The effect of consumption of low glycemic index, high fat content bread on anthropometric measurement and cardiometabolic risk factors in women with type 2 diabetes mellitus

  • Duygu SaglamEmail author
  • Mendane Saka
  • Nurhan Sayaca
Original Article


The aim of the present study was to examine the effects of consumption of breads with different glycemic index as part of a balanced diabetic diet on anthropometric and biochemical parameters in patients with type 2 diabetes mellitus. The study was conducted on 24 diabetic women who consulted the Dilovası State Hospital Medicine Polyclinic; the patients had been diagnosed with type 2 diabetes with body mass index (BMI) ≥ 25 kg/m2 and were aged 40.29 ± 6.81 years. A total of 24 subjects with type 2 diabetes were randomized to consume one of two breads as part of their diets, consuming whole grain bread or wheat bread for 4 weeks. Both groups’ macronutrient distribution was planned so that about 45–65% of their calorie intake was from carbohydrates, 25–35% was from fat, and 15–20% was from protein. All food with glycemic response except bread was suggested similarly for both groups. Nutritional status, glycemic index values of foods, anthropometric values (weight, waist circumference, BMI, etc.), body composition, and biochemical analysis [fasting plasma glucose, fasting insulin, HbA1c, HOMA-IR, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and C-reactive protein (CRP)] were measured at the beginning and the end of the study. Decrease in the average daily glycemic index in the whole grain bread group was 33.45 ± 9.72%, while it was 21.79 ± 5.97% in the bread made from whole wheat flour. The decrease in glycemic index was statistically significant. There was a significant reduction in body weight, BMI, and waist circumference in both groups, but differences between groups were not significant (p > 0.05). A statistically significant, positive relationship was found between decrease in glycemic index and decrease in waist circumference (r(22) = 0.46, p = 0.025). While there was a significant decrease in HbA1c in patients who consume whole grain bread, there was a significant decrease in insulin and HOMA-IR in those who consume wheat bread. There were no statistically significant changes in plasma glucose, HDL cholesterol, total cholesterol, and triglyceride levels (p > 0.05). There is a need to further research to determine the effects of breads with different glycemic indices on glycemic control in patients with type 2 diabetes.


