Glycative Stress Research
Online edition : ISSN 2188-3610
Print edition : ISSN 2188-3602
Received : July 10, 2014
Accepted : August 2, 2014
Published online : September 30, 2014

Original Artcle

Prevention of postprandial hyperglycemia by the combinationof a staple food and a side dishMegumi Matsushima, Masayuki Yagi, Umenoi Hamada, Mari Ogura, Yoshikazu Yonei
Anti-Aging Medical Research Center and Anti-Glycation Research Center, Graduate School of Life and Medical Sciences, Doshisha University

Abstract

Objective: The degree of postprandial blood glucose level elevations varies depending on the choice of staple food; foods
with a low glycemic index (GI) produce a slow elevation of postprandial blood glucose level, and blood glucose elevations canbe slowed by adding dietary fiber to staple food. This study was conducted to assess the effects of various combinations of astaple food (carbohydrate) and a side dish on changes in postprandial blood glucose level, with the aim to develop a method of
reducing glycation stress.
Results: In the subjects exhibiting a blood glucose elevation of AUC ≥ 5,000 after eating cooked rice, the postprandial blood
glucose levels observed after taking each of 9 staple foods were compared. A comparison of postprandial blood glucose levels
following ingestion of udon (thick Japanese wheat flour noodle) + side dish revealed that ingestion of udon + salad produced
slower blood glucose level elevations and a smaller AUC than udon taken alone (p = 0.029). Udon + soft boiled egg produceda smaller AUC than udon taken alone (p = 0.023). Udon supplemented with dietary fiber produced a smaller AUC than cookedrice (p = 0.040). Udon topped with braised meat and eggplant produced a smaller AUC than udon taken alone (p = 0.034). A
comparison of postprandial blood glucose levels following ingestion of cooked rice + side dish revealed that a bowl of rice
topped with braised meat and eggplant produced a smaller AUC than cooked rice taken alone (p < 0.001). The AUC of a bowlof rice topped with braised meat and eggplant was similar to that of udon topped with braised meat and eggplant (p > 0.1).
Conclusion: A combination of a staple food and a side dish may be more effective than low-GI foods in suppressing glycationstress. Not only choice of low-GI foods, but also choice of side dishes is important to the suppression of meal-related glycationstress.

KEY WORDS: glycemic index, postprandial hyperglycemia, glycation stress, dietary fiber
Introduction

The phenomenon in which reducing sugars such as glucose
bind to protein non-enzymatically to form glycoproteins is
known as glycation. Glycation stress refers to a form of stresson the body caused by a load of reducing sugar or aldehyde 1, 2).
As an aging risk factor, glycation stress can serve as apromoter of skin aging, diabetic complications, and otherconditions. Available methods of glycation stress reduction
include the suppression of hyperglycemia, the suppressionof glycation reactions, and the degradation and excretion ofglycation reaction products.
We previously assessed the effects of choice of staple foodand the addition of dietary fiber on changes in postprandial
blood glucose levels, showing that adding dietary fiber inadvance suppresses blood glucose level elevations after
meals 3). However, the staple food cooked rice tends to produce

greater elevations of blood glucose levels than pasta; there
may be much room for improving the way of eating cookedrice in relation to other foods. Before starting the present
study, we hypothesized that blood glucose level elevations
could be suppressed by taking a staple food and a side dishin combination. In addition, provided that the differencein postprandial blood glucose level among different staple
foods is lessened by taking a staple food and a side dishin combination, a glycation stress suppressing effect may
be achieved by combining a staple food, even if chosen
freely, with an appropriately chosen side dish. In the present
study, we assessed the effects of choice of staple food andits combination with various side dishes on changes in
postprandial blood glucose levels, with the aim to develop amethod of reducing glycation stress from the viewpoint ofsuppression of hyperglycemia.

