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OBJECTIVE:--Cereal fiber intake is linked to reduced risk of type 2 diabetes in epidemiological observations. The pathogenic background of this phenomenon is unknown. Based on recent findings, we hypothesized that intake of purified insoluble oat fiber may improve whole-body insulin sensitivity. RESEARCH DESIGN AND METHODS--A randomized, controlled, single-blind, cross-over study was performed, and 17 overweight or obese subjects with normal glucose metabolism were analyzed. After consumption of nine macronutrient-matched portions of fiber-enriched bread (white bread enriched with 31.2 g insoluble fiber/day) or control (white bread) over a time period of 72 h, whole-body insulin sensitivity was assessed by euglycemic-hyperinsulinemic clamp. Energy intake was individually adjusted by providing standardized liquid meals. Hydrogen breath tests were performed to control for dietary adherence. RESULTS:--When analyzing the entire cohort, whole-body glucose disposal was improved after fiber consumption (M value 6.56 ± 0.32 vs. 6.07 ± 0.27 mg · min⁻¹ · kg⁻¹; P = 0.043). Thirteen subjects had increased hydrogen breath test concentrations after fiber consumption, indicating probable dietary adherence. Restricting analysis to these subjects, improvements in M value (6.85 ± 0.34 vs. 6.06 ± 0.32 mg · min⁻¹ · kg⁻¹; P = 0.003) and insulin sensitivity, expressed as M/I ratio (M value divided by mean serum insulin at steady state: 3.73 ± 0.23 vs. 3.21 ± 0.27; P = 0.02), after fiber consumption were more pronounced. Plasma lipids, serum magnesium, ghrelin, and adiponectin concentrations, as well as substrate utilization and body weight, were not significantly changed by fiber intake (P > 0.15). CONCLUSIONS:--Increased insoluble dietary fiber intake for 3 days significantly improved whole-body insulin sensitivity. These data suggest a potential mechanism linking cereal fiber intake and reduced risk of type 2 diabetes.

Objective: To examine whether inflammatory bowel disease (IBD) is associated with ischemic/inflammatory conditions during pregnancy. Study Design: A retrospective cohort study using the 2000 to 2012 Kaiser Permanente Southern California maternally-linked medical records ( n =395 781). The two major subtypes of IBD, ulcerative colitis and Crohn’s diseases were studied. Adjusted odds ratios (ORs) were used to quantify the associations. Result: A pregnancy complicated by IBD was associated with increased incidence of small-for-gestational age birth (OR=1.46, 95% confidence interval (CI)=1.14 to 1.88), spontaneous preterm birth (OR=1.32, 95% CI=1.00 to 1.76) and preterm premature rupture of membranes (OR=1.95, 95% CI=1.26 to 3.02). Further stratifying by IBD subtypes, only ulcerative colitis was significantly associated with increased incidence of ischemic placental disease, spontaneous preterm birth and preterm premature rupture of membranes. Conclusion: The findings underscore the potential impact of maternal IBD on adverse perinatal outcomes. Clinicians should be aware that the association between IBD and adverse perinatal outcome varies by IBD subtypes.

Objective: Arabinoxylan (AX) consumption is associated with metabolic improvement during diabetes and with modulation of ghrelin, an orexigenic gut hormone. The effect of AX consumption on ghrelin secretion in disturbed metabolic states is unknown. Therefore, we investigated the postprandial responses to AX consumption of serum glucose, insulin and triglycerides and plasma total and acylated ghrelin in subjects with impaired glucose tolerance (IGT). Design: Randomized, single-blind, controlled, crossover intervention trial. Subjects: Seven female and four male adults with IGT, aged 55.5 years, and body mass index (BMI) 30.1 kg/m2. Intervention: Subjects received either placebo or 15 g AX supplement for 6 weeks with a 6-week washout period in-between. Main outcome measurements: Postprandial responses of serum glucose, insulin and triglycerides, and plasma total and acylated ghrelin after a liquid meal challenge test (LMCT) measured at the beginning and at the end of the dietary intervention at -20, -5, 0, 15, 30, 45, 60, 90, 120, 150, 180, 210 and 240 min. Results: After LMCT, AX consumption resulted in lower postprandial responses in serum glucose, insulin and triglycerides (P<0.05). Compared to placebo, total plasma ghrelin was also reduced by 42+/-8 pg/ml (P<0.001) after AX consumption with no difference in plasma acylated ghrelin. Conclusion: AX consumption improved postprandial metabolic responses after an LMCT in subjects with IGT and reduced total ghrelin response. However, acylated ghrelin responses were unchanged, suggesting that the acylated ghrelin-mediated orexigenic regulation is not improved as only total plasma ghrelin decreased.