Bread Cardiometabolic Glycemic index Type 2 diabetes mellitus 



The authors thank the volunteers who participated in this trial.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study and the study received the approval of the Committee on Human Research of Acibadem University code of ethics 215-7/12 (Istanbul, Turkey).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Oğuz, A., Gedik, O., Hatemi, H., Yılmaz, T., Kamel, N., & Yılmaz, C. Glycemic control of Turkish adult diabetic patients. Turkish J Endocrinol Metabol. 2008: 12(2).Google Scholar
  2. 2.
    American Diabetes A. (4) Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes care. 2015;38(Suppl):S20–30. Scholar
  3. 3.
    American Diabetes A, Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61–78. Scholar
  4. 4.
    Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009;(1):CD006296. doi:
  5. 5.
    Goff LM, Cowland DE, Hooper L, Frost GS. Low glycaemic index diets and blood lipids: a systematic review and meta-analysis of randomised controlled trials. Nutr Metabol Cardiovasc Dis : NMCD. 2013;23(1):1–10. Scholar
  6. 6.
    Baysal, A. Beden Ağırlığının Denetimi. Diyet El Kitabı 2002; 39–64.Google Scholar
  7. 7.
    Bakanlığı TCS, Müdürlüğü SHG. Türkiye sağlıklı beslenme ve hareketli hayat programı (2010–2014). Ankara: Kuban Matbaacılık Yayıncılık; 2010.Google Scholar
  8. 8.
    Satman İ, İmamoğlu Ş, Yılmaz C, Akalın S, Değirmenci C. Diyabet ve sağlıklı beslenme: Ankara, Türkiye Endokrinoloji ve Metabolizma Derneği Diabetes Mellitus Çalışma ve Eğitim Grubu; 2011.Google Scholar
  9. 9.
    Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA. 2007;297(19):2092–102. Scholar
  10. 10.
    Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363(22):2102–13. Scholar
  11. 11.
    Sloth, B., Krog-Mikkelsen, I., Flint, A., Tetens, I., Björck, I., Vinoy, S., ... & Raben, A. No difference in body weight decrease between a low-glycemic-index and a high-glycemic-index diet but reduced LDL cholesterol after 10-wk ad libitum intake of the low-glycemic-index diet. Am J Clin Nutr 2004;80(2), 337–347.Google Scholar
  12. 12.
    Brand-Miller JC, Holt SH, Pawlak DB, McMillan J. Glycemic index and obesity. Am J Clin Nutr. 2002;76(1):281S–5S.CrossRefGoogle Scholar
  13. 13.
    Gaesser GA. Carbohydrate quantity and quality in relation to body mass index. J Am Diet Assoc. 2007;107(10):1768–80. Scholar
  14. 14.
    Liese AD, Schulz M, Fang F, Wolever TM, D’Agostino RB Jr, Sparks KC, et al. Dietary glycemic index and glycemic load, carbohydrate and fiber intake, and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2005;28(12):2832–8.CrossRefGoogle Scholar
  15. 15.
    Rossi M, Bosetti C, Talamini R, Lagiou P, Negri E, Franceschi S, et al. Glycemic index and glycemic load in relation to body mass index and waist to hip ratio. Eur J Nutr. 2010;49(8):459–64. Scholar
  16. 16.
    Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity. 2007;15(5):1061–1067.CrossRefGoogle Scholar
  17. 17.
    Murakami K, Sasaki S, Okubo H, Takahashi Y, Hosoi Y, Itabashi M. Dietary fiber intake, dietary glycemic index and load, and body mass index: a cross-sectional study of 3931 Japanese women aged 18–20 years. Eur J Clin Nutr. 2007;61(8):986–95. Scholar
  18. 18.
    Jenkins DJA, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012;172(21):1653–60.CrossRefGoogle Scholar
  19. 19.
    Zhang H, Liu Y, Zhao J, Zhai U. Determination of the glycemic index of the wild rice and the effects of wild rice on insulin resistance in rats. Wei Sheng Yan Jiu. 2015;44(2):173–8. 84Google Scholar
  20. 20.
    Kaczmarczyk MM, Miller MJ, Freund GG. The health benefits of dietary fiber: beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon cancer. Metabolism. 2012;61(8):1058–66. Scholar
  21. 21.
    Mirrahimi A, Chiavaroli L, Srichaikul K, Augustin LS, Sievenpiper JL, Kendall CW, et al. The role of glycemic index and glycemic load in cardiovascular disease and its risk factors: a review of the recent literature. Curr Atheroscler Rep. 2014;16(1):381. Scholar
  22. 22.
    de Rougemont A, Normand S, Nazare JA, Skilton MR, Sothier M, Vinoy S, et al. Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects. Br J Nutr. 2007;98(6):1288–98. Scholar
  23. 23.
    Frost GS, Brynes AE, Bovill-Taylor C, Dornhorst A. A prospective randomised trial to determine the efficacy of a low glycaemic index diet given in addition to healthy eating and weight loss advice in patients with coronary heart disease. Eur J Clin Nutr. 2004;58(1):121–7. Scholar
  24. 24.
    Philippou E, McGowan BMC, Brynes AE, Dornhorst A, Leeds AR, Frost GS. The effect of a 12-week low glycaemic index diet on heart disease risk factors and 24 h glycaemic response in healthy middle-aged volunteers at risk of heart disease: a pilot study. Eur J Clin Nutr. 2008;62(1):145–9.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  1. 1.Health Sciences Faculty, Department of Nutrition and DieteticsAcıbadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
  2. 2.Health Sciences Faculty, Department of Nutrition and DieteticsBaşkent UniversityAnkaraTurkey
  3. 3.Istanbul Kartal Dr Lütfi Kırdar Training and Research HospitalIstanbulTurkey

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