Glycemic index and glycemic load of commercial Italian foods

Glycemic index and glycemic load of commercial Italian foods

Accepted Manuscript Glycemic index and glycemic load of commercial Italian foods F. Scazzina, M. Dall’Asta, M.C. Casiraghi, S. Sieri, D. Del Rio, N. P...

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Accepted Manuscript Glycemic index and glycemic load of commercial Italian foods F. Scazzina, M. Dall’Asta, M.C. Casiraghi, S. Sieri, D. Del Rio, N. Pellegrini, F. Brighenti PII:

S0939-4753(16)00024-7

DOI:

10.1016/j.numecd.2016.02.013

Reference:

NUMECD 1563

To appear in:

Nutrition, Metabolism and Cardiovascular Diseases

Received Date: 20 November 2015 Revised Date:

10 February 2016

Accepted Date: 13 February 2016

Please cite this article as: Scazzina F, Dall’Asta M, Casiraghi M, Sieri S, Del Rio D, Pellegrini N, Brighenti F, Glycemic index and glycemic load of commercial Italian foods, Nutrition, Metabolism and Cardiovascular Diseases (2016), doi: 10.1016/j.numecd.2016.02.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Glycemic index and glycemic load of commercial Italian foods

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Scazzina F1, Dall’Asta M1, Casiraghi MC2, Sieri S3, Del Rio D1, Pellegrini N1*, Brighenti F1

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Human Nutrition Unit, Department of Food Science, University of Parma, Italy

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Human Nutrition Unit, Department of Food, Environmental and Nutritional Sciences (DeFENS),

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University of Milan, Italy

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Italy

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Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano,

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*Corresponding author; Email: [email protected]; Phone: +39 0521 903907

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Keywords: glycemic index; glycemic load; database; Italian commercial foods

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Abstract

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Background and Aim: The glycemic index (GI) and glycemic load (GL) are useful parameters in the

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nutritional classification of carbohydrate foods. Diets characterized by a low GI and/or a low GL

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have been repeatedly and independently associated with decreased risk of diabetes and other

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chronic diseases. The aim of this study is to report the GI and GL value of carbohydrate-rich foods

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available on the Italian market and mostly consumed in Italy.

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Methods and Results: GI values were determined according to FAO/WHO (1997) and ISO (2010).

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Overall, the 141 commercial foods that were analyzed represent food categories that are the source

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of >80% carbohydrate intake in Italy. The food items chosen were based mainly on the market

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share of the brand within each food category and grouped into 13 food categories: 1) beverages:

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fermented milk drink, juice, smoothie, soft drink; 2) biscuits; 3) breads; 4) bread substitutes; 5)

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breakfast cereals; 6) cakes and snacks; 7) candy and confectionery; 8) cereals; 9) desserts and ice-

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creams; 10) marmalade and jam; 11) pasta; 12) pizza; 13) sugar and sweetener.

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Conclusion: This database of commercial Italian foods partly overcomes the lack of information on

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GI and GL of local foods, contributing to a better understanding of the association between GI/GL

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and health and providing a more informed choice to Italian consumers and health practitioners.

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ACCEPTED MANUSCRIPT Introduction

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The glycemic index (GI) was developed to systematically classify foods according on their ability

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to raise postprandial glycemia [1]. Carbohydrates in foods with a low GI are more slowly digested

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and absorbed and, consequently, diets with a low GI are beneficial in controlling postprandial

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plasma glucose excursions [2]. Since the overall impact of one food on postprandial response is due

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to the combination of GI and the amount of carbohydrate in that food, a derived index has been

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proposed [3]. The glycaemic load (GL) is defined as the mathematical product of the grams of

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available carbohydrate in the food portion and the food's GI, divided by 100. The physiological

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validity of the GL concept as predictor of postprandial glycemia and insulin demand has been

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demonstrated for foods high in carbohydrate and low in fat and protein [4]. Subsequently, GL was

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standardized to the energy of the food portion consumed (GL/1000 kJ) for better representing

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carbohydrate-based foods combined with fat and protein [5]. The food GL, standardized to energy,

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is the single best predictor of the glycemic response of foods, taking into consideration not only the

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quantity of carbohydrates but also the presence of other nutrients [6].

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In nutritional epidemiology the use of GI and/or GL, as a descriptor of diets and food patterns, is common. Diets low in GI and GL, but not in total carbohydrates, are associated to lower type 2

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diabetes mellitus (T2DM) risk [7,8], cardio-vascular disease (CVD) risk [9,10], levels of pro-

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inflammatory markers and fasting insulin [2]. However, conflicting results have appeared in the

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literature. For example, opposing conclusions have been reported on the risk of T2DM, where no

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association with diabetes risk was observed in a random subcohort (n = 16,835) of the EPIC study

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[11] while, on the other hand, GI/GL resulted to be important factors in diabetes prevention in the

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EPIC-Netherlands cohort [12]. However, as also highlighted by the authors of the above-mentioned

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papers, a major methodological issue for the validity of GI/GL data in epidemiological research is

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the use of international GI/GL food databases in local contexts, which may not correctly represent

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the actual products present on the local market. A second methodological issue is the limited

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number of foods or preparations mapped for GI/GL in an ever-growing food market.

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Despite some doubts on the validity of the GI concept raised by recent guideline documents [13], the ability to control postprandial glycemia is considered to be extremely useful by most

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health institutions [6, 14-20].

