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18.06.2016
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As one possible way to tackle obesity, a great interest has been stimulated in understanding the relationship between different types of dietary carbohydrate and appetite regulation, body weight and body composition. IntroductionThe rising prevalence of obesity, not only in adults but also in children and adolescents, is one of the most important public health problems in developed and developing countries [1].
Classification of CarbohydratesThe classification of dietary carbohydrates is based on the degree of polymerization (DP) and type of linkage (alpha or beta).
Specific attention will be paid to fructose, either being part of sucrose or high fructose corn syrup (HFCS), because there is (inconsistent) evidence that the consumption of fructose may be part of the cause of the obesity epidemic [14]. Glycemic Index and Glycemic LoadThe glycemic response to ingestion of a carbohydrate depends on the amount, rate of digestion, absorption and metabolism of the ingested carbohydrate. 72 Hour Diet Pill100% Ephedra Free and All-Natural Take 3 capsules 30 minutes before breakfast and lunch. The present article reviews the conclusions from recent reviews and meta-analyses on the effects of different starches and sugars on body weight management and metabolic disturbances, and provides an update of the most recent studies on this topic. Even though more and more people are becoming aware of the magnitude of the problem and the serious consequences associated to the development of obesity [2,3], it continues to grow.
This divides carbohydrates into three main groups, sugars (DP 1–2), oligosaccharides (short-chain carbohydrates) (DP 3–9) and polysaccharides (DP > or = 10) [12].
The term “starches” in this review addresses only the starch polysaccharides (amylose, amylopectin and modified starches). To describe the physiological effect of a food’s carbohydrate content on postprandial blood glucose concentration, the glycemic index of foods (GI) has been introduced [19]. P57 HoodiaA‚ CactusA‚ slimming capsule, which is designed for people who are overweight all over the world.
So it works fast and has dual effect, help you suppress appetite and quickly burns calories from first day. From the literature reviewed in this paper, potential beneficial effects of intake of starchy foods, especially those containing slowly-digestible and resistant starches, and potential detrimental effects of high intakes of fructose become apparent. Lifestyle changes together with genetic predisposition play an important role in the obesity problem [4].
The glycemic index of a food quantifies the area under the glycemic response curve (AUC) of a test food, compared to the same amount (usually 50 g of available carbohydrate) of a reference food, most often glucose or white bread [19]. This supports the intake of whole grains, legumes and vegetables, which contain more appropriate sources of carbohydrates associated with reduced risk of cardiovascular and other chronic diseases, rather than foods rich in sugars, especially in the form of sugar-sweetened beverages. Large numbers of new products and technological advances have led to a lifestyle characterized by the high availability of energy-dense foods and a high level of physical inactivity [5]. Generally, foods with a GI ? 55 are classified as low GI, whereas foods with a GI ? 70 are classified as high GI foods.
Although, weight loss is usually not so difficult to attain, especially for people with a strong motivation, the real problem remains in the maintenance of the achieved body weight, since during this period individuals have to continue with habits learned during the intervention in an environment that promotes just the opposite.
Low-GI foods are those that elicit a low postprandial glucose response which, in turn, induces a lower rise in circulating insulin and related gastrointestinal hormones, such as incretins, gastric inhibitory polypeptide (GIP), and glucagon-like peptide-1 (GLP-1).
The lower but sustained insulin secretion reduces free fatty acids levels improving cellular glucose metabolism [20].


Nevertheless, lifestyle change in diet and physical activity are still regarded as the primary strategy for weight loss, weight management, as well as for improving metabolic alterations [6]. Consequently, blood glucose levels remain closer to baseline despite continued glucose absorption from the small intestine. Dietary recommendations have not changed much over the last forty years and the most commonly recommended macronutrient distribution is still 50–60% for carbohydrates, 30% for fat and 10–20% for proteins. In contrast, high-GI foods increase insulin secretion leading to a postprandial hyperinsulinemia, which has a lipogenic effect.
Energy restriction and adherence to the energy-restricted diet appear to be more important than the macronutrient distribution of such a diet in causing weight loss [7]. Because the glycemic response to food ingestion not only depends on the GI but also on the total amount of carbohydrates ingested, the concept of glycemic load (GL) has been introduced.
However, increasing evidence shows that changes in protein, carbohydrate and lipid proportions could be a key factor to improve body weight regulation after a weight loss program [8]. Thus, macronutrient distribution, together with food properties (energy density, satiety value, taste, metabolic response elicited, etc.), are all nutritional factors conditioning energy balance.
