Central

Journal of Human Nutrition & Food Science

Research Article

A Cereal Product High in Slowly
Digestible Starch Increases
Subsequent Feelings of Satiety
and Decreases Glucose andInsulin Responses
Sophie Vinoy1*, Roberte Aubert2 and Didier Chapelot3
Mondelez Int R&D, Nutrition Research, France
Université Paris 7, Faculté Xavier Bichat, France
3
Laboratoire des Réponses Cellulaires et Fonctionnelles à l’Hypoxie, Université Paris
13, France
1
2*Corresponding author
S Vinoy, Mondelez International R&D, Nutrition
Department, 6 rue Razel, 91400 Saclay, France,
Email: sophie.vinoy@mdlz.com
Submitted: 26 March 2020
Accepted: 08 April 2020
Published: 10 April 2020
ISSN: 2333-6706
Copyright© 2020 Vinoy S, et al.
OPEN ACCESS

Keywords• Slowly digestible starch• Glycaemic index• Satiety• Insulin• Cereal products• glucose response

Abstract
Objectives: To compare the effects of two cereal products differing by their slowly digestible starch (SDS) content and by their glycaemic index (GI) on
plasma glucose and insulin (Experiment I) and on subjective satiety scores (Experiment II) when eaten as part of a realistic breakfast.
Design: A randomised double-blind within-subject design with subjects eating the breakfast with a high SDS (HSDS) or low SDS (LSDS) cereal product incounter-balanced order.
Subjects: Twelve healthy young adults (6 males, 6 females) participated in both Experiments I and II and 12 adults (6 males, 6 females) were added toparticipate in Experiment II.
Methods: In Experiment I, blood samples were drawn prior to and at various rates over a postprandial interval of 240 min for plasma glucose and insulin
assays. In Experiment II, hunger and gastric fullness scales were rated prior to and every 30 min over the same postprandial interval as in Experiment I.
Results: In Experiment I, plasma glucose and insulin incremental areas under the curves (iAUC) over 120 min were lower in the HSDS than in the LSDS
condition (P = 0.03 and P = 0.004 respectively). Total AUC over the 240 min (tAUC) for plasma insulin but not glucose was lower in the HSDS than in the LSDS
condition (P = 0.01). At 240 min, plasma glucose concentrations were higher in the HSDS than in the LSDS condition (P = 0.04). In Experiment II, hunger ratings
were lower and gastric fullness ratings higher in the HSDS than in the LSDS but this difference occurred mainly between 90 and 160 min.
Conclusions: A cereal product with a high SDS content reduces the postprandial glucose and insulin responses and increases the satiety of a breakfast.

INTRODUCTION
The glycaemic index (GI) concept [1] has led to a better
understanding of the biological and behavioural effects ofcarbohydrate (CHO) containing foods. Accumulating evidence
suggests that the consumption of low GI foods as opposed tohigh GI foods can affect a number of health outcomes. Thus, innormal weight sedentary women, a high-GI diet was reported to
be associated with an increase in body weight and body fat overthe 6 years of follow-up [2]. In several meta-analyses identified,a low GI diet had a beneficial effect in the prevention of type2 diabetes and cardiovascular diseases [3-6], and additional
works suggested that a high-GI diet is associated with oxidative
stress [7,8]. GI is also considered to improve the control ofeating behaviour and energy balance. Several studies havesuggested that the adoption of low GI diets could contribute to

the prevention of obesity and its associated risk factors [9-13]
although in a recent review did not confirm this health interest
due to potential confounding factors [14].

As breakfast is usually high in CHO, this meal is particularly
appropriate for studying the impact of GI on satiety. Breakfast
consumption in children [15] and in adults [16] was associatedwith lower hunger feelings over the morning, resulting in lessspontaneous snacking and a reduced energy intake at lunch[17,18]. However, the effect of breakfast on satiety may vary
according to the type of CHO-rich food that is usually consumed
at breakfast. Therefore, breakfasts based on low-GI cereal
products should be more satiating than those with a high GI since
the uptake of glucose would be spread over the whole morning
period. However, a recent study did not confirm the interest of
low GI breakfast on food choices and satiety [19].

Cite this article: Vinoy S, Aubert R, Chapelot D (2020) A Cereal Product High in Slowly Digestible Starch Increases Subsequent Feelings of Satiety and Decreases Glucose and Insulin Responses. J Hum Nutr Food Sci 8(1): 1132.