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In this context, there is need to communicate information on GI/GL to the general public and

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health professionals and to establish better and unbiased tools for nutritional research, with a focus

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on foods and preparations that are consumed locally. Due to the lack, to date, of a detailed set of

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data including commercial food products sold on the Italian market, the aim of the present study

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was to measure a sufficiently large and detailed set of GI/GL values of commercial foods to be the

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further applied to present and future epidemiological studies.

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Methods

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All the analyses have been performed at the Department of Food Science (Nutrition Unit) of the

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University of Parma and at the Department of Food, Environmental and Nutritional Sciences

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(DeFENS) of the University of Milan over 10 year period between 2005 and 2015. The GI values

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were determined following the method described by the Food and Agriculture Organization/World

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Health Organization [16] and, later, applying the guidelines set up by the International Standards

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Organisation [21].

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Subjects

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Healthy subjects were recruited from the local communities during the last 10 years. All subjects

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met the inclusion criteria: non-smoking, aged 18–69 years, stable body weight, BMI of 19–25

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kg/m2, normal glucose tolerance, regular physical activity, normal dietary habits, no history of

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eating disorders, no gastrointestinal disorders, no diabetes, no medications known to affect glucose 4

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subjects of this study were previously informed on the details of the protocol, and about the risks

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involved in participation and they gave their written informed consent to participate to the study,

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according to the Helsinki declaration on human rights. The studies were case-by-case approved by

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the ethical committees of the University of Parma and of the University of Milan.

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Foods

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The 13 food categories investigated were: 1) beverages: fermented milk drink, juice, smoothie, soft

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drink; 2) biscuits; 3) breads; 4) bread substitutes; 5) breakfast cereals; 6) cakes and snacks; 7) candy

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and confectionery; 8) cereals; 9) desserts and ice-creams; 10) marmalade and jam; 11) pasta; 12)

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pizza; 13) sugar and sweeteners, representing the source of >80% of the carbohydrate intake as

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extrapolated from dietary intake data obtained in two cohort studies in northern Italy [22, 23]. Food

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items were commercial products belonging to the above categories selected according to the market

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share of the producer within each category. In addition, specialty foods or different brands were

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also selected in order to expand the category surveyed. Each food was purchased in a single batch

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on the local market or directly obtained by the producer in sufficient amounts to provide the

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required number of food portions to the selected number of volunteers. Portion sizes were

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calculated according to manufacturers’ nutrition information. All food items were portioned to

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provide either 50 g of available carbohydrate or 25 g for foods with low available carbohydrates

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content. Three items in candy and confectionary category (Tic Tac – two flavors- Mon Cheri and

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Pocket Espresso to GO) were administered in a smaller portion (12.5 g of available carbohydrates)

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because of the unrealistic portion and of the alcohol and caffeine content, respectively. Pasta and

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wholegrain cereal samples were cooked following the same procedure for each food: one portion of

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pasta or wholegrain cereals was cooked in 1 liter of boiling water with 5 g of salt for the time

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indicated on the pack label. The reference meal was glucose monohydrate in iso-carbohydrate

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amount.

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Experimental procedures

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The volunteers attended each testing session after a 12 h overnight fast, having been instructed to

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consume the same meal the evening before each test day, and not to drink alcohol or to perform

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vigorous physical exercise. Furthermore, subjects followed a controlled diet the day before the test,

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excluding dietary fiber-rich foods to avoid any second meal effect [24]. Generally, each group of

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volunteers tested from 2 to 10 food items.

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Subjects consumed the provided food portion within 15 min, with 500 ml of still water as the only

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beverage. They remained seated during the 2 h of the study and were not permitted to further eat or

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drink until the end of session. The reference meal, glucose monohydrate, was dissolved in 500 ml of

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water and was consumed by the subjects in two or three separate occasions, at the beginning and at

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the end of the assigned set of products, and in one middle occasion when the assigned food items to

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a set of volunteers were more than three.

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Sample collection and blood glucose analysis

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Blood glucose concentrations were measured in capillary whole blood obtained by finger prick

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(Accu-Chek Advantage System, Roche Diagnostics Limited, Lewes, UK) in the fasted state and at

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15, 30 45, 60, 90 and 120 min after consumption of the test product. Blood samples were collected

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in a heparin/fluoride treated vials (Microvette CB 300 FH, Sarstedt, Germany) and stored at -20°C

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until analysis. Glucose concentration was measured by means of an automatic analyzer with a

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combined enzymatic-electrochemical detector (YSI 2300 STAT PLUS, Yellow Spring Instruments,

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OH, U.S.A.).

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ACCEPTED MANUSCRIPT Data analysis

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The incremental area under the blood glucose response curve (IAUC) was calculated geometrically

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using the trapezoid rule, ignoring the area below the fasting baseline. For each test food, the IAUC

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was expressed as a percentage of the mean IAUC of the isocarbohydrate reference food glucose

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(tested 2-3 times) consumed by the same subject. The GI of each food was then calculated as the

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mean value across all subjects consuming that food.

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The GL (g glucose equivalents)/1000kJ values were calculated by multiplying the amount of

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carbohydrate contained in a 1000kJ portion of the food by the GI value of that food, which was then

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divided by 100.

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Statistical analysis

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The GI value in the database for each food was reported as mean (± SEM). Individual values

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overcoming the mean by at least 2 SD were excluded from the mean calculation, as specified in the

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ISO methodology [21].

