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Nik Shanita Safii - Glycemic index practices among Malaysia athletes
 

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    Nik Shanita Safii - Glycemic index practices among Malaysia athletes Nik Shanita Safii - Glycemic index practices among Malaysia athletes Presentation Transcript

    • NIK SHANITA SAFII, PHD DIETETICS PROGRAM SCHOOL OF HEALTHCARE SCIENCES FACULTY OF HEALTH SCIENCES UNIVERSITI KEBANGSAAN MALAYSIA GLYCEMIC INDEX PRACTICES AMONG MALAYSIAN ATHLETES
    • CONTENT OF PRESENTATION: ▪ Sports Scenario in Malaysia ▪ Introduction To The Glycemic Index (GI) ▪ Overview on glycemic index and exercise performance ▪ The experience of doing research Among Athletes ▪ GI practices among athletes: Before and Current Findings ▪ Conclusion Inspiring Futures, Nurturing Possibilities 2MDA Scientific Conference_22 June 2013 Inspiring Futures, Nurturing Possibilities
    • SPORTS SCENARIO IN MALAYSIA • 1) 1971 – NATIONAL SPORT COUNCIL OF MALAYSIA WAS ESTABLISHED: • to promote locally & internationally as well as participate in the development of sports in Malaysia. • 2) 1983 – CONCEPT PAPER ON THE ESTABLISHMENT OF NATIONAL SPORTS INSTITUTE (ISN). • 3) 1992 – ISN OFFICIALLY OPENED AND BECAME A CRUCIAL ENTITY TO THE PREPARATION OF ATHLETES FOR THE XVI • COMMONWEALTH GAMES. 4) 1998 – MALAYSIA, THE 1ST ASIA COUNTRY TO HOST THE XVI COMMONWEALTH GAMES. Inspiring Futures, Nurturing Possibilities
    • SPORTS SCENARIO IN MALAYSIA 5) 2006-2007 – EXPANSION TO THE ISN BUILDING: to accommodate the increased number of staff & sport science laboratories. to meet the needs and requirements of the national athletes. 6) 25 MAY 2007 – THE MINISTER OF YOUTH & SPORTS DECIDED ON NEW FUNCTION OF ISN: the entity that focuses in sports research, sports medicine and sports science in Malaysia. to provide support services from elite level to grassroots level through scientific approach. Inspiring Futures, Nurturing Possibilities
    • INTRODUCTION TO THE GLYCEMIC INDEX What Is Glycemic Index? The concept of GI has been introduced by Jenkins et al. in early 1980s. DEFINITION: GI – a way of ranking foods based on the actual postprandial blood glucose response compared to a reference food, either glucose or white bread. 5 Inspiring Futures, Nurturing Possibilities
    • …DEFINITION IOM (2002): CHO-containing foods - have a wide range of effects on blood glucose concentration during the course digestion (glycemic response). High GI food resulting in a rapid rise followed by a rapid fall in blood glucose concentration. Low GI food result in a slow extended rise and a slow extended fall. 6 Inspiring Futures, Nurturing Possibilities
    • The GI – calculated by measuring the incremental area under the blood glucose curve (IAUC) following ingestion of a test food providing 50 g available CHO, compared with the IAUC after consumption of an equal CHO intake from reference food. GI = IAUC test food x 100 IAUC reference food DETERMINANT: GI Category ≥ 70 = high GI 55 - 69 = moderate GI < 55 = low GI (Brand - Miller et al. 1996) 7MDA Scientific Conference_22 June 2013
    • Glucose (reference food) Doughnut (test food) 57% 100% Blood glucose level is plotted on a graph & the IAUC is calculated using a computer program Lotus 123 (Wolever et al. 1991) … Measuring the GI of the food IAUC CALCULATION USING LOTUS 123 PROGRAM
    • ▪ GI on Carbohydrate (CHO) Feeding Before Exercise ▪ GI and CHO Intake During Exercise ▪ GI and Post-Exercise Nutrition 9MDA Scientific Conference_22 June 2013 OVERVIEW ON GLYCEMIC INDEX / GLYCEMIC LOAD AND EXERCISE PERFORMANCE
    • GI ON CARBOHYDRATE (CHO) FEEDING BEFORE EXERCISE 10MDA Scientific Conference_22 June 2013
    • Study 1: Indicated higher blood glucose & [FFA] at the end of exercise & a 20 min longer time to exhaustion in the LGI than in the HGI trial. 3 other studies: have found an improvement in endurance performance with the consumption of LGI & moderate-GI CHO
    • 12MDA Scientific Conference_22 June 2013 … GI ON CARBOHYDRATE (CHO) FEEDING BEFORE EXERCISE Many studies found that ingesting LGI foods or meals more than 1 hr before exerise results in higher [blood glucose] & higher [FFA] than when HGI CHO is ingested (Chen et al 2008; Stannard et al 2000; Stevenson et al 2006; Stevenson et al 2005; Wee at al 2005; Wong et al 2008; Wu et al 2003; Wu & Williams 2006) Wong et al (2008): found a 2.8% improvement in half-marathon times after the consumption of LGI CHO.
