Glycemic Index And Glycemic Load Of Selected Chinese .

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Online Submissions: mdoi:10.3748/wjg.v16.i12.1512World J Gastroenterol 2010 March 28; 16(12): 1512-1517ISSN 1007-9327 (print) 2010 Baishideng. All rights reserved.BRIEF ARTICLEGlycemic index and glycemic load of selected Chinesetraditional foodsYa-Jun Chen, Feng-Hua Sun, Stephen Heung-sang Wong, Ya-Jun HuangBun, Egg Tart, Green Bean Dessert, Chinese HerbalJelly, Fried Rice Vermicelli in Singapore-style, and SpringRoll), 10 of them belonged to moderate GI foods (BakedBarbecued Pork Puff, Fried Fritter, “Mai-Lai” Cake, “Pineapple” Bun, Fried Rice Noodles with Sliced Beef, Barbecue Pork Bun, Moon Cakes, Glutinous Rice Ball, InstantSweet Milky Bun, and Salted Meat Rice Dumpling), theothers belonged to high GI foods (Fried Rice in Yangzhou-Style, Sticky Rice Wrapped in Lotus Leaf, SteamedGlutinous Rice Roll, Jam and Peanut Butter Toast, PlainSteamed Vermicelli Roll, Red Bean Dessert, and FrozenSweet Milky Bun).Ya-Jun Chen, Feng-Hua Sun, Stephen Heung-sang Wong,Ya-Jun Huang, Department of Sports Science and PhysicalEducation, The Chinese University of Hong Kong, Hong Kong,ChinaAuthor contributions: Chen YJ and Sun FH performed themajority of experiments; Wong SH designed the study andwrote the manuscript; Huang YJ provided analytical tools andwas also involved in editing the manuscript.Supported by General Research Fund from Research GrantsCommittee of The Government of the Hong Kong SAR, China,No. 4440178Correspondence to: Stephen Heung-sang Wong, Professor,Department of Sports Science and Physical Education, TheChinese University of Hong Kong, Shatin, Hong Kong,China. hsswong@cuhk.edu.hkTelephone: 852-26096095 Fax: 852-26035781Received: October 30, 2009 Revised: November 24, 2009Accepted: December 1, 2009Published online: March 28, 2010CONCLUSION: The GI and GL values for these Chinesetraditional foods will provide some valuable informationto both researchers and public on their food preference. 2010 Baishideng. All rights reserved.Key words: Glycemic index; Glycemic load; Chinesetraditional foodsAbstractAIM: To determine the glycemic index (GI) and glycemic load (GL) values of Chinese traditional foods inHong Kong.Peer reviewer: Shogo Kikuchi, MD, PhD, Professor, Depart ment of Public Health, Aichi Medical University School ofMedicine, 21 Karimata, Yazako, Nagakute-cho, Aichi-gun,Aichi 480-1195, JapanMETHODS: Fifteen healthy subjects (8 males and 7females) volunteered to consume either glucose or oneof 23 test foods after 10-14 h overnight fast. The bloodglucose concentrations were analyzed immediatelybefore, 15, 30, 45, 60, 90 and 120 min after food consumption using capillary blood samples. The GI valueof each test food was calculated by expressing the incremental area under the blood glucose response curve(IAUC) value for the test food as a percentage of eachsubject’s average IAUC value for the glucose. The GLvalue of each test food was calculated as the GI valueof the food multiplied by the amount of the availablecarbohydrate in a usual portion size, divided by 100.Chen YJ, Sun FH, Wong SH, Huang YJ. Glycemic index andglycemic load of selected Chinese traditional foods. World JGastroenterol 2010; 16(12): 1512-1517 Available from: 512.htm ODUCTIONThe glycemic index (GI) was firstly introduced by Jenkinset al[1]. It was defined as the incremental area under theblood glucose response curve (IAUC) after a portion offood containing 50 g available carbohydrate expressed as apercentage of that after the same amount of carbohydrateRESULTS: Among all the 23 Chinese traditional foodstested, 6 of them belonged to low GI foods (Tuna FishWJG www.wjgnet.com1512March 28, 2010 Volume 16 Issue 12

