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Studies on the Glycemic Index of Raisins and on the Intestinal

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Studies on the Glycemic Index of Raisins and on the Intestinal ABSTRACT The glycemic index (GI) measures the magnitude of the postprandial increase in blood glucose caused by a test food compared with a reference food/beverage, such as a glucose solution or white bread, containing the same amount of carbohydrate. The insulin index is determined in a similar manner of GI calculation, except that blood insulin AUC is used in place of blood glucose AUC. Low GI and insulin index foods are desirable because foods with low GI and insulin index result in gradual increase in postprandial glycemia/insulinemia and lower blood glucose/insulin fluctuations compared with foods with high GI and insulin index. This attenuated glycemic and insulinemic responses of low GI and insulin index foods is associated with reduced risks of obesity, diabetes mellitus, and chronic diseases. Fructose has low glycemic and insulin index, and a high fructose-containing food, such as raisins, would be expected to have low glycemic and insulin index values. In addition to its low glycemic and insulin index, small, or “catalytic” amounts of fructose (e.g., 5- 10 g) lower the glycemic response to other carbohydrates. However, prefeeding of fructose is necessary to achieve this effect due to the slow intestinal absorption of fructose. The overall objective of this dissertation was to investigate the current interest of carbohydrate metabolism. The first goal was to determine a difference in carbohydrate iii metabolism in populations with different metabolic status. The second objective was to determine fructose absorption in the presence of erythritol in vivo and in vitro. The GI and insulin index of raisins were determined and compared in healthy sedentary young adults, endurance athletes, and people with impaired glucose tolerance. The GI of raisins was low (GI ≤55) in the healthy sedentary people (49.4 ± 7.4) and people with pre-diabetes (49.6 ± 4.8) and was moderate (GI 55-69) in the athletes (62.3 ± 10.5), but there were no differences among the subject groups (P = 0.437). The insulin index of raisins was not significantly different among the groups. Raisins are a low to moderate GI food, with a correspondingly low insulin index. In the second study, the effect of the simultaneous ingestion of an equimolar amount of erythritol and fructose on fructose absorption was determined in healthy subjects. Breath hydrogen production with a beverage of equimolar mixture of 50 g fructose and 33.3 g erythritol (FE) was 207% higher than that of a beverage of 50 g fructose (F) (P <0.05). Serum fructose levels were 20% lower in the FE compared with F (P < 0.05). However, serum erythritol level in FE was increased to 727.7 ± 22.2 mmol/min/L, which it was negligible in F (P < 0.05). The rise in breath hydrogen levels in FE versus F indicated greater carbohydrate malabsorption. Because of the considerable rise in serum erythritol and the decrease in serum fructose in the FE versus F groups, it appeared that erythritol was absorbed at the expense of fructose. The third study investigated the effect of erythritol on intestinal fructose absorption using Caco-2 cells. The inhibitory effect of erythritol on fructose absorption that we observed in healthy humans was reproducible in a Caco-2 cell model at high iii doses of fructose and erythritol. Erythritol inhibited fructose absorption in a dose- dependent fashion (P < 0.05). In conclusion, raisins, a high fructose-containing food, has a low GI and insulin index. A mixture of an equimolar amount of fructose and erythritol also had low glycemic and insulinemic responses. However, increased gastrointestinal distress after intake of the mixture of fructose and erythritol may limit the usage of those carbohydrates. Further research should focus on the interaction of sugar alcohol s and other food components which may impact on carbohydrate absorption and gastrointestinal distress. iv Dedicated to my Lord, Jesus Christ v ACKNOWLEDGMENTS It has been a quite journey with joy and tears, and this dissertation would not have been possible without support, encouragement, and prayer of these people. I specially appreciate Dr. Steve Hertzler. His invaluable support, intellectual idea, guidance, and expertise have facilitated my growth as a scientist. Especially, I thank him for his patience and deep understanding of the most difficult period of my study. I am grateful to Dr. Anne Smith for her advice, guidance, and kindness. Her invaluable support and encouragement was crucial for the completion of my study. I thank Dr. Mark Failla for his help, discussion, advice, and expertise with cell culture model. I also wish to thank my committee member, Dr. Martha Belury and Dr. Gail Kaye, for great suggestions