    • 13MDA Scientific Conference_22 June 2013 GI and CHO Intake During Exercise ▪ Ingesting CHO during prolonged exercise (>90 min) at moderate to high intensities (50-80% VO2max) improves performance (Coyle et al 1986, 1983). ▪ The CHO & fluid requirements of athletes during exercise vary depending on intensity & duration of the event @ training session & climatic conditions. ▪ Solid foods & foods with a high fructose content (LGI) are generally avoided by athletes due to gastrointestinal side effect during exercise (Murray et al 1989).
    • 14MDA Scientific Conference_22 June 2013 GI and Post-Exercise Nutrition ▪ Nutrition (amount, timing & frequency of CHO ingestion) is one of the most important aspects of recovery, which involve in synthesis of muscle glycogen to replace stores lost during exercise (Jentjens & Jeukendreup 2003). ▪ Initial research suggested that consuming HGI CHO during recovery increased muscle glycogen synthesis post exercise.
    •  Current IOC guidelines advocate the ingestion of protein after exercise (as this is when maximal stimulation of muscle protein synthesis is required) (Slater & Phillips 2011).  The IOC recommends that 20-25 g of high quality/or high biological value protein is included after resistance exercise (Phillips & Van Loon 2011) .  The combination of carbohydrates and protein post exercise is important to restore muscle glycogen and promote protein synthesis (Slater & Phillips 2011). 15 Inspiring Futures, Nurturing Possibilities
    • THE EXPERIENCE OF DOING RESEARCH AMONG ATHLETES 16 RESEARCH: 1) Clearly documented the beneficial effects of NUTRITION on physical performance. 2) UNDERNUTRITION @ suboptimal eating habits will result on persistent fatigue, poor recovery, illness & unwanted weight loss. Inspiring Futures, Nurturing Possibilities
    • DETERMINATION OF GI IN SELECTED HIGH-CONSUMPTION MALAYSIAN FOODS ▪ Atkinson et al (2008) have systematically tabulated published & unpublished sources of reliable GI values from 1981–2007. Over 2480 individual food items available on-line http://dx.doi.org/10.2337/dc08-1239 ▪ To date, not much data available on GI of Malaysian local foods. ▪ Few studies looked at: The glycemic & insulin responses (rather than the GI) of tradisional Malaysian meals i.e. Nasi Lemak, Roti Telur, Soup Noodle (Khalid et al. 1996) & Fried Noodle (Hapizah et al. 2000). Development and determination of glycemic index and types of carbohydrate in endurance athletes’ food choices (Nik Shanita S 2004) A Study of Blood Glucose Response Following Temperate and Tropical Fruit Ingestion in Healthy Adults (Barakatun Nisak et al. 2005) Glycaemic Index of Eight Types of Commercial Rice in Malaysia (Barakatun Nisak et al. 2006). Determination of glycemic index of selected Malaysian foods (Daniel Robert et al 2006). Glycemic index of common Malaysian fruits (Daniel Robert et al 2008). Amylose and Amylopectin in Selected Malaysian Foods and its Relationship to Glycemic index (Nik Shanita et al 2011). 17 Inspiring Futures, Nurturing Possibilities
    • 18 Normal Pre obese Obese Subjects characteristics Development and determination of glycemic index and types of carbohydrate in endurance athletes’ food choices (Nik Shanita S 2004) Inspiring Futures, Nurturing Possibilities