Therefore, the GL provides a summary measure of the relative glycemic impact of a typical serving of the food. Therefore, they have the potential to contribute to better maintenance of body weight and better metabolic regulation.Scientific evidence shows that high-fat diets have a high energy density and low satiety value, which facilitate passive overconsumption [9]. Foods with a GL ? 10 have been classified as low GL, and those with a value ? 20 as high GL [21]. On the other hand, high-protein diets could be an alternative, since proteins have a high satiety effect that may favour energy intake control [10]. Indeed, high carbohydrate and specifically high sugar consumption are often considered particularly harmful with respect to energy balance disturbances due to their specific properties related to postprandial metabolism, the balance between nutrient storage and oxidation, the effects on hunger and satiety, and hence on caloric intake and energy balance (Figure 1). The present article reviews the conclusions from the latest reviews and meta-analyses, if available, on the effects of different starches and sugars on parameters of body weight management and metabolic disturbances and provides an update of the most recent studies on this topic. Short-Term Effects on Energy Intake and SatietyAlthough the mechanisms are not totally clear, a primary mechanism by which starches are thought to regulate satiety and food intake is through their effect on blood glucose. Most nutritional intervention studies use GI to compare the effects after carbohydrate consumption. Two recent reviews concluded that consumption of high-GI foods increase hunger and decrease satiety levels in short-term human intervention studies [23,24]. Postprandial plasma glucose, insulin and appetite (hunger, fullness, and desire to eat) were measured over 4 h.
The results indicated that consumption of uncooked WM, a slowly digestible starch, leads to lower postprandial glucose and insulin concentrations without an effect on appetite compared to the consumption of rapidly digested MS [25]. The meals (50 g carbohydrates) consisted of refined wheat bread (RWB), wholegrain wheat bread (WWB), refined wheat pasta (RWP) and wholegrain wheat pasta (WWP) and were served after an overnight fast.
Appetite ratings and blood glucose were assessed for 180 min after which an ad libitum lunch meal was served and EI measured. Results showed that wholemeal breads increased satiety measures compared to their refined counterparts; however no differences were observed in the subsequent EI [26]. Forty-seven healthy subjects consumed a breakfast and, two hours later, a snack containing barley, wheat, or refined rice, followed 90 min later by an ad libitum lunch. The intake of a whole grain high-fiber barley, whole grain wheat, or refined rice breakfast and snack did not decrease energy intake at lunch [27].
A randomized crossover intervention study by Aston and coworkers [28], consisting of two consecutive 12-week periods to assess the effects of a reduced glycemic index diet on appetite, did not find differences in satiety, nor in energy intake from a midmorning snack 2 h and an ad libitum lunch 4 h after a high or low GI breakfast differing in GI by 12 units at the end of the intervention period in 19 subjects [28].
Resistant starch, a fermentable carbohydrate, has been proposed to have properties similar to dietary fiber [29] and therefore could also affect satiety and exert a beneficial role in weight regulation.
Some in vivo studies in humans have shown that meals high in resistant starch resulted in lower glucose and insulin responses and induced greater satiety for 2–6 h [30]. Fibers were baked in muffins and were chosen in order to represent soluble, insoluble, and RS characteristics.
Twenty healthy subjects (7 men and 13 women) tested the five different muffins (identical macronutrient content) in five different visits where the satiety level was evaluated postprandially for 3 h.
Results showed that subjects were less hungry after eating RS than after eating the low fiber muffin and RS stimulated less desire for food intake than the low fiber treatment. Twenty young healthy adult males consumed either RS or placebo divided equally between two mixed meals (breakfast and lunch) on two separate occasions. Effects on appetite were assessed using an ad libitum test meal 3 h after the lunch was consumed and from 24-h diet diaries for the whole 24 h of the study day. There was a significantly lower energy intake following the RS supplement compared to the placebo supplement at both the ad libitum test meal and over the 24 h [31]. Effect on Energy ExpenditureThe more prolonged energy availability after SDS consumption may also lead to a more extended increase in energy expenditure. However, there are few studies regarding the effects of starch consumption on energy expenditure.
The 24 h energy expenditure was significantly increased after 14 days on the sucrose diet compared with the other diets.
However, this increase was explained by the increased intake of energy and fructose on this diet [32]. A review by Dulloo and co-workers of energy balance studies in animal models suggested that a tendency for sugar-fed animals to have higher metabolizable energy intakes which induced increases in metabolic rate [33]. The reviewed studies indicated that differences in energy balance between sugar and starch are small and that any increase in thermogenesis that occurred in some of the groups fed sugar-rich diets was in response to the higher energy intake rather than due to a lower efficiency of utilization of sucrose per se [33]. Metabolic rate was measured by indirect calorimetry in the fasting state and postprandially for 5 h.


Results showed that the replacement of digestible starch by RS in a single meal lowered DIT, however, the ingestion of lactulose resulted in a substantial rise in DIT which was related to its fermentation [34]. A more recent crossover study by Keogh and coworkers [35] examined the effect of barley flour, high in soluble fiber and amylose, incorporated into breakfast and lunch compared with otherwise identical meals containing white wheat flour on the thermic effect of food. Energy expenditure was measured before and after the test lunch, showing no differences in the thermic effect of the foods.
Effect on Body WeightMuch interest has been focused on the relationship between glycemic index and body-weight loss or body weight regulation.
