Skip to main content Accessibility help

Efficacy of fibre additions to flatbread flour mixes for reducing post-meal glucose and insulin responses in healthy Indian subjects

  • Hanny M. Boers (a1), Katrina MacAulay (a2), Peter Murray (a2), Rajendra Dobriyal (a3), David J. Mela (a1) and Maria A. M. Spreeuwenberg (a1)...


The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide, including in developing countries, particularly in South Asia. Intakes of foods generating a high postprandial glucose (PPG) response have been positively associated with T2DM. As part of efforts to identify effective and feasible strategies to reduce the glycaemic impact of carbohydrate-rich staples, we previously found that addition of guar gum (GG) and chickpea flour (CPF) to wheat flour could significantly reduce the PPG response to flatbread products. On the basis of the results of an exploratory study with Caucasian subjects, we have now tested the effect of additions of specific combinations of CPF with low doses of GG to a flatbread flour mix for their impacts on PPG and postprandial insulin (PPI) responses in a South-Asian population. In a randomised, placebo-controlled full-cross-over design, fifty-six healthy Indian adults consumed flatbreads made with a commercial flatbread mix (100 % wheat flour) with no further additions (control) or incorporating 15 % CPF in combination with 2, 3 or 4 % GG. The flatbreads with CPF and 3 or 4 % GG significantly reduced PPG (both ≥15 % reduction in positive incremental AUC, P<0·01) and PPI (both ≥28 % reduction in total AUC, P<0·0001) compared with flatbreads made from control flour. These results confirm the efficacy and feasibility of the addition of CPF with GG to flatbread flour mixes to achieve significant reductions in both PPG and PPI in Indian subjects.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Efficacy of fibre additions to flatbread flour mixes for reducing post-meal glucose and insulin responses in healthy Indian subjects
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Efficacy of fibre additions to flatbread flour mixes for reducing post-meal glucose and insulin responses in healthy Indian subjects
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Efficacy of fibre additions to flatbread flour mixes for reducing post-meal glucose and insulin responses in healthy Indian subjects
      Available formats