    • 19 Wet Wt Energy g (kcal) g % en g % en g % en 1 Roti canai & dhal 146 372 50 54 9 10 15 34 2 Sardine Sandw ich 121 327 50 61 11 14 9 25 3 Karipap 120 356 50 57 9 11 13 33 4 Mihun goreng 225 392 51 52 9 9 17 39 5 Makaroni goreng 206 369 51 55 11 12 13 33 6 Doughnut 108 351 50 57 10 11 13 32 7 Nasi lemak 215 413 51 50 15 15 16 36 8 Nasi goreng 250 379 50 53 11 11 15 36 9 Teh tarik (sw eetened creamer) 100 357 50 56 10 11 13 33 Range of macronutrient (g) Test Food 50 - 51 9 - 15 9 -17 CHO Protein Fat Test foods – based on Malaysian hockey players & cyclist food choices
    • 20 Test Food MeanGI Glycemic Index category Tehtarik: TT (n=6) 74 ± 6.4 HIGH Nasi lemak: NL (n=6) 66 ± 5.1 INTERMEDIATE Nasi goreng: NG (n=5) 59 ± 4.4 INTERMEDIATE Sardine sandwich: SS (n=6) 73 ± 2.9 HIGH Roti canai & dhal: RC (n=5) 71 ± 4.6 HIGH Karipap: K (n=5) 54 ± 1.4 LOW Mihungoreng: MG (n=6) 98 ± 7.6 HIGH Makaroni goreng: MC (n=4) 76 ± 3.7 HIGH Doughnut: D (n= 6) 57 ± 2.8 INTERMEDIATE RESULTS Classification of GI: HIGH (> 70), INTERMEDIATE (55-70), LOW (< 55) Source: Brand-Miller et al. (1996)
    • CURRENT NUTRITION SCENARIO AMONG MALAYSIAN ATHLETES ▪ Less emphasis on nutrition. • Energy intake (EI) not compatible with energy expenditure (EE) ie. NEGATIVE ENERGY BALANCE (EB) • Inconsistent meal patterns. • Meal skipping. • No meal before training. • Resistance from coach, manager & athletes. ▪ Misuse of supplements. ▪ High dependency ▪ Replace with meals 21
    • 1) Energy requirements of national athletes, SEA Games KL. 1991 - Ismail et al (1997) Mal. J. Nutr 3:71-81 2) Commonwealth Games, KL. 1998 – Ismail & Arumugam (1998) 3) National Rugby Team – Ismail & Zawawi (1999) 4) Nutritional Status of National Netball players – Nik Shanita & Hera (1999) 5) Energy balance among adolescent divers & gymnasts – Ismail & Poo (2000) 6) National Footballers below 16 years old – Ismail & Azdie (2000) 7) Nutritional status of National Hockey player, SEA Games KL, 2001 – Nik Shanita et al (2002) 8) Energy balance among Malaysian cyclist – Nik Shanita et al (2004) SOME LOCAL STUDIES ABOUT NUTRITIONAL STAUS OF MALAYSIAN ATHLETES
    • OVERALL: 49 out of 194 = 25%!! ARE THE NATIONAL ATHLETES ENERGY REQUIREMENT (ER) MET ? Gender/type of sports No of athlete % achieved ER Male athletes 18 / 84 21 Female athletes 7 / 24 29 Boxers 0 / 17 None Rugby players 2 / 15 13 Diver (male) 5 / 7 71 Diver (female) 2 / 6 33 Rythmic gymnast 0 / 8 None Footballers 13 / 24 54 Cyclist 2 / 9 22
    • ▪ 125 national athletes 92 males, 33 females, aged 18-31y ▪ 15 sports: racquet (squash, badminton), combat (boxing, karate, taekwondo, silat, wushu), aquatic (diving), gymnastics (artistics, rhythmic), skilled (fencing, archery, weightlifting), team (football, hockey) ▪ BMR measured ventilated hood system (Deltatrac Metabolic Monitor MBM-200) 24
    • PHYSICAL CHARACTERISTICS OF ATHLETES 25
    • BMR EQUATION SPECIFIC FOR MALAYSIAN ATHLETES BMR (kcal/day) = 669 + 13 weight + 192 sex (1 m, 0 f) ▪ Compared to Deltatrac measurement (Measured-Estimated): Male (n=92) Female (n=33) Diff (kcal) RMSPE Diff (kcal) RMSPE FAO/WHO/UNU (1985) 25 ± 18 172 71 ± 24 154 Harris & Benedict (1919) 31 ± 18 170 -2 ± 23 131 Cunningham (1980) -45 ± 18 178 -67 ± 22 141 Ismail et al (1998) 253 ± 18 304 199 ± 24 240 De Lorenzo (1999) -19 ± 17 168 - - Wong et al. (2012) -4 ± 18 172 -20 ± 24 135 RMSPE = root mean squared prediction errors = the smaller the better 26
    • GI PRACTICES AMONG ATHLETES: BEFORE AND CURRENT FINDINGS 27 Inspiring Futures, Nurturing Possibilities
    • …GI PRACTICES AMONG ATHLETES: 21ST SEA GAMES (2001) ▪ 19 Male National Cyclists ▪ Underwent General Preparation (GPP) training for 21st SEA Games ▪ Objective was to investigate knowledge, attitude, practices (KAP) about nutrition and their food choices before training / competition.  Method: KAP using validated Nutrition KAP questionnaire and antropometric measurements using Seca Beam balance & BIA.  Results: 28
    • 29 • Nutrition knowledge level of cyslist was categorised as good. • About 55% cyclists consumed CHO containing food 3-4 hour before training. • Only, 23% of them consumed either fluid or food 30 min after their training session. ▪ For GI practices, results revealed that 59% of the cyclist chose high GI food while 24% preferred intermediate GI and only 17% correctly selected low GI food as their pre-exercise meal. Inspiring Futures, Nurturing Possibilities
    • MALAYSIAN ATHLETES GI PATTERN : GI FOOD PRACTICES FOR ELITE ATHLETES MOHD IZHAM M. NATIONAL SPORTS INSTITUTE Inspiring Futures, Nurturing Possibilities
    • STUDY BACKGROUND ▪ 6 Male Elite Track Athletes ▪ Undergone General Preparation (GPP) training after World Championship. Mainly focus for endurance (800 – 700km per weeks) and gym (2 times per weeks) training ▪ Objective is to investigate GI food pattern among elite track cyclist undergo general preparation phase (GPP). 31
    • METHOD Anthropometry ▪ Body weight and skinfold thickness were obtained using a digital scale (SECA) and skinfold calipers using ISAK measurement Dietary assessment ▪ Participants recorded food intake over three days (2 days training and 1 days rest). Average dietary intakes were measured using Nutrimart. ▪ Frequency GI food intake where calculated and category based on International Table of Glycemic Index and Glycemic Load Values. 32
    • RESULT Macronutrient Intakes Percentage Food Selection Energy (kcal) CHO (g) Protein (g) Fat (g) Low GI (%) High GI (%) Moderate GI (%) Others** (%) Pre Training 618 58 21 7 47* 34 8 11 During Training 895 157 31 4 17 70* 13 0 After Training 548 29 44 0 25 63* 13 0 Breakfast 667 22 23 8 44 0 44 11 Lunch 443 35 48 18 50* 0 8 42 Evening Tea 174 18 3 8 100* 0 0 0 Dinner 733 98 34 28 33 39* 17 11 * Higher intakes on GI foods ** Others mean beside CHO food 33
    • CONCLUSION ▪ Gel, sport drinks, banana, rice and juice were top 5 high GI food consumed while whole meal bread, muesli, sports bars, full cream milk, and recovery drink were top 5 low GI food consumed. ▪ Majority subjects apply low GI food before training while high GI food during and immediately after training. ▪ Future case study will be conducted to estimate GI and GL intake from diet record. 34