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Results and Discussion

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Several groups of healthy volunteers (319 female, 305 male, total number 624) were recruited. The

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anthropometric characteristics of subjects are reported in Table 1. After statistical analysis, 0.8% of

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individual GI values has been excluded since they overcame the mean by at least 2 SD. In total 141

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food items were tested from 13 food categories. The measured GI values of the foods are shown in

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Table 2. For each food item, in addition to mean GI, the minimum and the maximum values are

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reported. GL values were calculated for 1000 kJ and not related to portion because it is difficult to

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define the serving size for each item since portion sizes vary markedly among food industries and

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consumers. Thus, expressing the glycemic effect of foods on an isoenergetic basis is a logical and

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practical approach. In addition, the year in which foods were analyzed is also shown. This

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information is necessary because the GI values of commercial foods might change over time if food

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manufacturers make changes in the ingredients or in the processing methods. The variability observed in the GI value for foods of similar nature and category could reflect

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real differences among the foods. Food factors that can influence the GI of processed foods include

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processing, preparation and cooking methods, the physical form of the food, the type of sugars and

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starch, the presence of other macronutrients and antinutrients, and the ripeness or the maturity of the

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raw materials. For example, different brands of the same type of food, such as a size of pasta, may

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look and taste almost the same, but differences in the type of flour used, the technological aspects

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(time/temperature/humidity drying cycles; extrusion dies) and the cooking time can result in

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differences in the degree of starch gelatinization and consequently the GI values. This is evident

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comparing the three analyzed spaghetti (i.e., classici, n° 5 and n°12).

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The variability in GI values within the same category, or subcategory, is comparable with the

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variability of the international GI data [25, 26]. For example, boiled white rice has a GI of 64 in our

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study (Table 2, Cereals, n. 92) and 69 in the international GI databases [25, 26]; cookies with dried

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berries had 53 (Table 2, Biscuits n.15) in our study and 50 in the international GI databases [25, 26].

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It is important to highlight a limitation of this database. Since some products were tested years ago,

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their ingredient formulation or technological preparation could have been modified ever since.

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Therefore, it would be suitable setting some methodological rules. For instance, re-testing every few

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years food items with GI falling close to 55 or 70, the edges of the GI scale; re-testing reformulated

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products, where the primary source(s) of carbohydrate have been substituted, or different cereal

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cultivars utilised, or the macronutrient composition has been modified. For this purpose, the co-

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operation between food companies and laboratories testing GI is essential in order to provide the

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most accurate information.

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CONCLUSION 8

ACCEPTED MANUSCRIPT We measured the GI values of 141 different carbohydrate-rich foods. The relevance of the obtained

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data is that they refer to local Italian food items. Since there is a need to improve the amount and

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quality of information on GI/GL values available to the general public and to health professionals in

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the framework of prevention, an Italian database including local foods commonly consumed is of

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great value. For example, substituting high for low GI versions of food within the same category

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will make a significant contribution to reducing the GI of the Italian diet. Moreover, an updated and

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expanded database of GI/GL of Italian foods will result in more reliable data for all clinical and

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research applications in the local context. Furthermore, information on GI/GL of industrial products

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could motivate food manufacturers to develop a greater range of low-GI processed foods. However,

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when commercial products are taken into account, the obvious limitation linked to possible change

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in food formulation/preparation during the years must be kept in mind. Moreover, even if the

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variability of GI values within the same category (or subcategory) is comparable with the variability

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of the international GI data, this variability could be greater if food products are prepared for

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different national markets. For example, one product could have a different formulation for each

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country in which it is commercialized, even if it has the same commercial name.

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Further studies are needed to investigate how the GI value of a food changes when the food is consumed in the context of a mixed meal (e.g., pasta with sauce, jam with bread etc.). Such

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additional data will help both researchers and consumers in making the correct selection of

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carbohydrate-based foods.

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Acknowledgments

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We gratefully thank all volunteers involving in glycemic index measurements. Moreover, for food

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product supplies, we acknowledge: Barilla G. e R. Fratelli S.p.A. (Parma), Dr Schär AG/SPA

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(Postal, BZ), Monviso SpA (Andezeno -TO), Novaterra Zeelandia Spa (Ossona-MI), Panem Italia

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Spa (Muggiò-MI), Raviolificio Lo Scoiattolo SpA (Lonate Ceppino-VA), Rigoni di Asiago S.r.l 9

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(Asiago-VI), Riso Gallo S.p.A. (Robbio- PV), Roberto Industria Alimentare Spa (Susegana-TV),

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Soremartec Italia S.r.l. (Alba, CN), Yakult Italia S.r.l. (Milano).

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Declaration of interest

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The authors declare that they have no competing interests.

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References

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[1] Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index

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of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 1981;34:362–6.

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[2] Schwingshackl L, Hoffmann G. Long-term effects of low glycemic index/load vs. high glycemic

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meta-analysis. Nutr Metab Cardiovasc Dis 2013;23:699–706.

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[3] Salmeron J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, et al. Dietary fiber,

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glycemic load, and risk of NIDDM in men. Diabetes Care 1997;20:545–50.

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[4] Brand-Miller JC, Thomas M, Swan V, Ahmad ZI, Petocz P, Colagiuri S. Physiological

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validation of the concept of glycemic load in lean young adults. J Nutr 2003;133:2728–32.

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[5] Bao J, Atkinson F, Petocz P, Willett WC, Brand-Miller JC. Prediction of postprandial glycemia

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to the risk of type 2 diabetes: a meta-analysis of prospective cohort studies. Br J Nutr

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2011;106:1649–54.

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[9] Ma XY, Liu JP, Song ZY. Glycemic load, glycemic index and risk of cardiovascular diseases:

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meta-analyses of prospective studies. Atherosclerosis 2012;223:491–6.

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[10] Sieri S, Krogh V, Berrino F, Evangelista A, Agnoli C, Brighenti F, et al. Dietary glycemic load

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and index and risk of coronary heart disease in a large italian cohort: the EPICOR study. Arch

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Intern Med 2010;170:640–7.

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[11] Sluijs I, Beulens JW, van der Schouw YT, van der A DL, Buckland G, Kuijsten A, et al.

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Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with

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risk of type 2 diabetes in eight European countries. J Nutr 2013;143:93–9.

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[12] Sluijs I, van der Schouw YT, van der A DL, Spijkerman AM, Hu FB, Grobbee DE, et al.

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Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective

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Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study. Am J Clin Nutr

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[13] SACN (Scientific Advisory Committee on Nutrition). Carbohydrates and Health. Published by

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[14] IDF (International Diabetes Federation). Guideline for Management of Post-meal glucose.

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484) and carbohydrates with a low glycaemic index (ID 480, 481, 482, 1300) pursuant to Article

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13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2010; 8:1491.

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human nutrition. Report of a Joint FAO/WHO expert consultation 1998; FAO Food and Nutrition

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Sunyer FX, Mayer-Davis E, et al. Dietary carbohydrate (amount and type) in the prevention and

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management of diabetes. Diabetes Care 2004;27:2266–71.

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[18] Connor H, Annan F, Bunn E, Frost G, McGough N, Sarwar T, et al. Nutrition Subcommittee of

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the Diabetes Care Advisory Committee of Diabetes UK. The implementation of nutritional advice

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for people with diabetes. Diabet Med 2003;20:786–807.

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nutritional management of diabetes mellitus in the new millennium. A position statement by the

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Canadian Diabetes Association. Can J Diabetes Care 2000;23:56–69.

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Nutrienti ed energia per la popolazione italiana. Ed. SICS, Milano, 2010; IV revisione.

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(GI) and recommendation for food classification In: International Standards Organisation. ISO

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26642–2010.

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ACCEPTED MANUSCRIPT [25] Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and

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glycemic load values: 2002. Am J Clin Nutr 2002;76:5–56.

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[26] Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and

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[27] Scazzina F, Dall'Asta M, Pellegrini N, Brighenti F. Glycaemic index of some commercial

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gluten-free foods. Eur J Nutr 2015;54:1021-6.

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ACCEPTED MANUSCRIPT Table 1: The subject characteristicsa. Women (n=319)

Age (years)

27 ± 1

28 ± 1

Weight (kg)

73.9 ± 0.8

57.6 ± 0.5

Height (m)

1.80 ± 0.1

1.65 ± 0.1

BMI (kg/m2)

23.9 ± 0.1

21.4 ± 0.2

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The values are reported as mean and standard error of the mean.

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Men (n=305)

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Table 2: Glycemic Index and Glycemic Load of 141 commercial Italian foods.

Commercial name

GI

SEM GI min

Number of subjects

Available carbohydrate (g/portion)

GL/1000kJ Year of analysis/

79

10

25

31

2011

GI max

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Food number and item

SC

BEVERAGES Fermented milk drink

Reference

1 Milk, cow, fermented, with probiotics Juice

Yakult (Yakult Italia)

2 Juice, green apple (100%) Smoothie

Succo di mela verde (100%) (Pfanner)

67

7

45

96

9

50

43

2011

3 Smoothie, apple, pear, banana

Frullato mela, pera e banana Storie di frutta (Mulino Bianco, Barilla)

68

5

45

88

9

50

44

2011

Coca-Cola (Coca-Cola) Estathè deteinato limone (Ferrero)

73 38

7 3

41 28

96 51

9 9

50 50

49 26

2011 2011

72 71 66

6 7 5

51 40 47

92 98 90

9 9 9

50 50 50

48 48 44

2011 2011 2011

Gran Cereale Frutta (Grancereale, Barilla)

51

7

28

94

9

50

17

2010

Gran Cereale Cioccolato (Grancereale, Barilla) Gran Cereale Classico (Grancereale, Barilla) Macine (Mulino Bianco, Barilla)

52

10

15

110

9

50

19

2010

49

4

34

74

10

50

16

2005

52

7

24

88

10

50

18

2006

Molinetti (Mulino Bianco, Barilla)

58

7

24

87

10

50

20

2006

EP

BISCUITS 9 Biscuits, rolled oat, whole-meal soft wheat flour, 9.2% fruits (rising, dried apple, hazelnuts) 10 Biscuits, rolled oat, whole-meal soft wheat flour, chocolate (4.8%) 11 Biscuits, rolled oat, whole-meal soft wheat flour, wheat fiber 12 Biscuits, soft wheat flour, butter, cream 13 Biscuits, soft wheat flour, oat flour, whole-meal buckwheat flour (6.2%)

Estathè limone (Ferrero) Estathè pesca (Ferrero) Estathè verde (Ferrero)

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4 Cola 5 Tea, black, deteinated, lemon (7% fructose) 6 Tea, black, lemon 7 Tea, black, peach juice (9.5%) 8 Tea, green

