Low Glycemic Index Research Articles

Reduced risk of gastrointestinal bleeding associated with eupatilin in aspirin plus acid suppressant users: nationwide population-based study.

Mucoprotective agents, such as eupatilin, are often prescribed to prevent gastrointestinal (GI) bleeding in addition to an acid suppressant despite the absence of a large-scale study. We evaluated the additional effect of eupatilin on the prevention of GI bleeding in both the upper and lower GI tract in concomitant aspirin and acid suppressant users using the nationwide database of national claims data from the Korean National Health Insurance Service (NHIS). An aspirin cohort was constructed using the NHIS claims data from 2013 to 2020. Patients who manifested with hematemesis, melena, or hematochezia were considered to have GI bleeding. A Cox proportional hazards regression model was used to determine the risk factors for GI bleeding associated with the concomitant use of GI drugs and other covariates among aspirin users. Overall, a total of 432,208 aspirin users were included. The concurrent use of an acid suppressant and eupatilin (hazard ratio [HR] = 0.85, p = 0.016, vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding. Moreover, a more than 3-month duration (HR = 0.88, p = 0.030) of acid suppressant and eupatilin prescription (vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding. Eupatilin administration for ≥ 3 months showed additional preventive effect on GI bleeding in concomitant aspirin and acid suppressant users. Thus, cotreatment with eupatilin with a duration of 3 months or longer is recommended for reducing GI bleeding among aspirin plus acid suppressant users.

Genetic and enzymatic characterization of Amy13E from Cellvibrio japonicus reclassifies it as a cyclodextrinase also capable of α-diglucoside degradation.

Cyclodextrinases are carbohydrate-active enzymes involved in the linearization of circular amylose oligosaccharides. Primarily thought to function as part of starch metabolism, there have been previous reports of bacterial cyclodextrinases also having additional enzymatic activities on linear malto-oligosaccharides. This substrate class also includes environmentally rare α-diglucosides such as kojibiose (α-1,2), nigerose (α-1,3), and isomaltose (α-1,6), all of which have valuable properties as prebiotics or low-glycemic index sweeteners. Previous genome sequencing of three Cellvibrio japonicus strains adapted to utilize these α-diglucosides identified multiple, but uncharacterized, mutations in each strain. One of the mutations identified was in the amy13E gene, which was annotated to encode a neopullulanase. In this report, we functionally characterized this gene and determined that it in fact encodes a cyclodextrinase with additional activities on α-diglucosides. Deletion analysis of amy13E found that this gene was essential for kojibiose and isomaltose metabolism in C. japonicus. Interestingly, a Δamy13E mutant was not deficient for cyclodextrin or pullulan utilization in C. japonicus; however, heterologous expression of the gene in E. coli was sufficient for cyclodextrin-dependent growth. Biochemical analyses found that CjAmy13E cleaved multiple substrates but preferred cyclodextrins and maltose, but had no activity on pullulan. Our characterization of the CjAmy13E cyclodextrinase is useful for refining functional enzyme predictions in related bacteria and for engineering enzymes for biotechnology or biomedical applications.IMPORTANCEUnderstanding the bacterial metabolism of cyclodextrins and rare α-diglucosides is increasingly important, as these sugars are becoming prevalent in the foods, supplements, and medicines humans consume that subsequently feed the human gut microbiome. Our analysis of a cyclomaltodextrinase with an expanded substrate range is significant because it broadens the potential applications of the GH13 family of carbohydrate active enzymes (CAZymes) in biotechnology and biomedicine. Specifically, this study provides a workflow for the discovery and characterization of novel activities in bacteria that possess a high number of CAZymes that otherwise would be missed due to complications with functional redundancy. Furthermore, this study provides a model from which predictions can be made why certain bacteria in crowded niches are able to robustly utilize rare carbon sources, possibly to gain a competitive growth advantage.