and advice. I appreciate Dr. Sonhee Park for her advice, encouragement, friendship, and prayer all through my difficult days. I thank Bryan Wolf, Jennifer Williams, and Courtney Colombo for the opportunity to work with them and learn from them. I would like to thank Michelle Asp, Rubina Khan, and other study assistants for their hard work. I thank all the subjects who participated in my two clinical trials for their endurance, cooperation, and kindness. I wish to thank to Tianyao Huo and Sagar Thakkar for their suggestions and technical support regarding cell culture. I acknowledge the support and love from my family during my study. I thank concerns, encouragements, and prayer of my friends. The research was supported by Abbott Laboratories, Ross Products Division and California Raisins Marketing Board. vi VITA November 15, 1973……………………….…………………….Born-Seoul, South Korea 1996……….………………………..………...………………….B.S. Food and Nutrition Ewha Womans University 1998……....…………………………………………...………….M.S. Food and Nutrition Ewha Womans University 1999-2006……………………………………........................Graduate Research Assistant The Ohio State University 2005……………………………………………………….....Graduate Teaching Assistant The Ohio State University 2006-Present………………………………………………………………...Dietetic Intern The Ohio State University PUBLICATIONS 1. Hertzler S, Kim Y, Khan R, Asp M, Savaiano D. (2006) Intestinal disaccharidase depletions, In: Shils ME, Shike M, Ross AC, Cabellero B, Cousins RJ, eds. Modern Nutrition in Health and Disease. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins;189-1200. 2. Hertzler SR and Kim Y. Glycemic and insulinemic responses to energy bars of differing macronutrient composition in healthy adults. Med Sci Monit 2003; 9(2):CR84- 90. 3. Chang, N., Kim, K., and Kim, Y. Folate nutritional status of women of childbearing age. Nutritonal Sciences 1999; 2(1):51-55 vii 4. Kim, Y., Kim, K., and Chang, N. Dietary folate intake of Korean women of childbearing age. Korean J. Nutriton 1999; 32(5):585-591 5. Chang, N., Kim, Y., and Kim, K. Effects of dietary folate concentrations on plasma and tissue folate concentrations in rats. Korean J. Nutrition 1998; 31(3):243-252. 6. Chang, N., Kim, K., Kim, Y., Seo JB, and Kwon O. Effects of alcohol administration and dietary folate on plasma homocysteine and liver histopathology. Korean J. Nutrition 1998; 31(7):1121-1129 FIELDS OF STUDY Major Field: Nutrition viii TABLE OF CONTENTS Page Abstract…………………………………………………………………………………..ii Dedication……………………………………………………………………………….v Acknowledgments……………………………………………………………………….vi Vita……………………………………………………………………………………...vii List of Tables………………………………………………………………………...…xii List of Figures………………………………………………………………………….xiii Chapters: 1. Introduction………………………………………………………………………....1 2. Literature Review…………………………………………………………………...8 Glycemic index……………………………………………………………………..8 Methodological aspects of glycemic index testing protocols…………………..9 Food factors influencing glycemic index……………………………………..12 Subject characteristics that influence glycemic index………………………...15 Insulin index………………………………………………………………….18 Catalytic doses of fructose, glucokinase, and postprandial glycemia……………..19 Fructose absorption……………………………………………………………….23 Clinical assessment of fructose absorption: breath hydrogen testing…………25 Fructose absorption capacity in humans………………………………………27 Dietary factors affecting fructose absorption………………………………...28 Glucose…………………………………………………………………...28 Amino acids………………………………………………………………31 Fructose, sorbitol, and carbohydrate malabsorption……………………...31 Facilitation of fructose absorption by glucose: proposed mechanisms……………32 Disaccharidase-related transport system……………………………………...32 Solvent drag mediated paracellular pathway…………………………………34 Apical GLUT2………………………………………………………………..36 ix Erythritol-Introduction…………………………………..………………………..40 Erythritol absorption…………………………………...………………………….42 Erythritol distribution……………………………………………………………...44 Metabolism of malabsorbed erythritol by the colonic microflora…………………45 Effect of erythritol on glycemic and insulinemia………………………………….47 Laxative effect of erythritol………………………………………………………..47 References………………...……………………………………………………….48 3. Determination of the glycemic and insulin index values of raisins in three populations………………………………………………………………….……..61 Introduction……………………………………………………………………..…61 Methods……………………………………………………………………..……..63 Results………………………………………………………………………..…....66 Discussion…………………………………………………………………..……..68 References…………………………………………………………………….…...73 4. Inhibition of fructose absorption by erythritol in healthy adults……..…..……….81 Introduction………………………………………………………………………..81 Methods…………………………………………………………………………....83 Results……………………………………………………………………………..87 Discussion…………………………………………………………………………90 References…………………………………………………………………………94 5. Erythritol inhibits transepithelial transport of fructose
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