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Nutrition Research 29 (2009) 551 557 www.nrjournal.com

Glycemic response of mashed potato containing high-viscocity hydroxypropylmethylcellulose

Helen J. Lightowler, C. Jeya K. Henry
Functional Food Centre, Oxford Brookes University, Gipsy Lane Oxford OX3 0BP, UK Received 5 June 2009; revised 22 June 2009; accepted 22 June 2009

Abstract Potatoes generally have one of the highest glycemic index values of any food. Relatively small differences in the glycemic response (GR) of regularly consumed starch foods have shown beneficial effects on health. Lowering the GR of a potato-based meal has potentially wide-reaching health benefits. High-viscosity hydroxypropylmethylcellulose (HV-HPMC) is a modified cellulose dietary fiber extensively used in the food industry. We hypothesized that the GR of a highglycemic index product such as mashed potato would be lower with the addition of HV-HPMC. In a nonblind, randomized, repeat-measure, crossover controlled trial, 15 healthy adults consumed portions of mashed potato with different doses (0%, 1%, 2%, and 4%) of a specially selected and optimized HVHPMC and a reference food (glucose) on separate occasions. Five subjects were excluded from the final analysis due to noncompliance with study procedures. Capillary blood glucose was measured in fasted subjects and at 15, 30, 45, 60, 90, and 120 minutes after starting to eat. For each sample, the incremental area under the blood glucose response curve was calculated and the GR determined. There was a significant lowering effect of HV-HPMC on GR (P b .001) of mashed potato. Glycemic responses for all mashed potato samples with the HV-HPMC were significantly lower than the standard mashed potato: 1% level (P b .05), 2% level (P b .05), and 4% level (P b .05). However, there was no significant effect of the HV-HPMC dose on GR. We conclude that addition of select HV-HPMC to mashed potato blunts GR. 2009 Elsevier Inc. All rights reserved.
Keywords: Abbreviations: Potato, Human, Glycemic response, High-viscosity hydroxypropylmethylcellulose; Randomized cross over trial, Blood glucose response curve GI, glycemic index; GR, glycemic response; HV-HPMC, high-viscosity hydroxypropylmethylcellulose; IAUC, incremental area under the blood glucose response curve; CV, coefficient of variation.

1. Introduction Carbohydrates are conventionally classified as monosaccharide, oligosaccharide, and polysaccharide based on their chemical composition. It is now recognized that such a classification does not correspond to the metabolic response when ingested. Thus, carbohydrate foods may be classified on the basis of their postprandial glycemia, leading to the development the glycemic index (GI).
Corresponding author. Tel.: +44 1865 483818; fax: +44 1865 483618. E-mail address: jhenry@brookes.ac.uk (C.J.K. Henry). 0271-5317/$ see front matter 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.nutres.2009.06.004

The concept of GI was first developed by Jenkins et al [1] over a quarter of a century ago and has proven to be an important and innovative concept in nutritional science. There is an important body of evidence to support the therapeutic potential of low-GI diets, not only in diabetes [26] but also in subjects with hyperlipidemia [7,8]; however, there remains a need for long-term studies to assess the effect of low-GI diets for coronary heart disease [9]. Since the introduction of the GI concept, a variety of foods have been classified as low, medium, and high GI. Among the high-GI foods are potato, rice, white bread, and numerous other tubers and cereals [10]. Potatoes generally have one of