Vinoy S, et al. (2020)

CentralA major concern relates to whether the GI of each individual
food item can predict the GI of the total meal. A predictivemodel based on the various GIs of high-CHO foods appears to
be satisfactory when the meal is moderate in fat [20] but they
are more strongly associated with the GI of the meal than the
carbohydrate GI per se when the fat and protein contents of themeal are high [21].
It is known that GI may depend mainly on digestive factors
including the rate of gastric emptying, [22-24] digestion anduptake of glucose, leading to a modulation of the insulin response[1,23]. This difference is influenced by botanical origin and/or
food processing [25-28]. Thus, using cereal-based products, wehave previously demonstrated that a slowly digestible starch(SDS) high content, due to a low level of starch gelatinisation,
actually resulted in a low GI of this food [29,30].
The aim of this study was to assess whether a high-SDS (HSDS)
low GI food included in a traditional breakfast could modify the
biological and behavioural postprandial profiles. In a first part(Experiment I), glucose and insulin responses were assessed.
In a second part (Experiment II), we followed the time-courseof satiety scores in a larger subject sample, since behaviouralvariables show a greater variability [31] than biological ones.

METHODS
Subjects

Twenty-four subjects participated in the study, divided in
two experimental parts. The same twelve healthy adults (6males, 6 females) participated in Experiments I and II and afurther 12 adults (6 males, 6 females) participated in ExperimentII. They were 18-40 years old, with a body mass index (BMI) of
19.0-25.1 kg/m2 (Table 1). They were recruited through local
advertisement. All subjects underwent a pre-study clinicalexamination and were healthy with no personal history of illness
or gastrointestinal surgery. The absence of restrained eating
habits was confirmed by the Three-Factor Eating Questionnaire[32]. Subjects were excluded if they reported food allergies. All
subjects signed a written informed consent prior to the beginningof the study. The protocol was approved by the Ethics Committeeof Lorraine (France) and complied with the ethical guidelinesof the Declaration of Helsinki (amended at Tokyo, Venice, Hong
Kong and Somerset West).

Test meals

The subjects consumed two breakfasts (Table 2), whichwere similar in energy and macronutrient content with the same
proportion of energy provided by protein (11%), fat (23%) andTable 1: Anthropometric characteristics of the subjects (mean ± s.e.m).
Age (yrs)

Body weight (kg)Height (cm)BMI (kg/m )2

BMI: body mass index

Experiment I(n = 12)Experiment II(n = 24)174 ± 2175 ± 1

23.4 ± 1.0
64.1 ± 2.4
21.1 ± 0.4

J Hum Nutr Food Sci 8(1): 1132 (2020)23.5 ± 0.68
65.9 ± 1.9
21.4 ± 0.4

Table 2: Energy and macronutrient contents of the high slowly available
glucose (HSDS) and the low slowly available glucose (LSDS) versions of
the test breakfasts.
HSDS

LSDS

Energy (kJ)

1730

1678

Fat (g)12

10

Protein (g)FibreCarbohydrate (g)

11
2

11
2

65

68

slowly-digestible starch (g)

9.6

0.5

Calculated glycaemic index *47

73

starch (g)rapidly-digestible starch (g)

24
34

21
47

* Each carbohydrate component is expressed as a percentage of total
carbohydrate in the meal and multiplied by the relevant glycaemic
index (GI). The sum of these values represents the calculated GI for
the meal: the GI values used for each carbohydrate component areskimmed milk 32, full fat milk 27, chocolate powder 65, orange juice
57, honey plain biscuit 45, chocolate-flavoured ready to eat cereal 84.
All GI values were taken from Foster-Powell et al.(Foster-Powell et al.,2002) with the exception of both cereal products for which the GI waspreviously measured (internal data).

carbohydrate (66%). The choice of energy load (about 1674 kJ,
400 kcal) was based on the mean energy intake of French adultconsumers at breakfast [33]. The breakfast meals were composedof items usually consumed for breakfast in France. They
differed in the GI of the cereal product, previously determinedaccording to the recommended protocol [34]. The in vitro CHO
digestibility profiles of the cereal foods were determined by the
Englyst method [35,36]. The difference in SDS content was aconsequence of the level of starch gelatinisation parameters usedin manufacturing both cereal products [28,29]. The HSDS versionof the breakfast consisted of 62.5 g of commercial honey-plain
biscuit for breakfast with chocolate chips (GI = 45 and SDS = 15.4
g / 100 g), skimmed milk (180 ml), chocolate powder (10 g) andorange juice (80 ml). The low SDS (LSDS) version of the breakfast
consisted of 56 g of commercial chocolate-flavoured ready-to-eat
cereal (GI = 84 and SDS = 0.9 g / 100 g), full fat milk (180 ml),chocolate powder (10 g) and orange juice (80 ml).

