title: Baseline insulin sensitivity affects response to high-amylose maize resistant starch in women: a randomized, controlled trial The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Resistant Starch from High-Amylose Maize Increases Insulin Sensitivity in Overweight and Obese Men123 Resistant Starch Bagels Reduce Fasting and Postprandial Insulin in Adults at Risk of Type 2 Diabetes. Dietary Fibre Improves First-phase Insulin Secretion in Overweight Individuals The Therapeutic Potential of Resistant Starch in Modulation of Insulin Resistance, Endotoxemia, Oxidative Stress and Antioxidant Biomarkers in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial A randomized trial to determine the impact of a digestion resistant starch composition on the gut microbiome in older and mid-age adults. Impact of Resistant Starch on Body Fat Patterning and Central Appetite Regulation Resistant starch supplementation influences blood lipid concentrations and glucose control in overweight subjects. Is there any place for resistant starch, as alimentary prebiotic, for patients with type 2 diabetes?
abstract: Background Resistant starch ( RS ) is a type of dietary fiber that can improve glucose metabolism , but its effects may be modulated by sex or baseline insulin sensitivity . This study was design ed to examine the effect of high-amylose maize resistant starch ( HAM-RS2 ) on insulin sensitivity ( SI ) in women , and to determine if SI status affects the response to RS . Methods This was a r and omized , placebo-controlled , double-blind , cross-over study . Participants were 40 healthy , non-diabetic women aged 22–67 years in the normal-weight to obese BMI range ( 20.6–47.4 kg/m2 ) . Two doses of HAM-RS2 were tested , 15 and 30 g per day , administered in the form of cookies . Participants were r and omized to the order in which they received the experimental and placebo product . Each arm was 4 weeks , with a 4-week wash-out period in between . SI was assessed at the end of each 4-week arm of product consumption by frequently- sample d , insulin-modified , intravenous glucose tolerance test and minimal modeling . Participants were categorized as being insulin resistant ( IR ; SI < 7.8 ) or insulin sensitive ( IS ; SI ≥ 7.8 ) based on Gaussian analysis . The effect of treatment arm on SI was examined by mixed-model analysis within IR and IS sub-groups , using all available data . In addition , SI was examined by ANOVA among just those women who completed all three arms of the study with valid SI results . Results Among IR participants , SI was on average ~16 % higher after the 30 g arm when compared to the control arm by mixed-model analysis ( n = 40 , P < 0.05 ) , and tended to be 23 % higher by ANOVA among women who completed all arms ( n = 23 , P = 0.06 ) . HAM-RS2 did not affect SI in IS women . Conclusion Consumption of HAM-RS2 at 30 g/day in the form of a snack food item was associated with improved insulin sensitivity in women with insulin resistance . Clinical trials registry numberNCT01521806 BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin ( HbA1c ) , plasma glucose , lipids , and C-reactive protein ( CRP ) in T2DM patients . DESIGN Subjects with T2DM managed by diet alone ( n=162 ) were r and omly assigned to receive high-carbohydrate , high-glycemic-index ( high-GI ) , high-carbohydrate , low-glycemic-index ( low-GI ) , or low-carbohydrate , high-monounsaturated-fat ( low-CHO ) diets for 1 y. RESULTS The high-GI , low-GI , and low-CHO diets contained , respectively , 47 % , 52 % , and 39 % of energy as carbohydrate and 31 % , 27 % , and 40 % of energy as fat ; they had GIs of 63 , 55 , and 59 , respectively . Body weight and HbA1c did not differ significantly between diets . Fasting glucose was higher ( P=0.041 ) , but 2-h postload glucose was lower ( P=0.010 ) after 12 mo of the low-GI diet . With the low-GI diet , overall mean triacylglycerol was 12 % higher and HDL cholesterol 4 % lower than with the low-CHO diet ( P<0.05 ) , but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo ( time x diet interaction , P=0.044 ) . Overall mean CRP with the low-GI diet , 1.95 mg/L , was 30 % less than that with the high-GI diet , 2.75 mg/L ( P=0.0078 ) ; the concentration with the low-CHO diet , 2.35 mg/L , was intermediate . CONCLUSIONS In subjects with T2DM managed by diet alone with optimal glycemic control , long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate . Differences in total : HDL cholesterol among diets had disappeared by 6 mo . However , because of sustained reductions in postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM This study evaluated the effects of 2 levels of intake of high-amylose maize type 2 resistant