Contact Address: Professor Yoshikazu Yonei
Anti-Aging Medical Research Center, Graduate School of Life and Medical Sciences,
Doshisha University 1-3, Tataramiyakodani, Kyotanabe-shi, Kyoto, 610-0321 Japan
Phone/Fax: +81-774-65-6394; Email: yyonei@mail.doshisha.ac.jp
Co-authors; Matsushima M, meg19881120@yahoo.co.jp, Yagi M, myagi@doshisha.ac.jp,
Hamada U, hamada@yonei-labo.co.jp, Ogura M, mogura@dwc.doshisha.ac.jp_ 53 _

Glycative Stress Research 2014; 1 (3): 53-59(c) Society for Glycation Stress ResearchStaple food and side dish combination prevents postprandial hyperglycemia

Methods
Subjects

Subjects were recruited from among those with relevanceto the Department of Anti-Aging Medicine, Doshisha University
Faculty of Life and Medical Sciences., as in the previous
study 3 ). The subject inclusion criteria comprised healthy
persons aged 20 years or older who did not meet any of thefollowing exclusion criteria: those with food or drug allergy,
pregnant or lactating women, patients under treatment withmedication or follow-up, patients with the diagnosis of
diabetes mellitus, patients with a pronounced cardiopulmonary
functional disorder, patients on therapeutic medication for
hypertension, persons with a past history of gastrointestinal
surgery, and persons suspected of having infectious
disease. Other subjects judged by the investigator as being
inappropriate for inclusion in the study were also excluded
from the study.
The study population comprised 19 subjects with
relevance to Anti-Aging Medical Research Center, Doshisha
University Faculty of Life and Medical Sciences (9 males
and 10 females, age 30.3 ± 12.0 years, BMI 20.8 ± 2.5). These
subjects provided written consent to participate in the study
after being given a full explanation of the study.

Protocol for blood glucose test

A blood glucose test was performed according to theunified protocol established by the Japanese Association for the
Study of Glycemic Index (JASGI) 4) as reported previously 3).

On the day before the test, excessive exercise, taking
meals after 8:00 p.m, surfeit, overdrinking, and staying up
late at night were prohibited. If the subject felt ill on the
day before the test, or prior to or during the test, the test was
postponed or terminated.
On the day of the test, the reference diet and each test
food were taken over a period of 5-10 minutes, with about
30 chews per mouthful. Blood glucose was measured at 15(2nd time), 30 (3rd time), 45 (4th time), 60 (5th time), 90(6th time), and 120 minutes (7th time) after the start of foodingestion (taking each test food). Each subject measured
glucose levels using a glucose meter for self monitoring(GLUCOCARD MyDia, ARKRAY, Inc., Kyoto).

Test foods

The reference diet and test foods used in the present study
are listed in Table 1 . Nutrient contents in some of thesefoods were calculated using the Standard Tables of Food
Composition in Japan 2010 5).
Handmade udon and ingesting indigestible dextrinblended udon (udon supplemented with dietary fiber)
were used as staple foods, with cooked rice serving as thereference diet, as reported in the previous study 3). Thesematerials were supplied by Hanamaru, Inc. (Chuo-ku, Tokyo,
Japan). Thereafter, the influence of side dishes on blood
glucose levels were assessed using udon with a soft boiledegg (Japanese common name “ontama udon”), vegetableudon (Japanese common name “salad udon”), a bowl ofrice topped with braised meat and eggplant (mabonasu)(cooked rice + mabonasu), and udon topped with mabonasu

Table 1. Staple food consumption and nutrients in test food items
Food items

Staple foodConsumption

Energy( kcal)Protein(g)

Lipids(g)

Carbohydrates(g)Dietary fiber(g)Amount of carbohydrates
other than dietary fiber

Cooked rice 200g + furikake(seasoned dried condiments forsprinkling over rice)

200

347

5.6

1.2

75.2

0.6

74.6

Kakeudon(handmade udon + soup stock)

270

346

8.6

1.1

75.9

2.3

73.6

Handmade udon (small-serving)

210

273

7.0

0.9

59.5

1.7

57.8

Udon with a soft boiled egg(handmade udon + soft boiled egg)

210

371

13.9

7.8

61.2

1.7

59.5

Salad udon
(handmade udon + vegetables)

