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.

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.

Thesis (MTech (Food Technology))--Cape Peninsula University of Technology, 2013. / Acha starch was isolated and purified from clean and milled acha grain. Functional, thermal and physicochemical properties of acha starch were analysed using appropriate methods. Wheat starch was used as the reference standard. Acha bread from acha grain was baked and the consumer sensory acceptability was evaluated and white wheat bread was used as the reference standard. The effect of baking, boiling, steaming and microwaving on the starch and glycemic properties of the acha starch was evaluated. With regard to thermal properties, gelatinisation temperature of acha and iburu starches typifies that of waxy starch. Acha starch has similar retrogradation temperature profiles as that of wheat. There were however significant differences in some of the functional properties (pasting and turbidity) and physico-chemical properties (in vitro starch digestibility), but no significant difference in the texture profile analysis (TPA) and water binding capacity (WBC). WBC of both acha varieties was higher than that for wheat starch. Due to its high break down viscosity, white acha starch can be included in foods that are subjected to high temperature processing. This indicates that both acha starch varieties can be used for hot and cold desserts as well as for soft jelly like sweets and confectionery toppings. A prescreening exercise using carboxymethyl cellulose (CMC), Xanthan gum, yeast and acha starch as the variables was successful in concluding a recipe which rendered acha bread with the optimum specific loaf volume for both white and black acha bread. The optimum recipe consisted 8.0 % acha starch, 2.0 % xanthan gum, 2.0 % CMC and 1.0 % yeast. The majority of the consumer panellists found the crust colour, taste and aroma to be moderately desirable. This implies that most consumers find acha bread to have the potential to be marketed as wheat free bread. The different processing methods baking, boiling, microwaving and steaming, affected the black and white acha starch hydrolysis. The amount of starch hydrolysed for the different processing methods was in the following order: baking > boiling > microwaving > steaming. It can thus be concluded that different processing methods affects the micro structure and physical properties of the acha and wheat samples which thus influence their starch hydrolysis. The equilibrium percentage of starch hydrolysed after 180 min incubation was affected differently for the various starches, black acha, white acha and wheat starch by the different processing methods and times. In the case of baking black acha starch and wheat bread were affected similarly. However, this was not the case for microwaving, steaming and boiling, where both acha starch varieties and wheat starch were affected in the same way. The rate of starch hydrolysis for both acha varieties and wheat grain for the different processing methods, steaming, boiling, microwaving and baking was affected to the same degree respectively.

Introduction: The global burden of diabetes can be minimised by interventions focusing on the control of glucose levels. Effective self-management and quality of care have improved diabetes outcomes such as glycaemic levels. However, few studies directly evaluate the relative importance of individual aspects of self-management and quality of care on glycaemic control. Therefore, I evaluated the individual contribution and relative importance of specific aspects of self-management and quality of care on the glycaemic control of Mexican patients with type 2 diabetes. Methods: A longitudinal cohort study was conducted. Consecutive patients were recruited from the waiting rooms in five primary care practices in the city of Aguascalientes, Mexico (from December 2009 to April 2010). These practices are part of the largest social security institution in Mexico (the Mexican Institute for Social Security). Predictors of glycaemic control were measured from medical records and interviews with patients at baseline. Self-management was measured using four questionnaires: the Diabetes Knowledge Questionnaire (DKQ-24), the Medical Prescription Knowledge Questionnaire (MPKQ), the Summary of Diabetes Self-Care Activities (SDSCA), and the Diabetes Self Efficacy Scale. Quality of care was measured using three questionnaires and by extracting data from medical records to evaluate an index of continuity of care (MMCI) and treatment intensification. The questionnaires used were the continuity of care scale from the General Practice Assessment Questionnaire (GPAQ), the Patient–Doctor Communication Scale (PDCS), and the Patient Satisfaction with Diabetes Care scale (PSDC). Glycaemic control (HbA1c levels) was measured at two time points: baseline and six month follow-up. The main analysis was a multivariate regression model with HbA1c at six-month follow-up as the dependent variable and with self-management and quality of care as predictors and demographic and clinical factors as covariates. A secondary analysis considered the interaction between self-management and quality of care in the prediction of HbA1c at six-month follow-up using a multivariate regression model including HbA1c at baseline in the model. Results: The multivariate linear regression model, that included all variables, was significant and explained 36 % of the variance (P <0.01). Patients had lower HbA1c at follow-up if they had lower levels of HbA1c at baseline, received care at one particular practice in the city, had diabetes of shorter duration, and were prescribed monotherapy. When HbA1c at baseline was removed from the model it explained 14% of the variance (P <0.01). Practice and medical prescription remained significant. In addition, lower levels of HbA1c at follow-up were related to the patient undergoing appropriate treatment intensification by their general practitioner. In the secondary analysis, the interaction showed that if treatment was not intensified, good self-managers had lower HbA1c (P <0.01) but if treatment was intensified, the level of self-management had no effect. Conclusions: Treatment intensification was the main predictor of lower HbA1c levels at follow-up. Although none of the self-management predictors was significantly related to HbA1c, an exploratory analysis of self-management/quality of care interactions showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up.