starch ( HAM-RS2 ) on  insulin sensitivity ( SI ) in participants with waist circumference ≥89 ( women ) or ≥102 cm ( men ) . Participants received 0 ( control starch ) , 15 , or 30 g/d ( double-blind ) of HAM-RS2 in r and om order for 4-wk periods separated by 3-wk washouts . Minimal model SI was assessed at the end of each period using the insulin-modified i.v . glucose tolerance test . The efficacy evaluable sample included 11 men and 22 women ( mean ± SEM ) age 49.5 ± 1.6 y , with a BMI of 30.6 ± 0.5 kg/m2 and waist circumference 105.3 ± 1.3 cm . A treatment main effect ( P = 0.018 ) and a treatment × sex interaction ( P = 0.033 ) were present . In men , least squares geometric mean analysis for SI did not differ after intake of 15 g/d HAM-RS2 ( 6.90 × 10−5 pmol−1 · L−1 × min−1 ) and 30 g/d HAM-RS2 ( 7.13 × 10−5 pmol−1 · L−1 × min−1 ) , but both were higher than after the control treatment ( 4.66 × 10−5 pmol−1 · L−1 × min−1 ) ( P < 0.05 ) . In women , there was no difference among the treatments ( overall least squares ln-transformed mean ± pooled SEM = 1.80 ± 0.08 ; geometric mean = 6.05 × 10−5 pmol−1 · L−1 × min−1 ) . These results suggest that consumption of 15–30 g/d of HAM-RS2  improves SI in men . Additional research is needed to underst and the mechanisms that might account for the treatment × sex interaction observed BACKGROUND Type 2 diabetes ( T2D ) incidence continues to rise . Although increasing dietary fiber intake is an established strategy for improved glycemic control , most adults consume insufficient amounts . Fiber-enhanced functional foods can increase fiber intake , and there is particular interest in resistant starch ( RS ) as a high-fiber ingredient . Studies show that high-amylose maize resistant starch , type 2 ( HAM-RS2 ) improves acute and chronic glycemic responses , but more studies are needed in individuals at high risk of T2D with RS delivered in commonly consumed foods . OBJECTIVE The objective of this study was to examine the chronic effects of consuming bagels high in HAM-RS2 on fasting and postpr and ial glycemic markers in adults at increased risk of T2D . METHODS With the use of a r and omized , double-blind crossover design , 24 men and women with a mean ± SE age of 55.3 ± 1.59 y and body mass index ( in kg/m2 ) of 30.2 ± 0.57 consumed 1 bagel containing 25 g HAM-RS2/d or 1 control wheat bagel/d for 56 d each , separated by a 4-wk washout . Fasting and postpr and ial oral-glucose-tolerance test ( OGTT ) glucose and insulin were measured on study days 1 and 57 of each bagel treatment . RESULTS The RS bagel treatment result ed in significantly lower fasting ( 22.1 % , P = 0.04 ) , 2-h ( 23.3 % , P < 0.008 ) , and 3-h ( 18.9 % , P = 0.05 ) insulin incremental areas under the curve and fasting insulin resistance ( homeostasis model assessment of insulin resistance ; 23.1 % , P = 0.04 ) than did the control bagel treatment . Fasting and postpr and ial OGTT glucose concentrations did not differ between the RS and control bagel treatments on study days 1 or 57 . CONCLUSIONS These data suggest that consumption of a high-HAM-RS2 bagel improves glycemic efficiency by reducing the amount of insulin required to manage postpr and ial glucose while improving fasting insulin sensitivity in adults at increased risk of T2D . This research provides support for a feasible dietary strategy for T2D risk reduction . This trial was registered at clinical trials.gov as NCT02129946 Previous work has shown increased insulin sensitivity , increased hepatic insulin clearance and lower postpr and ial insulin responses following treatment with resistant starch , a type of dietary fibre . The objective of this study was to further explore the effects of resistant starch on insulin secretion . Twelve overweight ( BMI 28.2±0.4 kg/m2 ) individuals participated in this r and omized , subject-blind crossover study . Participants consumed either 40 g type 2 resistant starch or the energy and carbohydrate-matched placebo daily for four weeks . Assessment of the effect on insulin secretion was made at the end of each intervention using an insulin-modified frequently sample d intravenous glucose tolerance test ( FSIVGTT ) . Insulin and C-peptide concentrations were significantly higher during the FSIVGTT following the resistant starch compared with the placebo . Modelling of the data showed significantly improved first-phase insulin secretion  with resistant starch . These effects were observed without any changes to either body weight or habitual food intake . This study showed that just four weeks of resistant starch intake significantly increased the first-phase insulin secretion in individuals at risk of developing type 2 diabetes . Further