Chen YJ et al . GI and GL of Chinese foodsfrom a reference food, usually glucose or white bread, taken by the same subject. The glycemic load (GL) was morerecently introduced to reflect overall glucose response[2,3],and it was calculated as the GI value of the food multiplied by the amount of the available carbohydrate in ausual portion size, divided by 100. GI and GL of foodshave been shown to related to some chronic diseases,such as diabetes[2,3], metabolic syndrome[4], cardiovasculardisease[5] and even some types of cancers[6]. Low GI andGL diets could contribute to a reduction in body mass inoverweight, obese adolescents[7], or coronary heart disease(CHD)[8] and have a small but clinically useful effect onmedium-term glycemic control in patients with diabetes[9].The relevance of dietary GI and GL is still debated[10]and the availability of a reliable table of GI is critical forcontinuing research and resolution of the controversy.The GI and GL values of over 2480 individual food itemswere listed in the more recent edition of the internationalGI and GL tables[10], among which there were only about50 Chinese foods. Chinese traditional foods, althoughsome styles are very popular and well-known worldwide,are very different from western foods with recipesfollowed strictly as laboratory instructions.In some studies investigating the effect of food intake on local people[11,12], there were no precise GI andGL values for many local Chinese foods. They had touse international GI tables to find similar foods or seekfor a “best estimate” from experts in this field. Thesestudies indicated that there might be some differencesbetween the estimated GI values and the real values.Furthermore, during recent years the GI and GL valuesof different local foods have been reported[13-15]. Therefore, it was worthwhile to determine the GI and GLvalues of Chinese traditional foods so as to advise localindividuals on their daily diets and provide tools to undertake related studies in this area. The purpose of thisstudy was to determine GI and GL values of some Chinese traditional foods in Hong Kong, which would bepreliminary information which may act as the basis forthe development of a GI and GL database for Chinesetraditional foods.required not to consume unusually large meals and havebalanced diets on the previous day. After 10-14 h overnight fast, the subjects were required to report to the labbetween 8 am and 10 am. On arrival, the subjects restedfor around 15 min and the baseline finger-prick capillarysamples were collected. Then the subjects consumedeither reference (50 g anhydrous glucose) or test foodscontaining 50 g of available carbohydrate, based on theinformation from the label of food or from the foodnutrition content table provided by the Center of FoodSafety, the Government of the Hong Kong Special Administrative Region[17]. Each subject was given 50 g anhydrous glucose 3 times and 25 g anhydrous glucose twiceas a reference. Among all the selected foods, 2 foods,which contained both 50 g and 25 g available carbohydrate, were tested twice to compare whether the different portion sizes gave the same result. Only one foodcontained 25 g available carbohydrate for size limitation.The intervals between two tests were at least twodays. Foods for testing were randomized in blocks of4 foods[18]. A drink of 250 mL water was served withtest food in each test and all foods were required to beconsumed within 10 min. Further blood samples werecollected at 15, 30, 45, 60, 90, and 120 min after starting to eat. All the blood samples were analyzed with YSIglucose analyzer (YSI 1500, USA; YSI).The food items included Baked Barbecued Pork Puff(BBPP), Fried Rice in Yangzhou-style (FRYS), FriedFritter (FF), “Mai-Lai” Cake (MLC), Tuna Fish Bun(TFB), Sticky Rice Wrapped in Lotus Leaf (SRWLL),Steamed Glutinous Rice Roll (SGRR), “Pineapple” Bun(PAB), Jam and Peanut Butter Toast (JPBT), Fried RiceNoodles with Sliced Beef (FRNSB), Egg Tart (ET),Plain Steamed Vermicelli Roll (PSVR), Green BeanDessert (GBD), Barbecue Pork Bun (BPB), Red BeanDessert (RBD), Moon Cakes (MC), Glutinous Rice Ball(GRB), Chinese Herbal Jelly (CHJ), Instant Sweet MilkyBun (ISMB), Frozen Sweet Milky Bun (FSMB), FriedRice Vermicelli in Singapore-style (FRVSS), Salted MeatRice Dumpling (SMRD) and Spring Roll (SR). All foodswere prepared on the test morning or the day beforethe test; when necessary the foods were steamed