Coronary heart disease prevention in the primary care setting, where time is extremely limited, requires valid instruments that efficiently screen for unhealthy lifestyle habits. Identification of the individuals who would most benefit from dietary intervention is particularly important in this context. We used dietary intake data derived from a full-length food frequency questionnaire to simulate responses to our previously validated short dietary quality screener. We determined the prospective association of the resulting diet-quality index (DQI) with changes in anthropometric and cardiometabolic risk variables in 2181 men and women in a 10-year follow-up. Multiple linear regression analyses revealed that a higher DQI score at baseline related directly ( P =0.002) to high-density lipoprotein cholesterol (HDL-C) and inversely ( P <0.016) to waist circumference (WC), triacylglycerides (TG), the TG to HDL-C ratio and the total cholesterol to HDL-C ratio at follow-up. A low DQI score is predictive for an increase in WC and the development of an unfavourable cardiometabolic profile.

Background: Sensory factors are important determinants of appetite and food choices but little is known about the relationship between body weight and sensory capabilities. Objective: To investigate the relationship between measured body weights, misreporting of body weight and sensory capabilities. Design: In a cross-sectional sensory study, body weight was assessed by measured and self-reported body weight in healthy men ( n = 130) and women ( n = 181). Sensory capabilities were assessed as odour detection and identification, and detection for salty, sweet, sour and bitter taste. Results: Odour detection, odour identification and taste perception scores were lower in subjects with a BMI >= 28 kg/m(2) than in subjects with a BMI < 28 kg/m(2) in the age group < 65 years whereas in subjects >= 65 years scores were higher in subjects with a BMI >= 28 kg/m(2) than in subjects with a BMI < 28 kg/m(2) ( BMI*age group: P = 0.015, 0.053 and 0.015, respectively). Independent of age, scores were highest in under reporters of body weight ( P = 0.008, 0.001 and 0.017). Differences in taste perception could be attributed to sour ( P 0.015) and bitter ( P = 0.026) perception, but not to salty or sweet perception. Conclusion: Relationship between sensory capabilities and body mass is age dependent. Compared to overweight subjects, the sensory capabilities of normal weight individuals appear to be higher ( < 65 years) and lower ( >= 65 years). At any age, however, subjects who under reported their body weight show higher sensory capabilities.

Insoluble dietary fibre intake is associated, by unknown mechanisms, with a reduced risk of type 2 diabetes. We investigated whether a short-term dietary intervention with purified insoluble fibres influences acute and delayed responses of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1. Fourteen healthy women with NGT were studied for 300 min on six to eight occasions. Subjects consumed three matched portions of control (C) or fibre-enriched bread (10.4-10.6 g/portion; wheat fibre [WF], oat fibre [OF], and, in a substudy [n=9], resistant starch [RS]) followed by control (C-C, C-WF, C-OF, C-RS) on subsequent days. Fibre enrichment accelerated the early insulin response (fibrextime interaction p=0.026 for WF, p<0.001 for OF, p=0.126 for RS; time of maximal concentration [T(max)], C 57.9+/-5.9, WF 49.3+/-2.5 [p=0.086], OF 46.1+/-2.9 [p=0.026], RS 46.7+/-5.8 min [p=0.029]). It was also associated with an earlier postprandial GIP response after OF (T(max), C 83.6+/-7.2, WF 70.7+/-6.0 [p=0.054], OF 64.3+/-6.9 [p=0.022], RS 60.0+/-5.0 [p>0.15]). Increased fibre intake for 24 h was further associated with a reduced postprandial glucose response on the following day subsequent to ingestion of a control meal (AUC(C-C) 4,140+/-401, AUC(C-WF) 2,850+/-331 [p=0.007], AUC(C-OF) 2,830+/-277 [p=0.011]), with no difference in maximal concentration and T(max) of glucose responses. No differences in insulin responses were observed 24 h after the fibre-enriched diets compared with control (p>0.15). Colonic fermentation was increased only on study days C-OF (p=0.017) and C-RS (p=0.016). The consumption of highly purified insoluble dietary fibres accelerated the acute GIP and insulin response and was further associated with enhanced postprandial carbohydrate handling the following day upon ingestion of a control meal.

Weight gain and risk of type 2 diabetes are inversely associated with a high intake of insoluble cereal fibres. Because nutrient-induced changes of ‘satiety hormones’ from the gut may play a role in this process, we evaluated the effects of purified insoluble fibres on postprandial responses of plasma peptide YY (PYY), serum ghrelin and satiety as secondary outcome measures of a study investigating effects of cereal fibres on parameters of glucose metabolism. Fourteen healthy women were studied on six occasions in a randomized, single-blind, controlled crossover design. After 24 h run-in periods and 10 h overnight fasts, subjects ingested isoenergetic and macronutrient matched portions of control white bread or fibre-enriched bread (wheat-fibre or oat-fibre) at 08.15 hours. Gut hormones and hunger scores were measured for 300 min. Basal PYY and ghrelin concentrations were not different between the test meals (P>0·15). Postprandial responses of PYY and ghrelin were blunted after the intake of wheat-fibre (total area under the curve (AUC) PYY, 177·9 (sem 8·1) (pmol/l) min; P=0·016; ghrelin 51·0 (sem 2·5) (pmol/l) min; P=0·003), but not after oat-fibre (PYY 226·7 (sem 25·7) (pmol/l) min; P>0·15; ghrelin 46·2 (sem 1·6) (pmol/l) min; P=0·127), compared to control (PYY 247·5 (sem 25·6) (pmol/l) min; ghrelin 42·5 (sem 1·3) (pmol/l) min). Postprandial hunger scores were unaffected by the different test meals (P>0·15). Thus, oat- and wheat-fibre consumption result in different postprandial responses of PYY and ghrelin, but interestingly do not differ in satiety effects.

