Compared to the overnight fasted state, a high carbohydrate (CHO) breakfast 3-4 hours before exercise enhances endurance performance. However, the optimal type or composition of the pre-exercise meal to be consumed is less clear. Glycaemic and insulinaemic responses to a meal play a key role in subsequent metabolism during exercise. The investigations described in this thesis focused on the influence of I) the composition and 2) glycaemic index (GI) of CHO breakfasts 3 hours before exercise on postprandial and exercise metabolism and endurance running capacity.

Doctor of Philosophy (PhD) / Introduction: The conventional approach to weight loss, recommended by almost all health authorities around the world, has been to reduce the total amount of fat in the diet and replace with carbohydrates. However, research trials using this approach have produced only modest results at best, and despite the active promotion of low fat eating and an apparent decline in fat consumption, rates of overweight and obesity have continued to climb. More recently low glycaemic index (GI) and high protein diets have become popular and are widely used by the public. However, only a small number of randomised controlled trials have been conducted and none directly comparing the two. Both approaches effectively reduce glycaemic load (GL) and aim to reduce post-prandial glycaemia and insulinaemia. This study aimed to evaluate the ability of diets with reduced GL to enhance the weight loss effects of a reduced-fat diet, to compare the two approaches of reducing GL on metabolic and anthropometric changes, and to investigate any benefit of combining both approaches to produce the lowest GL. Methods: We conducted a 12-week intervention in 129 overweight or obese young adults who were assigned to one of four diets with varying GL, protein, carbohydrate and GI, but similar fat (30% energy), fat type and fibre content. DIET 1 (highest GL) contained 55% E as carbohydrate; DIET 2 was a low-GI version of DIET 1; DIET 3 was a high protein diet with 25% E as protein; DIET 4 (lowest GL) was a low-GI version of DIET 3. The increase in protein in DIETS 3 and 4 came primarily from lean red meat. All key foods and some pre-prepared frozen meals were provided to maximise dietary compliance. Outcome measures were body weight, body fat, lean mass, waist circumference and the following blood parameters: total cholesterol, LDL-cholesterol, HDL-cholesterol, triacylglycerols (TAG), free fatty acids, C-reactive protein, fasting insulin, fasting glucose and leptin. Insulin resistance and β-cell function were assessed using homeostatic model assessment (HOMA) and the newer computer models HOMA2-insulin sensitivity and HOMA2-β-cell function. Results: While all groups lost similar amounts of weight (4.2 to 6.2% of initial weight, p=0.09), the proportion who lost >5% of body weight varied significantly by diet: 31%, 56%, 66% and 33% in groups 1, 2, 3 and 4 respectively (p=0.011). Differences were strongest in women (76% of the total group) who showed significant differences among groups in percentage weight change (-3.7 ± 0.6%, -5.7 ± 0.6%, -6.5 ± 0.5%, -4.1 ± 0.7% respectively, p=0.005) and fat loss (-3.1 ± 0.4kg, -4.9 ± 0.6kg, -4.8 ± 0.4kg, -3.6 ± 0.7kg respectively, p=0.007). Total and LDL-cholesterol increased on DIET 3 (high protein) compared to a fall on diet 2 (high carbohydrate/low-GI, p=0.013). TAG, HDL-cholesterol and glucose homeostasis improved on all four diets, with no effect of diet composition. Goals for energy distribution were not achieved exactly: both carbohydrate groups ate less fat and the diet 2 group ate more fibre. Conclusions: Reducing GL, through either substituting low-GI foods or replacing some carbohydrate with protein, improved the efficacy of a reduced-fat diet in women and in those with high TAG. Combining both approaches to produce the lowest GL did not promote further weight or body fat loss. Although weight loss was similar in all four diets for the group as a whole, overall clinical outcomes were superior on the high carbohydrate, low-GI diet.