Magister Chirurgiae Dentium (MChD) / Chronic inflammation of the periodontium is known as periodontal disease. The inflammation can be contained only within gingival connective tissue or can progress, leading to the loss of gingival connective tissue and alveolar bone. Lately, periodontal disease is considered as a co-morbidity of diabetes mellitus (Polak, Sanui et al., 2020). Though studies that have assessed the relationship of periodontal status with the glycemic control in type 1 diabetes mellitus adolescents, such studies have not been conducted in South Africa.

The glycaemic index (GI) is a measurement used to classify foods according to their potential for raising blood glucose levels. The GI of a foodstuff is generally measured by determining the increment in blood glucose concentration after the consumption of a test meal over a set period of time and comparing it with an isoglucosidic control meal (normally white bread or glucose) and expressed as a percentage within a group of individuals (in vivo). Rapid analysis methods (in vitro) are being developed and evaluated worldwide, and in many cases the values obtained have correlated well with the GI values determined by in vivo methods. The criticism against rapid analysis methods is that the methods do not provide numerical GI values. Proposed labelling legislation in South Africa recommends that suppliers should only indicate if the product has a high, intermediate or low GI. The purpose of this study was to investigate existing rapid assessment methods for the prediction of GI, and develop such a method for South Africa to be used by food producers as a screening tool during product development in line with the newly proposed national labelling requirements. The preliminary studies on the developed rapid assessment method indicated good repeatability (CV 0.78%), reproducibility and precision (CV 3.5%). Further comparative trials indicated that the in vitro method accurately predicts the GI category of Almera potatoes (Solanum Tuberosum L. cultivar Almera) and Gero fat free litchi and raspberry flavoured yoghurt, in line with results found from in vivo analysis. Significant inter-laboratory variability of in vivo analysis of GI values obtained for the Almera potato cultivar was found, and the need for future alignment of methodology and sample preparation is recommended./p> / Dissertation (MSc)--University of Pretoria, 2010. / Food Science / unrestricted