studies exploring this effect in individuals with type 2 diabetes are required Aims : This trial aims to determine the effects of resistant starch ( RS ) subtype 2 ( RS2 ) on glycemic status , metabolic endotoxemia and markers of oxidative stress . Methods : A r and omized , controlled , parallel-group clinical trial group of 56 females with type 2 diabetes mellitus ( T2DM ) was divided to 2 groups . The intervention group ( n = 28 ) and control group ( n = 28 ) received 10 g/day RS2 or placebo for 8 weeks , respectively . Fasting blood sample s were taken to determine glycemic status , endotoxin , high sensitivity C-reactive protein ( hs-CRP ) , malondialdehyde ( MDA ) , total antioxidant capacity ( TAC ) , antioxidant enzymes concentrations as well as uric acid at baseline and after the intervention . Results : After 8 weeks , RS2 caused a significant decrease in the levels of MDA ( -34.10 % ) , glycosylated hemoglobin ( -9.40 % ) , insulin ( -29.36 % ) , homeostasis model of insulin resistance ( -32.85 % ) and endotoxin ( -25.00 % ) , a significant increase in TAC ( 18.10 % ) and glutathione peroxidase ( 11.60 % ) as compared with control . No significant changes were observed in fasting plasma glucose , quantitative insulin sensitivity check index , hs-CRP , superoxide dismutase , catalase and uric acid in the RS2 group as compared with the control group . Conclusion : Supplementation with RS2 may be improved glycemic status , endotoxemia and markers of oxidative stress in patients with T2DM BACKGROUND The elderly often have a diet lacking resistant starch ( RS ) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes . OBJECTIVE The primary objective was to assess if elderly ( ELD ; ≥ 70 years age ) had microbiome dysbiosis compared to mid-age ( MID ; 30 - 50 years age ) adults and then determine the impact of daily consumption of MSPrebiotic ® ( a RS ) or placebo over 3 months on gut microbiome composition . Secondary objectives included assessment of stool short-chain fatty acids ( SCFA ) and inflammatory markers in ELD and MID Canadian adults . DESIGN This was a prospect i ve , placebo controlled , r and omized , double-blinded study . Stool was collected at enrollment and 6 , 10 and 14 weeks after r and omization to placebo or MSPrebiotic ® . Microbiome analysis was done using 16S rRNA sequencing of DNA extracted from stool . SCFA analysis of stool was performed using gas chromatography . RESULTS There were 42 ELD and 42 MID participants r and omized to either placebo or MSPrebiotic ® who completed the study . There was significantly higher abundance of Proteobacteria ( Escherichia coli/Shigella ) in ELD compared to MID at enrollment ( p < 0.001 ) that was not observed after 12 weeks of MSPrebiotic ® consumption . There was a significant increase in Bifidobacterium in both ELD and MID compared to placebo ( p = 0.047 and 0.006 , respectively ) . There was a small but significant increase in the stool SCFA butyrate levels in the ELD on MSPrebiotic ® versus placebo . CONCLUSIONS The study data demonstrated that MSPrebiotic ® meets the criteria of a prebiotic and can stimulate an increased abundance of endogenous Bifidobacteria in both ELD and MID without additional probiotic supplementation . MSPrebiotic ® consumption also eliminated the dysbiosis of gut Proteobacteria observed in ELD at baseline . CLINICAL TRIAL REGISTRY NUMBER NCT01977183 listed on NIH website : Clinical Trials.gov . The full trial protocol is available on request from the corresponding author . NUCLEOTIDE SEQUENCE ACCESSION NUMBERS The 16S rRNA sequencing data and meta data generated in this study have been su bmi tted to the NCBI Sequence Read Archive ( SRA : http://www.ncbi.nlm.nih.gov/bioproject/381931 ) Background Adipose tissue patterning has a major influence on the risk of developing chronic disease . Environmental influences on both body fat patterning and appetite regulation are not fully understood . This study was performed to investigate the impact of resistant starch ( RS ) on adipose tissue deposition and central regulation of appetite in mice . Methodology and Principle Findings Forty mice were r and omised to a diet supplemented with either the high resistant starch ( HRS ) , or the readily digestible starch ( LRS ) . Using 1H magnetic resonance ( MR ) methods , whole body adiposity , intrahepatocellular lipids ( IHCL ) and intramyocellular lipids ( IMCL ) were measured . Manganese-enhanced MRI ( MEMRI ) was used to investigate neuronal activity in hypothalamic regions involved in appetite control when fed ad libitum . At the end of the interventional period , adipocytes were isolated from epididymal adipose tissue and fasting plasma collected for hormonal and