Anita Mofidi Najjar1, Patricia M. Parsons1, Alison M. Duncan1, Lindsay E.

Robins
on1, Rickey Y. Yada2 and Terry E. Graham1*, The acute impact of ingestion of bre
ads of varying composition on blood glucose, insulin and incretins following fir
st and second meals, British Journal of Nutrition (2010), 101, 391 398
Introducción
Breads are a major component of the wide range of CHOcontaining foods in the Nor
th American diet. Strategies to optimize blood glucose and insulin responses to
bread consumption include replacement of wheat flour with flour types richer in
dietary fibres such as barley flour.
Los panes son un componente importante de la amplia gama de CHOcontaining alimen
tos en la dieta norteamericana. Estrategias para optimizar las respuestas de glu
cosa en sangre e insulina para el consumo de pan, la sustitución de la harina de t
rigo con harina de tipos más ricos en fibras dietéticas, tales como harina de cebada
.
In recent years, investigations have suggested that the incretin hormones, gluco
se-dependent insulinotropic polipéptido (GIP) and glucagon-like peptide-1 (GLP-1)
are intimately involved in the postprandial regulation of CHO.
En los últimos años, las investigaciones han sugerido que las hormonas incretinas, p
olipéptido insulinotrópico dependiente de glucosa (GIP) y similares al glucagón péptido-
1 (GLP-1) están íntimamente implicados en la regulación post-prandial de CHO.
Have been shown to be responsible for approximately half of the postprandial ins
ulin release and are thought to be important in pancreatic b cell integrity. The
major stimulus for incretin secretion is the presence of CHO in the gut.
Se ha demostrado que ser responsable de aproximadamente la mitad de la liberación
de insulina postprandial y se cree que son importantes en la integridad de la célu
la b pancreática. El principal estímulo para la secreción de incretinas es la presenci
a de HC en el intestino.
Data suggesting that a low glycaemic index meal not only lowers the acute glicem
ia but also improves glycaemia and insulinaemia after the subsequent (second) me
al, a phenomenon called the second meal effect.
Datos que sugieren que una comida de bajo índice glucémico, no sólo reduce la glicemia
aguda sino que también mejora la glucemia y la insulinemia después de la posterior
(la segunda) comida, un fenómeno llamado efecto de segunda comida.
The primary objective of the present study was to determine the acute postprandi
al effect of 50 g available CHO in the form of breads made with different grain
flours or leavening processes on the rate of gastric emptying and biomarkers of
glucose homeostasis. El objetivo principal del presente estudio fue determinar e
l efecto agudo post-prandial de 50 g CHO disponibles en forma de panes elaborado
s con harinas de cereales o de diferentes procesos de fermentación de la tasa de v
aciamiento gástrico y biomarcadores de la homeostasis de la glucosa.
A secondary objective was to examine the impact of these breads on the above bi
omarkers following consumption of a standard second meal. We hipótesis sed that wh
ite bread would be associated with the most extreme metabolic responses while mo
re favourable responses would occur following ingestion of sourdough and whole w
heat breads.
Métodos
Sujetos
11 pacientes , masculinos, obesos de Guelph Ontario. No fumadores y sin historia
de enfermedades gastrintestinales, alergias al gluten, dislipidemia, diabetes o
cualquier enfermedad crónica. No tomaban medicación (a excepción de 2 voluntarios que
tomaban medicación para la hipertensión) o productos naturistas.
Protocolo de estudio
The volunteers were asked to maintain their usual diet and general lifestyle thr
oughout the study, and to abstain from strenuous physical activity and ingestion
 of alcohol, cafeína substances and analgesic drugs that contain paracetamol for 4
8 h prior to testing. Dietary records were kept for the 3 d preceding each of th
e study days. The night before each Studio day, the volunteers were provided wit
h the same comerciáis prepared frozen meal for consistency. Each volunteer consume
d four different test breads on separate occasions, at least 1 week apart, in a
single blind, randomized, crossover design. On each occasion, the volunteer repo
rted following a 12 h, overnight fast.