Characteristics and feeding intolerance in critically ill adult patients receiving peptide-based enteral nutrition: A retrospective cross-sectional study

Patients who experience gastrointestinal (GI) intolerance and hyperglycemia (or glucose intolerance) may not achieve appropriate caloric requirements and experience poor outcomes. The aim was to examine patient characteristics, disease severity, and enteral nutrition (EN) formula use in relation to feeding intolerance and healthcare resource utilization. A retrospective, cross-sectional design using real-world data from PINC AI™ Healthcare Database, 2015-2019 was used. Critically ill hospitalized adults who required ≥3 days of 100% whey peptide-based EN, other peptide-based diets, or intact-protein standard and diabetic EN formulas were included. Primary outcomes were enteral feeding intolerance, including GI intolerance and hyperglycemia. Pairwise comparisons of other peptide-based and standard intact-protein groups with 100% whey-peptide were completed. Associations between EN group with GI intolerance and hyperglycemia, respectively, were evaluated via multivariable logistic regressions. Across 67 US hospitals, 19,679 inpatients (3242,100% whey-peptide, 3121 other peptide-based, and 13,316 standard intact-protein) were included. The 100% whey-peptide group had higher severity of illness and frequencies of comorbidities compared with other peptide-based and standard intact-protein groups. Hospital length of stay, intensive care unit stay, and 30-day readmission were similar across peptide-based cohorts. After controlling for demographic, visit, and severity characteristics, odds of GI intolerance were 18% higher for the other peptide-based group and 15% higher for the standard intact-protein group compared with the 100% whey-peptide group (each P<0.03). In secondary analysis, odds of hyperglycemia were 81% higher for the other peptide-based group compared with the subgroup of very high-protein/low carbohydrate 100% whey-peptide (P<0.001). Lower GI intolerance and greater glycemic control were associated with the use of 100% whey-peptide formulas relative to other formulas. Appropriate and optimal delivery of EN using specialized peptide-based formulas is a strategy to minimize feeding intolerance and benefit critically ill patients.

The effects of glycemic index on prostate cancer progression in a xenograft mouse model.

Previously, we found low-carbohydrate diets slowed prostate cancer (PC) growth and increased survival vs. a Western diet in mice, by inhibiting the insulin/IGF-1 axis. Thus, we tested whether modifying carbohydrate quality to lower glycemic index (GI) without changing quantity results in similar benefits as with reduced quantity. Male SCID mice injected with LAPC-4 cells were single-housed and randomized when their tumors reached 200 mm3 on average to a LoGI (48% carbohydrate kcal, from Hylon-VII) or HiGI Western diet (48% carbohydrate kcal, from sucrose). Body weight and tumor volume were measured weekly. Body composition was assessed 35 days after randomization. Blood glucose and serum insulin, IGF-1 and IGFBP3 were measured at study end when tumor volumes reached 800 mm3. We analyzed gene expression of mice tumors by RNA-sequencing and human tumors using the Prostate Cancer Transcriptome Atlas. There were no significant differences in tumor volume (P > 0.05), tumor proliferation (P = 0.29), and overall survival (P = 0.15) between groups. At 35 days after randomization, the LoGI group had 30% lower body fat (P = 0.007) despite similar body weight (P = 0.58). At sacrifice, LoGI mice had smaller livers (P < 0.001) and lower glucose (P = 0.15), insulin (P = 0.11), IGF-1 (P = 0.07) and IGF-1:IGFBP3 ratio (P = 0.05), and higher IGFBP3 (P = 0.09) vs. HiGI, although none of these metabolic differences reached statistical significance. We observed differential gene expression and pathway enrichment in mice tumors by diet. The most upregulated and downregulated gene in the LoGI group showed expression patterns more closely resembling expression in human benign prostate tissue vs. PC. In this single mouse xenograft model, consuming a low GI diet did not delay PC growth or survival vs. a high GI diet despite suggestions of decreased activation of the insulin/IGF-1 pathway. These data suggest that improving carbohydrate quality alone while consuming a high carbohydrate diet may not effectively slow PC growth.

The Health Effects of Low Glycemic Index and Low Glycemic Load Interventions on Prediabetes and Type 2 Diabetes Mellitus: A Literature Review of RCTs.