    • DEVELOPMENT & VALIDATION OF SPORTS NUTRITION KNOWLEDGE, ATTITUDE & PRACTICE (KAP). TAN MT, UKM, KL Objective: To develop and validate a sports nutrition KAP questionnaire. Method: Developmental Phase 35 Development of Sport Nutrition KAP Questionnaire • Questions related to sport nutrition were adapted and modified based on meta-analysis of several literature reviews Inspiring Futures, Nurturing Possibilities
    • 36 KNOWLEDGE • Development food portion size booklet for athletes (Aainaa et al. 2007) and development food source booklet for athletes(Norhasniza et al. 2007). • Development of a general nutrition knowledge questionnaire for adults (Parmenter & Wardle 1999). • The Female Collegiate Cross-Country Runner: Nutritional Knowledge and Attitudes (Zawila et al. 2003). • Nutrition Knowledge, Practices, Attitudes and Information Sources of Mid-American Conference College Softball Players (Hornstrom et al. 2011) ATTITUDE • Theory Planned Behaviour (TPB) questionnaire. • The Female Collegiate Cross- Country Runner: Nutritional Knowledge and Attitudes (Zawila et al. 2003). • Modification of a Nutritional Questionnaire for Older Adults and the Ability of Its Knowledge and Attitude Evaluations to Predict Dietary Adequacy (Thomas et al.1990) PRACTICE • KAP study. Technical Working Group (Research), the National Coordinating Committee on Food and Nutrition (NCCFN) Ministry of Health Malaysia 1997. Inspiring Futures, Nurturing Possibilities
    • Validation Phase Results: Reliability tests on Knowledge with Cronbach’s alpha – 0.75-0.86 Attitude – 0.71-0.77 Practice – 0.71-0.85 37 Subjects : 38 football athlete, aged 17-23 years (21 athlete from Harimau B, 17 athlete from Harimau C) Study location : ISN and MSN Bukit Jalil Inspiring Futures, Nurturing Possibilities
    • No. Question Score Correct (n) Wrong (n) 1. Ingesting high glycemic index (GI) food before exercise will provide constant fuels through out the exercise duration. 3(7.9%) 35(92.1%) 2. The glycemic index (GI) values for fructose and galactose are lower than glucose. 21(55.3%) 17(44.7%) 3. A low glycemic load (GL) diet can be achieved by choosing foods with low glycemic index (GI) types of foods. 22(57.9%) 16(42.1%) 4. Increased acidity in the food may increase the value of the glycemic index (GI) of that particular food 14(36.8%) 24(63.2%) 5. High glycemic index foods eg. white rice is suitable to be taken after exercise. 34(89.5%) 4(10.5%) 38 RESULTS: GLYCEMIC INDEX KNOWLEDGE 89.5% - High glycemic index foods eg. white rice is suitable to be taken after exercise. 36.8% - Increased acidity in the food may increase the value of the glycemic index (GI) of that particular food Only 7.9% - disagree that ingesting high glycemic index (GI) food before exercise will provide constant fuels through out the exercise duration. Inspiring Futures, Nurturing Possibilities
    • CONCLUSION ▪ More study on the GI of typical Malaysian foods, knowledge and attitudes of athletes. ▪ Future research will need to carefully designed to support the evidence that the GI of foods may play a role in planning of diets and to unwind the complexities of GI, nutrition and physical performance. 39 Inspiring Futures, Nurturing Possibilities
    • 40