by hotwater. Because of special cooking methods and habits,some Chinese traditional foods were actually mixedmeals. However, they were very popular in China and allof them were prepared by fixed methods. Therefore, theGI value of the same kind of food produced in differentplaces was expected to be similar. The detailed information of each food was listed in Table 1.MATERIALS AND METHODSParticipantsFifteen healthy adults (8 males and 7 females, mean SE: age, 25.4 1.2 years; BMI, 21.2 0.6 kg/m2) volunteered to participate in the study. All subjects reportedno history of diabetes and all female subjects were nonpregnant and non-lactating. The present study was approved by the University Clinical Research Ethical Committee and all subjects gave written informed consent.Statistical analysisThe individual GI value was calculated by expressing theIAUC for each test food as a percentage of each subject’saverage IAUC for the glucose. IAUC were calculatedignoring area beneath the fasting level[16,19]. The mean ofall the individual GI values for each test food calculatedfrom all subjects was the GI value for that food. GLvalues were calculated by multiplying GI values of afood by the carbohydrate content of the usual portionProceduresThe GI values of 23 Chinese traditional foods weredetermined by using the Food and Agriculture Organization (FAO) recommended methods[16]. All subjectswere required to refrain from alcohol consumption andvigorous physical activities 24 h before test. They wereWJG www.wjgnet.com1513March 28, 2010 Volume 16 Issue 12

Chen YJ et al . GI and GL of Chinese foodsTable 1 Portion size, macronutrient composition and preparation of the test foodsFood ItemsServing (g) Energy (kcal) Protein (g) Available CHO (g) Fat (g)Fiber (g)Sugar 1.530.6BPBRBD1192633092478.79.550.050.08. FRVS (50 g)FRVS (25 g)SMRD (50 .013.412.06.03.43.21.60.7SMRD (25 g)1001805.725.06.71.70.3SR (25 g)11438810.425.027.42.22.5Method of preparationHoixe Cake Shop, H.K.; InstantInstantOcean Empire International Ltd., H.K.;InstantInstantMaxim’s MX, H.K.; InstantMaxim’s MX, H.K.; InstantInstantHoixe Cake Shop, H.K.; InstantInstantInstantMaxim’s MX, H.K.; InstantInstantNISSIN brand, Nissin Foods Co., LTD.;InstantMaxim’s MX, H.K.; InstantNISSIN Brand, Nissin Foods Co., LTD.;InstantKee Wah Bakery Shop, H.K.; InstantLee Chun Brand, Lee Chun Food Ltd.,H.K.; BoiledGuang Jian Tang Brand, Kwong TaiAgency Co., Ltd.; InstantInstantAMOY Brand, Amoy Food Ltd., H.K.;Frozen, SteamedInstantInstantOcean Empire International Ltd., H.K.;InstantOcean Empire International Ltd., H.K.;InstantInstantBBPP: Baked barbecued pork puff; FRYS: Fried rice in Yangzhou-Style; FF: Fried fritter; MLC: “Mai-Lai” Cake; TFB: Tuna fish bun; SRWLL: Sticky ricewrapped in lotus leaf; SGRR: Steamed glutinous rice roll; PAB: “Pineapple” Bun; JPBT: Jam and peanut butter toast; FRNSB: Fried rice noodles with slicedbeef; ET: Egg tart; PSVR: Plain steamed vermicelli roll; GBD: Green bean dessert; BPB: Barbecue pork bun; RBD: Red bean dessert; MC: Moon cakes; GRB:Glutinous rice ball; CHJ: Chinese herbal jelly; ISMB: Instant sweet milky bun; FSMB: Frozen sweet milky bun; FRVS: Fried rice vermicelli in singapore-style;SMRD: Salted meat rice dumpling; SR: Spring roll.sizes of this food, divided by 100. The usual portionsizes of different foods were taken from manufacturers’information or from mean values of testing foods.The differences in IAUC and GI values betweenmale and female subjects were compared with independent samples t-test. The differences in IAUC and GI values between FRVS (50 g) and FRVS (25 g), SMRD (50 g)and SMRD (25 g) were compared with paired t-test. Thedifferences in the mean IAUC value and within-subjectcoefficient of variation for repeated references (CVref)between Reference (50 g) and Reference (25 g) were alsocompared with paired t-test. The results were analyzedusing the SPSS for Windows version 12.0 (SPSS, Chicago, IL) software package. The values were presented asmean SE and the significance level was set at P 0.05.The mean IAUC value of all the test foods calculatedfrom