Diets with a low glycemic index (GI) and a low glycemic load (GL) can improve glycemic control, blood lipids, blood pressure and BMI in prediabetes and type 2 diabetes (T2DM), but evidence regarding other aspects of cardiometabolic health is limited. We searched the literature for RCTs published from 2013 to 2023 and reviewed the evidence on low-GI/GL diets and their effects on different aspects of health in prediabetes and T2DM, aiming to build a report on all relevant outcomes included in the studies. We included 14 RCTs with 1055 participants, who were mostly middle-aged individuals with T2DM. Interventions were mostly low GI and lasted 1-36 months. Low-GI/GL foods and diets showed benefits in terms of short-term glycemic control, weight and adiposity. Longer-term trials would be necessary to determine whether these benefits persist over time and/or lead to lower CVD risk and mortality. Effects on lipid profile were inconsistent. Some studies also reported positive effects of low-GI/GL interventions on blood pressure, inflammatory biomarkers, renal function and gut microbiota composition. Future trials should focus on some of these novel outcome measures, which may provide important insights into the metabolic effects of low-GI diets on individuals with diabetes.

A Review on Biological and Nutritional Value of Kiwi Fruit

Kiwifruit, scientifically known as Actinidia deliciosa, stands out as a nutritional powerhouse among fruits, belonging to the family Actinidiaceae. Renowned for its exceptional nutrient density, the kiwi offers a remarkable blend of health-enhancing compounds that contribute to its unique status in the realm of fruits. What distinguishes kiwifruit is its unparalleled concentration of vitamin C, surpassing even citrus fruits. A single medium-sized kiwi contains more than the recommended daily intake of this crucial antioxidant, known for bolstering the immune system, aiding collagen synthesis, and promoting skin health. Furthermore, the kiwifruit boasts an abundance of dietary fiber, which aids digestion and helps regulate blood sugar levels. Its notable potassium content supports heart health by regulating blood pressure, while other essential minerals like magnesium and copper contribute to various bodily functions. What sets kiwifruit apart is its rich array of phytochemicals and antioxidants, such as flavonoids and carotenoids, which combat oxidative stress, reduce inflammation, and potentially lower the risk of chronic diseases like heart disease and certain cancers. Interestingly, kiwifruit contains actinidain, an enzyme that aids in protein digestion, making it particularly beneficial for individuals seeking improved digestive health. Moreover, its low glycemic index makes it a favorable choice for those managing blood sugar levels. The unique combination of nutrients, antioxidants, and digestive enzymes in kiwifruit not only distinguishes it as a delicious and refreshing addition to the daily diet but also positions it as a standout contender among fruits in promoting overall health and well-being.

High-beta-glucan and low-glycemic index functional bulgur produced from high-beta-glucan barley

A high β-glucan hull-less barley (cv. Chifaa) was used in bulgur production and its technological and nutritional properties were compared with bulgurs of another hull-less barley and durum wheat. Although Chifaa bulgur had longer cooking time (9.5 min) which is expected to have an increasing effect on total organic matter (TOM), it had lower TOM (1.31 g/100 g) than the durum bulgur. The phenolics of barleys were significantly higher than those of Kiziltan wheat. The amounts of total phenolic contents decreased after bulgur production. While glycemic index (GI) of durum bulgur was high, GI of barley bulgurs were medium probably due to their higher β-glucan contents. The GI of Chifaa (56.25) is very close to the limit value of low GI foods (56). The limit to bear the health claim is 3 g of β-glucans/serving. The results indicated that this can be provided per serving of high β-glucan barley bulgur.

