1) Low glycemic index (GI) diets can help with weight management and reducing risk of heart disease by increasing satiety and reducing subsequent food intake. 2) Studies found that low GI breakfasts led to lower lunch energy intake in children and reduced appetite and increased satiety over 6 days compared to high GI meals. 3) Glycemic index is a key factor in diabetes management as it classifies carbohydrates based on their effects on blood glucose levels, and prescribing low GI diets can help with tight blood glucose control.

1. Welcome

2. GLYCAEMIC INDEX – A Key Factor In Diabetes Management PRESENTED BY Ms. Mayuri Madhavrao Choudhary

5. Glucose in blood

7. Prevalence of diabetes Year 2000 Year 2030 Source : WHO, report 2011 (http://www.who.int/diabetes/facts/world_figures/en/index )

8. Dietary management in diabetes Source : National Consensus Dietary Guidelines For Healthy Living and prevention of obesity, diabetes and related diseases (2009) S. No. Nutrient Current consensus guidelines 1 Carbohydrates 50-60 % of total energy 2 Proteins 10-15 % of total energy 3 Fats Total fat < 30 % of total energy Saturated fatty acids < 10 % Trans fatty acids < 1 % PUFAs 5-8 % MUFAs 10-15 %

9. Foods to be avoided and permitted Source : Diet and Diabetes – NIN (1993) Nutrition and Dietetics – Shubhangini Joshi (2005) Dietetics – Srilakshmi (2009) Foods to be avoided Foods to be eaten in moderation Foods permitted Simple sugars, syrups, sweets, dried fruits, cake, candy, alcohol and alcoholic beverages, soft drinks, sweetened juices etc. Organ meats like liver , brain , kidney etc. Fats, cereals, pulses, meat, egg, nuts, roots, fruits etc. Green leafy vegetables, lemon, clear soups, onion, mint, spices, salad, plain coffee or tea, skimmed and buttermilk etc.

10. Historical aspects of the dietary management of diabetes Source : Human nutrition and dietitics (Garrow J.S.2000)

13. Glycaemic Index Definition – The area under the curve for the increase in blood glucose after the injection of 50 gm of carbohydrate in the food during the 2 hr post prandial period relative to the same amount of carbohydrate from a reference food (i.e.glucose) tested in the same individual under the same conditions and using the initial blood glucose concentration as a baseline. In simple words, the glycaemic index is a way of ranking carbohydrate containing foods according to the extent to which they raise blood sugar levels after eating. Formula – Incremental area of the test food GI = --------------------------------------------- x 100 Incremental area of the glucose

16. Source: Rizkalla et al. (2002) British journal of Nutrition 88, suppl. 3,s255-s262

18. Factors influencing glycaemic index value

20. Effect on because of the nature of starch …

21. TITLE – Glycaemic index of food: A physiological basis for carbohydrate exchange Jenkins et al. (1981) Objective – To determine the effect of different foods on the blood glucose level.

23. Table 1 : Glycaemic index of different foods Grains, Cereal products GI Dried legumes GI Dairy products GI Bread (white) 69 Kidney beans 29 Ice-cream 36 Bread (whole meal) 72 Soya beans 15 Milk (skim) 32 Millet 71 Chick peas 36 Milk (whole) 34 Rice (brown) 66 Lentils 29 Miscellaneous GI Rice (white) 72 Fruits GI Honey 87 Sponge cake 46 Apples 39 Peanuts 13 Breakfast cereals GI Banana 62 Potato crisps 51 All bran 51 Oranges 40 Tomato soup 38 Cornflakes 80 Orange juice 46 Sausages 28 Root Vegetables GI Raisins 64 Fish fingers 38 Beetroot 64 Sugars GI carrots 92 Fructose 20 Potato 75 Maltose 105 Sweet potato 48 Sucrose 59 Glucose 100

26. TITLE – The glycaemic index of potatoes: the effect of variety, cooking method and maturity Soh and Brand-Miller (1999) Objective – To determine the impact of variety, cooking method and maturity on the glycaemic index of potatoes.

29. Conclusion Potatoes, regardless of variety, cooking method and maturity, have exceptionally high GI values. New potatoes have relatively lower GI values which is attributed to differences in starch structure.

30. Effect on because of the composition of food …

33. Standardization – 4 percent of methi seed powder, 20 percent of cooked bengalgram flour, 4 percent of spice mix. For glycaemic index – n = 9 healthy Age group – 40-50 years. Reference food – White bread Food for comparison – chapati prepared of only dicocuum flour. Calculation of GI.

34. The glycaemic index of the designed chapati

36. Dicoccum wheat products have been found beneficial for the management of diabetes. Enrichment of functional food ingredients like methi seed powder and pulse has brought the enriched chapati under low glycaemic index food successfully.

37. Effect on because of the particle size …

39. Methodology – Test foods – six conventional cereal based preparations i.e. chapathi, dosai, idali, pongal, poori and upittu with suitable accompaniments. In vitro study carried out in the laboratory with specific procedure For in vivo study - All the selected subjects remained on their usual diets, but fasted overnight before the study. Reference food - Glucose Total 6 groups (n= 8-10) received 50 g carbohydrate portions of one of the six foods on seperste mornings. No. of subjects Age group (yrs) NIDDM 57 42-59 NORMAL HEALTHY 59 22-40

40. Table : Mean blood glucose concentration after 30 min in normal and diabetic subjects Food Mean blood glucose concentration (mmol/l) {after 30 min} NIDDM subjects Normal subjects Chapati 11.3 + 0.7 5.4 + 0.7 Dosai 13.7 + 1.5 6.6 + 0.5 Idali 10.6 + 2 4.9 + 0.8 Pongal 13.3 + 1 6.2 + 1 Poori 8.3 + 1.1 5.4 + 0.5 Upittu 12 + 0.8 4.9 + 0.6

42. Cross references for factors affecting

45. Benefits of the

47. Low in t he weight management.

48. TITLE – The effect of altered glycaemic index breakfasts on subsequent food intake and satiety in children aged 9-12 years. By – Warren et al. 2003 Objective – 1. To study the effect of consuming breakfasts of varying GI on appetite and food intake.

52. TITLE – The effect of low and high GI meals on appetite, satiety and energy intake after 6 d low or high GI diet. By – Norouzy et al. (2003) Objective – 1. To determine the effect of consuming one low or high GI meal on appetite, energy and micronutrient intake.

54. Results Value in the table are median values for sumed VAS score Table : median Summed VAS scores Appetite Satiety Fullness feeling Prospective consumption LOW GI 1788 2631 2518 2076 HIGH GI 2263 2180 2337 2451

55. Results Table : Mean nutrient intake Significantly lower energy intake during the low GI compared with the high GI period. No significant differences in individual micronutrient intake. Energy (kcal) CHO (g) Fat (g) Protein (g) Fibre (g) LOW GI 2930 324 106 177 46 HIGH GI 3268 338 110 178 47

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