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The effect of postprandial glycaemia on cognitive function – response to Young and Benton

Published online by Cambridge University Press:  05 June 2020

Olivia M. Marchand
Affiliation:
Department of Human Nutrition, University of Otago, Dunedin, New Zealand
Fiona E. Kendall
Affiliation:
Department of Human Nutrition, University of Otago, Dunedin, New Zealand
Charlene M. Rapsey
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
Jillian J. Haszard
Affiliation:
Department of Human Nutrition, University of Otago, Dunedin, New Zealand
Bernard Venn*
Affiliation:
Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Abstract

Type
Letter to the Editor
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society

We would like to thank Young and Benton for their interest in our work. With reference to our study(Reference Marchand, Kendall and Rapsey1), of the 98·8 g total available carbohydrate in the trifle, 60·4 g came from the added sugars (sucrose or isomaltulose). For glycaemic index (GI) testing, in which 50 g of available carbohydrate was used, this equated to 30·6 g of the test sugars. We acknowledge that the difference of 11 GI units between trifles was relatively small, but the design was not based on maximising a difference in GI. This study was designed as a practical experiment using the principle of replacing high-GI with low-GI ingredients as suggested by the Glycemic Index Foundation(2). The relatively small difference in GI may have had an influence on the outcome, but we have also compared cognitive test scores to the same sugars ingested as sugar-sweetened beverages, thereby maximising the difference in GI between these sugars (33 GI units), and found no effect on cognitive outcomes(Reference Keesing, Mills and Rapsey3). Young and Benton suggest that we did not consider interpersonal variability in glycaemic response. We are well aware of inter- and intra-individual variability in glycaemic response and have published on the subject with a view to improving reliability(Reference Williams, Venn and Perry4). However, Young and Benton appear to overlook that our study had a crossover design which controls for an individual’s glucose tolerance status. The crossover design also addresses the comment regarding the vegan alternative.

In practice, people eat foods and meals with all of the attendant nutrient interactions and our study was designed as a practical experiment. Again though, in our previous study with sugar-sweetened beverages in which no nutrient interactions were present, there was no differential effect on cognitive performance following ingestion of the sucrose- and isomaltulose-sweetened beverages(Reference Keesing, Mills and Rapsey3).

The rationale for measuring cognitive outcomes over a 2-h period was explained in the Introduction of our article. The difference in glycaemic response to food is greatest during this time period allowing sufficient time for exogenous glucose to cross the blood–brain barrier(Reference Abi-Saab, Maggs and Jones5). Our aim was to test cognitive performance under different prevailing blood glucose concentrations. We note that differences in memory have been found over longer test durations but that there are heterogenous findings(Reference Nilsson, Radeborg and Bjorck6).

There may be dietary aspects that affect cognitive performance and we would be very interested to read of developments in this area. However, if the purpose is to assess the impact of postprandial glycaemia on cognitive performance, then we would hope that strong trial designs are used to isolate the glycaemic response from other design factors.

Acknowledgements

The authors declare they have no conflicts of interest.

References

Marchand, OM, Kendall, FE, Rapsey, CM, et al. (2020) The effect of postprandial glycaemia on cognitive function: a randomised crossover trial. Br J Nutr 123, 13571364.CrossRefGoogle Scholar
Glycemic Index Foundation. https://www.gisymbol.com/swap-it/ (accessed May 2020).Google Scholar
Keesing, C, Mills, B, Rapsey, C, et al. (2019) Cognitive performance following ingestion of glucose-fructose sweeteners that impart different postprandial glycaemic responses: a andomised control trial. Nutrients 11, 2647.CrossRefGoogle Scholar
Williams, SM, Venn, BJ, Perry, T, et al. (2008) Another approach to estimating the reliability of glycaemic index. Br J Nutr 100, 364372.CrossRefGoogle ScholarPubMed
Abi-Saab, WM, Maggs, DG, Jones, T, et al. (2002) Striking differences in glucose and lactate levels between brain extracellular fluid and plasma in conscious human subjects: effects of hyperglycemia and hypoglycemia. J Cereb Blood Flow Metab 22, 271279.CrossRefGoogle ScholarPubMed
Nilsson, A, Radeborg, K & Bjorck, I (2009) Effects of differences in postprandial glycaemia on cognitive functions in healthy middle-aged subjects. Eur J Clin Nutr 63, 113120.CrossRefGoogle ScholarPubMed