height-for-age were determined. Results: The mean monthly household income was RM3,610 with 59.6% of parents having attained secondary education. The prevalence of possible risk of overweight, being overweight and obesity were 3.9%, 7.9% and 8.1%, respectively while the prevalence of underweight and stunting was 8.0% and 8.4%. A majority of the preschoolers consumed breakfast, lunch and dinner every day, with the proportion of children skipping their main meals at about 15.0%. Parents' education level and household income were significantly associated with intakes of fruits, vegetables, milk and dairy products, as well as fast food. However, there was no significant association between children's body weight status and frequency of main meals intake, fruits, vegetables, milk and dairy products, and fast food intake. Conclusion: The preschoolers demonstrated moderately healthy food habits; nevertheless even at this young age, they were inclined towards fried foods, snacking and fast foods intake. Parents and guardians should play a more significant role in educating and promoting good nutrition and food habits among preschoolers

Comparison of breastfeeding practice using deuterium oxide dose to mother technique with maternal recall breastfeeding practice among mothers in Klang Valley

The assessment of exclusive breastfeeding is important to invest the efforts to promote and support breastfeeding practices. Hence this study was carried out to compare breastfeeding practices among mothers using deuterium dose to mother technique with maternal recall breastfeeding practice. A total of 30 mother-infant pairs from a university hospital and government health clinics in Klang Valley participated and completed the study. Mother-infant pairs were recruited into the study when infants were aged 3 months ± 1 week. Anthropometric measurements (height, weight, waist circumference for mother; length and weight for infant) were carried out. Socio-demographic questionnaire was self-administered while breastfeeding practices were interview administered using maternal recall breastfeeding practice questionnaire (MRBF). This was followed by baseline saliva collection of mother-infant pairs before dose and 6 days after mothers were given 30 ± 0.01 g of D2O. The post dose saliva sample of mother-infant pairs were collected 6 times at day 1,2,3,4,13 and 14.The results showed that majority of mothers (57%) were university graduates but majority were stay at home mothers. Meanwhile, mothers had BMI with mean 25 ± 4 kg/m2. The results from MRBF questionnaire showed that all mothers were practicing exclusive breastfeeding and their infant never received any water sources other than their breast milk. However, the deuterium dose to mother technique revealed only 3% of mothers were actually practicing exclusive breastfeeding. From the isotopic data, the calculated mean intake of milk was 721 ± 243 g/day while the mean non-milk oral intake of 122 ± 22 g/ day. In contrast exclusive breastfeeding infants received only 10 g/day non milk oral intake, demonstrating exclusive breastfeeding practice of mothers. There were different breastfeeding practice reported from mother using deuterium oxide dose to mother technique with maternal recall breastfeeding practice

Original Research Improvement of Dietary Quality with the Aid of a Low Glycemic Index Diet in Asian Patients with Type 2 Diabetes Mellitus

Objectives: This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM). Methods: Asian patients with T2DM (N 5 104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record. Results: At week 12, both groups achieved the recommendations for carbohydrate (52 6 4% and 54 6 4% of energy) and fat (30 6 4% and 28 6 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A 1c level at week 12 for patients in the lowest GI/GL quartile (D 5 20.7 6 0.1%) compared with those in the highest GI/GL quartile (D 5 20.1 6 0.2%). Conclusions: These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM

Body mass index (BMI) of adults: findings of the Malaysian Adult Nutrition Survey (MANS)

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 - 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25-29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40-49 years. Obesity was highest for those whose household income was between RM1,500-3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urban-rural differential in both obesity and overweight. The study found 9.02% (CI: 8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country's resources and development

Development of dietary assessment methods for use in the South Asian community

The main objective of this study was to develop and validate methods for assessing dietary intakes in the South Asian community. A 75-food item food frequency questionnaire (FFQ) and a food checklist were developed. Together with a 24 hour recall of intake, the FFQ and food checklist were calibrated against a 4-day weighed record (WR) as the reference method.The calibration studies were carried out in two parts. The first calibration study was of the FFQ in both men and women while the second calibration study was that of the food checklist and the 24 recall in women only. In the FFQ calibration study, a total of 58 subjects (23 men, 35 women) between the ages of 19 and 76 years of Pakistani, Punjabi and Gujerati origin participated. In both calibration studies, demographic information of each subject was gathered. This allowed us to determine any differences between responders and non responders and non-responders. For the first calibration study, results for men and women combined together suggested reasonable agreement between FFQ and WR estimates of intake, gender specific agreement was, however, poor. The ranking of subjects was poor with gross misclassification in the range of 5% to 14% in men and 15% to 29% in women.In the second calibration study, 44 women between the ages of 17 and 60 years of Pakistani, Punjabi and Gujerati origin participated. There was also poor correlation between nutrient estimates of food checklist vs WR and 24 hour recall vs WR. 13% and 14% to 27% of the subjects in the food checklist and 24 hour recall respectively were grossly misclassified in their ranking.In both studies, subject recruitment and completion of the study protocol were major problems, which undermined the confidence with which one can interpret the results.</p

The effect of low glycemic index bread eaten with different dillings on blood glucose response in healthy individuals

White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2 ) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 m m o l . m i n / L ) w a s s i g n i f i c a n t l y h i g h e r t h a n a l l t h e t e s t m e a l s (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 Jurnal Sains Kesihatan Malaysia 6 (1) 2008: 1-102 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/ L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further

Pengetahuan pengurusan berat badan di kalangan wanita bekerja di Kuala Lumpur

Obesity prevalence and body image consciousness are on the rise, and women often try to lose weight using a variety of methods. This paper reports the knowledge on body weight management amongst working women aged 30 – 45 years in Kuala Lumpur. Respondents comprised 131 school teachers and 122 civil servants. Anthropometric measurements included body weight and height; while knowledge on weight management was assessed using a questionnaire. The respondents were Malay (64%), Chinese (26%) and Indian women (10%) with mean age of 38.3 ± 4.6 years old. The respondents were grouped into two weight categories based on body mass index (BMI): normal weight (BMI 18.5 to 24.9 kg/m2) and overweight (BMI ≥ 25.0 kg/m2). Mean body weight and BMI were significantly different (p < 0.001) between the two weight categories. Overweight and normal weight groups had mean body weight of 69.0 ± 9.5 kg and 53.5 ± 5.3 kg; while mean BMI were 29.2 ± 3.6 kg/ m2 dan 21.9 ± 1.7 kg/m2; respectively. Mean scores for knowledge on weight management were similar for both weight categories, 62.4 ± 13.7 and 61.8 ± 13.4 for overweight and normal weight, respectively. A majority of overweight (71%) and normal weight (73%) women had moderate level (scores 50–74%) of weight management knowledge. However, it was interesting to note that there were more overweight women (20%) who had high knowledge level(scores ≥ 75%) as compared to normal weight women (15%). Only 9% of overweight and 12% of normal weight women demonstrated low knowledge level (scores <50%). School teachers were significantly (p < 0.001) more knowledgeable than civil servants in weight management matters with mean knowledge scores of 65.5 ± 12.3 and 58.4 ± 13.9, respectively. On the whole, the results indicated that women were fairly knowledgeable in healthy body weight management. Knowledge on body weight management is essential for preventing comorbidity risks related to overweight problem. The study also revealed that there was a need for nutrition education related to body image and effective weight management