Doctor of Philosophy (PhD) / Introduction: The conventional approach to weight loss, recommended by almost all health authorities around the world, has been to reduce the total amount of fat in the diet and replace with carbohydrates. However, research trials using this approach have produced only modest results at best, and despite the active promotion of low fat eating and an apparent decline in fat consumption, rates of overweight and obesity have continued to climb. More recently low glycaemic index (GI) and high protein diets have become popular and are widely used by the public. However, only a small number of randomised controlled trials have been conducted and none directly comparing the two. Both approaches effectively reduce glycaemic load (GL) and aim to reduce post-prandial glycaemia and insulinaemia. This study aimed to evaluate the ability of diets with reduced GL to enhance the weight loss effects of a reduced-fat diet, to compare the two approaches of reducing GL on metabolic and anthropometric changes, and to investigate any benefit of combining both approaches to produce the lowest GL. Methods: We conducted a 12-week intervention in 129 overweight or obese young adults who were assigned to one of four diets with varying GL, protein, carbohydrate and GI, but similar fat (30% energy), fat type and fibre content. DIET 1 (highest GL) contained 55% E as carbohydrate; DIET 2 was a low-GI version of DIET 1; DIET 3 was a high protein diet with 25% E as protein; DIET 4 (lowest GL) was a low-GI version of DIET 3. The increase in protein in DIETS 3 and 4 came primarily from lean red meat. All key foods and some pre-prepared frozen meals were provided to maximise dietary compliance. Outcome measures were body weight, body fat, lean mass, waist circumference and the following blood parameters: total cholesterol, LDL-cholesterol, HDL-cholesterol, triacylglycerols (TAG), free fatty acids, C-reactive protein, fasting insulin, fasting glucose and leptin. Insulin resistance and β-cell function were assessed using homeostatic model assessment (HOMA) and the newer computer models HOMA2-insulin sensitivity and HOMA2-β-cell function. Results: While all groups lost similar amounts of weight (4.2 to 6.2% of initial weight, p=0.09), the proportion who lost >5% of body weight varied significantly by diet: 31%, 56%, 66% and 33% in groups 1, 2, 3 and 4 respectively (p=0.011). Differences were strongest in women (76% of the total group) who showed significant differences among groups in percentage weight change (-3.7 ± 0.6%, -5.7 ± 0.6%, -6.5 ± 0.5%, -4.1 ± 0.7% respectively, p=0.005) and fat loss (-3.1 ± 0.4kg, -4.9 ± 0.6kg, -4.8 ± 0.4kg, -3.6 ± 0.7kg respectively, p=0.007). Total and LDL-cholesterol increased on DIET 3 (high protein) compared to a fall on diet 2 (high carbohydrate/low-GI, p=0.013). TAG, HDL-cholesterol and glucose homeostasis improved on all four diets, with no effect of diet composition. Goals for energy distribution were not achieved exactly: both carbohydrate groups ate less fat and the diet 2 group ate more fibre. Conclusions: Reducing GL, through either substituting low-GI foods or replacing some carbohydrate with protein, improved the efficacy of a reduced-fat diet in women and in those with high TAG. Combining both approaches to produce the lowest GL did not promote further weight or body fat loss. Although weight loss was similar in all four diets for the group as a whole, overall clinical outcomes were superior on the high carbohydrate, low-GI diet.

Pães integrais são alimentos de consumo habitual da população brasileira, porém há poucas informações a respeito da resposta glicêmica pós-prandial, O presente trabalho teve como objetivo avaliar a resposta glicêmica produzida, em indivíduos saudáveis, após o consumo de pães de fôrma rotulados como integrais. Oito pães de fôrma integrais de três categorias (clássico, light e com grãos) foram avaliados, após o consumo de porcão equivalente a 25 g de carboidratos disponíveis, através do índice glicêmico (IG) e carga glicêmica (CG). Os voluntários (n=15) compareceram ao laboratório em jejum (10 a 12 horas), pela manhã, em onze ocasiões (três dias para o consumo do pão controle e um dia para cada tipo de pão de fôrma integral). A glicemia foi determinada em jejum (t=0) e após o consumo de cada pão nos tempos: 15; 30; 45; 60; 90 e 120 minutos. A curva de resposta glicêmica, a área sob a curva (ASC) e o cálculo do IG e CG para cada um dos pães foram realizados. Considerando a glicose como referência, os pães integrais clássicos (n=2) apresentaram alto IG (71 %); os light (n=2), IG baixo (50 %) e médio (58 %) e; os com grãos (n=4), IG baixo (44 e 49 %) e médio (57 e 60 %). Os pães de fôrma light e com grãos apresentaram IG menor que os do tipo clássico (p<0,05), os