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the highest GI values of any food, although published GI values are highly variable [10], depending on potato variety [11,12] and processing and cooking methods [13,14]. There is widespread consumption of potatoes in the Western world. In the United Kingdom, the potato is a major staple, contributing approximately 10% total carbohydrate intake and 13% dietary fiber intake [15]; average potato consumption (fresh and processed) totals 810 g per person per week [16]. Moreover, in the United States, in 2007, the per capita disappearance (a proxy for consumption) of fresh and processed potatoes was more than 57 kg [17], equivalent to 1099 g per person per week. Potato is a source of high-quality protein and has a favorable ratio of protein calories to total calories, as well as being an important source of minerals and vitamins. Potato products are a diverse group, varying from baked potato to potato crisps, ready-to-eat or convenience foods. Potato has low-carbohydrate content compared with other roots and tubers and is nearly fat-free. When calculated on the basis of cooked staples, notably cereals, the energy content of potato is lower than that of other staples. Potato's low-energy density is advantageous when potatoes are included (without added fat or rich sauces) in diets in the developed world, where obesity is on the increase. Potato products have also been reported to enhance satiety; however, this same attribute may be disadvantageous in parts of the developing world where diets are energy deficient. In the past decade, there have been a few studies relating to glycemic response (GR) of potatoes. A wide variation in GI ranging from 56 to 94 was found with commercially available potatoes in Great Britain [12]. Recent studies have shown that temperature at which cooked potato is served profoundly influences the GI in subjects with varied insulin sensitivity [11]. Cold potatoes have significantly lower GI than hot potatoes do, presumably due to higher resistant starch content [18]. Use of vinegar dressing and addition of toppings or fillings was also reported to lower the GI of potato meals [19,20]. However, to the best of our knowledge, this study is the first one on reducing GI of a ready-to-eat potato product. There are several factors that may alter the GR of a food, including food structure, ratio of amylose and amylopectin, the level of food processing, cooking technique, and the presence of other nutrients such as fat, protein, and dietary fiber [21]. The high nutritional value and low-fat content of potatoes make it a recommended food for obese individuals and those with prediabetes and diabetes. Small differences in the GR of regularly consumed starch foods have shown beneficial effects on health [22-24]. Recognizing the high GR of boiled, baked, and mashed potatoes, the opportunity to reduce the GR of such products by the addition of a single food ingredient seems most appealing. Lowering the GR of a potato-based meal, therefore, has potentially wide-reaching health benefits. High-viscosity hydroxypropylmethylcellulose (HVHPMC) is a modified cellulose, soluble dietary fiber that

generates viscous solutions in the gastrointestinal tract. It has been extensively used by the food industry as thickening and gelling agent. The lipid-lowering effects of HV-HPMC are well known [25-27]. However, studies have also shown that HV-HPMC reduces postprandial blood glucose concentrations in subjects with type 2 diabetes [28] or those at risk of diabetes [29,30]. Dietary fiber is known to slow the absorption of glucose from the small intestine. In addition, certain dietary fibers contribute to the production of shortchain fatty acids that may modulate both carbohydrate and fat metabolism. The functionality of hydroxypropylmethylcellulose in food products is extremely varied. A careful selection process of the viscosity, dissolution, thermogelling, and mouthfeel properties of the HV-HPMC was therefore necessary to ensure both its ease of manufacture and its palatability in the test food. In light of the above-mentioned findings, we hypothesized that HV-HPMC, which is a modified cellulose dietary fiber when added to mashed potato (a high-GI food product), would lower the GR of this food. In previous studies conducted with diabetic or overweight subject, a dose of 4 g or above of HV-HPMC in various test food products was necessary to observe a favorable reduction in glucose response [28-30]. Thus, the objective of the present study was to investigate the dose-response effect of HV-HPMC (at 0%, 1%, 2%, and 4%) in lowering GR of mashed potato in healthy, normal-weight subjects. Our study is relevant because the aim was to reduce the GI of prepacked mashed potato, which has become an increasingly popular convenience food product both in Europe and the United States. 2. Methods and materials 2.1. Subjects Fifteen healthy subjects (8 males, 7 females) were recruited to take part in the study. Subjects were randomly selected from a pool currently participating in studies on the GR of different foods. Exclusion criteria were as follows: age, younger than 18 years or older than 65 years; pregnant or lactating; fasting blood glucose value greater than 110 mg/ dL (N6.1 mmol/L); blood pressure greater than 140/90 mmHg; and medical condition(s) or medication(s) known to affect glucose regulation or appetite. In addition, subjects were excluded from the study if they did not comply with experimental procedures or follow testing safety guidelines. Ethical approval for the study was obtained from the University Research Ethics Committee at Oxford Brookes University. Subjects were given full details of the study protocol and the opportunity to ask questions. All subjects gave written informed consent before participation. 2.2. Anthropometric measurements All anthropometric measurements were made in the fasting state during the first test session. Height was recorded to the nearest centimeter using a stadiometer (Seca Ltd,