Modifying rheological properties of psyllium by gamma irradiation enables development of low glycaemic index food with a predicted gastrointestinal tolerance

Gel forming dietary fibre like psyllium (PS) is effective in slowing down rate of digestion as well as absorption of glucose thereby reducing the postprandial glucose level and hence is used to develop functional foods for diabetic patients. The fortification level is however limited which otherwise elicit unwanted rheological response and poor sensorial quality in final product. In the present study this limitation was overcome by improving the functionality of the fibre by gamma radiation processing of the polysaccharides. We assessed the changes in rheological properties of radiation processed PS (RPPS) at different doses which enabled us to optimise the irradiation dose and levels of fortification of the RPPS in wheat flour for preparation of Indian unleavened bread (chapati). We observed that PS processed at a dose of 25 kGy could be incorporated to a level as high as 14 % in wheat flour yielding a sensorially better product compared to unfortified wheat flour. Further, the most striking effect observed for RPPS fortified chapati was reduction in the release of glucose upon subjecting to simulated gastrointestinal digestion. Finally, clinical and in vitro fermentation studies also confirmed a low GI value and high gastrointestinal tolerance of RPPS fortified chapati.

Analisis kandungan energi dan zat gizi makro pada formula enteral non susu berbasis kacang merah (Phaseolus vulgaris) untuk pasien diabetes mellitus tipe II

Background: Individuals at the age of 40 years face a 6-fold higher risk of developing Type II diabetes. Modification of enteral nutrition is necessary to address nutritional needs in patients with eating difficulties. Nutritional therapy for Type II diabetes patients should focus on controlling blood glucose levels by selecting foods with low glycemic index and high fiber content. Red beans, rich in protein, carbohydrates, and fiber, offer potential benefits in blood glucose control and as a dairy substitute for individuals with cow's milk allergies, making them a viable candidate for hospital-based enteral nutrition.Objectives: This study aims to determine the macronutrient content, flow test, food cost, and organoleptic test of non-dairy liquid food based on local ingredients. The study uses a completely randomized design.Methods: A complete randomized design was employed for this research. Product development activities were conducted in June 2022 at the Nutritional Kitchen of Jantung dan Pembuluh Darah Harapan Kita Hospital. Preparation of non-dairy liquid food using red beans as a base, proximate analysis of nutritional content, flow test through an NGT tube, food cost calculation, and organoleptic assessment involving ten respondents were carried out.Results: Proximate analysis of the formula yielded the following composition: water content 85,88%, ash 0,25%, protein 1,95%, fat 2,343%, carbohydrates 9,60%, and fiber 1,38%. The flow test for the red bean formula through the Fr 16 NGT tube demonstrated a rate of 50cc/31,90 seconds. The calculated food cost for one recipe of red bean formula was Rp. 8,734.00. Organoleptic evaluation results indicated that the majority of respondents favored the aroma (80%), taste (60%), color (100%), and texture (90%).Conclusion: The red bean formula meets the protein and carbohydrate requirements of the diabetes mellitus diet standards, while the fat and fiber content do not yet meet the diabetes mellitus diet standards.

Effect of plasma-activated water on the formation of endogenous wheat starch-lipid complexes during extrusion

The aim of this study was to investigate the effect of plasma-activated water (PAW) during extrusion on the formation of endogenous starch complexes with wheat starch (WS) as a model material. Using PAW during the extrusion process resulted in an increase in amylose content from 27.87 % to 30.07 %. Results from Fourier transform infrared spectroscopy, X-ray diffraction, and differential scanning calorimetry indicated that the PAW facilitated the formation of endogenous starch-lipid complexes during extrusion. PAW120 (distilled water treated by plasma for 120 s) showed a better promotion effect than PAW60 (distilled water treated by plasma for 60 s). EWS120 (WS extruded using PAW120) exhibited lower peak viscosity and swelling power, but higher solubility, particle size, and resistant starch content compared with EWS0 (WS extruded using distilled water) and EWS60 (WS extruded using PAW60). In a word, the acidic substances in PAW may lead to hydrolysis of starch and generate more amylose, thus improving the amount of endogenous starch-lipid complexes. The present study provides a novel extrusion method to obtain modified starch with higher RS content than common extrusion, which has potential application in the industrial production of functional foods with low glycemic index.

Panicle Architecture in Enhancing Grain Yield in Rice (Oryza sativa L.)