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Soft drink

4

28

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Fior di Latte (Mulino Bianco, Barilla)

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4

26

61

9

50

21

2012

Segreti di Bosco (Mulino Bianco, Barilla)

53

7

29

79

9

50

21

2012

Pavesini (Pavesi, Barilla)

52

5

27

71

10

25

29

2004

Gemme Integrali (Mulino Bianco, Barilla) 46

6

28

73

9

50

18

2012

18 Biscuits, gluten-free

Frollino gluten-free (Dr. Schaer)

37

7

12

61

10

50

16

[27]

Bocconcini (Panem) Pan Gustavo (Novaterra Zeelandia)

71 72

6 8

42 35

87 103

10 10

50 25

39 21

2010 2014

87

11

20

140

10

25

40

2014

Pagnottelle classiche (Mulino Bianco, Barilla) Pan bauletto al grano duro (Mulino Bianco, Barilla) Pan bauletto bianco (Mulino Bianco, Barilla) Pan bauletto 5 cereali e soia (Mulino Bianco, Barilla)

62

11

27

100

9

50

28

2009

68

7

43

96

9

50

31

2009

59

7

37

96

10

50

28

2007

60

9

26

93

9

50

24

2009

Pan Bauletto Fior di Fibra (Mulino Bianco, Barilla) Pane Bianco all'olio d'oliva (Coop)

53

5

34

76

10

50

22

2013

73

7

48

103

10

25

33

2011

Cuor di Lino (Mulino Bianco, Barilla)

58

10

26

95

9

50

22

2012

Pane a fette a basso indice glicemico e ad alto contenuto di fibre (Roberto Industria Alimentare)

41

2

31

49

10

25

17

2011

63

4

50

87

10

25

27

2011

30 Bread, sliced, soft wheat flour, olive Pane Bianco (Roberto Industria

SC

M AN U

TE D

25 Bread, sliced, soft wheat flour (58%), soy grain (6.2%), barley flour (0.5%), oat flour (0.5%), rye flour (0.5%), spelt flour (0.5%) 26 Bread, sliced, soft wheat flour, durum wheat bran (9.3%) 27 Bread, sliced, soft wheat flour, extra virgin olive oil 28 Bread, sliced, soft wheat flour, flaxseeds (4.9%), soy grain (4.3%) 29 Bread, sliced, soft wheat flour, low GI and high fiber

EP

24 Bread, sliced, soft wheat flour

Pan Semola (Novaterra Zeelandia)

AC C

BREADS 19 Bread, bite-sized, soft wheat flour 20 Bread, bakery made from an industrial mix for bread preparation 21 Bread, bakery made from an industrial mix for bread preparation 22 Bread, rolls, soft wheat flour, sugar (5.4%) 23 Bread, sliced, durum wheat flour

RI PT

14 Biscuits, soft wheat flour, rice flour (3.2%), milk 15 Biscuits, soft wheat flour, wholemeal wheat flour, raisin, dried blueberries (5.9%), wheat fiber 16 Biscuits, sugar, soft wheat flour, “Savoiardo”-type 17 Biscuits, whole-meal soft wheat flour (66%), sugar cane (5.6%) Gluten-free

ACCEPTED MANUSCRIPT

oil (2.5%) 31 Bread, sliced, whole-meal wheat flour 32 Bread, small French loaf, soft wheat flour Gluten-free

Alimentare) Pan Bauletto Integrale (Mulino Bianco, Barilla) Sfilatini al grano tenero (Mulino Bianco, Barilla)

33 Bread, sliced, gluten-free 34 Bread, sliced, sourdough, glutenfree 35 Bread rolls, gluten-free

43 Melba toast, soft wheat flour, whole-meal barley flour (10%), rolled oat (2%) 44 Melba toast, soft wheat flour, bran and rolled oat, with psyllium and soluble fibers 45 Melba Toast, whole-meal wheat flour (50.1%), soft wheat flour Gluten-free

10

50

24

2012

65

9

20

100

9

50

31

2009

Pane a fette gluten-free (Coop) Pane a fette gluten-free (Dr. Schaer)

61 52

6 7

44 31

Panino gluten-free (Dr. Schaer)

63

8

25

Grissini classici friabili (Mulino Bianco, Barilla) Grissini Fibra Activa (Panmonviso) Cracker salati Sfoglia di grano (Mulino Bianco, Barilla) Cracker integrali Sfoglia di grano (Mulino Bianco, Barilla) Spianate croccanti con semi di zucca (Grancereale, Barilla)

66

7

RI PT

84

10 10

50 50

29 25

[27] [27]

83

10

50

35

[27]

100

10

25

31

2004

SC

96 87

M AN U

34

52 63

5 8

26 39

82 103

12 10

50 50

17 25

2008 2010

63

5

44

88

10

50

25

2010

53

5

31

70

10

50

22

2012

63

8

32

98

9

25

19

2015

64

11

24

126

10

50

33

2005

45

5

24

67

9

50

22

2012

Fette biscottate Fibra Activa (Panmonviso)

47

6

26

75

10

50

15

2009

Fette Biscottate Le Integrali (Mulino Bianco, Barilla)

73

9

38

119

9

50

35

2005

67

6

45

92

10

50

36

[27]

TE D

39 Crackers, whole-meal soft wheat flour 40 Crispbread, soft wheat flour (54%), rye flour (36%), pumking seeds (7.5%) 41 Focaccia, soft wheat flour, with extra virgin olive oil (8.7%) 42 Melba toast, soft wheat flour