male subjects (IAUCmale) was lower than that fromfemale subjects (IAUCfemale) (91.10 3.09 mmol·min·L-1vs 118.60 4.05 mmol·min·L-1, P 0.001), however therewere no differences between the mean GI value of all thetest foods determined from data of male subjects (GImale)and that from female subjects (GIfemale) (64 2 vs 67 2, P 0.224). When grouped by each test food, there wereno differences either in the mean IAUC or GI value between male and female subjects.The mean IAUC value calculated from the dataelicited by 50 g anhydrous glucose (IAUCref50) washigher than that from the data elicited by 25 g anhydrousglucose (IAUCref25) (167.54 14.54 mmol·min·L-1 vs108.40 8.86 mmol·min·L-1, P 0.001). However, therewere no differences in the mean within-subject CVref(CVref 100% SD/mean) (28.00% 3.55% vs21.56% 3.74%, P 0.163) for the 14 subjects between50 g and 25 g anhydrous glucose.The mean IAUC value calculated from the food containing 50 g carbohydrate was higher than that elicited bythe same food containing 25 g carbohydrate (FRVS: 89.24RESULTSAll subjects completed the experiment except one subjectwho did not consume the foods containing 25 g availablecarbohydrate for individual reasons. The determined GIand GL values of test foods were shown in Table 2.WJG www.wjgnet.com1514March 28, 2010 Volume 16 Issue 12

Chen YJ et al . GI and GL of Chinese foodsTable 2 Determined GI and GL values of test foods (mean SE)Food itemsIAUC-1(mmol·min·L )Foods containing 50 g available carbohydrateBBPP92.14 10.75FRYS133.70 13.85FF110.83 16.18MLC95.63 12.43TFB79.91 9.78SRWLL137.55 10.81SGRR143.03 12.96PAB106.39 11.69JPBT116.51 11.36FRNSB107.17 12.36ET74.70 7.82PSVR153.15 18.87GBD90.24 11.54BPB112.11 9.28RBD122.20 11.45MC90.96 9.65GRB98.76 13.04CHJ84.19 7.29ISMB115.44 12.42FSMB114.33 11.52FRVS (50 g)87.41 9.64SMRD (50 g)116.32 14.96Foods containing 25 g carbohydrateFRVS (25 g)64.26 11.09SMRD (25 g)85.99 9.15SR (25 g)53.05 7.2795% CI-1(mmol·min·L )GI95% CIAvailable carbohydrate(g per serving)GL(per 66.73-108.1084.23-148.4155 880 669 961 846 483 589 865 872 866 745 390 854 669 975 856 761 1047 367 572 854 669 30-88.2266.24-105.7537.34-68.7558 981 750 539-7865-9739-6087.5139.620.55111310 10.17 mmol·min·L-1 vs 64.26 11.09 mmol·min·L-1,SMRD: 117.23 16.04 mmol·min·L -1 vs 85.99 9.15 mmol·min·L-1, P 0.05), however there were no differences between the two GI values (FRVS: 55 6 vs 58 9, P 0.745; SMRD: 70 9 vs 81 7, P 0.319).religion, and festival. For the famous classes divided bydistrict, there are styles of Guangdong, Beijing, Shanghai, Sichuan, North-West, etc. These all above mentionedstyles are well-known worldwide. Quite different fromWestern cooking whose recipes are followed strictly likelaboratory instructions, Chinese cooking allows for acreative and stylistic touch to it and it is also one important reason why Chinese foods are always absent in theinternational GI and GL tables. In this study, by using arecommended standard method, GI and GL values of23 Chinese traditional foods were determined.Although GI was a classification of the blood glucoseraising potential of carbohydrate foods, many other factors such as food form, particle size, cooking methods,presence of other macronutrients and starch structure,might affect the GI of foods[14,21]. Fat and protein addedto carbohydrate foods have been suggested to reduce thepostprandial glycemic responses which occurred by different mechanisms, such as delaying gastric emptying[22];however, most of the studies found that the amount ofprotein or fat in commonly consumed foods did not affectthe glycemic responses[23,24]. It was also found in the present study that no relation existed between the amounts offats or protein in foods and their GI values.Though there was a recommended standard protocolfor the determination of GI[16,25], there were still somemethodological factors which will influence the accuracyin GI determination. According to an inter-laboratorystudy[21], the GI values of foods were more precisely determined using capillary than venous blood sampling. Arecent study[26] also found that the CV of