The architecture of the rice panicle is a crucial focus in breeding for both high yield and quality. It stands as a significant agronomic trait that influences the number of grains per panicle, playing a direct role in contributing to the overall yield of rice grains. Unravelling the genetic basis of panicle architecture is crucial for improving the grain yield in rice. In this study, the panicle architecture traits were meticulously dissected into five distinct components viz., number of primary rachis, number of secondary rachis, grain number on primary rachis, grain number on secondary rachis and total grain number. These components were systematically phenotyped in F2 and F3 population derived from a cross between DRR Dhan 48 and Maudamani. ‘DRR Dhan 48’ is a biofortified elite fine grain medium slender grain type cultivar with high zinc (22 ppm in polished rice) and low glycemic index (51.1). It has resistance to bacterial blight with the incorporation of xa5, xa13 and Xa21 in the background of Improved Samba Mahsuri. ‘Maudamani’ is a high yielding cultivar with high grain number and short bold grain type. Analysis of variance, histograms and boxplots revealed highly significant variation for the studied traits. Grain number in F2 population ranged from 29 to 333 grain with a mean of 162.72 whereas in F3, its varied from 49 to 368 with a mean of 184.17. Correlation analysis revealed significant correlation among the studied traits. The continuous variation observed in the population for panicle traits indicates that genetic control is governed by multiple minor loci. The presence of superior transgressive segregants highlights a complementary gene action influencing panicle architecture traits. The present investigation on panicle architecture offers scope for improving rice varieties and creating new germplasm resources and provides valuable information for further unravelling the genetic basis determining rice panicle architecture.

The Correlation Between Amylopectin Chain-Length and Glycemic Index Value of Carbohydrate Foods: A Review

The relationship between starch characteristics and the glycemic index (GI) of carbohydrate foods is interesting to study. One of the advances in analytical techniques in characterizing starch is measuring the degree of polymerization of amylopectin chains. Amylopectin is the main component of carbohydrate starch granules. There have been many publications regarding long chain fractions of amylopectin. The aim of this research is to analyze the relationship between amylopectin chain length and the glycemic index of carbohydrate foods. The method used was to tabulate various studies related to data on amylopectin chain length and the glycemic index of carbohydrate foods. Then a regression analysis was carried out between the degree of polymerization of the amylopectin chain and the Pearson correlation between the degree of polymerization and the glycemic index value. The research results showed that there was a strong correlation between the amylopectin chain length with degree of polymerization (DP) 6-12, 13-24, and 25-36 with the glycemic index value of carbohydrate foods. The degree of polymerization of the amylopectin chain is the number of glucose units that make up the chain. The resulting regression equation is y=0.3123x-0.6256 with a value of r2=0.991. The chain length of amylopectin influences starch properties, including the glycemic index. Starches with shorter amylopectin chains have a lower glycemic index, while starches with longer amylopectin chains have a higher glycemic index. The results of this research provide a new perspective for the field of food chemistry that the characteristics of amylopectin influence the glycemic index value of carbohydrate foods.

Inhibition mechanism of rice glutelin on extruded starch digestion: From the structural properties of starch and enzyme activity

To increase the anti-digestion ability of extruded rice starch (ERS), the influence of rice glutelin (RG) on digestive and structural characteristics of ERS were investigated. The resistant starch content increased from 4.49 % to 18.08 % as the RG content increased, while the digestion rate and digestion velocity constant were reduced by the incorporation of RG. Morphological observations showed that ERS was adhered and encapsulated by RG, and the specific area of starch granules were decreased after the addition of RG. The results of XRD and FTIR suggested that the long-range and short-range orders of ERS were improved due to the complexation with RG. The thickness of crystalline of ERS was increased while its amorphous region thickness was reduced by the supplementation with RG. The 1H NMR and 13C NMR data revealed that the branching degree and double helix content of ERS was increased by 46.24 % and 52.67 % when RG content reached to 12 %. Additionally, the addition of RG altered the molecular weight and chain length distribution of ERS. The α-amylase activity and glucoamylase activity was inhibited by RG. These results could provide a valuable basis for the application of RG in extruded rice starchy foods with lower glycemic index.