quais apresentaram IG igual ao pão francês (controle). Como foi consumida a mesma quantidade de carboidratos disponíveis, a menor proporção de açúcar solúvel na categoria light parece ter sido o fator que induziu ao menor IG observado. Em relação à CG, um pão de fôrma integral light (CG=10) e outro com grãos (CG=7) foram classificados como baixa CG; os demais pães integrais (n=6) foram classificados como média CG (11 a 16). Todos os pães integrais apresentaram CG inferior a do pão controle (CG=18) (p<0,05) e entre os integrais novamente os da categoria light e com grãos foram os que apresentaram menor CG. Assim, foi observada variação na resposta glicêmica após o consumo de pães de fôrma integrais, sendo que a redução no conteúdo de açúcares solúveis, para os pães light, e a adição de grãos integrais, nos pães com grãos, favoreceram menor elevação da resposta glicêmica pós-prandial. / Whole meal breads are part of the habitual daily diet of the Brazilian population, but there is little information on the postprandial glycaemic response. The aim of this work was to evaluate the glycaemic response produced, in healthy volunteers, following the consumption of breads labeled as whole meal. Eight whole meal breads of three different categories (classic, light and grains) were evaluated, after the consumption of a portion containing approximately 25 g of available carbohydrates, using the glycaemic index (GI) and glycaemic load (GL). The subjects (n=15) attended to the laboratory after an overnight fasting (10 to 12 hours), in eleven different occasions (three days for the consumption of the control bread and a day for each whole meal bread). In every occasion, a portion of bread containing 25 g of available carbohydrate was consumed. Capillary blood samples were taken immediately before (t=0) and 15, 30, 45, 60, 90 and 120 minutes after the consumption of test breads. The glycaemic response curve, area under the curve (AUC), GI and GL for each bread were obtained. Considering glucose as reference, the classic breads (n=2) had high GI (71 %); the light (n=2), low (50 %) and medium (58 %) GI; and grains (n=4), low (44 and 49 %) and medium (57 and 60 %) GI. The light and grain breads had lower GI than the classic (p<0,05), which presented GI similar to white bread (control). As the same amount of available carbohydrates was consumed, the reduced proportion of soluble sugars in the light category breads seems to be a factor that induced the lower GI observed. In relation to the GL, one light bread (GL=10) and a grain bread (GL=7) were classified as low GL; the other whole meal breads (n=6) were classified as medium GL (11 to 16). All whole meal breads had lower GL than the control bread (GL=18) (p<0,05), and among the whole meal breads the ones in both light and grain categories presented the lower GL. Therefore, it was possible to observe variation on the glycaemic responses following the consumption of whole meal breads, the reduction in soluble sugar content, in the light breads, and the addition of whole grains, in the grain breads, favored lower elevation in the postprandial glycaemic response.

Pães integrais são alimentos de consumo habitual da população brasileira, porém há poucas informações a respeito da resposta glicêmica pós-prandial, O presente trabalho teve como objetivo avaliar a resposta glicêmica produzida, em indivíduos saudáveis, após o consumo de pães de fôrma rotulados como integrais. Oito pães de fôrma integrais de três categorias (clássico, light e com grãos) foram avaliados, após o consumo de porcão equivalente a 25 g de carboidratos disponíveis, através do índice glicêmico (IG) e carga glicêmica (CG). Os voluntários (n=15) compareceram ao laboratório em jejum (10 a 12 horas), pela manhã, em onze ocasiões (três dias para o consumo do pão controle e um dia para cada tipo de pão de fôrma integral). A glicemia foi determinada em jejum (t=0) e após o consumo de cada pão nos tempos: 15; 30; 45; 60; 90 e 120 minutos. A curva de resposta glicêmica, a área sob a curva (ASC) e o cálculo do IG e CG para cada um dos pães foram realizados. Considerando a glicose como referência, os pães integrais clássicos (n=2) apresentaram alto IG (71 %); os light (n=2), IG baixo (50 %) e médio (58 %) e; os com grãos (n=4), IG baixo (44 e 49 %) e médio (57 e 60 %). Os pães de fôrma light e com grãos apresentaram IG menor que os do tipo clássico (p<0,05), os quais apresentaram IG igual ao pão francês (controle). Como foi consumida a mesma quantidade de carboidratos disponíveis, a menor proporção de açúcar solúvel na categoria light parece ter sido o fator que induziu ao menor IG observado. Em relação à CG, um pão de fôrma integral light (CG=10) e outro com grãos (CG=7) foram classificados como baixa CG; os demais pães integrais (n=6) foram classificados como média CG (11 a 16). Todos os pães integrais apresentaram CG inferior a do pão controle (CG=18) (p<0,05) e entre os integrais novamente os da categoria light e com grãos foram os que apresentaram menor CG. Assim, foi observada variação na resposta glicêmica após o consumo de pães de fôrma integrais, sendo que a redução no conteúdo de açúcares solúveis, para os pães light, e a adição de grãos integrais, nos pães com grãos, favoreceram menor elevação da resposta glicêmica pós-prandial. / Whole meal breads are part of the habitual daily diet of the Brazilian population, but there is little information on the postprandial glycaemic response. The aim of this work was to evaluate the glycaemic response produced, in healthy volunteers, following the consumption of breads labeled as whole meal. Eight whole meal breads of three different categories (classic, light and grains) were evaluated, after the consumption of a portion containing approximately 25 g of available carbohydrates, using the glycaemic index (GI) and glycaemic load (GL). The subjects (n=15) attended to the laboratory after an overnight fasting (10 to 12 hours), in eleven different occasions (three days for the consumption of the control bread and a day for each whole meal bread). In every occasion, a portion of bread containing 25 g of available carbohydrate was consumed. Capillary blood samples were taken immediately before (t=0) and 15, 30, 45, 60, 90 and 120 minutes after the consumption of test breads. The glycaemic response curve, area under the curve (AUC), GI and GL for each bread were obtained. Considering glucose as reference, the classic breads (n=2) had high GI (71 %); the light (n=2), low (50 %) and medium (58 %) GI; and grains (n=4), low (44 and 49 %) and medium (57 and 60 %) GI. The light and grain breads had lower GI than the classic (p<0,05), which presented GI similar to white bread (control). As the same amount of available carbohydrates was consumed, the reduced proportion of soluble sugars in the light category breads seems to be a factor that induced the lower GI observed. In relation to the GL, one light bread (GL=10) and a grain bread (GL=7) were classified as low GL; the other whole meal breads (n=6) were classified as medium GL (11 to 16). All whole meal breads had lower GL than the control bread (GL=18) (p<0,05), and among the whole meal breads the ones in both light and grain categories presented the lower GL. Therefore, it was possible to observe variation on the glycaemic responses following the consumption of whole meal breads, the reduction in soluble sugar content, in the light breads, and the addition of whole grains, in the grain breads, favored lower elevation in the postprandial glycaemic response.

In the intensive care units, hyperglycaemia among the critically ill is associated with poor outcomes. Many studies have been done on managing hyperglycaemia in the critically ill. Patients in the ICU continue to benefit from the outcome of extensive studies including several randomized clinical trials on glycaemic control with intensive insulin therapy. Tight glycaemic control has now emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and cost. Although the debate on tight glycaemic control is on going, managing glycaemic level in ICUs is gaining widespread acceptance as the adverse effects are well known. However, in the less acute wards, to date there have only been a single randomized, controlled study to examine the benefit of glycaemic control. Patients in the less acute wards do not receive the same level of care, as glycaemic control is not regarded as important and not a priority. Glycaemic goals in the less acute wards are often judged based on clinical experience rather than adhering to a standard protocol or a treatment guideline. It is important that patients in the less acute wards received the level of care as practised in the ICU. If hyperglycaemia worsens outcome in the ICU, a similar effect is seen within less acute wards. Hence, tight glycaemic control needs to be extended in the less critical setting as well. To support the establishment of a control protocol for patients in less acute wards, a method that has been successful in the critical care and can be adapted to the less acute wards, is the model based or model-derived control protocol. Model-based protocol can deliver a safe and effective patient-specific control, which means the glycaemic control protocol can be devised to each individual patient. Hence, a physiological model that represents the glucose-insulin regulatory system is presented in this thesis. The developed model, Intensive Control Insulin-Nutrition-Glucose (ICING) is based on the best aspects of two previous clinically-validated glucose-insulin models.