The principle aims of this work were two fold; firstly to identify the current dietary intakes (specifically dietary glycaemic carbohydrate (CHO)) and physical activity (PA) and cardiorespiratory fitness (CRF) levels of a UK, postpubertal, adolescent population (n = 105) and assess the relationship between these factors, adiposity and cardiometabolic health. Diet and health relationships were assessed whilst accounting for energy misreporting and controlling for levels of PA and CRF. The effect of excluding dietary misreporters on the associations between glycaemic CHO and health was assessed whilst comparing an established technique (the Goldberg equation) to a novel approach (the ratio of energy intake (EI) to energy expenditure (EE)), which utilised RT3 accelerometry data (EI:EE(RT3)). Associations of PA and metabolic risk factors were also assessed whilst comparing two child specific PA thresholds for the assessment of PA subcomponents. Secondly, the impact of a flexible, ad libitum, low GI dietary intervention on cardiometabolic health was examined in an „at risk‟, overweight, postpubertal, adolescent population. Glycaemic index (GI) but not glycaemic load (GL) was shown to be associated significantly with anthropometric measures (body mass index (BMI), waist circumference (WC)) and adiposity (body fat percentage (BF%)) in this general group of post-pubertal adolescents from Bedfordshire. When adjusting for dietary intake, CRF was also associated with adiposity but PA was not. The prevalence of misreporting varied depending on the method used to assess the validity of dietary intakes; between 23% and 31% increasing to 62.1% (in overweight) of adolescents under reported energy intakes and up to 11.1% over reported. The novel application of a triaxial accelerometer to measure EE resulted in more under and over reporters being identified than when compared to the widely used Goldberg equation. Increased dietary GI was associated with increased odds of having a high WC; however, associations between GL and other risk factors were less clear; no associations with risk were observed. Excluding dietary misreporters from analysis had important implications for these associations. Only after removal of misreporters by EI:EE(RT3) was a borderline significant positive association between GL and blood glucose (BG) revealed using multiple analysis of covariance (MANCOVA), that was not present in prior analyses. Increased GI (moderate vs low GI intake) was significantly associated with reduced high density lipoprotein cholesterol (HDL) and increased triglyceride (TG) levels (borderline significant) after removal of misreporters. In addition, using different PA thresholds to assess PA intensity resulted in different relationships between PA subcomponents and metabolic risk factors. Regardless of the threshold used, evidence suggested that limiting sedentary (SED) behaviour and engaging in moderate to vigorous PA (MVPA) is beneficial for blood pressure (BP) in this adolescent population. Additionally, irrespective of the threshold utilised, higher levels of vigorous PA (VPA) were associated with reduced odds of having a high clustered risk score and the associations observed between CRF and risk factors were stronger than those observed with PA. Despite a lack of significant improvement in individual metabolic risk factors as a result of the low GI (LGI) dietary intervention, there was a significant reduction in clustered risk score for the LGI group at week 12. A borderline significant improvement in glycated haemoglobin (HbA1c) was also observed as a result of the LGI intervention compared to those in the control group. Conversely, there appeared to be an unfavourable effect of the LGI diet on fasting insulin levels and thus the diet‟s impact on health overall is unclear. The small sample size of this randomised controlled trial (RCT) means that caution is required when interpreting the results. These data suggest that future research in this age group should target improvements in CRF and a lower dietary GI to reduce adiposity. Controlling for dietary misreporting appears to have a significant impact on associations of glycaemic CHO and cardiometabolic health and should be an important consideration of future research. The low GI intervention may be an effective approach for reducing glycaemic CHO, whilst maintaining a healthy macronutrient intake, in comparison to more restricted dietary regimens published in the literature. However, the impact of this regime needs to be confirmed utilising a larger sample of adolescents. This may provide a useful approach for future research aiming to assess the impact of reduced GI and GL.

In recent years our understanding of the physical demands of soccer has improved. We know that the intensity at which the game is played has increased and that the fixture schedules for professional teams can often be very congested. These factors are likely to have increased the importance placed on the physical condition of players. Therefore, the process of monitoring the fitness levels of players is likely to be an important task within clubs. Any fitness assessments that are employed need to be sensitive enough to detect changes that may result from different training stimuli. A further critical consideration for clubs is what are the best practices to implement in order to maximise recover between matches? The two areas that are central to successful recovery of performance are the restoration of muscle and liver glycogen stores and the rapid reduction of muscle soreness. We have a good understanding of the importance of carbohydrate feeding in the immediate hours following the completion of exercise, furthermore that high levels of carbohydrate consumed during short recovery periods can improve subsequent endurance running capacity in both continuous and intermittent exercise. However, there is dearth of literature investigating the effects that different types (glycemic index) of carbohydrates have on subsequent performance of high intensity intermittent exercise. Furthermore, we know that the movement patterns experienced in soccer commonly induce symptoms of muscle damage. Despite this there is little research based information on modalities that reduce these potentially detrimental side-effects (Bamett, 2006). For these reasons the series of investigations that have been conducted in this thesis were designed with the intent to examine areas that are critical to the preparation and recovery of soccer players. The first of five experimental chapters collated information on the use of fitness testing within English professional football. It was concluded that the practise of fitness testing players is extremely commonplace and that field-based testing protocols were far more popular an assessment method. The second experimental chapter went on to demonstrate that the most commonly used fitness test within professional football (MSFT) was sensitive enough to detect performance changes that occur as a result of training. A further finding within the context of the question was that it is possible for female players to significantly improve aerobic capabilities with additional high intensity aerobic training. The third experimental chapter investigated the effect different glycemic index high CHO diets could have on recovery of performance following 90 min of intermittent soccer type exercise. This study concluded that consuming either predominately high or low GI CHO mixed meals in the 24h recovery period between bouts of high intensity prolonged intermittent exercise had no difference on measures of performance. The final two experimental chapters went on to investigate the effects of cold water immersion on indices of muscle damage following intermittent exercise. Results from these investigations suggest that submerging individuals in 10°C water immediately following high intensity intermittent exercise reduces some but not all indices of muscle damage. In summary, fitness assessments of players are commonly made within professional football clubs. The most common test used was the MSFT and this appears to be sensitive to changes that result as a consequence of training. During recovery from high intensity intermittent exercise the importance of carbohydrates is apparent although the type of carbohydrate appears to be less important, furthermore, cold-water immersion may be effective in reducing some but not all indices of muscle damage.

Introduction Patients with serious psychiatric disorders have an increased morbidity and mortality in somatic diseases and elevated prevalence of both diabetes and prediabetes. This increased frequency of somatic diseases is believed to be associated with life style choices and side effects of the antipsychotic medication. Aim In our study we investigated the prevalence of diabetes and prediabetes and compared metabolic risk factors and treatments between patients with and without serious psychiatric disorders in patients with diabetes in Region Örebro County (RÖC). Material and methods The prevalence of diabetes and prediabetes was determined in 944 patients identified from psychiatric outpatient clinics in RÖC. Information about risk factors and treatments were acquired by retrospective examination of medical records. Results Diabetes was identified in 113 patients and prediabetes in 42 patients. In patients with diabetes and serious psychiatric disorders men had significantly higher levels of HbA1c (p&lt;0.01) and creatinine (p&lt;0.01) compared to women, whereas women had higher BMI (p&lt;0.05). No significant differences in HbA1c and BMI were found between patients with psychiatric disorders and all patients in RÖC with diabetes. Patients with psychiatric disorders did however have a significantly higher number of current smokers and a lower prescription of antihypertensive medication. Conclusions The prevalence of diabetes and prediabetes were 12.0% and 4.4%, respectively, in patients with serious psychiatric disorders. Our study indicates no difference in glycaemic control between psychiatric and non-psychiatric patients with diabetes, but there are differences in certain risk factors connected to diabetes.

The metabolic syndrome is a cluster of disorders (obesity, dyslipidaemia, hyperinsulinaemia and hypertension) which individually or collectively lead to an increase in the risk of cardiovascular disease. Over the years it has been associated with endothelial dysfunction, raised markers of chronic inflammation, insulin resistance and clotting dysregulation. Studies have shown that the prevalence of the metabolic syndrome in adults over the age of 20 years to be 24%, with approximately 12 million adults within the United Kingdom fulfilling the criteria for diagnosis. Numbers of individuals with the metabolic syndrome continue to rise following population trends of increasing sedentary lifestyle, high calorie intake, smoking, and stress. Associated is an increase in obesity, type 2 diabetes, cardiac disease, stroke and death. The increase is such that we can no longer be complacent about how we address the metabolic syndrome or its associated components. The management of the metabolic syndrome is varied and includes alterations in diet, physical exercise, and oral medication. It is well documented that a 10% reduction in weight leads to reductions in lipid abnormalities, diabetes and diabetes-related deaths, other total morbidity and deaths. Many dietary regimens have been postulated to benefit not only weight gain but improve cardiovascular risk. To address this we investigated the effect three different diets (low fat; low carbohydrate, high fat; and low glycaemic load) had on the metabolic syndrome to assess whether it is the changes in dietary caloric or macronutrient intake, or overall weight loss that had the greater influences on those aspects of metabolic syndrome which could potentially reduce cardiovascular risk.