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Birmingham, UK), with subjects standing erect and without shoes. Body weight (recorded to the nearest 0.1 kg) and body fat were measured using the Tanita BC-418 MA (Tanita UK Ltd, Yiewsley, UK), with subjects wearing light clothing and no shoes. Body mass index was calculated using the standard formula: weight (kg)/height2 (m2). Waist circumference was measured midway between the lowest rib margin and iliac crest and recorded to the nearest 0.1 cm. Blood pressure (systolic and diastolic, mm Hg) was measured using an automated Digital Blood Pressure Monitor, UA-767 (A & D Company Limited, Tokyo, Japan). 2.3. Test foods A nonblind, randomized, repeat-measure, crossover design trial was used to study the GR to 3 mashed potato samples with different doses of selected HV-HPMC against a standard mashed potato and a reference of glucose containing 25 g available carbohydrate. The mashed potato test samples contained an optimized HV-HPMC at the 1% level, 2% level, and 4% level. The HV-HPMC used in the current study was FORTEFIBER Soluble Dietary Fiber (The Dow Chemical Company, Midland, Mich) and was selected based on optimization of viscosity, ease of formulation, and mouthfeel for the potato application. High-viscosity hydroxypropylmethylcellulose is an odorless, tasteless, nonfermentable fiber. The protocol used to measure GR was adapted from that described by Wolever [31] and Brouns et al [32] and is in line with procedures recommended by the Food and Agriculture Organization/World Health Organization (WHO) [21]. Subjects tested each mashed potato sample once and the reference food 3 times in random order on separate days, with at least a 1-day gap between measurements to minimize carryover effects. Subjects were studied in the morning after a 12-hour overnight fast. Subjects consumed the reference food/mashed potato sample at a comfortable pace, within 12 to 15 minutes. Each mashed potato sample and the reference food was served with 250 mL water. Subjects remained sedentary during each test session. 2.4. Blood glucose measurements Fasting blood samples were taken at 5 and 0 minutes before consumption of the food, and the baseline value was taken as a mean of these 2 values. The reference food/ mashed potato sample was consumed immediately after this, and further blood samples were taken at 15, 30, 45, 60, 90, and 120 minutes after starting to eat. Blood was obtained by finger-prick using Unistik 3 single-use lancing device (Owen Mumford, Woodstock, UK), and blood glucose was measured using the HemoCue Glucose 201+ analyzer (HemoCue Ltd, Dronfield, UK). Quality control tests were carried out daily using control solutions from the manufacturer; the analyzers were also regularly calibrated against a clinical dry chemistry analyzer (Reflotron Plus; Roche, Welwyn Garden City, UK).

2.5. Calculation of GR For the reference food and each mashed potato sample, the incremental area under the curve (IAUC), ignoring the area beneath the baseline, was calculated geometrically [21]. To determine the GR for each mashed potato sample, the IAUC for each subject was expressed as a percentage of the mean IAUC for the reference food eaten by the same subject. Previous research has shown that the time frame for the calculation of GR may be critical [33]; consequently, IAUC 0-90 minutes and IAUC 0-120 minutes were calculated. 2.6. Statistical analyses Data preparation and statistical analysis were carried out using the Statistical Product and Service Solutions software (version 14.0.1, 2005; SPSS Inc, Chicago, Ill). Data are presented as the mean SD or SEM. Levels of intraindividual variation of the 3 reference (glucose) tests were assessed by determining the coefficient of variation (CV). Before statistical analysis, the normality of the data was tested using the Shapiro-Wilks statistic. Where data were skewed (ie, IAUC 0-90 minutes and IAUC 0-120 minutes), nonparametric tests were used. Repeated-measures analysis of variance, with Bonferroni correction, or Friedman 1-way analysis of variance (nonparametric) was used to compare the maximum postprandial blood glucose response, IAUC, and GR between the reference test, standard mashed potato, and 3 mashed potato test samples. Statistical significance was set at P b .05.

3. Results Of the 15 subjects recruited, 5 subjects were excluded from the final analysis due to noncompliance with study procedures. Thus, data are presented on 10 subjects (5 male, 5 female). The Food and Agriculture Organization/WHO [21] recommends that to determine the GR of a food, tests should be repeated in 6 or more subjects. Characteristics of the subjects are shown in Table 1.

Table 1 Baseline characteristics of the subjects who completed the study Measurement Age (y) Height (m) Weight (kg) Body mass index (kg/m2) Waist circumference (cm) Fat mass (%) Lean body mass (kg) Systolic blood pressure (mm Hg) Diastolic blood pressure (mm Hg) FBG (mg/dL a) 37 1.69 72.4 25.2 85.6 26.6 52.7 120 76 85 15 0.07 16.1 4.7 16.0 10.9 12.7 11 9 4

Values are means SD. FBG indicates fasting blood glucose. a To convert mg/dL glucose to mmol/L, multiply mg/dL by 0.0555.

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Fig. 1. Change in blood glucose (mean SEM) in healthy subjects after consumption of glucose (x), standard mashed potato (), and mashed potato + 1% HV-HPMC (). BG indicates blood glucose.

Fig. 3. Change in blood glucose (mean SEM) in healthy subjects after consumption of glucose (x), standard mashed potato (), and mashed potato + 4% HV-HPMC (). BG indicates blood glucose.

Data (mean SD) for intraindividual variation in GR to the 3 reference tests was 19% 14% CV. This value is consistent with previously reported data in healthy subjects [31]. The interindividual variation in GR to the reference tests was 53% CV. 3.1. Peak rise in blood glucose Figs. 1-3 show the incremental blood glucose curves for the reference food and mashed potato samples. Maximum postprandial blood glucose response (peak rise) was significantly different between the glucose and mashed potato samples, (F4,36 = 39.99, P b .001; Table 2). Compared with the reference food, peak rise in blood glucose was significantly lower for the standard mashed potato (P = .007) and for all mashed potato samples with HV-HPMC at the 1%

level (P b .001), 2% level (P b .001), and 4% level (P = .001). In addition, mean peak rise in blood glucose in the mashed potato samples with 1%, 2%, and 4% HV-HPMC was significantly lower than for the standard mashed potato (P = .001, P = .003, and P = .003, respectively). 3.2. IAUC values Mean IAUC values for each mashed potato sample are presented in Table 2. There were significant differences in the values of IAUC 0-90 minutes (2(4) = 33.04, P b .001) and IAUC 0-120 minutes (2(4) = 28.88, P b .001). Compared with the reference food, IAUC 0-90 minutes was significantly lower for all mashed potato samples (P = .005). In addition, the values of IAUC 0-90 minutes in all mashed potato samples with HV-HPMC were significantly lower than those in the standard mashed potato (P = .005). Similar results were seen with IAUC 0-120 minutes. Compared with the reference food, IAUC 0-120 minutes was significantly lower for the standard mashed potato (P = .009) and for all mashed potato samples with HV-HPMC (P = .005). In addition, the values of IAUC 0-120 minutes were significantly higher in the standard mashed potato compared with the mashed potato samples with 1% (P = .013), 2% (P = .009), and 4% (P = .005) HV-HPMC. 3.3. Glycemic response There was a significant lowering effect of HV-HPMC on GR using both 90-minute (F3,27 = 14.49, P b .001) and 120minute (F3,27 = 8.89, P b .001) areas for calculation (Table 2). glycemic response (90 minutes) and GR (120 minutes) for the standard mashed potato were significantly higher than that for all mashed potato samples with HV-HPMC: 1% level (P = .021, P = .033), 2% level (P = .018, P = .049), and 4% level (P = .002, P = .016). There was no significant effect of increasing the dose of HV-HPMC on GR whether using 90-

Fig. 2. Change in blood glucose (mean SEM) in healthy subjects after consumption of glucose (x), standard mashed potato (), and mashed potato + 2% HV-HPMC (). BG indicates blood glucose.

H.J. Lightowler, C.J.K. Henry / Nutrition Research 29 (2009) 551557 Table 2 Blood glucose measurements after consumption of the reference food and 4 test meals Glucose Peak rise (mg/dL ) IAUC 0-90 min c (mg/dL b) IAUC 0-120 min d (mg/dL b) GR (90 min) e GR (120 min) f
a b

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Standard potato 44.3 4.3 1988 240 2029 239 74 5 76 7

Potato + 1% HV-HPMC 26.6 3.9 1245 246 1347 262 43 5 47 5

Potato + 2% HV-HPMC 29.0 4.1 1336 257 1451 281 47 5 51 6

Potato + 4% HV-HPMC 20.0 2.8 843 115 1002 122 35 6 42 8

65.5 7.2 2861 454 2920 489

Values are means SD. Values significantly lower than the standard potato. a Maximum postprandial blood glucose response. b To convert mg/dL glucose to mmol/L, multiply mg/dL by 0.0555. c IAUC 0-90 min = incremental area under the blood glucose curve 0 to 90 minutes postprandial. d IAUC 0-120 min = incremental area under the blood glucose curve 0 to 120 minutes postprandial. e GR (90 min) = GR at 90 minutes postprandial, expressed as a percentage of the mean IAUC for glucose. f GR (120 min) = GR at 120 minutes postprandial, expressed as a percentage of the mean IAUC for glucose. P b .05. P b .01. P b .001.

or 120-minute areas for calculation. Thus, the addition of 1% HV-HPMC was an adequate concentration to elicit a positive response on GR.

4. Discussion Previous research has shown the lipid-lowering effects of HV-HPMC and the reduction of postprandial blood glucose concentrations in subjects with type 2 diabetes or those at risk of diabetes. The aim of this study was to investigate the effect of mashed potato with added HV-HPMC on the GR in normal-weight subjects. The results from this study extend those from earlier work, which showed that the addition of HV-HPMC blunts GR, especially in obese subjects. However, the present study reports the incorporation of HV-HPMC in a popular and widely consumed product, notably mashed potato, and its consequent reduction in GR. With increasing concerns about food allergies and the desire to consume gluten-free diets, potato products, notably mashed potato, have become increasingly popular worldwide. Although anxiety about the high-GI value of mashed potato has restricted its wider appeal, mashed potato is a highly nutritious food packed with vitamin C and potassium. Previous studies have shown that GI values of potatoes vary widely from 56 to 85 depending on the variety and the preparation method used [34]. Preparation of mashed potatoes increased the GR by a further 15% to 20% when compared with baked or boiled potatoes [35]. In this context, lowering the GR of mashed potato by adding a dietary fiber is very relevant to increase its widespread consumption and to improve its nutritional profile. Previous studies investigating the glycemic effects of HV-HPMC were all done on overweight, obese, or diabetic subjects. Reppas et al [28] reported a 15% reduction in IAUC using 10 g HV-HPMC in diabetic patients, and Maki et al [29] found a 35% reduction in IAUC using 4 g HV-

HPMC in overweight subjects. Incorporating such high doses of fiber into a food product could affect its palatability and cause undesirable gastrointestinal effects such as bloating and flatulence. In the present study, the amount of HV-HPMC required to reduce the mean IAUC in healthy subjects by 37% was very low (1%; Table 2), which is less likely to cause any adverse gastrointestinal symptoms. However, the results are in marked contrast to a recent study in which low doses (1 and 2 g) of HV-HPMC in a powdered beverage mix was consumed by overweight and obese subjects as part of a high-carbohydrate (75 g) meal consisting of a bagel, butter, and 23 g anhydrous glucose [30]. The authors found reduction in postprandial insulin response but failed to find any significant effect on postprandial glucose response. Nevertheless, it should be noted that the present study used a single test food with 50 g available carbohydrate rather than a high-carbohydrate complex meal used by Maki et al [30]. Dietary fibers are known to form viscous gels in the gastrointestinal tract, thereby slowing the absorption of glucose by creating a temporary barrier through which glucose molecules need to be transported to reach the gastrointestinal brush border. The inclusion of viscous fibers, such as guar gum, psyllium, and -glucan, has all been shown to reduce postprandial glycemia in both diabetic and nondiabetic subjects [36-40]. Because HV-HPMC also produces a viscous gel in the gastrointestinal tract, the mechanism of action may be speculated to be similar to that observed with the viscous fibers such as guar gum, psyllium, and -glucan. An additional mechanism by which HV-HPMC may reduce GR may be due to structural changes that may have occurred during the processing of mashed potato in the presence of HV-HPMC. During the cooking of potato starch, the presence of HV-HPMC may influence starch digestibility by interacting with the amylose fraction. For example, Brennan et al [40] showed that guar gum decreased the rate of starch digestibility of wheat bread because of the starch