The studies described in this thesis were undertaken to examine the factors affecting adolescents cognitive function across the school morning. Specifically, the effects of breakfast consumption, breakfast glycaemic index (GI) and a mid-morning bout of exercise were examined, whilst the final experimental chapter examined their combined effects. The battery of cognitive function tests used in the present study was administered via a laptop computer and took approximately 15 min to complete. Across all experimental chapters, the visual search test (assessing visual perception), the Stroop test (assessing attention) and the Sternberg paradigm (assessing working memory) were used. Furthermore, in chapter V the Flanker task (also assessing attention) was added to the testing battery. The first experimental study (chapter IV) examined the effects of consuming a self-selected breakfast on cognitive function, compared to breakfast omission. Ninety-six adolescents (12 to 15 years old) completed two experimental trials (breakfast consumption and breakfast omission), scheduled seven days apart, in a randomised crossover design. Following breakfast consumption, accuracy on the more complex level of the visual search test was higher than following breakfast omission (p = 0.021). Similarly, accuracy on the Stroop test was better maintained across the morning following breakfast consumption when compared with breakfast omission (p = 0.022). Furthermore, responses on the Sternberg paradigm were quicker later in the morning following breakfast consumption, on the more complex levels (p = 0.012). Breakfast consumption also produced higher self-report energy and fullness, lower self-report tiredness and hunger, and higher blood glucose concentrations, compared with breakfast omission (all p < 0.001). Overall, the findings suggested that breakfast consumption enhanced adolescents cognitive function, when compared with breakfast omission. The second experimental study (chapter V) examined the effects of consuming a high GI breakfast, a low GI breakfast and breakfast omission on cognitive function. Forty-one adolescents (12 to 14 years old) completed three experimental trials, each scheduled seven days apart, in a randomised crossover design. There was a greater improvement in response times across the morning following a low GI breakfast, compared to breakfast omission on the complex level of the Stroop test (p = 0.009) and both levels of the Flanker task (p = 0.041), and compared to following a high GI breakfast on the complex level of the visual search test (p = 0.025) and all levels of the Sternberg paradigm (p = 0.013). Furthermore, accuracy was enhanced following a low GI breakfast, compared to breakfast omission on the more complex levels of the visual search test (p = 0.032), Sternberg paradigm (p = 0.051) and Flanker task (p = 0.001), and compared to following a high GI breakfast on both levels of the Stroop test (p = 0.033) and the more complex levels of the Sternberg paradigm (p = 0.002) and Flanker task (p = 0.014). Furthermore, participants exhibited a lower glycaemic response following the low GI breakfast (p < 0.001), though there was no difference in the insulinaemic response (p = 0.063), compared to following the high GI breakfast. Overall, the findings suggest that a low GI breakfast is the most beneficial for adolescents cognitive function, compared with a high GI breakfast and breakfast omission. The third experimental study (chapter VI) examined the effects of a mid-morning bout of exercise, following a self-selected breakfast, on cognitive function. Forty-five adolescents (12 to 13 years old) completed two experimental trials (exercise and resting), scheduled seven days apart, in a randomised crossover design. There was a greater improvement in response times across the morning following the mid-morning bout of exercise on all levels of the Sternberg paradigm (p = 0.010). There was also a greater improvement in response times across the morning on the visual search test following the exercise (p = 0.009), but this improved speed was combined with a greater decrease in accuracy following the exercise (p = 0.044). This suggests that following exercise, the adolescents exhibited a speed-accuracy trade-off, whereby they responded quicker, but this was to the detriment of accuracy. Overall, the findings suggest that whilst the mid-morning bout of exercise improved some components of cognitive function (e.g. response times on the Sternberg paradigm), it did not affect other components (e.g. Stroop test performance). The final experimental study (chapter VII) examined the combined effects of breakfast GI and a mid-morning bout of exercise on adolescents cognitive function. Forty-two adolescents (11 to 13 years old) were allocated to matched high GI (n = 22) and low GI (n = 20) breakfast groups. Within the matched groups, participants completed two experimental trials (exercise and resting) in a randomised, crossover design. The findings indicate that, for the complex level of the Stroop test, following the high GI breakfast there was a greater improvement in response times across the morning on the resting trial, whereas following the low GI breakfast response times improved across the morning on both the exercise and resting trials, though the magnitude of the improvement was greatest on the exercise trial (p = 0.012). On the Sternberg paradigm, response times improved across the morning following the low GI breakfast regardless of exercise, whereas following the high GI breakfast response times improved across the morning on the exercise trial, though remained similar across the morning on the resting trial (p = 0.019). Overall, the findings suggest that the effects of the mid-morning bout of exercise were dependent upon the breakfast GI and the component of cognitive function being examined and that, for the Stroop test, the beneficial effects of the low GI breakfast and mid-morning bout of exercise were additive. Overall, the results from this thesis suggest that breakfast consumption is more beneficial than breakfast omission and more specifically, that a low GI breakfast is more beneficial than both a high GI breakfast and breakfast omission, for adolescents cognitive function across the school morning. However, the effects of exercise appear to be more variable, with the effect of exercise depending upon the component of cognitive function examined and the GI of the breakfast consumed. Overall, the findings presented in this thesis suggest that the nutritional effects on adolescents cognitive function (i.e. the effects of breakfast consumption and GI) were stronger and more consistent than the exercise induced effects.