210

395

9.5

6.6

71.5

4.4

67.1

Udon supplemented with dietary fiber

250

349

7.1

1.5

77.1

2.6

74.5

Bowl of rice topped with braisedmeat and eggplant(cooked rice + mabonasu)

180

498

18.0

11.1

79.0

4. 2

74.8

Udon topped with braised meatand eggplant(handmade udon + mabonasu)

230

501

18.5

11.7

80.7

5. 9

74.8

Udon: thick Japanese wheat flour noodle. Udon with a soft boiled egg: commonly called “ontama udon. Braised meat and eggplant: mabonasu.
Numerical figures for food items shown in black were calculated using the Standard Tables of Food Composition in Japan 2010 5).
Numerical figures for food items shown in red were calculated using the nutritional facts indicated on the respective labels.

_ 54 _Glycative Stress Research(udon supplemented with dietary fiber + mabonasu), whichwere selected from among recipes recommended by thecollaborating udon manufacturer.
The amount of carbohydrates other than dietary fiber ineach test food was set at 75 ± 10 g in order to correspond to
the 75 g amount of carbohydrates other than dietary fiber
for the 75 g oral glucose tolerance test (OGTT) in common
use for diagnosing diabetes mellitus, except for kakeudon(wheat noodles served hot in broth), ontama udon, and saladudon, taken alone, which were used exactly in the amounts
indicated on their labels to reflect the recipes shown by theudon manufacturers. The amount of carbohydrates other than
dietary fiber was obtained by subtracting the amount of
dietary fiber from the amount of carbohydrates.
Of the foods used in the experiments, udon and udon
supplemented with dietary fiber were supplied by Hanamaru,
Inc. Packed cooked rice (Sato No Gohan; Sato Foods Co.,
Ltd., Niigata, Japan) was used as reference diet. Retort-packed
sauce packs (Mabonasu No Moto; Marumiya, Suginami-ku,
Tokyo, Japan) were used for braised meat and eggplant.

Statistical analyses

The 0-minute value was subtracted from the blood
glucose level measured over time after eating each test foodto obtain Δblood glucose level; the largest change in thelevel observed up to 120 minutes after the start of ingestion
was considered as the maximum blood glucose level change.
Using these parameters, the area under the blood glucose
elevation curve (AUC) was calculated. Data obtained were
statistically analyzed by the Mann-Whitney U-test forsignificant differences between 2 groups and Tukey’s multiple
comparison test among 3 groups or more, using the SPSS
statistical analysis software. A two-sided p-value of less than
5% was considered to indicate a significant difference.

Ethical Considerations

The present study was conducted in compliance with the
ethical principles of the Declaration of Helsinki (Note ofClarification added at the 2004 World Medical Association
General Assembly in Tokyo) and Japan’s Act on theProtection of Personal Information, and with reference tothe Ministerial Ordinance on Good Clinical Practice (GCP)
for Drug (Ordinance of Ministry of Health and Welfare

No. 28 of March 27, 1997) and the Ethical Guidelines for
Epidemiological Research established by Japan’s Ministryof Health, Labour and Welfare, and Ministry of Education,
Culture, Sports, Science and Technology. The present study
was conducted after examination and approval for the ethics
and appropriateness of the study at a meeting of the Doshisha
University Ethics Committee for Scientific Research Involving
Human Subjects (Approval number # 1228).

