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Glycemic and Insulinemic Responses to Pumpkin and Unripe Papaya in Type 2 Diabetic Subjects

Kaniz Fatema*
Bangladesh Institute of Health Sciences (BIHS), 125/1, Kallayanpur, Darussalam, Mirpur-1216, Dhaka, Bangladesh.

Farzana Rahman
Bangladesh Institute of Health Sciences (BIHS), 125/1, Kallayanpur, Darussalam, Mirpur-1216, Dhaka, Bangladesh.

Nurunnahar Sumi
Bangladesh Institute of Health Sciences (BIHS), 125/1, Kallayanpur, Darussalam, Mirpur-1216, Dhaka, Bangladesh.

Liaquat Ali
Bangladesh Institute of Health Sciences (BIHS), 125/1, Kallayanpur, Darussalam, Mirpur-1216, Dhaka, Bangladesh.

Khadizatul Kobura
Bangladesh Institute of Health Sciences (BIHS), 125/1, Kallayanpur, Darussalam, Mirpur-1216, Dhaka, Bangladesh.

Abstract/ Executive Summary:

Glycemic and Insulinemic responses to pumpkin and unripe papaya by estimating their glycemic index (GI) and insulinemic index (measured by c-peptide) from Bangladeshi origin were investigated in T2DM patients. Based on serving size in the Bangladeshi society, the GL of those two food items were also calculated. Ten T2DM subjects, under a cross-over design, consumed equi-carbohydrate amount (25g of total carbohydrate) of the vegetables and WB (white bread, as reference food), with a run in period of 7 days between the consecutive items. Serum levels of glucose were estimated at 0, 15, 30, 45, 60, 90, 120, 150 and 180 min, respectively, and c-peptide levels were at 0 and 180 min only. GI and GL were calculated by standard formulas. Unripe papaya showed significant lower serum glucose response compared to that of bread and pumpkin. The GI of pumpkin and unripe papaya were 74 ± 42 and 23 ± 7, respectively. The substantially lowered glycemic response and GI values in pumpkin and unripe papaya were not paralleled by an increased insulin response. The GL of Pumpkin and unripe papaya were 6.4 and 1.5, respectively. As judged against the mean values of the international table, pumpkin of Bangladeshi origin is a high GI and unripe papaya is a very low GI food. However, from the dietary practices in Bangladeshi society, pumpkin and papaya may be used as a low and very low GL food respectively.

Keywords: Diet, Vegetable, Unripe papaya, Pumpkin, Type 2 diabetes mellitus, Glycemic index, Glycemic load.

Location: Department (OPD) of Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM)

Start Date:

End Date:

Program Area: Resource Development and Management

Commodity: Papaya, Pumpkin

Objectives:

The present study was designed to explore these responses for pumpkin and unripe papaya consumed as vegetable (with only boiled preparation) in Bangladeshi type 2 diabetes mellitus subjects.

Methodology:

Subjects Subjects were selected from out patients department (OPD) of Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM). A total number of ten T2DM subjects (6 males and 4 female) took part in the study. Diabetes was diagnosed and classified by the WHO criteria. The mean (±SD) of plasma HbA1c level was < 8%. Exclusion criteria of the study subject were those suffering from acute and chronic complications of DM using oral contraceptives, steroids, diuretics and insulin, at the pregnant stage and those suffering from any other illness revealed on clinical examinations. Subjects were requested to maintain their usual daily food intake and activity throughout the study period. The purpose and protocol of the study were explained to the subjects and written consent was obtained. Tested foods and its preparation The study included 2 test meals (pumpkin and unripe papaya) and white bread (WB) as reference food. Both test foods and reference food consisted of 25 g available carbohydrates. To get 25 g available carbohydrate weight of white bread, pumpkin and unripe papaya were 39, 258 and 438 g, respectively. For test food, fresh pumpkin and papaya were purchased from the local Dhaka city market in bulk quantities sufficient to conduct all tests, Pumpkin and unripe papaya were first washed, weighed (258 and 438 g, respectively) and then steamed with water for 5 min. The steamed samples were then taken into a plate. The test meals were served at room temperature. The nutrient composition of the test meals is shown In Table 2. As reference food freshly baked bread was sliced and portioned to the calculated weight (39 g). Each portion was bagged individually and stored frozen. On the days of trial, white bread portions were removed from the freezer 45 min before serving and allowed to thaw at room temperature. Experimental procedure On the first day after selection and taking of consent detailed sociodemographic data, family history of the patients and medical history were taken and physical and clinical examinations were done on the first day of visit using a pre-tested questionnaire. Anthropometric measurements included height, weight; waist circumference and hip circumference were taken. Thereafter, subjects were required to go through the study protocol on four separate occasions (one trial for test food and two repeated trial for the reference food) in the morning after a 10 to12 h overnight fasting and advised not to take any kind of medicine or smoke on the previous day except the prescribed one. The test of the reference food was repeated once in order to obtain at least two values in each subject, thus the precision was improved (Brouns et al., 2005). Test and reference meals were given to patients under a cross-over design with a wash out period of 7 days to avoid the ‘second meal effect’ (Wolever et al., 1988). Patients were advised to rely on recommended standard carbohydrate diet and also instructed not to eat legumes in the meal preceding the fast. An intravenous cannula was inserted into a superficial vein in the forearm on the day of experiment, drawing the fasting (0 h) blood sample of the patient, subjects were requested to consume the test food with 250 ml plain water (during the protocol of the test potato) or the glucose in 250 ml water (during the protocol of the reference food) in random order at a comfortable place within 10 min. Further blood samples were drawn at 15, 30, 45, 60, 90, 120, 150 and 180 min after the initial intake of sample. Patients took their prescribed medicine at the beginning of the meal. All the information and data obtained were recorded in a predesigned Case Record Form. Blood sample was allowed to centrifuge at 3000 rpm for 15 min. The plasma separated was allocated in the labeled eppendrof tubes and preserved at −70°C until biochemical analysis. C-peptideGlucose ratio was calculated with calculating values of glucose and C-peptide in study participants at zero and 180 min. These ratio evaluated C-peptide (equivalent to insulin) status of the patients in response to their glucose responses after ingestion of test foods. Laboratory method Serum glucose was estimated by glucose-oxidase (GOD-PAD) method using reagents from SERA PAK, USA (Trinder, 1969). Insulin (measured by c-peptide as a marker of insulin) was determined by ELISA method using kits from DRG Diagnostics (Germany) and glycosylated hemoglobin (HbA1c) was measured by high-performance liquid chromatography (HPLC) method Ethical consideration The protocol was approved by the Ethical Review Committee of the Diabetic Association of Bangladesh (BADAS). Statistical analysis All analysis were done using the statistical package for social science (SPSS) software for Windows. The incremental areas under the curve (iAUC) was calculated by the standardized criteria (Wolever et al., 1991), ignoring any area below the baseline. The average iAUC for the two white bread tests was used as the reference value and each subject’s individual GI for each food was calculated. To compare THE difference between Means, ANOVA (bonferroni test) was performed where appropriate. All parametric variables were expressed as M ± SD and non-parametric data were expressed in percentage value. P < 0.05 was considered as the statistically significant.

Article Link (Online Journal): Available online http://www.academicjournals.org/ijnam

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

The GL of Pumpkin and unripe papaya were 6.4 and 1.5, respectively. As judged against the mean values of the international table, pumpkin of Bangladeshi origin is a high GI and unripe papaya is a very low GI food. However, from the dietary practices in Bangladeshi society, pumpkin and papaya may be used as a low and very low GL food respectively

Knowledge Management: Journal