adipokine measurement . Mice on the HRS and LRS diet had similar body weights although total body adiposity , subcutaneous and visceral fat , IHCL , plasma leptin , plasma adiponectin plasma insulin/glucose ratios was significantly greater in the latter group . Adipocytes isolated from the LRS group were significantly larger and had lower insulin-stimulated glucose uptake . MEMRI data obtained from the ventromedial and paraventricular hypothalamic nuclei suggests a satiating effect of the HRS diet despite a lower energy intake . Conclusion and Significance Dietary RS significantly impacts on adipose tissue patterning , adipocyte morphology and metabolism , glucose and insulin metabolism , as well as affecting appetite regulation , supported by changes in neuronal activity in hypothalamic appetite regulation centres which are suggestive of satiation Resistant starch ( RS ) includes the sum of starch and degradation products of starch that resist small intestinal digestion and enter the colon . This study was planned to examine the effect of resistant starch on hypolipidemic actions , blood glucose , insulin levels and humoral immune responses in healthy overweight subjects . Healthy overweight subjects ( over 120 % of their ideal body weights ) were fed either 24 g/d of resistant corn starch ( RS ) or regular corn starch ( CS ) for 21 d with their regular meals . Although this double-blind feeding regiment result ed in no significant changes in their weights or other physical parameters for the relatively acute period of intakes , there were significant lowering effects of serum total cholesterol ( p < 0.05 ) and serum LDL-cholesterol ( p < 0.05 ) in subjects supplemented RS . Compared with the control starch group , the RS supplementation also reduced the mean fasting serum glucose concentrations ( p < 0.05 ) . Resistant starch supplement result ed in the increase in serum immunoglobulin G ( IgG ) concentrations . Serum insulin and complement 3 ( C3 ) were unaffected . Tested resistant starch supplementation was reported to be palatable with minimal bowel discomfort . These results suggest that RS supplementation improves the blood lipid profile and controls the blood glucose levels in healthy overweight subjects without bowel discomfort . Therefore , RS has a potential to be used as one of the promising food ingredients for reducing risk factors involved in the development of atherosclerosis and type 2 diabetes in overweight individuals . However , in order to prove RS as a novel therapeutic agent of cardiovascular diseases and diabetes , controlled trials with larger sample sizes and longer duration are warranted OBJECTIVE The aim of the present study was to determine effects of Resistant Starch ( RS2 ) on metabolic parameters and inflammation in women with type 2 diabetes ( T2DM ) . METHODS In this r and omized controlled clinical trial , 60 females with T2DM were divided into intervention ( n = 28 ) and placebo groups ( n = 32 ) . They received 10 g/d RS2 or placebo for 8 weeks , respectively . Fasting blood sugar ( FBS ) , glycated hemoglobin ( HbA1c ) , lipid profile , high-sensitive C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) and tumor necrosis factor-alpha ( TNF-α ) were measured at baseline and at the end of the trial . Paired t test , unpaired t-test and ANCOVA were used to compare the quantitative variables . The data were analyzed using SPSS software version 13.0 . RESULTS RS2  decreased HbA1c ( -0.3 % , -3.6 % ) , TNF-α ( -3.4 pg/mL , -18.9 % ) , triglyceride ( -33.4 mg/dL , -15.4 % ) , and it increased HDL-c ( + 9.4 mg/dL , + 24.6 % ) significantly compared with the placebo group ( p < 0.05 ) . Changes in FBS , total cholesterol , low-density lipoprotein , hs-CRP and IL-6 were not significant in the RS2 group compared with the control group . RS2 can improve glycemic status , inflammatory markers and lipid profile in women with T2DM . CONCLUSIONS Although findings of the present study indicated positive effects of RS2  on inflammation and metabolic parameters , more studies are needed to confirm efficacy of RS2 as an adjunct therapy in diabetes
target: Conclusions This meta- analysis has provided evidence that RS supplementation can improve fasting glucose , fasting insulin , insulin resistance and sensitivity , especially for diabetic with overweight or obesity .
background: Background The role of resistant starch ( RS ) in glucose , insulin , insulin resistance or sensitivity , and lipid parameters have been reported in several studies and remained controversial .
  A pooled analysis which assessed these parameters has not been performed .
  Thus , we conducted a meta- analysis to sum up existing evidence about the issue .