Corresponding author

* Corresponding author: H. M. Boers, fax +31 10 460 5993, email


Hide All
1. Hu, FB (2011) Globalization of diabetes. The role of diet, lifestyle and genes. Diabetes Care 34, 12491257.
2. International Diabetes Federation (2011) Guideline for management of postmeal glucose in diabetes. Brussels, Belgium: International Diabetes Federation.
3. Wachters-Hagedoorn, RE, Priebe, MG, Heimweg, JAJ, et al. (2007) Low-dose acarbose does not delay digestion of starch but reduces its bioavailability. Diabet Med 24, 600606.
4. Chiasson, JL, Josse, RG, Gomis, R, et al. (2002) Acarbose for prevention of type 2 diabetes mellitus: The STOP-NIDDM randomised trial. Lancet 359, 20722077.
5. Thomas, D & Elliott, EJ (2009) Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. The Cochrane Database of Systematic Reviews, issue 1, Art. No.: CD006296.
6. Blaak, EE, Antoine, JM, Benton, D, et al. (2012) Impact of postprandial glycaemia on health and prevention of disease. Obes Rev 13, 923984.
7. Van De Laar, FA, Lucassen, PLBJ, Akkermans, RP, et al. (2006) Alpha-glucosidase inhibitors for people with impaired glucose tolerance or impaired fasting blood glucose. The Cochrane Database of Systematic Reviews, issue 4, Art. No. CD005061.
8. Schnell, O, Mertes, G & Standl, E (2007) Acarbose and metabolic control in patients with type 2 diabetes with newly initiated insulin therapy. Diabetes Obes Metab 9, 853858.
9. European Food Safety Authority Panel on Dietetic Products Nutrition and Allergies (2012) Guidance on the scientific requirements for health claims related to appetite ratings, weight management, and blood glucose concentrations. EFSA Journal 10, 2604.
10. Lafiandra, D, Riccardi, G & Shewry, PR (2014) Improving cereal grain carbohydrates for diet and health. J Cereal Sci 59, 312326.
11. Henry, CJK & Kaur, B (2014) Diet-based management and treatment of diabetes. In World Clinics – Diabetologia – Type 2 Diabetes Mellitus, pp 119 [V Mohan and R Unnikrishnan, editors]. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.
12. Khawaja, KI, Fatima, A, Mian, SA, et al. (2012) Glycaemic, insulin and ghrelin responses to traditional South Asian flatbreads in diabetic and healthy subjects. Br J Nutr 108, 18101817.
13. Jenkins, DJA, Kendall, CWC, Axelsen, M, et al. (2000) Viscous and nonviscous fibres, nonabsorbable and low glycaemic index carbohydrates, blood lipids and coronary heart disease. Curr Opin Lipidol 11, 4956.
14. Marciani, L, Gowland, PA, Spiller, RC, et al. (2001) Effect of meal viscosity and nutrients on satiety, intragastric dilution, and emptying assessed by MRI. Am J Physiol Gastrointest Liver Physiol 280, G1227G1233.
15. Woerle, HJ, Albrecht, M, Linke, R, et al. (2008) Importance of changes in gastric emptying for postprandial plasma glucose fluxes in healthy humans. Am J Physiol Endocrinol Metab 294, E103E109.
16. Blackburn, NA, Redfern, JS, Jarjis, H, et al. (1984) The mechanism of action of guar gum in improving glucose tolerance in man. Clin Sci (Lond) 66, 329336.
17. Edwards, CA, Johnson, IT & Read, NW (1988) Do viscous polysaccharides slow absorption by inhibiting diffusion or convection? Eur J Clin Nutr 42, 307312.
18. Goni, I & Valentin-Gamazo, C (2003) Chickpea flour ingredient slows glycemic response to pasta in healthy volunteers. Food Chem 81, 511515.
19. Thondre, PS & Henry, CJK (2009) High-molecular-weight barley beta-glucan in chapatis (unleavened Indian flatbread) lowers glycemic index. Nutr Res 29, 480486.
20. Radhika, G, Sumathi, C, Ganesan, A, et al. (2010) Glycaemic index of Indian flatbreads (rotis) prepared using whole wheat flour and atta mix-added whole wheat flour. Br J Nutr 103, 16421647.
21. Boers, HM, MacAulay, K, Murray, P, et al. (2016) Efficacy of different fibres and flour mixes in South-Asian flatbreads for reducing post-prandial glucose responses in healthy adults. Eur J Nutr (Epublication ahead of print version 21 June 2016).
22. Mohanan, C, Nediyedath, SK & Shanmugam, A (2013) Wheat flour composition. Publication number: US20130209648 A1.
23. Tosh, SM (2013) Review of human studies investigating the post-prandial blood-glucose lowering ability of oat and barley food products. Eur J Clin Nutr 67, 310317.
24. Wanders, AJ, van den Borne, JJGC, De, GC, et al. (2011) Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev 12, 724739.
25. Li, SS, Kendall, CWC, De Souza, RJ, et al. (2014) Dietary pulses, satiety and food intake: a systematic review and meta-analysis of acute feeding trials. Obesity 22, 17731780.
26. Blundell, J, De, GC, Hulshof, T, et al. (2010) Appetite control: methodological aspects of the evaluation of foods. Obes Rev 11, 251270.
27. Brennan, CS (2005) Dietary fibre, glycaemic response, and diabetes. Mol Nutr Food Res 49, 560570.
28. Ekstrom, LM, Bjorck, IM & Ostman, EM (2013) On the possibility to affect the course of glycaemia, insulinaemia, and perceived hunger/satiety to bread meals in healthy volunteers. Food Funct 4, 522529.
29. Gatenby, SJ, Ellis, PR, Morgan, LM, et al. (1996) Effect of partially depolymerized guar gum on acute metabolic variables in patients with non-insulin-dependent diabetes. Diabet Med 13, 358364.
30. Wolever, TMS, Jenkins, DJA, Nineham, R, et al. (1979) Guar gum and reduction of post-prandial glycaemia: effect of incorporation into solid food, liquid food and both. Br J Nutr 41, 505510.
31. Wolf, BW, Wolever, TMS, Lai, CS, et al. (2003) Effects of a beverage containing an enzymatically induced-viscosity dietary fiber, with or without fructose, on the postprandial glycemic response to a high glycemic index food in humans. Eur J Clin Nutr 57, 11201127.
32. Slaughter, SL, Ellis, PR, Jackson, EC, et al. (2002) The effect of guar galactomannan and water availability during hydrothermal processing on the hydrolysis of starch catalysed by pancreatic alpha-amylase. Biochim Biophys Acta 1571, 5563.