the IAUC val-DISCUSSIONThe availability of reliable GI values of different foodsis critical for not only researchers but also commonpeople. The University of Sydney has determined theglycemic and insulin responses to more than 1750 foodsand shown that the GI is a reproducible measure of daylong postprandial glycemia[9]. In the more recent editionof international tables of GI and GL[10], over 2480 GIvalues of individual food items were listed. Because ofthe close relationship between the food GI and humanhealth, labeling of GI on foods has been proposed oris occurring in Australia, South Africa, Sweden, UnitedKingdom, and Ger many, with several commerciallaboratories measuring the GI of foods[20].During recent years, the GI values of some localfoods have been measured in different countries prior totheir utilization in research and clinical settings amongthe local population[13-15]. Since there was little information about GI values of Chinese traditional foods inHong Kong in the literature, and that had limited therelated research in this area[11,12], it was worthwhile tosetup a GI and GL database for Chinese traditionalfoods. However, there are so many traditional and special Chinese foods, according to folk culture, district,WJG www.wjgnet.com1515March 28, 2010 Volume 16 Issue 12

Chen YJ et al . GI and GL of Chinese foodsues was significantly lower for capillary than for venousblood. So in the present study, capillary blood sampleswere selected for determining the GI values of foods.One study suggested that the composition and characteristics of the evening meal might influence glucosetolerance the next morning[27]. However, no differencewas found in another study on within-individual variationinfluenced by subject preparation between controlled trials and uncontrolled trials[28]. Furthermore, a more recentreport suggested that simply advising subjects to avoidcertain types of foods was almost as good and might bemore cost-effective[20]. Thus, in the present study all thesubjects were just advised to have a balanced dinner eachnight before the test. Furthermore, all subjects in thepresent study were also required to refrain from alcoholconsumption and vigorous physical activities 24 h beforetest, foods for testing were randomized in blocks of 4foods, and the intervals between two tests were at leasttwo days[16,18].The FAO recommended the reference food testshould be repeated at least three times in each subject[16].A recent study suggested that no evidence to justifydoing 3 tests rather than 2 tests was found because thedifference was small and not significant[20]. In our study,the reference of 50 g anhydrous glucose was tested threetimes to determine the GI and GL values for 20 of the23 foods.In the present study, though the mean IAUC valuescalculated from female subjects were higher than thatcalculated from male subjects, there were no differencesin the mean GI values between them, which is consistentwith a previous study[20].One study showed that GI value was negatively related to the within-individual CVref, and low within-subjectvariation (CVref 30%) was required for accuracy inGI determination[20]. Another study also found that mostof the variation of GI values was due to within-subjectvariation, and in normal subjects the mean CVref wasabout 25.0%[22]. In the present study, both CVref of 50 gglucose and that of 25 g glucose were less than 30%, andthere were no differences between the two values. Thisresult might indicate that the determined GI values wereaccurate in some extent.No differences were found between the two GIvalues determined for the same food containing different amounts of available carbohydrate (50 g and 25 g)in this study. It might suggest that when the portion ofone food containing 50 g available carbohydrate wastoo large for subjects to consume, it was appropriate toselect the portion of the food containing 25 g availablecarbohydrate to determine the GI values. The result wasconsistent with a previous study which showed that therelative glycemic responses to the foods containing different levels