Acute meal studies seem to point to an effect of glycaemic index on appetite and hence on body weight regulation, however, the results of longer-term studies of weight loss are not as clear. Indeed, recent conclusions from different reviews suggest that there is no evidence that an ad libitum diet with a low-GI causes more weight loss than a diet with a high-GI when total carbohydrate intake is not different [36].
Likewise, it is also confirmed that there is insufficient evidence that an exchange of sugar for non-sugar carbohydrates in the context of a reduced-fat ad libitum diet or energy-restricted diet result in greater weight reduction [37]. On the other hand, an overall systematic review suggested an overall positive effect of low glycemic or low glycemic load diets on weight loss [38]. Both the higher protein content and the lower GI improved completion rate and weight loss maintenance [39]. Animal studies observed that a diet high in RS reduced adipose tissue with no changes in body weight, suggesting a central role of short-chain fatty acids [40]. A recent study showed that an amylose-rich, high RS, ad libitum diet resulted in both less body weight and less body fat gain than a high amylopectin, low RS, diet [41]. Mice fed the high GI diet showed a rapid-onset (from week 5) marked increase in body fat mass compared to mice in the other three starch groups [42]. In combination, the findings described above suggest that RS and SDS are attractive dietary targets for weight gain prevention and weight loss diets.
Starch Intake and LipidsAlthough there is strong evidence that the amount and type of fat in the diet can have strong effects on metabolism, the types of carbohydrates influencing metabolic parameters is also of great interest. In this sense, slowly digestible starch seem to be related to some benefits on lipid metabolism, while rapidly digestible starch or high glycemic index carbohydrates are associated with a higher prevalence of the metabolic syndrome [63]. Low glycemic index foods may alter serum lipids by prolonging absorption time, spreading the nutrient load, and modifying the endocrine and metabolite response to food [64].
It has been also suggested that low glycemic index foods or carbohydrates that are not so resistant to absorption, but rather are slowly absorbed, possess some of the features of dietary fiber in providing a substrate for colonic bacterial fermentation [64]. In the small intestine, they form lente or sustained release carbohydrates which have been related to improvements in blood lipid profiles in hyperlipidemic individuals [65].
Resistant starch may lower plasma lipid levels, especially plasma cholesterol, by delaying gastric emptying, thereby limiting hepatic lipogenesis owing to less glucose as substrate and less insulin as an activator.
It may also interfere with digestive enzymes decreasing substrates availability for hepatic lipid synthesis or it may interfere with micelle formation, resulting in less cholesterol absorption. Likewise, RS may inhibit hepatic cholesterol biosynthesis due to the inhibitory effects of propionate (derived from colonic fermentation of RS) on HMG-CoA reductase activity [66].In a randomized crossover study of matched diets differing only in GI and glycemic load (GL) by Shikany et al. In larger cohort studies, low glycemic index foods or low glycemic index diets have been associated with higher HDL-cholesterol levels and reduced incidence of diabetes and cardiovascular disease [67]. Likewise, in an older, metabolically controlled, study of 20 type 2 diabetic men and women fed high and low glycemic index diets for two 24-day periods by Jarvi et al.
RS seems to decrease plasma cholesterol and triglyceride concentrations [30], but little is still known about the impact of RS on lipid metabolism.
Animal studies indicate that a high RS diet leads to a lower weight of fat depots and can reduce serum total cholesterol triacylgycerol concentrations [70,71]. In humans, five weeks of RS feeding lowered fasting cholesterol and triglyceride concentrations [72]. Breath samples were collected hourly following the meal and gluteal fat biopsies were also obtained at 0 and 24 h.
Resistant starch, regardless of dose, had no effect on carbohydrate metabolism, free fatty acids or triacylglycerol concentration, nor on meal fat storage. However, data from indirect calorimetry showed that an addition of 5.4% RS to the diet significantly increased postprandial fat oxidation by 23%. Thus, the authors suggested that replacement of total dietary carbohydrate with RS increases postprandial lipid oxidation and may decrease fat accumulation in the long term [30].The intervention study by Robertson et al. Eight non-diabetic subjects and four subjects with diet-controlled type 2 diabetes participated in a randomized cross-over study by Culling et al. Volunteers had to follow three isoenergetic diets, each for three days: high-fat (50% energy from fat), high-starch and high-sugar (70% energy from carbohydrate each). Analysis of the variables showed that fasting triacylglycerol (TG) concentrations were greatest following the high-sugar diet, and lowest following the high-fat diet. Postprandial metabolism of two starches with different rates of hydrolysis in vitro was studied by Ells et al. One contained predominantly rapidly digestible starch and the other contained predominantly slowly digestible starch. Ten healthy female volunteers ate each test starch as part of a moderate fat test meal (containing 75 g test starch and 21 g fat) in a double-blind randomized crossover design. The metabolic response to each starch was measured after an overnight fast, in an acute 6 h study, before and after 14 days of daily consumption of 75 g test starch. Significantly more rapid and greater changes were found in glucose metabolism, as well as on non-esterified fatty acids, after consumption of the rapidly digestible starch.



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