33. Dhital, S, Gidley, MJ & Warren, FJ (2015) Inhibition of α-amylase activity by cellulose: kinetic analysis and nutritional implications. Carbohydr Polym 123, 305312.
34. Symons, LJ & Brennan, CS (2004) The influence of (1–3) (1–4)-beta-D-glucan-rich fractions from barley on the physicochemical properties and in vitro reducing sugar release of white wheat breads. J Food Sci 69, C463C467.
35. Jukanti, AK, Gaur, PM, Gowda, CLL, et al. (2012) Nutritional quality and health benefits of chickpea (Cicer arietinum L.): a review. Br J Nutr 108, S11S26.
36. Nestel, P, Cehun, M & Chronopoulos, A (2004) Effects of long-term consumption and single meals of chickpeas on plasma glucose, insulin, and triacylglycerol concentrations. Am J Clin Nutr 79, 390395.
37. Zafar, TA, Al-Hassawi, F, Al-Khulaifi, F, et al. (2015) Organoleptic and glycemic properties of chickpea-wheat composite breads. J Food Sci Technol 52, 22562263.
38. Johnson, SK, Thomas, SJ & Hall, RS (2005) Palatability and glucose, insulin and satiety responses of chickpea flour and extruded chickpea flour bread eaten as part of a breakfast. Eur J Clin Nutr 59, 169176.
39. Juntunen, KS, Laaksonen, DE, Autio, K, et al. (2003) Structural differences between rye and wheat breads but not total fiber content may explain the lower postprandial insulin response to rye bread. Am J Clin Nutr 78, 957964.
40. Juntunen, KS, Niskanen, LK, Liukkonen, KH, et al. (2002) Postprandial glucose, insulin, and incretin responses to grain products in healthy subjects. Am J Clin Nutr 75, 254262.
41. Kallio, P, Kolehmainen, M, Laaksonen, DE, et al. (2008) Inflammation markers are modulated by responses to diets differing in postprandial insulin responses in individuals with the metabolic syndrome. Am J Clin Nutr 87, 14971503.
42. Ludwig, DS (2002) The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 287, 24142423.
43. Laaksonen, DE, Toppinen, LK, Juntunen, KS, et al. (2005) Dietary carbohydrate modification enhances insulin secretion in persons with the metabolic syndrome. Am J Clin Nutr 82, 12181227.
44. Fang, FS, Tian, H, Li, CL, et al. (2011) Comparison of postprandial insulin and fasting insulin on the evaluation of cardiovascular risk factors. Zhongua Yi Xue Za Zhi 91, 946949.
45. Greenfield, JR, Samaras, K, Chisholm, DJ, et al. (2007) Effect of postprandial insulinemia and insulin resistance on measurement of arterial stiffness (augmentation index). Int J Cardiol 114, 5056.
46. Morgan, LM, Flatt, PR & Marks, V (1988) Nutrient regulation of the entero-insular axis and insulin secretion. Nutr Res Rev 1, 7997.
47. Pilichiewicz, AN, Chaikomin, R, Brennan, IM, et al. (2007) Load-dependent effects of duodenal glucose on glycemia, gastrointestinal hormones, antropyloroduodenal motility, and energy intake in healthy men. Am J Physiol Endocrinol Metab 293, E743E753.
48. Wachters-Hagedoorn, RE, Priebe, MG, Heimweg, JAJ, et al. (2006) The rate of intestinal glucose absorption is correlated with plasma glucose-dependent insulinotropic polypeptide concentrations in healthy men. J Nutr 136, 15111516.
49. Ellis, PR, Dawoud, FM & Morris, ER (1991) Blood glucose, plasma insulin and sensory responses to guar-containing wheat breads: effects of molecular weight and particle size of guar gum. Br J Nutr 66, 363379.
50. Jarvi, AE, Karlstrom, BE, Granfeldt, YE, et al. (1995) The influence of food structure on postprandial metabolism in patients with non-insulin-dependent diabetes mellitus. Am J Clin Nutr 61, 837842.
51. Aston, LM, Stokes, CS & Jebb, SA (2008) No effect of a diet with a reduced glycaemic index on satiety, energy intake and body weight in overweight and obese women. Int J Obes (Lond) 32, 160165.
52. Peters, HPF, Ravestein, P, Van Der Hijden, HTWM, et al. (2011) Effect of carbohydrate digestibility on appetite and its relationship to postprandial blood glucose and insulin levels. Eur J Clin Nutr 65, 4754.
53. Wikarek, T, Chudek, J, Owczarek, A, et al. (2014) Effect of dietary macronutrients on postprandial incretin hormone release and satiety in obese and normal-weight women. Br J Nutr 111, 236246.
54. Clark, MJ & Slavin, JL (2013) The effect of fiber on satiety and food intake: a systematic review. J Am Coll Nutr 32, 200211.
55. Ekstrom, LMNK, Bjorck, IM & Ostman, EM (2016) An improved course of glycaemia after a bread based breakfast is associated with beneficial effects on acute and semi-acute markers of appetite. Food Funct 7, 10401047.
56. Kuwa, K, Nakayama, T, Hoshino, T, et al. (2001) Relationships of glucose concentrations in capillary whole blood, venous whole blood and venous plasma. Clin Chim Acta 307, 187192.
57. Larsson-Cohn, U (1976) Differences between capillary and venous blood glucose during oral glucose tolerance tests. Scand J Clin Lab Invest 36, 805808.
58. Ceriello, A (2005) Postprandial hyperglycemia and diabetes complications: is it time to treat? Diabetes 54, 17.
59. Kageyama, S, Nakamichi, N, Sekino, H, et al. (1997) Comparison of the effects of acarbose and voglibose in healthy subjects. Clin Ther 19, 720729.
60. Eelderink, C, Moerdijk-Poortvliet, TCW, Wang, H, et al. (2012) The glycemic response does not reflect the in vivo starch digestibility of fiber-rich wheat products in healthy men. J Nutr 142, 258263.
61. Rizza, RA, Toffolo, G & Cobelli, C (2016) Accurate measurement of postprandial glucose turnover: why is it difficult and how can it be done (relatively) simply? Diabetes 65, 11331145.


Type Description Title
Supplementary materials

Boers supplementary material
Tables S1-S7 and Figures S1-S3b

 Word (54 KB)
54 KB

Efficacy of fibre additions to flatbread flour mixes for reducing post-meal glucose and insulin responses in healthy Indian subjects

  • Hanny M. Boers (a1), Katrina MacAulay (a2), Peter Murray (a2), Rajendra Dobriyal (a3), David J. Mela (a1) and Maria A. M. Spreeuwenberg (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed