Isomaltulose (Palatinose™): Recent Evidence for Health Benefits

Isomaltulose (Palatinose™): Recent evidence for health benefits

Sangeetha Shyam M.Sc. PhD Senior Lecturer, Division of Nutrition and Dietetics Fellow, Centre for Translational Research, Institute for Research, Development & Innovation (IRDI) International Medical University, Malaysia [email protected]

CENTRE FOR TRANFROMATIVE CTNH NUTRITION AND HEALTH Sangeetha Shyam Sangeetha Shyam NSM 2020 1 2

• No financial disclosures • Beneo GmBH donated the isomaltulose COI-Declaration for some of the clinical research done by our research group

Sangeetha Shyam NSM 2020 3

• Isomaltulose (IM) and its special bond Outline of • Brief review on physiological effects of IM • Some Malaysian data today’s • Regulation and health claims with regards to IM presentation

Sangeetha Shyam NSM 2020 The rush for sugar alternatives

• Excessive sucrose intake causes postprandial glycaemic surge and can lead to NCD • Sugar (sucrose) plays an indispensable role in diet • Therefore, there is an urgent need for possible alternatives to sucrose • IM is a promising alternative to sucrose due to its suitable sweetness, potential physiological benefits, and feasible production processes

Tian Y et al. Sucrose isomers as alternative sweeteners: properties, production, and applications. Applied microbiology 4 and biotechnology. 2019;103(21-22):8677-87. Sangeetha Shyam NSM 2020 Isomaltulose – A biochemist's delight

o Interesting disaccharide o A natural sweet constituent of honey o Like sucrose composed of glucose and fructose o But bonded differently

• Brand name: Palatinose™ • (6-0-α-D-glucopyranosyl-D-fructofuranose) • CAS Reg. No. 13718-94-0

• Total molecular formula: C12H22O11 x H2O • Molecular weight: 360.32 Meet the BOND

Sangeetha Shyam NSM 2020 5 Commercial production of Palatinose TM

Sugarbeet Sugar isomaltulose

Sucrose PalatinoseTM

OH OH O O Produced via non-GMO HO OH Enzyme HO

1 O HO OH enzymatic rearrangement of HO O 1 OH 2 HO 1 OH OH 6 OH sucrose O O 2 6 1 OH OH OH

[glucose] [fructose] [glucose] [fructose]

Sangeetha Shyam NSM 2020 6 IM Digestion in small intestine

Hydrolysis of Palatinose™ takes 4-5 times longer compared to sucrose

Scheme of hydrolysis of sucrose, starch & Palatinose™ in the small intestine Isomaltulose is hydrolysed at the same enzyme complex involved in the digestion of sucrose and starch* It is digested at the isomaltase site.

* The amylopectin derived glucose-glucose 1-6 linkage Rate of hydrolysis – sucrose vs. Palatinose™ from in vitro enzyme kinetic studies Palatinose™ (isomaltulose) is slowly released • is a “slow-release” carbohydrate For the • Is completely digested Nutritionist: • Supplies glucose /energy at a slower pace and over a longer period of time What is vs. sucrose Isomaltulose?

Isomaltulose containing foods in Malaysia

✓ Child growing-up formula ✓ Oral nutritional supplements ✓ Muscle-building supplements ✓ Health supplements ✓ Sports supplements

Sangeetha Shyam NSM 2020 Physiological Effects and Application of Isomaltulose Reviewing the evidence

Sangeetha Shyam NSM 2020 9 Low Glycemic Index Prototype Isomaltulose— Update of Clinical Trials

Maresch et al (2017) Nutrients 9(4), pii: E381. doi: 10.3390/nu9040381 Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409720/

Sangeetha Shyam NSM 2020 10 Dr Chang Sui Kiat Chinese Academy of Sciences, Guangzhou, China

Dr Amutha Ramadas Shyam S, Ramadas A, Chang SK. Isomaltulose: Recent evidence for health Monash University benefits. Journal of Functional Foods. 2018;48:173-8. Malaysia Sangeetha Shyam NSM 2020 11 Shyam S et al Isomaltulose: Recent evidence for health benefits. Journal of Functional Foods. 2018;48:173-8. Clinical evidence for the health benefits of isomaltulose

12 Sangeetha Shyam NSM 2020 Isomaltulose studies in children

Reference Participants Sugar IM Dosage IM Administration Health outcomes compared form affected by IM with IM PPGR Others/ Remarks

Sekartini et al., children aged 5- Sucrose 2.5g /100 ml Drink (Growing-up milk) improved 2013 6 years old cognition and (n = 50) attention at 180 post-meal

Taib et al. (2012 children aged 5- Sucrose and 4.48 g/ 200 ml Drink (Growing-up milk) improved 6 years old glucose cognition and (n = 30) attention

Fleddermann et Infants aged 4 to maltodextrin 2.1g/100mL Drink (in follow-on NS-glucose Well tolerated al., 2016 8 months formula) response at (n= 50) 60 mins PP

Shyam et al Isomaltulose: Recent evidence for health benefits. Journal of Functional Foods. 2018;48:173-8. Sangeetha Shyam NSM 2020 13 Isomaltulose studies in healthy adults

Reference n Sugar compared with IM IM Dosage IM Administration form Health outcomes affected by IM

PPGR B-OX CV Risk Others/ Remarks Kraemer et al., 2015 Maltodextrin NA Supplement Drink √ Improves sports performance and 13 recovery in athletes 1 König et al., 2016 Maltodextrin 75 g Drink Effects observed before and during 20 √ √ exercise Tan et al., 2017 40 Sucrose 50 g Drink √ Potential ethnic variation in response Maeda et al., 2013 10 Sucrose 50 g Drink √ Protection of pancreatic islets Holub et al., 2010 10 Sucrose 50 g Drink (at breakfast) √ √ Suraphad et al. 2017 Sucrose 50 g Drink (green tea) Improved plasma antioxidant capacity 20 √ √ Henry et al., 2017 Sucrose ~100 g/day IM in fruit drinks and 20 √ √ tea Keller et al., 2016 Maltodextrin 20 % of energy reqt. Drink √ Improved postprandial vasodilation 16 √ Arai et al., 2007 Dextrin to provide ~50 IM to partially (56%) replace Drink (at breakfast) Effects observed post-lunch (SME) 7 √ √ en% dextrin Dye et al., 2010 Sucrose 50 g Drink (milk based) NS- verbal or working memory, and 24 psychomotor performance Okuno et al., 2010 Sucrose 40 g (12 weeks) IM-blended sugar Improved HOMA-IR & Insulin 50 √ √ 2 sensitivity Shyam et al Isomaltulose: Recent evidence for health benefits. Journal of Functional Foods. 2018;48:173-8. 14 Isomaltulose studies in adults with dysglycaemia and dyslipidaemia

Reference Participants Sugar compared with IM IM Dosage IM Administration Health outcomes affected by IM form PPGR B-OX CV Risk Holub et al., Hyperlipidaemic Sucrose 50 g/d (4 weeks) in pudding, NS(HbA1C) NS–(Serum 2010 individuals (n=74) biscuits, toffees √ (FBG & IR) lipids) and beverages (milk drinks, soft drinks, tea beverages) van Can et Overweight Sucrose 75g Drink (at √ √ ↓FFA al., 2012 individuals with IGT breakfast)/ mixed- (n= 10) meal at lunch Takeda et al., Patients with MetS Dextrin IM to partially Drink (at breakfast) √ √ 2015 (n=25) (55.7%) replace dextrin to provide ~35 en% (24 weeks) Egi et al., Hyperglycaemic post- Standard enteral formula IM to provide Enteral formula √ 2010 esophagectomy (Glucose, dextrin and ~28 en% out of 50.3 individuals (n= 8) fructose providing 58.8 CHO en% CHO en%) Shyam et al Isomaltulose: Recent evidence for health benefits. Journal of Functional Foods. 2018;48:173-8. Sangeetha Shyam NSM 2020 15 Isomaltulose studies in adults with diabetes

Reference Participants Sugar compared IM Dosage IM Health outcomes affected by IM with IM Administra B- Others/ Remarks PPGR CV Risk tion form OX West et al., T1DM (n=7) Sucrose vs IM and 50 g Drink √ √ Dose given 30 2011b reduced INS dose mins pre exercise West et al., T1DM (n=8) Dextrose 75 g Drink √ √ Effects observed 2011a during and post- exercie Brunner et al. T2DM (n = 101) Sucrose 50 g/day In Sweet (NS- HbA1c) √ Improved 2012 (after 3 mon) Foods triglyceridemia Ang et al. 2012 T2DM (n = 101) IM+Whey/soy 50 g Drink NS-glucose When co- protein vs. IM+ with or response administered casein without with fast- protein absorbing protein lowered insulin action Ang and Linn T2DM (n=11) Sucrose 1 g/kg body Drink √ 2014 wt Shyam S et al Isomaltulose: Recent evidence for health benefits. Journal of Functional Foods. 2018;48:173-8. Sangeetha Shyam NSM 2020 16 • T2DM • Sports &T1DM