of available carbohydrate intake were thesame, at least between 25 g and 100 g[29].In conclusion, the GI and GL values for these Chinese traditional foods in the present study provide somevaluable information both to researchers and to common individuals on their food preference and they areWJG www.wjgnet.comalso preliminary references on the setup of a GI and GLdatabase for Chinese traditional foods later.ACKNOWLEDGMENTSThe authors would like to acknowledge Ms. Jiao Jiao forher assistance and thank all the subjects for participatingin this study.COMMENTSCOMMENTSBackgroundThe glycemic index (GI) and glycemic load (GL) are closely related to somechronic diseases, however, little was known about the GI and GL values of Chinese traditional foods even in the latest international GI and GL tables.Research frontiersPrevious studies have shown that GI is a reproducible measure of day-longpostprandial glycemia and over 2480 GI values of individual food items werelisted in the more recent edition of international tables of GI and GL. The relationship between food GI and human health has been largely investigated andis still one of the research hotspots in this research field. During recent years,the GI values of some local foods have been measured in different countriesbecause most of the published GI data are based on analysis carried out inwestern countries, while this has limited the application of GI tables to localresearchers or common people.Innovations and breakthroughsThe present study determined the GI and GL values of some selected Chinesetraditional foods which are very popular in Hong Kong. The results will providesome preliminary information which may act as the basis for the developmentof a GI and GL database for Chinese traditional foods.ApplicationsThe availability of reliable GI values of different foods is critical for not only researchers but also common people. Therefore, the results of this study will provide some valuable information both to researchers and to common individualson their food preference.TerminologyGI: GI was defined as the incremental area under the blood glucose responsecurve after a portion of food containing 50 g available carbohydrate expressedas a percentage of that after the same amount of carbohydrate from a referencefood, usually glucose or white bread, taken by the same subject. The differencesin the food GI values are mainly related to differences in the rate at which the carbohydrates are digested and absorbed. GL: GL was calculated as the GI value ofthe food multiplied by the amount of the available carbohydrate in a usual portionsize, divided by 100.Peer reviewBlood glucose response to intake of traditional Chinese foods was investigatedin this study. The aim of the study is interesting and the study design is good.REFERENCES123451516Jenkins DJ, Wolever TM, Taylor RH, Barker H, FieldenH, Baldwin JM, Bowling AC, Newman HC, Jenkins AL,Goff DV. Glycemic index of foods: a physiological basis forcarbohydrate exchange. Am J Clin Nutr 1981; 34: 362-366Salmerón J, Manson JE, Stampfer MJ, Colditz GA, WingAL, Willett WC. Dietary fiber, glycemic load, and risk ofnon-insulin-dependent diabetes mellitus in women. JAMA1997; 277: 472-477Salmerón J, Ascherio A, Rimm EB, Colditz GA, SpiegelmanD, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC. Dietaryfiber, glycemic load, and risk of NIDDM in men. DiabetesCare 1997; 20: 545-550McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW,Jacques PF. Carbohydrate nutrition, insulin resistance, andthe prevalence of the metabolic syndrome in the FraminghamOffspring Cohort. Diabetes Care 2004; 27: 538-546Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, SampsonMarch 28, 2010 Volume 16 Issue 12

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Glycemic index and glycemic load of selected Chinese traditional foods Ya-Jun Chen, Feng-Hua Sun, Stephen Heung-sang Wong, Ya-Jun Huang . were listed in the more recent edition of the international GI and GL tables[10], among which there were only ab

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