Lower GI bleed audit

Abstract Introduction In the UK, Lower GI Bleeding is common emergency presentation and accounts for 3% of emergency surgical referrals. The most common cause is Diverticular Bleeds. Other frequent causes are the benign anorectal conditions. 23% of patients admitted to Hospital with LGIB in the UK are discharged without diagnosis. Most LGIB resolves on its own but may require further interventions. Aim To describe current local practice of risk stratification with Shock Index and Oakland’s Score in comparison with existing national guidelines by the British Society of Gastroenterology (BSG). Method Retrospective Analysis of 36 patients who presented to the local A&amp;E with lower GI bleed between Sept 2021 – Nov 2021. Result Male:Female 18:18. Median age 56 years (3months – 95years). Haemorrhoids (9, 25%) accounted for most of the presentation. 1 patient (3%) had their shock index documented. 2 patients (6%) needed a CT angiogram. 16 patients (44%) were admitted under the EGS team. Out of these 16 patients, 7 (44%) needed inpatient endoscopy, while 3 (19%) required transfusion. Discussion There was a consistent finding of no documented shock index in the patients notes, likely because there is easy access to EWS that allow clinicians to interpret this in real time. The Oakland score was rarely used to determine if a patient could safely be discharged. Other specialties, endoscopy/gastroenterology or the emergency department, likely have different guidelines for the assessment of lower GI bleed. This could account for poor uptake, locally, of risk stratification as proposed by the BSG.

Determination of proximate composition, energy and glycemic index values of stiff porridge prepared from composite flours

Background : The glycemic index (GI) measures how fast or slow the blood sugar rises after the consumption of a food rich in carbohydrates. The prevalence of diabetes in Kenya is about 3% of adults. Among the regimens of type 2 diabetes mellitus (T2DM) is glycemic control using diet, although only a few diabetic persons (7%) practice it due to limited data on the GI of local foods such as stiff porridge (ugali) which is among the chief staple foods in Kenya. This study determined the proximate composition, energy and GI values of ugali from blends of cassava-millet, cassava-sorghum, cassava-millet-sorghum, whole maize-millet and maize-sorghum flour.&#x0D; Methods : Ugali was prepared in the ratio of 3:5 (w/v), flour to water. Proximate composition was determined using the Association of Official Analytical Chemists methods. Carbohydrate content was determined by difference (100-moisture+fat+protein+ash+fiber content). Energy values were determined using the Atwater method. The GI was determined based on Brouns' recommendation.&#x0D; Results : The moisture content, fat and protein content of maize-millet ugali was the highest at 67.5%, 5.7% and 9% respectively. Cassava ugali had the lowest fat (0.7%) and protein (1.2%). Cassava-millet ugali had the highest ash (3.1%) and fiber (11.5%) content whereas cassava-sorghum-millet ugali had the lowest ash (1.7%) and fiber (1.3%). Cassava ugali had the highest carbohydrate content (92.9%) whereas maize-sorghum ugali was the lowest (76.9%). Maize-millet ugali had the highest energy content (422.1 Kcal) while cassava ugali was the least (394.2 Kcal). Ugali from cassava-sorghum, cassava-millet, maize-millet, maize-sorghum and cassava-sorghum-millet flour recorded a GI of 46, 45, 47, 45 and 57 respectively.&#x0D; Conclusion : Cassava-sorghum, cassava-millet, maize- millet and maize-sorghum ugali have low GI and thus can be recommended in the management and prevention of T2DM.

DETERMINATION OF GLYCEMIC INDEX (GI) OF VARIOUS FROZEN DESSERT TYPES WITH ADDED SOLUBLE DIETARY FIBER IN VIETNAM

Objective: To determine the glycemic index (GI) of various frozen dessert types with added soluble dietary fiber. Methods: The study followed the method of determining the GI of food according to the National Standard TCVN10036: 2013. 11 subjects were served with 125 ml glucose 20% on three occasions, with 4 different frozen dessert types with added soluble dietary fiber (ice cream, gelato, vegan gelato and sorbet) providing an equal amount of available carbohydrate of 25 g, in every two days. Blood glucose levels are monitored continuously with Freestyle Libre 2. Result: The glycemic index of vegan gelato chocolate was 30±5,7; GI of coconut sorbet is 18±5; GI of black sesame ice cream is 14±3,5 and GI of mango gelato is 30±6,0; all of which are categorized as low GI food. Conclusions: This is useful both to health professionals advising individuals on their diets, and to improving the quality of life of diabetic people, people at risk of diabetes or in need of blood glucose control.

Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement.

This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.

Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review.

The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.

Characterization of Mixed Rice: Nutritional Value, Physicochemical Properties, Organoleptic, and Glycemic Index

The nutritional and physicochemical value of rice could be enhanced by mixing or combining white and brown rice with various beans. Besides nutritional and functional aspects, it is also crucial to consider organoleptic properties. Therefore, this study aimed to characterize nutritional value (proximate), physicochemical properties, organoleptic and Glycemic Index (GI) of mixed rice. A total of 10 mixed rice formulas, ranging from F1 to F10, and consisting of white rice, brown rice, black rice, aromatic rice, sticky rice, black-eyed peas and mung beans, were determined. These samples were analyzed for proximate, total phenolic compounds, pasting properties, and organoleptic tests (hedonic and ranking tests). Furthermore, 3 selected formulas based on the previous test were then evaluated for GI, and Glycemic Load (GL) was calculated. The results showed that adding black-eyed peas and mung beans (F9 and F10) increased the protein content of mixed rice while higher proportion of black or brown rice (F3 and F4) enhanced the fat content. The amylose content was decreased due to higher proportion of sticky rice (F6 and F8). Based on the hedonic test, the F1-F6 formula had a favorable rating. The ranking results indicated that F9 was better than F10, while F1 and F6 was the best among F1 to F4, as well as F5 to F8. Considering the constituent materials, F1, F6, F9 and commercial low GI rice were selected and tested for GI, and the test results showed 48.2, 54.7, 78.0, and 60.3, respectively. As a result, F1 and F6 have the potential to be developed as mixed rice because they have good nutritional value, physicochemical and organoleptic properties, as well as low GI.

The Effect of Meal Glycemic Index and Meal Frequency on Glycemic Control and Variability in Female Nurses Working Night Shifts: A Two-Arm Randomized Cross-Over Trial

BackgroundNight shift workers are exposed to circadian disruption, which contributes to impaired glucose tolerance. Although fasting during the night shift improves glucose homeostasis, adhering to this dietary strategy may be challenging. ObjectivesThis study evaluated the effect of fasting compared with the consumption of meals with different combinations of glycemic index (GI, low or high) and frequency (1 or 3 times) during the night shift on continuous glucose monitoring metrics. MethodsA 2-arm randomized cross-over trial was conducted on female nurses working night shifts. In each of those arms, the participants were either provided with no meal (fasted), low GI, or high-GI meal during the night shift with a meal frequency according to which arm they were randomly allocated to, either 1-MEAL or 3-MEAL. Outcome variables were glycemic control and variability (GC and GV) metrics during the night shift (21:30–7:00), in the morning after the night shift (07:00–13:00), and in the 24 h period (18:00–18:00). ResultsCompared to no meal, the consumption of 1 high-GI meal increased all GV metrics not only during the night shifts but also in the morning, for instance, as observed in the coefficient of variation (β = 0.03 mmol/L; 95% CI: 0.01, 0.05), and GV percentage (β = 4.13; 95% CI: 2.07, 6.18). The consumption of 1 or 3 low GI meals did not raise GC or GV metrics except for continuous overall net glycemic action during the night shifts after consuming 3 low GI meals. When controlling for GI, night shift meal frequency did not affect any metrics in any timeframe. ConclusionsHigh meal GI but not higher meal frequency during the night shift increased GC and GV in female night shift workers. Results for 1 low-GI meal during the night shift were not different from a glucose profile after no meal.This trial was registered at trialsearch.who.int as NL8715.