Dietary fibre consumption is associated with improved glucose homeostasis. In contrast, dietary polyphenols have been suggested to exert both beneficial and detrimental effects on glucose and insulin metabolism. Recently, we reported that a polyphenol-rich insoluble dietary fibre preparation from carob pulp (carob fibre) resulted in lower postprandial acylated ghrelin levels after a liquid meal challenge test compared with a control meal without supplementation. The effects may, however, differ when a different food matrix is used. Thus, we investigated the effects of carob fibre on glucose, insulin and ghrelin responses in healthy humans in combination with a glucose load. In a randomized single-blind cross-over study involving twenty healthy subjects (aged 22–62 years), plasma glucose, total and acylated ghrelin, and serum insulin were repeatedly assessed before and after the ingestion of 200 ml water with 50 g glucose and 0, 5, 10 or 20 g carob fibre over a period of 180 min. The intake of 5 and 10 g carob fibre increased the plasma glucose by 47 % and 64 % (P < 0·001), and serum insulin by 19·9 and 24·8 % (P < 0·001), compared with the control. Plasma acylated ghrelin concentrations did not change significantly after the consumption of carob-enriched glucose solution. Total ghrelin decreased only after 10 g carob fibre (P < 0·001) compared with control. In conclusion, we showed that polyphenol-rich carob fibre, administered within a water–glucose solution, increases postprandial glucose and insulin responses, suggesting a deterioration in glycaemic control.

Background/Objective: β-Carotene is often used as a marker for the amount of fruit and vegetables consumed, but little is known about plasma β-carotene concentrations in subjects whose habitual (long-term) diets are characterized by different amounts of foods of plant origin. We compared dietary β-carotene intake and plasma concentrations in women on habitual diets differing in the consumed amounts of foods of plant origin. Methods: A comparison of dietary β-carotene intakes and plasma β-carotene concentrations in women adhering to an average Western diet (n = 172), wholesome nutrition (following preventive recommendations) (n = 238) or a raw food diet (n = 104). Results: Dietary β-carotene intake was 5.5, 9.3, 14.7 mg/day for women adhering to an average Western diet, wholesome nutrition and raw food diet, respectively (p < 0.001). Corresponding multivariate adjusted plasma β-carotene concentrations were 1.07, 1.65, and 1.16 µmol/l, respectively (p < 0.001). Comparable dietary β-carotene intake resulted in lower multivariate adjusted plasma β-carotene in women adhering to a raw food diet and average Western diet compared to those on wholesome nutrition (p < 0.001 for all intake groups up to 20 mg/day). The amount of fruit and vegetable intake did not predict plasma β-carotene levels in women consuming a raw food diet. Conclusions: Plasma β-carotene concentrations differed among the diet groups, with highest plasma levels in women adhering to wholesome nutrition. Plasma β-carotene concentrations may not reflect β-carotene intake and the amount of fruit and vegetables consumed.

Recently, insoluble fibre from carob pulp has been found to affect blood lipids in animals in a similar manner as soluble dietary fibre. To investigate whether a carob pulp preparation containing high amounts of insoluble fibre has a beneficial effect on serum cholesterol in humans. Volunteers (n = 58) with hypercholesterolemia were recruited to participate in a randomised, double- blind, placebo-controlled and parallel arm clinical study with a 6 week intervention phase. All participants consumed daily both, bread (two servings) and a fruitbar (one serving) either with (n = 29) or without (n = 29) a total amount of 15 g/d of a carob pulp preparation (carob fibre). Serum concentrations of total, LDL and HDL cholesterol and triglycerides were assessed at baseline and after week 4 and 6. The consumption of carob fibre reduced LDL cholesterol by 10.5 +/- 2.2% (p = 0.010). The LDL:HDL cholesterol ratio was marginally decreased by 7.9 +/- 2.2 % in the carob fibre group compared to the placebo group (p = 0.058). Carob fibre consumption also lowered triglycerides in females by 11.3 +/- 4.5% (p = 0.030). Lipid lowering effects were more pronounced in females than in males. Daily consumption of food products enriched with carob fibre shows beneficial effects on human blood lipid profile and may be effective in prevention and treatment of hypercholesterolemia.