Design of Experiment I

A within-subject design was used. The two versions of the
breakfast meal were consumed in counterbalanced order, one
week apart. All the twelve subjects (6 males and 6 females)
were required to fast from 8.00 pm in the evening preceding
each test day and to refrain from fluid intake from midnight.
Subjects arrived at the study centre at least 30 min prior to thebeginning of the session and stayed in throughout the session.
They were isolated and comfortably installed. The onset ofbreakfast ingestion, designated as T0, was set according to thesubject’s usual breakfast time (± 30 min) and the measurement
period lasted 240 min. A catheter was inserted into theantecubital vein of one arm prior to the breakfast test and blood
samples were drawn 15 min before T0, at T0, and subsequently
at various intervals during the postprandial period (15, 30,
60, 90, 120, 150, 180 and 240 min). The total blood volume
for each subject did not exceed 150 ml for the whole trial.

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Vinoy S, et al. (2020)

CentralDesign of Experiment II

It was previously recommended to increase the number to atleast n = 18 because of the large between-subject and betweenday variability of the scores derived from visual analogue scales[37]. Thus, we decided to increase the sample to 24 subjects. The
12 subjects from Experiment I participated in Experiment II and
12 new subjects were recruited.

The same design and test breakfast meals were used as inExperiment I. Subjects were asked to assess hunger sensations
and gastric fullness on 100 mm linear visual analogue scales(VAS). The scale for assessment of hunger sensations ranged
from 0 (“not hungry at all”) to 100 (“very hungry”). The scale
for gastric fullness ranged from 0 (“stomach not full at all”) to
100 (“stomach full”). Hunger and gastric fullness were assessed
before the onset of eating (baseline) and 30, 60, 90, 120, 160, 190,
220 and 240 min throughout the postprandial period.

Calculations and statistical analyses

Analyses were conducted on Systat 10.1 (SPSS, Chicago, IL).
According to the method for analysing serial measurements[38], four pre-planned comparisons were considered of interest,
1) a plasma glucose incremental area under the curve (iAUC)
over the 120 min following breakfast such as that usuallyused to determine the GI 2) a total AUC (tAUC) to evaluate thedifference in the total amount of glucose disposal during themorning session (from T0 to T240 min), 3) the plasma glucose
peak level and 4) the plasma glucose level during the latter partof the interval between breakfast and lunch time, i.e. at 180
and 240 min, to determine whether the GI of breakfasts might
modify glucose availability at the end of the morning period.
The insulin variable was analysed similarly. The glucose andinsulin data showed a normal distribution. AUCs were calculatedusing the trapezoidal method and analysed by Student’s t tests.
Data are shown as means ± SEM with P < 0.05 considered to bestatistically significant. The hunger feelings and gastric fullness
ratings were analysed by repeated measures analyses of variance(ANOVA) with condition (high and low SDS), order (day 1, day2) and time (0 to 270 min) as within-subject factors and gender(male, female) as the between-subject factor. For each variable, atAUC was calculated on the whole session. They were expressedin mm per min and analysed by Student’s t tests.

RESULTS

Experiment I
The plasma glucose and insulin concentrations before
breakfast were not different between the conditions.
J Hum Nutr Food Sci 8(1): 1132 (2020)

The results for plasma insulin profiles were consistent withglucose (Figure 1B) but the peak was lower after the HSDS thanthe LSDS breakfast (64.6 ± 5.5 and 84.2 ± 8.4 µU.ml-1 respectively,
P = 0.032). A 26% reduction of the insulin iAUC over the 120 min
postprandial period was found in the HSDS compared to the LSDS
condition (5123 ± 291 and 6938 ± 550 µU.ml-1.min respectively,
P = 0.004). The insulin tAUC was also reduced by 25% (7905 ±449 and 10524 ± 1003 µU.ml-1.min respectively, P = 0.01). There
was no significant difference in insulin concentration between
the conditions at T180 and T240 min.
There was a positive correlation between the plasma glucose
and insulin iAUC (r = 0.62, P = 0.001).
A 7,0

150

HSDS
LSDS

Blood glucose (mmol.l-1)

Blood samples were immediately centrifuged (3000 rpm,
10 min) after withdrawal and plasma was stored at -20°C.
Samples for glucose analysis were stored at 4°C and analysed
within 6 hrs using the enzymatic colorimetric method GOD-PAP(Boehringer Mannheim reagents, 0.9% and 1.8% CV, intra- andinterassay respectively). Insulin analysis was conducted using aradio-immunological method (Cis bio reagents, 2.1% and 2.6%
CV, intra- and interassay respectively). The means of the withinand between- assay coefficients of variation (CV) were 3.5% and5.3% respectively.