Results

A comparison was made between kakeudon and ontama
udon (kakeudon + soft boiled egg) and between kakeudon andsalad udon (kakeudon + vegetables). Ontama udon produced nosignificant difference in maximum blood glucose level change,
with a 27% smaller AUC (p = 0.029, Figs. 1 and 2 ), comparedwith kakeudon. Salad udon tended to have smaller maximum
blood glucose level changes (p = 0.056 ), with a 28% smaller
AUC (p = 0.023, Figs. 3 and 4 ), compared with kakeudon.
Influence of a combination of cooked rice or udon
supplemented with dietary fiber and a shared side dish onblood glucose levels
When comparing cooked rice and udon supplemented
with dietary fiber, udon supplemented with dietary fiber had asmaller maximum blood glucose level change of 17 mg/dL (p= 0.013), with a 20% smaller AUC (p = 0.046, Figs. 5 and 6 ),than cooked rice.
A bowl of rice topped with braised meat and eggplant(mabonasu) produced a 15 mg/dL lower maximum blood
glucose level change (p = 0.046) and a 28% smaller AUC (p< 0.001, Figs. 7 and 8 ) than cooked rice taken alone.
When comparing udon topped with mabonasu and udon
supplemented with dietary fiber taken alone, no significant
difference in maximum blood glucose level change wasfound, and the AUC was smaller by 28% with udon topped
with mabonasu than with udon supplemented with dietaryfiber (p = 0.034, Figs. 9 and 10 ).
In both the maximum blood glucose level change and
AUC, no significant difference was found between a bowl ofrice topped with mabonasu and udon topped with mabonasu( Figs. 11 and 12 ).

6000
5000
Kakeudon ( n=11)

AUC△Blood glucose (mg/dL )

7000
90
80
70
60
50
40
30
20
10
0

Udon with a soft
boiled egg ( n=10)
0

20

40

60

80

100

p = 0.029

Kakeudon ( n=11)

4000
3000

Udon with a softboild egg ( n=10)

2000
1000

120

Time (min)0

Fig.1. Blood glucose level changes after ingestion of
kakeudon or udon with a soft boiled egg (ontamaudon).

Fig. 2. AUC after ingestion of kakeudon or udon with asoft boiled egg (ontama udon).

For maximum blood glucose level changes, no significant difference
was found, Mann-Whitney U-test. Bar indicates standard error mean.

_ 55 _

Mann-Whitney U-test. Bar indicates standard error mean.

Staple food and side dish combination prevents postprandial hyperglycemia

7000

80

6000

70
50

Kakeudon( n=11)40

Salad udon
( n=11)30
20

Kakeudon ( n=11)

3000

Salad udon ( n=11)

1000

0

50
Time (min)1000Fig. 3. Blood glucose level changes after ingestion of
kakeudon or salad udon.

Fig.4. AUC after ingestion of kakeudon or salad udon.
Mann -Whitney U-test. Bar indicates standard error mean.

For maximum blood glucose level changes, p < 0.1; kakeudon vs saladudon, Mann -Whitney U-test. Bar indicates standard error mean.

8000

100
90

7000

80
60

Udon supplemented
with dietary ﬁber
( n=15)

50
40
30

5000

Cooked rice ( n=17)

2000

10

1000

0
0

20

40

60 80 100 120 140
Time (min)0

Fig.5. Blood glucose level changes after ingestion of cookedrice or udon supplemented with dietary fiber.

For maximum blood glucose level changes, p < 0.05: cooked r ice vsudon supplemented with dietary fiber, Mann -Whitney U-test. Bar
indicates standard error mean.

Fig.6. AUC after ingestion of cooked rice or udon
supplemented with dietary fiber.
Mann -Whitney U-test. Bar indicates standard error mean.

8000

p < 0.001

7000
6000

Bowl of rice topped
with mabonasu( n=10)AUC△Blood glucose (mg/dL)

Udon supplemented withdietary ﬁber ( n=15)

4000
3000

Cooked rice
( n=17)

20

100
90
80
70
60
50
40
30
20
10
0

p = 0.040

6000

70
AUC

△Blood glucose (mg/dL)

4000

2000

10
0

p = 0.023

5000

60
AUC

△Blood glucose (mg/dL)

90

5000
4000
3000

Cooked rice ( n=17 )Bowl of rice topped withmabonasu ( n=10)
Cooked rice ( n=17)

2000

0

20

40
60
80
Time (min)

100

1000

120

0

Fig.7. Blood glucose level changes after ingestion of cookedrice or bowl of rice topped with braised meat andeggplant (mabonasu).

Fig.8. AUCs after ingestion of cooked rice or bowl of rice
topped with braised meat and eggplant (mabonasu).