Glucose is the primary fuel for the brain and also important for exercising muscle. The purpose of the thesis was to investigate the effects of the glycaemic index (GI) of mixed meals on appetite, cognitive performances and metabolic responses during intermittent exercise in recreationally active adults. Study one investigated whether a low GI (LGI) breakfast (GI = 42.5) could suppress appetite and reduce energy intake (EI) of 12 recreationally active females (28.2 ± 8.0 years) more than a high GI (HGI) breakfast (GI = 73.5). Area under the curve of the appetite score (AS AUC) following LGI breakfast was significantly greater than the HGI trial during the 60-min postprandial (pp) period (2568 ± 1027 vs. 2198 ± 821 mm∙min, p = 0.025). The HGI breakfast facilitated a stronger appetite suppressing effect up to eight hours post breakfast than the LGI trial (18834 ± 3906 vs. 21278 ± 3610 mm∙min, p = 0.028). The EI on the LGI trial day was significantly higher than on the pre-trial day (2,215 ± 576 vs. 1,748 ± 464 kcal, corrected p = 0.008). Fourteen recreationally active males (34.5 ± 8.9 years) in study two consumed the LGI (GI = 41.3) and HGI (GI = 74.3) breakfasts in the laboratory and then prescribed LGI and HGI meals in the free living environment. In line with study one, the AS AUC was significantly smaller following HGI than LGI breakfast over the 60-min pp period (2,989 ± 1,390 vs. 3,758 ± 1,290 mm∙min, p = 0.027). The HGI meals (GI = 76.9) suppressed appetite more than the LGI meals (GI = 39.6) over 12 hours on the trial day (35,454 ± 9,730 vs. 41,244 ± 8,829 mm∙min, p = 0.009) although energy balance was not different between trials. Study three investigated whether following a LGI breakfast (GI = 42.2) providing 1 g CHO kg-1 BM could result in a better vigilance and attention than a HGI breakfast (GI = 72.4), and reduced lunch EI in 16 recreationally active males (24.4 ± 3.6 years). A significant trial x time effect in the interference time of the Stroop Colour Word Task (SCWT) (p = 0.039) showed that the LGI breakfast maintained the attentional performance up to 90-min pp. Both high pre-task glucose concentration ([Glucose]) at 15-min pp and low pre-task [Glucose] at 105-min pp in the HGI trial were associated with unfavourable outcomes in vigilance in the Rapid Information Processing Task (RIPT). The LGI pre-task [Glucose] returning back to fasting level at 60-min pp was associated positively with the response time. The pre-lunch AS was a significant predictor of the lunch EI per fat free mass which explained 21% and 26% of variance in the LGI and HGI trials respectively. No significant difference was found in the ad libitum lunch EI between trials. Sixteen recreationally active males (27.8 ± 7.7 years) in study four consumed a LGI (GI = 42) and a HGI breakfast (GI = 72.8) providing 1.2 g CHO kg-1 BM consumed 60 minutes prior to intermittent running on two separate mornings. Better attentional performance at 150-min pp was found following LGI than HGI breakfast. The significant trial x time interaction in the SCWT (p = 0.045) showed the shortest interference time performed after the last exercise session in the LGI trial. The amounts of CHO and fat being oxidized were comparable between trials during three sessions of 16-min intermittent running with an average intensity of 65% V̇O2max. In conclusion, the pre-meal appetite sensation is more predictive of the subsequent meal EI than the pre-meal [Glucose]. The meal strategy for weight management in recreationally active adults may focus on greater appetite suppression by selecting HGI foods whilst maintaining healthy eating guidelines. Recreationally active males performing sports requiring high levels of vigilance and selective attention with low physical activity levels can benefit up to 60–90 min pp from the LGI breakfast. Their attentional performance can benefit from the LGI breakfast with moderate to high intermittent intensities in the late exercise period at 150–min pp. Recreationally active adults should consider the timing of meal consumption in relation to performing intermittent exercise, in order to maximize the advantages from the LGI or HGI breakfasts for cognitive performance or appetite suppression. They may be more liberal in pre-exercise food choices if substrate oxidation during intermittent running is only of their concern.