36

Focaccelle con olio di oliva extravergine (Mulino Bianco, Barilla) Fette Biscottate Le Dorate (Mulino Bianco, Barilla) Fette biscottate Cuori di orzo (Mulino Bianco, Barilla)

EP

37 Breadstick, with psyllium and oat 38 Crackers, soft wheat flour, salty

5

AC C

BREAD SUBSTITUTES 36 Breadstick, soft wheat flour

59

46 Puffed multigrain cakes (rice 66%, Gallette Chicchi al vento (Grancereale, corn 21%, millet 6%, buckwheat 6%) Barilla)

6

46

96

10

50

30

2009

62

8

34

97

10

50

32

2009

Plumcake (Mulino Bianco, Barilla)

47

6

28

Nastrine (Mulino Bianco, Barilla)

47

6

19

Kinder Délice (Kinder, Ferrero)

58

8

Kinder Délice cocco (Kinder, Ferrero)

56

6

Yogo brioss (Ferrero)

57

10

50

14

2005

71

9

50

12

2005

SC

74

89

10

25

14

2012

18

81

10

25

12

2012

5

31

79

10

25

21

2014

51

3

41

69

10

50

19

2007

60

7

38

93

10

25

27

2012

Kinder Pan e Cioc cacao (Kinder, Ferrero) 61

3

50

76

10

25

16

2014

Kinder colazione più (Kinder, Ferrero)

66

8

23

94

10

25

18

2014

Fiesta (Ferrero)

60

6

30

87

10

25

19

2012

Brioche Cereali e Cioccolato (Grancereale, Barilla) Pangoccioli (Mulino Bianco, Barilla)

66

3

60

80

10

50

22

2012

50

5

27

72

10

50

17

2009

44

4

23

58

9

50

17

2005

Camille (Mulino Bianco, Barilla) Brioss Albicocca e cereali (Ferrero)

M AN U

22

TE D

CAKES AND SNACKS 49 Plumcake, soft wheat flour, prepared with yogurt 50 Snack, puff pastry, soft wheat flour, covered with sugar 51 Sponge cake with cocoa, milk cream-filled, coated with chocolate 52 Sponge cake with cocoa, milk cream-filled, coated with chocolate and coconut pieces 53 Sponge cake, filled with marmalade and yogurt cream 54 Sponge cake, soft wheat flour, carrots (14%), almonds (7%) 55 Sponge cake, soft wheat flour, rolled barley and oat (2.5%), filled with apricot marmalade 56 Sponge cake, soft wheat flour, filled with chocolate cream 57 Sponge cake, soft wheat flour, grinded cereals (rice, barley, rye, oat, wheat) and cocoa, filled with barley malt cream 58 Sponge cake, soft wheat flour, orange cream-filled, coated with chocolate 59 Sponge cake, soft wheat flour, with almond and chocolate pieces 60 Sweet bread, rolls, with chocolate chips 61 Tarte, small, soft wheat flour, apricot jam Gluten-free

66

EP

48 Muesli, aggregated cereals, with concentrated fruit juices

Cereali croccanti classico (Grancereale, Barilla) Cereali croccanti frutta (Grancereale, Barilla)

AC C

BREAKFAST CEREALS 47 Muesli, aggregated cereals

RI PT

ACCEPTED MANUSCRIPT

Crostatina all'albicocca (Mulino Bianco, Barilla)

ACCEPTED MANUSCRIPT

70 71 72 73

74

75 76 77 78

79

80 81

10

50

13

[27]

Tic Tac Arancia (Ferrero) Tic Tac Menta (Ferrero) Pocket Espresso to GO (Ferrero)

68 67 71

6 6 7

50 48 44

93 87 100

10 10 10

12.5 12.5 12.5

44 45 36

2014 2014 2014

Choco fresh (Kinder, Ferrero)

55

5

31

83

10

25

9

2012

Merendero (Kinder, Ferrero)

42

5

26

71

10

25

11

2012

Nutella (Ferrero) Nutella & Go (Ferrero)

45 57

4 9

Nutella & GO Estathè Limone (Ferrero)

60

Milka cioccolato al latte (Modelez) Ovetto cioccolato (Dolci Preziosi) Pinguì cocco (Kinder, Ferrero)

RI PT

73

SC

68 69

25

26 22

68 94

10 10

25 25

12 17

2012 2012

6

34

93

10

25

22

2012

54 48 53

5 9 6

25 22 32

76 89 87

10 10 10

25 25 25

15 13 11

2012 2012 2012

Maxi king (Kinder, Ferrero)

58

7

28

91

10

25

11

2012

Pinguì cacao (Kinder, Ferrero)

51

5

26

69

10

25

11

2012

Softy nocciola (Kinder, Ferrero) Mon Chéri (Ferrero)

43 66

7 4

19 50

83 83

10 10

25 12.5

9 21

2012 2014

Raffaello (Ferrero)

52

7

26

83

10

25

8

2014

Rocher (Ferrero)

53

6

33

91

10

25

10

2014

Pocket Coffee (Ferrero) KitKat (Nestlè)