For maximum blood glucose level changes, p < 0.05; cooked rice vs.
bowl of rice topped with braised meat and eggplant, Mann-Whitney
U-test. Bar indicates standard error mean.

_ 56 _

Mann -Whitney U-test. Bar indicates standard error mean.

Glycative Stress Research

6000
p = 0.034

5000

70
60
50

4000

Udon topped withmabonasu ( n=8)

40

AUC

△Blood glucose (mg/dL)

80

30
20

Udon supplemented
with dietary ﬁber
( n=15)

10
0

0

50
100
Time (min)1000
0For maximum blood glucose level changes, no significant difference
was found, Mann -Whitney U-test.

Fig.10. AUCs after ingestion of udon supplemented withdietary fiber or udon topped with braised meat andeggplant (mabonasu).
Mann -Whitney U-test.

90

6000

80

NS

5000

70
60
50

Udon topped withmabonasu ( n=8)

40

4000
AUC

△Blood glucose (mg/dL)

Udon supplemented
with dietary ﬁber ( n=15)

2000

150

Fig. 9. Blood glucose level changes after ingestion of udon
supplemented with dietary fiber or udon topped
with braised meat and eggplant (mabonasu).

Bowl of rice topped
with mabonasu( n=10)

30
20
10
0

Udon topped withmabonasu ( n=8)

3000

3000
2000

Udon topped withmabonasu ( n=8)
Bowl of rice topped withmabonasu ( n=10)

1000
0

20

40

60 80 100 120 140
Time (min)0

Fig.11. Blood glucose level changes after ingestion of bowlof rice topped with braised meat (mabonasu) or
eggplant and udon topped with braised meat andeggplant (mabonasu).

Fig.12. AUCs after ingestion of bowl of rice topped withbraised meat and eggplant (mabonasu) or udon
topped with braised meat and eggplant (mabonasu).

For maximum blood glucose level changes, no significant difference
was found, Mann -Whitney U-test.

_ 57 _

Mann -Whitney U-test.

Staple food and side dish combination prevents postprandial hyperglycemia

Discussion

In the comparative study of different staple foods reported
previously, bread and pasta tended to produce lower valuesof both maximum blood glucose level change and AUC thancooked rice. Although a combination of cooked rice and asoup containing dietary fiber did not suppress changes in
postprandial blood glucose levels, the addition of dietary fiber
to udon was shown to lessen the elevation of blood glucose
levels after meals. In the present study, the effects of the
choice of side dish taken in combination with cooked rice on
postprandial blood glucose level elevations were assessed.
The salad udon experiment showed that the amount ofcarbohydrates other than dietary fiber was greater by nearly
10 g in salad udon than in kakeudon. Despite this fact,concurrent ingestion of salad and udon revealed a blood
glucose level reducing effect. It has already been reported thatblood glucose level elevations are more largely suppressedby taking vegetable salad before taking cooked rice 6, 7).
Dietary fiber contained in vegetables is known to delay
sugar absorption by increasing viscosity of the content in theupper gastrointestinal tract via its gelation, and influencing
the content movement rate as well as digestion and absorption
in the gastrointestinal tract 8), and to suppress postprandial
blood glucose level elevations by causing the secretion of
glucagon-like peptide -1 (GLP-1), an insulin secretagogue that
promotes insulin secretion via mechanical stimulation of thegastrointestinal tract 9 -11).
In the salad udon experiment in the present study, thegreater suppression of postprandial blood glucose levelelevation with salad udon than with kakeudon is attributable
to an effect of vegetables. The same experiment also
demonstrated that a dietary fiber effect of vegetables was
obtained by taking the vegetables concurrently with a staple
food.
The smaller AUC obtained with udon with a soft boiledegg (ontama udon) than with kakeudon is attributable to the
influence of the proteins and lipids contained in the eggs.
It is believed that elevations of postprandial blood glucose
levels were suppressed by the influence of proteins and lipids.
Especially lipids influence gastric smooth muscle movement
via gastrointestinal tract hormone and the vagus nerve to
reduce the gastric emptying rate 12), thus slowing the blood
glucose elevation after meals.
By adding braised meat and eggplant (mabonasu) as a sidedish to each staple food (cooked rice and udon supplemented
with dietary fiber), postprandial blood glucose level elevations
were suppressed compared with staple food alone. In addition
to the lipid effect 12), olive oil possesses GLP-1 secretagogue
activity 13) ; therefore, the vegetable dietary fiber and meat
proteins and lipids in mabonasu, and the lipid in the olive
oil used for cooking the test food, can be considered to haveacted in a multiplex way.
In addition, the carbohydrates other than dietary fibercontained in the retort-packed sauce for braised meat andeggplant (mabonasu) primarily comprise starch and areabsorbed in the form of glucose. The vegetables contain only
approximately 5 g of carbohydrates other than dietary fiber.
Therefore, it is unlikely that the observed suppression of
postprandial blood glucose level elevations was attributed
to the fact that the carbohydrates other than dietary fibercontained in braised meat and eggplant were different fromthose in other side dishes.

Because GI values are calculated from AUC, foods that
produce a sharp elevation and reduction of blood glucose
level have low GI values because of their low AUC. As statedwith regard to kakeudon and buckwheat noodles (soba) in ourprevious report 3), the AUC is lower for buckwheat noodles,
whereas the maximum blood glucose level change is lower
for udon. Because glycation is reportedly more likely toproceed at blood glucose levels of 160 mg/dL or more, it isalso important to suppress the maximum blood glucose levelchange in order to suppress glycation stress. For this reason, tosuppress glycation stress, it is necessary to choose food items
taking into account not only GI value, but also the maximum
blood glucose level change
It was found that postprandial blood glucose levels
were suppressed by eating a staple food and vegetables incombination, and by eating a staple food and a side dishin combination. When comparing cooked rice and udon
supplemented with dietary fiber, cooked rice was found to
be more likely to cause postprandial hyperglycemia, and no
significant difference was found in the postprandial blood
glucose level between a bowl of rice topped with braised meatand eggplant (mabonasu + cooked rice) and udon topped withbraised meat and eggplant (mabonasu + udon supplemented
with dietary fiber). These findings suggest that when thesame side dish is combined with different staple foods, thedifferences in postprandial blood glucose level among thestaple foods decrease. It is therefore concluded that a glycationstress suppressing effect more than that of low-GI foods canbe obtained by combining a staple food and a side dish.
It was found that in suppressing glycation stress, thechoice of side dish is more important than choice of staple
food. Since the choice of staple food may be related to mental
stress due to the inability to eat any staple food freely, we
believe that it is readily acceptable for daily dietary life tochoose a staple food freely, and take it in combination withappropriate side dishes.
It is recommended that the side dishes taken containdietary fiber, proteins, and lipids in a good balance, and theyshould also incorporate a vegetable possessing anti-glycation
activity. In the present study, braised meat and eggplant(Mabonasu) was used to this end. Western-type eggplantand spinach, which were contained in the braised meat andeggplant examined, have been reported to have anti-glycation
activity 14). Many vegetables are known to show anti-glycation
activity. We hypothesized that glycation stress could further
be suppressed by using anti-glycation vegetables as aningredient of side dishes.

Conclusion
A combination of a staple food and side dishes may be more
effective than low-GI foods in suppressing glycation stress.
While it is an approach to suppressing glycation stress frommeals to choose a staple food from among low-GI foods suchas pasta, as well as udon supplemented with dietary fiber,even high-GI foods such as cooked rice are expected to be
more effective than low-GI foods when combined with anappropriately chosen side dish.

_ 58 _Glycative Stress Research

Acknowledgments

A presentation of this study was made at the 13th
Scientific Meeting of Japanese Society of Anti-Aging
Medicine (Yokohama; June 2013), and it received the Best
Poster Award selected by high school students. Test foodsamples were provided by Hanamaru, Inc..

Statement of conflict of interest

The authors have no conflicts of interest related to thisstudy to declare.

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