Many adolescents with type 1 diabetes (T1DM) have suboptimal glycaemic control, increasing the risk of diabetic complications. This thesis explores some of the causes, consequences and therapeutic options for adolescents with T1DM and poor glycaemic control. Insulin resistance occurs in T1DM and normal puberty and contributes to poor glycaemic control. The effect of rosiglitazone, an insulin sensitizer, in addition to insulin on the glycaemic control of adolescents with T1DM was tested using a randomized, double blind placebo controlled trial. Treatment with rosiglitazone did not improve HbA1c, however there was a significant reduction in insulin dose and adiponectin, suggesting improved in insulin sensitivity. Insulin sensitivity by euglycaemic hyperinsulinaemic clamp varied widely between individuals and there was no consistent pattern with rosiglitazone. Potential markers of insulin resistance in T1DM were examined. Total and high molecular weight (HMW) adiponectin levels were lower in children and adolescents with T1DM than controls. HMW adiponectin was significantly associated with other markers of insulin resistance, such as insulin dose, body mass index standard deviation score (BMI-SDS), age, pubertal stage and duration of diabetes. There is increasing evidence that insulin resistance may play a role in T1DM complications. The natural history and risk factors for the development of microalbuminuria was described using a retrospective cohort study of 972 children and adolescents. Most cases of microalbuminuria were transient. Apart from baseline albumin excretion rate, HbA1c and age at diagnosis, other predictors of subsequently developing persistent microalbuminuria included several markers of insulin resistance (higher cholesterol, BMI-SDS, and insulin dose). In addition to insulin resistance, there are many other factors that contribute to glycaemic control. The role of the variability in carbohydrate intake was assessed using questionnaires and food diaries. Although carbohydrate consumption varied by approximately 45grams each day, it had no significant correlation with HbA1c. The impact of socioeconomic status, quality of life and health care delivery is discussed by comparing glycaemic control of children with T1DM in three diabetes centres. A model for the factors associated with poor glycaemic control in adolescents with T1DM is proposed, and the challenges of research and clinical practice in this population are discussed.

Emphasis on using the glycaemic index (GI) in addition to carbohydrate exchange lists has led to a greater variety of foods from which to choose for the diabetic population. Breakfast is regarded as the most important meal of the day and the glycaemic response to lunch can be improved by decreasing the GI of breakfast. However, most conventional breakfast cereals and bread exhibit a high GI. Dried beans have a low GI and various processes such as cooking and canning increase GI values, but still in the low GI range. In recent years, extrusion cooking has become one of the popular new processes developed by the food industry. Extrusion provides a convenient alternative for the ingestion of dry beans in the diet. Muffins are eaten by many South Africans and may be an ideal alternative for breakfast cereals and bread, especially if the GI of the muffins is low. The aim of this study was to determine the GI of a muffin baked with extruded bean flour and compare it to the GI of a muffin baked with whole wheat flour. Subjects and methodology: The study cohort consisted of ten healthy males and ten healthy females. Subjects randomly consumed test meals of glucose (the reference), bean muffins and whole wheat muffins on different days. Each test meal provided 509 available carbohydrate as analysed by the Englyst method. Results: The GI of the muffin baked with extruded bean flour (mean 53.0%, Confidence intervals (CI): 41.7; 64.2) was not significantly different from that of the whole wheat muffin (mean 55.5%, CI: 41.8; 69.2) but still in the low to intermediate GI category. Conclusion: Extrusion of dried beans results in a fine flour with relatively no intact starch which may explain the very low resistant starch content (1.6I100g) of the muffins. The small particle size of the fine flour could further have contributed to the higher than expected GI of the bean muffin because the size of the particle is inversely related to glycaemic response. Muffins baked with extruded dried bean meal are nevertheless regarded as an excellent choice for breakfast and as part of the prudent diet. Beans have additional health benefits and are included in the South African Food Based Dietary Guidelines. / Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2004.