Plasma glucose responses to the breakfast meal showed theusual postprandial peak followed by a progressive decrease to
the preprandial concentrations (Figure 1A). The peak level wasobserved with a mean delay of 30 min for both groups, with its
magnitude not different between conditions (5.9 ± 0.3 and 6.3± 0.3 mmol.l-1, ns). The ANOVA confirmed the difference of the
glucose responses between breakfasts with a 43% reductionof glucose iAUC over the postprandial 120 min in the HSDS
compared to the LSDS condition (50.6 ± 10.8 vs 89.3 ± 16.9
mmol.l-1.min respectively, P = 0.03). Conversely, tAUC of glucose
concentrations between T0 and T240min were not different
between conditions (1140 ± 34 and 1153 ± 39 mmol.l-1.min in
the HSDS and LSDS respectively, ns). Finally, plasma glucose
concentrations were not different between conditions at T180
min but were higher at T240 min after the HSDS than for the LSDS
breakfast (4.8 ± 0.2 and 4.5 ± 0.1 mmol.l-1 respectively, P = 0.04).

1500

*

120

6,5

1250

90
60

6,0

1000

30

5,5

0

*

5,0

500

0

4,0
0

B

750

250

4,5

30

60

90

120

150

180

210

240

Time (min)100

Plasma insulin (µU.ml-1)

Plasma assays

8000

HSDS
LSDS

*

6000

80

12000

*

10000

4000
2000

60

*

8000

0

6000
40
4000
20

2000

0

0
0

30

60

90

120

150

180

210

240

Time (min)Figure 1 Left. Profiles of plasma glucose (A), insulin (B) concentrations
following the consumption of the breakfast high (■) or low (○) in
slowly digestible starch (SDS). Right. Corresponding areas under the
curves (tAUC) over the whole session. Inset. incremental AUC over
120 min. The data are means ± SEM. *different from the high SDS
condition, P < 0.05.

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Vinoy S, et al. (2020)

CentralExperiment II
The hunger and gastric fullness scores before breakfast were
not different between the conditions. The global ANOVA forhunger scores (Figure 2) revealed a condition effect [F(1,21) =5.265, P = 0.032] and a condition and time interaction [F(7,147) =2.829, P = 0.009]. Comparisons showed that mean hunger scores
were significantly lower 90 min (P = 0.025), 120 min (P = 0.003)
and 160 min (P = 0.05) after the HSDS than the LSDS breakfast.
Consistently, the mean tAUC for hunger scores was significantly
lower following the HSDS than the LSDS breakfast (P = 0.017).
The global ANOVA for gastric fullness scores revealed acondition effect [F(1,21) = 8.589, P = 0.008] with no interaction
with time, gender or order, the levels of gastric fullness over thesession being higher in the HSDS than in the LSDS condition.
Consistently, the mean tAUC for gastric fullness scores was
significantly higher following the HSDS than the LSDS breakfast(P = 0.015).

DISCUSSION

Experiment I showed that a low-GI cereal product with ahigh slowly digestible starch content reduced the postprandial
glucose response of the meal in which it was introduced whencompared to a meal matched in terms of volume, macronutrientsand energy, but based on a high-GI cereal product. This difference
was not significant anymore when the whole session wasconsidered i.e., 240 min, suggesting that this difference in glucose
HSDS

100

14000

LSDS

Hunger AUC (mm.240 min)Hunger scores (mm)

A

80
60

*

*

*

40
20

12000
10000
8000
6000
4000
2000
0

0
0

30

60

*

90 120 150 180 210 240

Time (min)
HSDS
HSAG

100

LSDS
LSAG

80
60
40
20
0
0

30

60

90 120 150 180 210 240

Gastric fullness AUC (mmm.240 min)

Gastric fullness scores (mm)