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H.J. Lightowler, C.J.K. Henry / Nutrition Research 29 (2009) 551557 [2] Augustin LS, Franceschi S, Jenkins DJA, Kendall CWC, La Vecchia C. Glycemic index in chronic disease: a review. Eur J Clin Nutr 2002; 56:1049-71. [3] Jarvi AE, Karlstrom BE, Granfeldt YE, Bjorck IE, Asp NGL, Vessby BOH. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diabetes Care 1999;22:10-8. [4] Giacco R, Parillo M, Rivellese AA, Lasorella G, Giacco A, D'Episcopc L, et al. Long-term dietary treatment with increased amounts of fiberrich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 2000;23:1461-6. [5] Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, et al. Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men. Diabetes Care 2004;27:1866-72. [6] Brand JC, Colagiuri S, Crossman S, Allen A, Roberts DCK, Truswell AS. Low-glycemic index foods improve long-term glycemic control in NIDDM. Diabetes Care 1991;14:95-101. [7] Frost G, Leeds A, Trew G, Margara R, Dornhorst A. Insulin sensitivity in women at risk of coronary heart disease and the effect of a low glycemic diet. Metabolism 1998;47:1245-51. [8] Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000;71: 1455-61. [9] Kelly S, Frost G, Whittaker V, Summerbell C. Low glycaemic index diets for coronary heart disease. Cochrane Database Syst Rev 2004: CD004467. [10] Foster-Powell K, Holt SHA, Brand-Miller JC. International table of glycemic index and glycaemic load values: 2002. Am J Clin Nutr 2002;76:5-56. [11] Fernandes G, Velangi A, Wolever TMS. Glycemic index of potatoes commonly consumed in North America. J Am Diet Assoc 2005;105: 557-62. [12] Henry CJK, Lightowler HJ, Strik CM, Storey M. Glycaemic index values for commercially available potatoes in Great Britain. Br J Nutr 2005;94:917-21. [13] Leeman M, Ostman E, Bjrck I. Glycaemic and satiating properties of potato products. Eur J Clin Nutr 2008;62:87-95. [14] Bjorck I, Granfeldt Y, Liljeberg H, Tovar J, Asp NG. Food properties affecting the digestion and absorption of carbohydrates. Am J Clin Nutr 1994;59:S699-705. [15] Henderson L, Gregory J, Irving K, Swan G. The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years. Energy, Protein, Carbohydrate, Fat and Alcohol Intake, Vol. 2. London: TSO; 2003. [16] National Statistics. Family Food in 2006. London: TSO; 2008. [17] Lucier G, Dettmann R. Vegetables and Melons Outlook. A Report From the Economic Research Service. Washington, DC: USDA; 2008. [18] Najjar N, Adra N, Hwalla N. Glycemic and insulinemic responses to hot vs cooled potato in males with varied insulin sensitivity. Nutr Res 2004;24:993-1004. [19] Leeman M, Ostman E, Bjorck I. Vinegar dressing and cold storage of potatoes lowers postprandial and insulinemic responses in healthy subjects. Eur J Clin Nutr 2005;59:1266-71. [20] Henry CJK, Lightowler HJ, Kendall FL, Storey M. The impact of addition of toppings/fillings on the glycemic response to commonly consumed carbohydrate foods. Eur J Clin Nutr 2006;60:763-9. [21] FAO/WHO. Carbohydrates in Human Nutrition. Report of a Joint FAO/WHO Expert Consultation. Rome: FAO; 1998. [22] Wolever TMS, Mehling C. High-carbohydrate-low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. Br J Nutr 2002;87:477-87. [23] Brand Miller JC, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes. A meta-analysis of randomized controlled trials. Diabetes Care 2003;26:2261-7.

granules being coated by a layer of guar galactomannan. It may be speculated that HV-HPMC may also form a mucilaginous layer around the starch granules, thereby acting as a physical barrier during digestion. In summary, we have demonstrated that the addition of HV-HPMC reduces the GR to one of the popular high-GI foods, mashed potato. Although all levels of HV-HPMC tested showed significant reduction in mashed potato, there was no dose-dependent effect. One percent of HV-HPMC was sufficient to reduce the GR to mashed potato in a significant manner (Fig. 1). However, the mechanism by which HV-HPMC lowers postprandial glycemia needs to be compared with that of other natural dietary fibers such as glucan, guar gum, and psyllium gum. Another limitation is the feasibility of including HV-HPMC in other carbohydratebased food products without changing their palatability to reduce their GR in both healthy and diabetic subjects. Also, the test meal used in the present study is a ready-to-eat prepared food, which does not fully explain whether the effect of HV-HPMC will be retained even after cooking or processing of food products. The consumption of low-GI foods has been shown to be of benefit in the prevention and management of cardiovascular disease and diabetes. Many health agencies, notably the WHO, Diabetes UK, and Canadian Diabetes Association and Diabetes Australia, encourage the consumption of low-GI foods. However, the variety of low-GI foods still remains very limited in range and nutrient composition. The application of food science and technology to develop palatable foods with low GR will enable the successful implementation and consumption of low-GI foods by a wider population. The addition of a well-recognized and used fiber, HV-HPMC, to a ready-to-eat prepared potato product (mashed potato) lends itself to the possibility that the inclusion of select HV-HPMC in other convenience foods may be an efficient way to reduce GR. The future challenge is to determine the level and application of HV-HPMC in other popular foods, such as bakery, snacks, and pasta-based foods, that will enable the development of low-GI foods.

Acknowledgment This study was funded by The Dow Chemical Company, Midland, Mich. The authors thank Erwin de Waele and Susanne van Gerwen of Aviko B.V. for their cooperation and supply of the mashed potato samples and Linda Bellekom-Allen, Michiel Van Genugten, and Murray Coombs from The Dow Chemical Company for their input in this manuscript.

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