Sustained Glycaemic energy Control Isomaltulose- release Areas of Beta Sustained Evidence oxidation glucose of fats supply • Body weight • Cognitive management performance

Sangeetha Shyam NSM 2020 17 Glycaemic response to Isomaltulose

Sangeetha Shyam NSM 2020 18 Glycaemic Index (GI) values

Maltose 105

Glucose 10099

Maltodextrin 86

Sucrose 68 GI of 32, falls within the low- Honey 55 GI range of foods (GI <55) Lactose 46

Isomaltulose 32 PalatinoseTM Fructose 19

0 20 40 60 80 100 Atkinson et al.: International table of Glycemic Index and Glycemic load values: 2008. Diabetes Care 31, 2281 (2008) Sangeetha Shyam NSM 2020 19 Blood glucose and insulin response after isomaltulose or sucrose

Healthy Adults

Sucrose Sucrose

Palatinose™ Palatinose™

Isomaltulose (Palatinose™) shows a low glycemic and insulin response

Holub et al. Novel findings on the metabolic effects of the low glycaemic carbohydrate isomaltulose (Palatinose). Br J Nutr. 2010 Jun;103(12):1730-7.

Sangeetha Shyam NSM 2020 20 Effect of isomaltulose on incretin hormones

• Aim: Blood glucose and incretin response (GLP-1, GIP) to isomaltulose • Design: Double blind, placebo-controlled study, n= 10 healthy men (BMI ≤23) • 50 g isomaltulose / sucrose in 300 ml water • Blood sampling before (0 min) and up to 180 min after ingestion

• Results: ✓ Lower blood glucose and insulin response • ✓ Lower GIP response (released from K cells in upper GI tract) • ✓ Higher GLP-1 response (released from L cells in lower GI tract) • → Explanation by slower rate of hydrolysis and extension to more distal parts of gut

Maeda, et al. (2013). Effects of the naturally-occurring disaccharides, palatinose and sucrose, on incretin secretion in healthy non-obese subjects. Journal of Diabetes Investigation, 4,281–286. Sangeetha Shyam NSM 2020 21 Isomaltulose improves the incretin response in type 2 diabetics

With IM • GIP release was very low and delayed, overall 40% less vs sucrose • GLP-1 secretion higher and sustained, overall 6.3 folds higher vs sucrose

Plasma concentrations and iAUCs for GIP and GLP-1 in type 2 diabetics after intake of Palatinose™ or sucrose. Values are mean ± SEM. *p>0.05, ** p<0.01 and ***p<0.001 IM is slowly digested → by-passes the K-cells producing GIP and reaches the L-cells producing GLP-1. The different incretin response explains the favourable metabolic profile of Palatinose™.

Keyhani-Nejad et al. Effects of palatinose and sucrose intake on glucose metabolism and incretin secretion in subjects with type 2 diabetes. Diabetes Care. 2016; 1:39(3):e38-9. 22 Isomaltulose in diet improves blood glucose profile and fat oxidation over the day • Randomised, double-blind, cross-over study comparing low GI diet (Palatinose™) vs high GI diet (sucrose)

• n= 20 healthy Chinese men

• Over a day profile with sequence of several meals

• Two continuous monitoring techniques: • Continuous blood glucose monitoring

Henry CJ, et al. A low glycaemic index diet incorporating isomaltulose is • Whole body room calorimeter associated with lower glycaemic response and variability and promotes fat oxidation in Asians. Nutrients. 2017;9(5):473.

Sangeetha Shyam NSM 2020 23 Continuous glucose monitoring system (24h) Inclusion Palatinose™or sucrose during the test meals: Palatinose™ sucrose 30g with dinner in fruit drink 30g with breakfast added to tea 20g with lunch in fruit drink 20g with snack added to tea

n = 20, (age: 21-29; BMI:18-29) • Lower blood glucose response (p=0.002) & glucose variability (p<0.001) over 24 hours • Lower blood glucose response after dinner, breakfast and lunch (p<0.05) and after the same std dinner on day 2 as second meal effect (SME) • Higher fat oxidation after breakfast and lunch

Sangeetha Shyam NSM 2020 24 Reducing blood sugar levels matters

• Palatinose™ significantly lowers the blood glucose response, when consumed in place of sucrose, in all ethnic groups • Asians and in particular Malays respond even more than Europeans

Clinical study (RCT) comparing 50g Palatinose™ vs sucrose in 40 healthy adults from 4 ethnic groups

Tan et al., Ethnic variability in glycemic response to sucrose and isomaltulose. Nutrients. 2017; 9, 347. Sangeetha Shyam NSM 2020 25 Malaysian Studies

AP Dr Verna Lee, Dr Megan Chong Dr Tan Seok Shin Prof Dr Peter Barling SOM, IMU N&D, IMU N&D, IMU SOM, IMU (Retd)

Sangeetha Shyam NSM 2020 26 MalaysianResults for Isomaltulose (n=17) Mean glycaemic responses to 25 g & 75 g isomaltulose & sucrose (n= 17) Chee Shan (a) 25 g (b) 75 g IMU Masters 10.0 10.0 Student *** 9.0 *** 9.0 ** ** * 8.0 * 8.0 *** sucrose sucrose 7.0 7.0

6.0 6.0 isomaltulose isomaltulose

5.0 5.0

blood glucose level (mmol/L) glucose blood level blood glucose level (mmol/L) glucose blood level 4.0 4.0 0 15 30 45 60 90 120 0 15 30 45 60 90 120 time (mins) time (mins)

Values are expressed as mean ± SD. Mean difference is significant if p < 0.05 (*- p ≤ 0.05; **- p ≤ 0.01;

*** - p ≤ 0.001). Sangeetha Shyam NSM 2020 27 Chan CS et al., 2020 article under review MalaysianResults for Isomaltulose (n=14)

Postprandial Blood Glucose Response Curve in Malaysian Subjects (50g equivalents) 10.00 Gluose Ong Jia Wen 9.00 IMU NT Student

8.00 p = 0.064 Sucrose 7.00 6.00 Isomaltulose

5.00 Blood glucose level (mmol/L) level glucose Blood 4.00 0th 15th 30th 45th 60th 90th 120th Time (mins) Glucolin Isomaltulose Sucrose

Error bars indicate the standard error of the mean (SEM). Values are expressed in mean ± SEM Ong JW et al, 2020 Unpublished data

Sangeetha Shyam NSM 2020 28 MalaysianResults for Isomaltulose (n=14

Comparison of iAUC - isomaltulose & sucrose

isomaltulose p = 0.007 300 sucrose p = 0.038 250 p = 0.064 200

150 -

100 17) Mean Mean iAUC

0 25 g 50 g 75 g Dose (g)

Values are expressed as mean ± SD. Chan CS, article under review

Ong JW et al, 2020 Unpublished data 29 Sangeetha Shyam NSM 2020 MalaysianResults for (n=14) Isomaltulose of 50g Mean Peak Blood Glucose Level Mean Glycaemic Index p < 0.001* 10 8.66 ± 0.21 p=0.0 9 27* 8 6.47 ± 0.10 70 56 ± 5 7 6 5 60 4 (mmol/L) 3 2 50 1 37 ± 5 0 Isomaltulose Sucrose 40 Slower & lower PPG rise leads results in lower GI Mean Time to Peak 30

50 43.93 ± 2.47 38.57 ± 2.59 Glycaemic Index 20 40 10

30 Min)

( 0 20 10 0 Isomaltulose Sucrose Sangeetha Shyam NSM 2020 30 Ong JW et al, 2020 Unpublished data Sustained Energy Supply and Sports Performance

Sangeetha Shyam NSM 2020 31 Effects on substrate use and cycling performance

• Study Design • 2-arm cross-over design, randomised, double-blind, placebo controlled • n = 20 male endurance athletes (VO2max > 55 ml/kg) • Consumption of a beverage with 75g Palatinose™ or maltodextrin before exercise König D et al.: Nutrients. 2016 Jun 23;8(7):390. doi: Pre-run Endurance exercise Time Trial Test 10.3390/nu8070390 60-65% VO2max (6.5 kJ/kg bw)

-45‘ -30‘ -15‘ 0‘ 15‘ 30‘ 45‘ 60‘ 75‘ 90‘ end

Intake of 750 ml drink with 10% (75g) Palatinose™ or maltodextrin

• Primary outcome: Time to finish the time trial (TT)

• Secondary outcomes: Power output during final 5 min of TT, blood glucose, lactate, substrate oxidation

Sangeetha Shyam NSM 2020 32 Endurance performance Power output during the time trial

p=0.053 p = 0.08

• Better performance with Palatinose™:  Athletes still achieved a higher power output during the • Mean change: +4.6%, 90%CI: 4.0% final 5 minutes of the time trial • ††: Likely small benefit of Palatinose™ (93% likelihood)

König D et al.: Nutrients. 2016 Jun 23;8(7):390. doi: 10.3390/nu8070390Sangeetha Shyam NSM 2020 33 Effect of Isomaltulose on fuel use Fat oxidation and carbohydrate oxidation

Higher fat oxidation Lower carbohydrate oxidation Before exercise During end. exercise Before exercise During end. exercise

Mean  SD (n=17)

†† likely, ††† very likely difference for • Exercise-induced increase in fuel use different with Palatinose™: Palatinose™ vs maltodextrin  Palatinose™ allows for higher fat oxidation rates • and is more gentle on limiting carbohydrate resources König D et al.: Nutrients. 2016 Jun 23;8(7):390. doi: 10.3390/nu8070390

• at similar total energy expenditure Sangeetha Shyam NSM 2020 34 Isomaltulose and Endurance Sports

The type of carbohydrate consumed before exercise can influence fuel use and endurance performance:

Palatinose™ improved cycling performance (vs maltodextrin):

• Faster time to finish time trial • Higher power output in the time trial finish Palatinose™ provided glucose more steadily with positive influence on fuel use in preceding endurance exercise (vs maltodextrin) • More stable and sustained blood glucose profile • Higher fat oxidation rates Proposed mechanism: Lower carbohydrate oxidation could have allowed to spare glycogen sources for the final time trial performance

König D et al.: Nutrients. 2016 Jun 23;8(7):390. doi: 10.3390/nu8070390Sangeetha Shyam NSM 2020 35 Sustained Glucose Supply and Cognition

Sangeetha Shyam NSM 2020 36 Isomaltulose (Palatinose™) has shown cognitive benefits in children

Immediate memory 27 p <0.01

SE 26 ±

recalled 24

words of Breakfast concept with Palatinose™: 22

21 Number

0 • Replacing high GI carbohydrates like glucose 1 hour 3 hour for Palatinose™ provides sustained energy Mood for cognitive functioning 7

p <0.03 SE

• In school children, Palatinose™ improved cognitive ± 6

performance in the late morning, with scores 5

 better memory Mood

 improved mood 0 1 hour 3 hour Children seem particularly susceptible PalatinoseTM to the benefits of Palatinose™. Glucose

Sangeetha Shyam NSM 2020 37 Slow but complete release?

38 MalaysianResults for Isomaltulose (n=

Breath Hydrogen Response Post 50g 1.750

1.650 IM Inulin

1.550 Flat curve- 1.450

can roughly Hydrogen (ppm) Hydrogen 1.350 indicate

complete 14) 1.250 Palatinose™ absorption in Log Breath Breath Log small 1.150 intestine

1.050 Sucrose 0th 60th 120th 180th 210th Time points (mins)

S IM INU

Ng SQ et al., unpublished data

Sangeetha Shyam NSM 2020 39 Tolerance to isomaltulose in healthy adults

Gastrointestinal discomforts monitored Single Bolus ❑ Bloating Tolerance (%) ❑ Flatulence Dose (g) ❑ Borboryghmi ❑ Burping ❑ Abdominal pain 25 100 ❑ Stomach cramps ❑ Headache 50 67 ❑ Nausea ❑ Vomiting ❑ Loose stools 75 64 GI symptoms were correlated with increase in breath H2 responses 100 29

Even at a single bolus of 100g, there was no adverse Chan CS et al., 2020 article under review event requiring medical intervention

Sangeetha Shyam NSM 2020 40 Body weight management

Sangeetha Shyam NSM 2020 41 Effects of isomaltulose on body weight loss and substrate oxidation Body Weight Changes Body Fat Changes

Sucrose Sucrose

Palatinose™ Palatinose™

• Low-glycemic compared to high-glycemic diets have been shown to improve metabolic status and enhance fat oxidation Sucrose iAUC for RQ • Randomized, double-blind, controlled intervention study Palatinose™ • Effects of an energy-reduced diet containing isomaltulose vs. sucrose • More pronounced weight loss with isomaltulose, significant reduction in fat mass, higher decrease in energy intake, lower postprandial RQ

Sangeetha Shyam NSM 2020 42 Protocol

Design: double-blinded, randomized, cross- over study (n=20)

• 9 am – breakfast 250-mL drink and 140 g of cookies containing in a total of 50 g of Palatinose™ or glc/suc. • 11 am- exercise at moderate intensity for 30 min. • 12 noon- standardized lunch with 250-mL drink with 10% Palatinose™ or glc/suc, mini pizzas, and an apple Sangeetha Shyam NSM 2020 43 Regulation and Health Claims relating to Isomaltulose

Sangeetha Shyam NSM 2020 44 Permitted use for IM

• is generally recognized as safe (GRAS) by the U.S. Food and Drug Administration • is approved as a novel food by the European Commission • has the status FOSHU (food for specific health use) in Japan • has been approved for use as a sugar substitute in food by FSANZ. • Its non cariogenic /tooth-friendly property recognized by USFDA and EFSA

45 Sangeetha Shyam NSM 2020 46 Malaysia

Schedules under Food Regulations 1985. Link: http://fsq.moh.gov.my/v6/xs/dl.php?filena me=19d4d09ee581861426099a3a4753b7

15.pdf Sangeetha Shyam NSM2020 Shyam Sangeetha Malaysia https://www.nsmconference.org.my/wp- content/uploads/download/2019/presentation/S2- 03%20Nurul%20Hidayati%20Health%20claims.pdf

Sangeetha Shyam NSM 2020 47 Permitted Functions Claims for IM According to Malaysia Guide to Nutrition Labelling and Claims

The conditions for Isomaltulose function claims are :

1. Isomaltulose is slowly hydrolysed to glucose Minimum and fructose and therefore it provides longer Amount Other Conditions lasting energy compared to sucrose Required 2. Isomaltulose is a slower release source of energy compared to sucrose The addition and claims for isomaltulose 3. Isomaltulose provides longer lasting energy 15g per is not permitted in infant formula serving compared to sucrose product. 4. Isomaltulose is a slowly hydrolysed to glucose and fructose compared with sucrose

Reference: Food Safety and Quality Division of Ministry of Health. (2010). Malaysia Guide to Nutrition Labelling and Claims. Sangeetha Shyam NSM 2020 48 Summary

Sangeetha Shyam NSM 2020 49 Physiological Properties of Isomaltulose

Type of key studies Demonstrated Physiological Properties

Mouth pH-Telemetry Does not promote dental caries Small Intestine

- Hydrolysis Enzyme kinetics (in vitro) Slow hydrolysis into glucose + fructose (4-5 times slower than sucrose)

- Absorption Ileostomy-study Virtually complete digestion and absorption within the small intestine

- Incretin Incretin (gastrointestinal GIP ↓; GLP-1 ↑: Digestion and absorption mostly in hormones) distal part of the small intestine Large Intestine Gastrointestinal Tolerance No distress even at high levels

Metabolism Blood glucose response Slow increase, low glycaemic response Glucose (energy) delivery over a prolonged period of time Insulin response Low insulin response

Glycaemic Index (GI) GI= 32

Respiratory Quotient Promotes fat burning

Body Composition Loss of body fat and body weight/ Prevention of weight gain Sangeetha Shyam NSM 2020 50 Improved endurance Non-cariogenic

Slower hydrolysis Improved cognition

Summary Isomaltulose, its properties and potential health benefits

Sangeetha Shyam NSM 2020 51 Acknowledgements Prof PM Barling (Rt) (IMU)

• IMU Internal Grants Ms Chan CS • Collaborators Dr Tan Seok Shin (IMU) • IMU Students • Beneo GmBH Ms Ong JW

Dr Megan Chong (IMU)

References available on request Ms Lee JP [email protected] Dr. Amutha Ramadas (MUM) Ms Sylvia Ho

Dr Chang SK (Chinese Acad. of Sciences) Ms Chang CY

Ms Ng SQ AP Dr Verna Lee (IMU) 52 Sangeetha Shyam NSM 2020 Isomaltulose (Palatinose™): Recent Thank You! evidence for health benefits

#StaySafe Sangeetha Shyam M.Sc. PhD #StayHealthy Senior Lecturer, Division of Nutrition and Dietetics Fellow, Centre for Translational Research, Institute for Research, Development & Innovation (IRDI) International Medical University, Malaysia [email protected]

CENTRE FOR TRANFROMATIVE CTNH NUTRITION AND HEALTH Sangeetha Shyam Sangeetha Shyam NSM 2020 53