58 50

9 7

21 16

100 79

10 10

25

20 15

2014 2012

M AN U

67

6

TE D

66

42

EP

63 64 65

CANDY AND CONFECTIONERY Candy, orange Candy, peppermint Liquid praline, chocolate and coffee cream Chocolate bar, milk cream-filled, fresh Hazelnut and vanilla cream, with wafer balls coated with chocolate and hazelnut crumbs Hazelnut chocolate spread Hazelnut chocolate spread with breadsticks Hazelnut chocolate spread with breadsticks and black tea beverage Milk chocolate bar Milk chocolate egg -20 gramsMilk cream bar, sponge cake-filled, coated with chocolate and coconut, fresh Milk cream bar, sponge cake-filled, coated with chocolate and hazelnut crumbs, fresh Milk cream bar, sponge cake-filled, coated with chocolate, fresh Praline with hazelnut cream Praline with liqueur and whole cherry Praline, crispy wafer, milk creamfilled, coated with white chocolate and coconut Praline, crispy wafer, hazelnut spread-filled, coated milk chocolate and hazelnut crumbs Praline, with coffee cream Wafer bar, chocolate cream-filled,

Plumcake gluten-free (Dr. Schaer)

AC C

62 Plumcake, with yogurt

DESSERTS AND ICE-CREAMS 99 Pudding, chocolate 100 Slush, lemon 101 Sorbet, caffè/cappuccino 102 Sorbet, lemon

23 31

88 95

10 10

25 25

16 15

2012 2012

Duplo nocciolato (Ferrero)

59

6

27

83

10

25

12

2012

Bueno white (Kinder, Ferrero)

47

5

30

Happy Hippo (Kinder, Ferrero)

47

4

33

Rondnoir (Ferrero)

53

7

44

10

25

11

2012

64

10

25

10

2014

32

83

10

25

13

2014

5

22

70

10

25

12

2012

SC

79

M AN U

3 Cereals (rice, spelt, barley) Barley, pearled Rice (Carnaroli), white, regular Rice, parboiled Rice, parboiled Rice, parboiled, pre-cooked (ready to eat) 96 Rice, whole-meal, parboiled 97 Spelt, pearled 98 Wheat, pearled

7 7

Galak (Nestlè)

3 Cereali (riso, avena, Kamut®) (Riso Gallo) 3 Cereali (riso, farro, orzo) (Riso Gallo) Orzo (Barilla) Riso carnaroli (Scotti) Riso Blond Risotti (Riso Gallo) Riso Blond Veloce e Versatile (Riso Gallo) Riso Blond Espresso (Riso Gallo)

41

6

10

63

10

50

22

2009

44 58 64 53 61 67

8 8 11 6 11 8

11 19 23 33 32 31

86 82 111 85 110 101

10 9 10 10 10 10

50 50 50 50 50 50

25 31 38 31 36 36

2009 2009 2009 2009 2009 2009

Riso Blond Integrale (Riso Gallo) Farro (Barilla) Grano (Barilla)

56 63 72

6 10 8

18 24 36

75 96 100

10 9 9

50 50 50

31 32 37

2009 2009 2009

Danette al cioccolato (Danone) Granigel la granita classica siciliana (Dolfin) GranSoleil Gran dessert Caffè/Cappuccino (Ferrero) Sorbetto al limone (Carte d'or, Algida)

51 66

5 8

25 34

63 112

9 10

25 25

18 41

2009 2009

62

5

44

78

9

25

21

2009

72

6

33

86

9

25

36

2009

TE D

90 91 92 93 94 95

55 61

EP

CEREALS 89 3 Cereals (rice, oat, Kamut®)

Nutella B-ready (Ferrero) Tronky Nocciola (Ferrero)

AC C

coated chocolate 82 Wafer bar, hazelnut cream-filled 83 Wafer bar, hazelnut cream-filled with hazelnut crumbs 84 Wafer bar, hazelnut spread-filled with whole hazelnut, coated chocolate 85 Wafer bar, milk and hazelnut spread-filled, coated white chocolate 86 Wafer bar, milk and hazelnut spread-filled, partially coated with white chocolate 87 Crispy wafer, chocolate spreadfilled, coated dark chocolate 88 White chocolate bar

RI PT

ACCEPTED MANUSCRIPT

ACCEPTED MANUSCRIPT

110 Fruit spread, with thick apricot 111 Fruit spread, with thick cut orange 112 Jam, organic apricot, with apple juice 113 Jam, organic bitter orange, with apple juice 114 Jam, organic blueberry, with apple juice 115 Marmalade, bitter orange

PASTA 116 Pasta, penne, durum wheat flour 117 Pasta, penne, durum wheat flour 118 Pasta, short penne, durum wheat flour 119 Pasta, short penne, durum wheat whole-meal flour 120 Pasta, spaghetti, durum wheat flour 121 Pasta, spaghetti, durum wheat flour 122 Pasta, spaghetti, durum wheat flour 123 Pasta, spaghetti, whole-meal durum

4 4

26 35

69

6

39

63

3

51

74

5

9 9

RI PT

44 47

57

25 25

25 23

2009 2009

65 68

10 10

25 25

27 30

2009 2009

103

10

25

45

2010

74

10

25

44

2010

99

10

25

50

2010

SC

109 Fruit spread, wild blueberry

Fruttosa frutti di bosco (Rigoni di Asiago) Fruttosa pesca/albicocca (Rigoni di Asiago) Confettura extra albicocche (Bonne Maman) Confettura extra mirtilli selvatici (Bonne Maman) Rhapsodie de Fruit Wild Blueberry (St. Dalfour) Rhapsodie de Fruit Thick Apricot (St.Dalfour) Rhapsodie de Fruit Thick Cut Orange (St. Dalfour) Fiordifrutta albicocca (Rigoni di Asiago)