A venous catheter was inserted into the forearm by a trained technician, and kep
t clear for the duration of the experiment with a show saline infusion. After a
fasting blood sample was taken, volunteers consumed a serving of bread (without
any spread) together with 250 ml water within 10 min. At 3 h after bread consump
tion, volunteers consumed a standard, comerciáis prepared lunch (6-inch Subwayw sa
ndwich on white bread with 300 ml orange juice) within 15 min and were studied f
or an additional 2 h. The serving of the test breads probidad 50 g available CHO
and 1 g paracetamol, required portions of 98, 138, 109 and 127 g for white, who
le wheat, sourdough and whole wheat barley bread, respectively. Blood samples we
re taken at 0 (fasting), 15, 30, 60, 90, 120 and 180 min after the consumption o
f the bread as well as at 15, 30, 60, 90 and 120 min after consumption of the se
cond meal.
Examenes de estudio del pan
A portion (100 g) of each study test bread was analysed by two different laborat
ories (Industrial Laboratories of Canada (ILC) in Tilsonburg, Ontario and Agricu
lture and Agri-Food Canada (AAFC) in Guelph, Ontario) and the results were avera
ged (Table 2).
Cálculos y análisis de estadísticas
Area under the curve (AUC) was determined for blood glucose, serum insulin and p
aracetamol, plasma GIP and GLP-1 (GraphPad Prism, version 3.0; San Diego, CA, US
A). Data were analysed for the time periods 0 300 min (defined as entire study), 0 1
80 min (defined as the first meal) and 180 300 min (defined as the second meal). F
asting (0 min) concentrations were used as baseline in second meal AUC calculati
ons. Insulin sensitivity index was calculated using the method described by Mats
uda & DeFronzo(21). For the
characterization of paracetamol absorption, the ratio of peak serum concentrati
on (Cmax, mmol/l) to time until peak concentración (Tmax, min) was calculated.
All statistical analyses were performed using the StatisticalvAnalysis System (S
AS Institute Inc., version 9.1; Cary,vNC, USA). Significance (P,0·05) was tested b
y two-factorvrepeated measure ANOVA using a mixed model (treatment:vfixed effect
and volunteer: random effect) followed by thevTukey s test for multiple compariso
ns. Results are given asvmeans and their standard errors.
Resultados
11 voluntarios iniciaron el estudio, 10 lo terminaron puesto que 1 descontinuo d
ebido a enfermedad.
Examen del pan
El pan de cebada se vio tener un pH menor que el del pan blano, indicativo de un
a mayor cantidad de acidos organicos en este.
Glucosa en sangre
Fasting blood glucose concentrations did not significantly differ among the test
breads. There were significant differences in overall glucose responses to the
test breads with sourdough being lower than both white (P,0·05) and whole wheat (
P,0·007) breads as well as whole wheat barley being coger than whole wheat (P,0·05)
bread.
For each meal period as well as entire study, glucose AUC for sourdough was lowe
r than whole wheat (P,0·05) and for both the second meal period and the entire stu
dy sourdough was also lower than whole wheat barley (P,0·05) bread.
Insulina sérica y sensibilidad de la insulina
In addition, there were no significant differences in insulin sensitivity index
among the test breads.
Polipéptido plasmático insulinotrópico glucosa dependiente y peptido - I similar al gl
ucagon

Paracetamol sérico
There was no significant difference in paracetamol concentrations at any time-po
ints among the breads (Fig. 5). Furthermore, no difference was found in paraceta
mol AUC and Cmax:Tmax among the breads (data not shown), suggesting that gastric
emptying was not different among the treatments.
Conclusiones
Conclusion
The ingestion of 50 g available CHO in the form of different breads by middle-ag
ed overweight or obese men influenced not only the postprandial response to this
meal but also those of a standardized second meal. Contrary to our hypothesis,
the ingestion of white bread did not result in postprandial glycaemic or insulin
aemic responses that were greater than those of ultra-fine grind whole wheat bre
ads. In addition, the consumption of sourdough bread resulted in lower overall g
lucose and GLP-1 responses compared to those of these whole wheat and whole whea
t barley breads.