B

*

16000
14000

*

12000
10000
8000
6000
4000
2000
0

Time (min)Figure 2 Left. Hunger (A) and gastric fullness score (B) profiles
following the consumption of the breakfast high (■) or low (○) in
slowly digestible starch (SDS). Right. Corresponding areas under
the curves (AUC) over the whole session. The data are means ± SEM.
*different from the high SDS condition, P < 0.05.
J Hum Nutr Food Sci 8(1): 1132 (2020)

concentrations during the beginning of the morning session werecompensated at least partially during the rest of the session.
This hypothesis is supported by the fact that plasma glucose
concentrations were slightly higher 240 min after the HSDS thanthe LSDS breakfast. Previously, similar results were obtained
and showed that the mechanism of this change in postprandial
glucose response was the glucose rate of appearance from thecereal product [13,38,39]. Under very-low-moisture conditions,the extent of starch gelatinisation was reduced and resulted inpartially intact starch granules that were less susceptible to theaction of amylolytic enzymes [29,40]. Due to this low gelatinised
starch state, the appearance rate of glucose from the HSDS
breakfast was slower than the LSDS breakfast [41], and led to low
glycaemic response.
As expected, the glucose and insulin responses werecorrelated, but the correlation coefficient was rather weak.
However, this value is in the range of previous results obtained[16,23] and suggests that other factors are probably involvedin the glucose uptake by tissues such as NEFA levels [42,43]
or glycogen stores [44], two parameters that can widely vary
between subjects after an overnight fast. Indeed, studies haveshown that the macronutrient content in link to digestibilityof CHOs can dramatically influence the metabolism of glucose
derived from cereal products [23,45].

Experiment II showed that the HSDS breakfast modified the
feeling of satiety evaluated by hunger and gastric fullness scores
on VAS. These differences were mainly found between 90 and
160 min after the meal onset. This suggests that the effect of GI
on satiety may occur in a time-window located in the middle ofthe morning period and not during the late postprandial period
as generally suggested. It is important to remind that thesesatiety scores, including hunger scores, are not to be confusedwith the hunger signal that triggers the initiation of a meal. Theirmeaning is still under debate and it is possible that sensations ofgastric fullness play a major role. Although there is an increasing
amount of data arguing for the relevance of these satiety scoreson actual intake [37,46,47,48], this sensation could actually bemore the individual interpretation of gastric fullness than hunger
per se. This is supported by a previous study showing that gastricfullness scores were the only ones associated with actual intake[49]. Although in this paper, the magnitude of this difference insubjective scores was low, i.e. about 15 mm at its maximum forhunger and 10 mm for gastric fullness on a 100 mm scale, this has
been considered to be of clinical relevance [37,49]. Therefore, bymodifying the process of a cereal product (biscuit), it is possible
to modify the hunger feelings following the breakfast in which
this product was incorporated.
Although results of the two experiments cannot be compareddirectly, the biological and behavioural profiles were consistent.
In our studies, the differences in blood glucose disposal andinsulin concentration in Experiment I and in the postprandial
sensations of satiety in Experiment II were in agreement withsuch an inverse relationship. The exact mechanism of thisglucose-induced effect on satiety is still under debate. Absolute
glucose concentrations do not appear to be very important infood intake regulation, but transient and dynamic declines inblood glucose concentration seem to be strongly related to meal
initiation [49,50,51]. In addition, glucose influences appetite

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Centralpossibly through glucoreceptors and osmoreceptors in the
duodenal lumen, which may induce satiety through direct vagal
stimulation of the release of insulin and/or GLP-1 [52]. Based on
the type of cereal products used, with a high SDS content, i.e. slow
starch digestibility, this hypothesis could be considered.

CONCLUSION

In conclusion, a low-GI, HSDS cereal product consumed in amixed breakfast meal maintained postprandial plasma glucose
levels more efficiently over the whole morning, and reduced total
plasma insulin demand compared to a meal containing a high GI,
LSDS cereal product. In parallel, satiety feelings were increasedtransitorily from 90 to 180 min after the consumption of the test
breakfast high in slowly digestible starch, suggesting that suchcereal products may represent a benefit for consumers in foodcravings between meals. The mechanisms of action should be
investigated further to better understand how this kind of cereal
product may play a role in appetite regulation.

ACKNOWLEDGMENTS

We are grateful to Klaus Englyst, Englyst Carbohydrates Research & Services Ltd, Southampton, U.K. for his collaborationin determining the carbohydrate digestibility profile of the cereal
products, and Jeanine Louis-Sylvestre in the study supervisionand her scientific advice regarding the analysis and first draft ofmanuscript.

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Cite this article
Vinoy S, Aubert R, Chapelot D (2020) A Cereal Product High in Slowly Digestible Starch Increases Subsequent Feelings of Satiety and Decreases Glucose andInsulin Responses. J Hum Nutr Food Sci 8(1): 1132.

J Hum Nutr Food Sci 8(1): 1132 (2020)

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