82 85

M AN U

108 Conserve, wild blueberry

31 28

63

6

42

93

10

25

41

2010

68

6

46

95

10

25

45

2010

63

9

32

106

10

25

42

2010

Fiordifrutta arance amare (Rigoni di 51 Asiago) Fiordifrutta mirtilli neri (Rigoni di Asiago) 51

8

22

87

10

25

34

2010

9

9

104

10

25

33

2010

55

6

26

79

10

25

41

2010

Penne mezzane (De Cecco) Penne (Barilla) Pennette rigate (Barilla)

47 50 53

4 7 5

27 20 27

63 78 70

9 10 10

50 50 50

25 27 29

2008 2006 2008

Pennette integrali (Coop)

48

9

15

84

10

50

25

2008

Spaghetti classici (Voiello) Spaghetti n°5 (Barilla) Spaghetti n°12 (De Cecco) Spaghetti integrali (Barilla)

51 33 50 35

9 6 9 3

24 15 15 21

89 47 98 47

9 9 10 9

50 50 50 50

26 18 26 18

2010 2005 2005 2006

TE D

107 Conserve, apricot

7 8

Marmellata arance amare (Bonne Maman)

EP

MARMALADE AND JAM 105 Compote, organic berries 106 Compote, organic peach/apricot

GranSoleil Gran dessert Limone (Ferrero) 58 GranSoleil Gran dessert Vaniglia 57 (Ferrero)

AC C

103 Sorbet, lemon 104 Sorbet, vanilla

ACCEPTED MANUSCRIPT

PIZZA 137 Pizza margherita, pre-cooked, frozen SUGAR AND SWEETENERS 138 Fructose from corn 139 Sugar, cane 140 Sugar, from organic fruits 141 Sugar, refined

27

99

10

50

27

2005

Spaghetti Integrali (Misura)

53

10

15

101

10

50

28

2005

Raviolini con Carne di Vitello (Pastificio Rana) Tagliatelle all'uovo (Barilla)

58

7

23

81

10

50

20

2011

55

4

33

67

9

50

26

2005

51

7

33

86

10

50

28

2011

44

5

59

SC

Tagliatelle all'uovo (Pastificio Lo Scoiattolo) Mini farfalle con carote e zucca (Piccolini, Barilla) Mini penne rigate (Piccolini, Barilla)

RI PT

10

64

9

50

23

2011

11

10

110

10

50

31

2009

48

5

29

75

10

50

25

2011

47

7

16

83

10

50

24

2011

11

22

90

10

50

33

[27]

6 7

27 32

63 95

10 10

50 50

27 30

[27] [27]

61

6

40

95

10

50

22

[27]

Pizza margherita Bella Napoli (Buitoni)

56

7

35

86

9

25

18

2015

Fruttosio (da mais) (Despar) Zucchero di canna (Panela) Dolcedì (zucchero da frutta biologica) (Rigoni di Asiago) Zucchero Classico (Sadam-Eridania)

25 69 23

4 10 5

4 28 9

46 115 64

10 9 10

25 25 50

17 46 15

2013 2005 2009

91

10

47

127

10

25

61

2013

M AN U

21

Mini penne rigate con zucchine e spinaci (Piccolini, Barilla) Mini Pipe rigate con pomodori e carote (Piccolini, Barilla)

Fusilli gluten-free Pasta D'Oro (Sam Mills, 54 Sam Group) Penne gluten-free (Dr. Shaer) 48 Tagliatelle all'uovo gluten-free (Sine) 60

TE D

134 Pasta, penne, gluten-free 135 Pasta, tagliatelle, with eggs, glutenfree, fresh 136 Pasta, tortelli, stuffed with meat, gluten-free, fresh

55

Tortelli ripieni carne gluten-free (fresh pasta) (Sine)

EP

133 Pasta, fusilli, gluten-free

Spaghetti integrali (De Cecco)

AC C

wheat flour 124 Pasta, spaghetti, whole-meal durum wheat flour 125 Pasta, spaghetti, whole-meal durum wheat flour 126 Pasta, durum wheat flour, stuffed, with calf meat, fresh 127 Pasta, tagliatelle, durum wheat flour, eggs, dry 128 Pasta, tagliatelle, durum wheat flour, eggs, fresh 129 Small pasta, farfalle, durum wheat flour, carrot and pumpkin pulps 130 Small pasta, penne, durum wheat flour 131 Small pasta, penne, durum wheat flour, zucchini and spinach pulps 132 Small pasta, pipe, durum wheat flour, tomato and carrot pulps Gluten-free

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

GI: Glycemic index; SEM: Standard error of the mean; GI min: minimum GI value; GI max: maximum GI value; GL/1000kJ: glycemic load (GL) = g glucose equivalents, calculated based on a 1000kJ portion size.

ACCEPTED MANUSCRIPT 1) GI and GL are useful tools in the nutritional evaluation of food 2) Diets with low GI/GL have been associated with decreased risk of chronic diseases 3) A database of 141 carbohydrate-rich commercial Italian foods items was developed 4) The database may help health professionals/consumers in making healthy food choices

AC C

EP

TE D

M AN U

SC

RI PT

5) GI/GL of industrial products could motivate producers to develop new low-GI foods