Functional Foods: Can Food Technology Help in the Prevention and Treatment of Diabetes?

Rosalba Giacco, Beatrice De Giulio, Marilena Vitale, Rosaria Cozzolino

Institute of Food Science, National Research Council, Avellino, Italy.
Institute of Food Science, National Research Council, Avellino, Italy..

DOI: 10.4236/fns.2013.48108                

Abstract

Recently, the interest in functional foods is increased dramatically thanks to some scientific evidences demonstrating that, regardless of their nutritional value, some foods components beneficially influence several functions of the body, making them “functional” for the prevention and treatment of degenerative diseases, such as type 2 diabetes and cardiovascular diseases. In particular, the marketplace offers conventional and modified functional foods which acting on intestine, glucose and lipid metabolism are potentially useful for diabetic patients. The field of functional foods, however, presents some criticalities. Up to now, only few functional foods have obtained the statement of a “Health Claim”, either because there are not sufficient scientific evidences based on human intervention studies, that justify a “Health Claim”, or because data are not consistent with the proposed claims. In addition, some functional foods show a low palatability and a lack of variety. Both these issues limit their ordinary intake. This critical aspect also involves the lack of a possible synergistic effect deriving from the contemporary consumption in the diet of different functional foods, as observed with some healthy dietary pattern. Functional foods represent, then, a challenge for the food industry, which needs to implement and/or develop innovative technologies able to create new foods with improved healthy properties, but also with better organoleptic properties suitable for a daily consumption.

Keywords

Diabetes; Functional Food; Glycemic Index; Whole Grains; Food Technologies

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Salas-Salvadó, M. á. Martinez-González, M. Bulló and E. Ros, “The Role of Diet in the Prevention of Type 2 Diabetes,” Nutrition, Metabolism and Cardiovascular Diseases, Vol. 21, No. 2, 2011, pp. B32-B48. doi:10.1016/j.numecd.2011.03.009
[2]	A. K. Thompson, A. M. Minihane and C. M. Williams, “Trans Fatty Acids, Insulin Resistance and Diabetes,” European Journal of Clinical Nutrition, Vol. 65, No. 5, 2011, pp. 553-564. doi:10.1038/ejcn.2010.240
[3]	S. M. Hofmann and M. H. Tschop, “Dietary Sugars: A Fat Difference,” Journal of Clinical Investigation, Vol. 119, No. 5, 2009, pp. 1089-1092. doi:10.1172/JCI39332
[4]	M. G. Priebe, J. J. van Binsbergen, R. de Vos and R. J. Vonk, “Whole Grain Foods for the Prevention of Type 2 Diabetes Mellitus,” John Wiley & Sons, Ltd., Hoboken, 2008, doi:10.1002/14651858.CD006061
[5]	K. A. Harris and P. M. Kris-Etherton, “Effects of Whole Grains on Coronary Heart Disease Risk,” Current Athero sclerosis Reports, Vol. 12, No. 6, 2010, pp. 368-376. doi:10.1007/s11883-010-0136-1
[6]	P. Carter, L. J. Gray, J. Troughton, K. Khunti and M. J. Davies, “Fruit and Vegetable Intake and Incidence of Type 2 Diabetes Mellitus: Systematic Review and Meta-Ana lysis,” BMJ, Vol. 341, 2010, pp. c4229-c4236. doi:10.1136/bmj.c4229
[7]	M. B. Roberfroid, “Concepts and Strategy of Functional Food Science: The European Perspective,” American Journal of Clinical Nutrition, Vol. 71, No. 6, 2000, pp. 1660S-1664S.
[8]	S. Ross, “Functional Foods: The Food and Drug Admini stration Perspective,” American Journal of Clinical Nu trition, Vol. 71, No. 6, 2000, pp. 1735S-1738S.
[9]	American Dietetic Association, “Position of the American Dietetic Association: Functional Foods,” Journal of the American Dietetic Association, Vol. 109, No. 4, 2009, pp. 735-746. doi:10.1016/j.jada.2009.02.023
[10]	International Food Information Council, “Functional Foods: Attitudinal Research,” 2009. http://www.ific.org/research/funcfoodsres02.cfm
[11]	Institute of Food Technologists, “Functional Foods: Op portunities and Challenges,” 2009. http://members.ift.org/IFT/Research/IFTExpertReports/functionalfoodsreport.htm
[12]	A. T. Diplock, P. J. Aggett, M. Ashwell, F. Bornet, E. B. Fern and M. B. Roberfroid, “Scientific Concepts of Func tional Foods in Europe. Consensus Document,” British Journal of Nutrition, Vol. 81, No. 1, 1999, pp. S1-S27.
[13]	E. K. Kalra, “Nutraceutical-Definition and Introduction,” AAPS PharmSci, Vol. 5, No. 3, 2003, pp. 27-28. doi:10.1208/ps050325
[14]	A. Fardet, “New Hypotheses for the Health-Protective Mechanisms of Whole-Grain Cereals: What Is beyond Fibre?” Nutrition Research Reviews, Vol. 23, No. 1, 2010, pp. 65-134. doi:10.1017/S0954422410000041
[15]	J. L. Slavin, M. C. Martini, D. R. Jacobs Jr. and L. Marquart, “Plausible Mechanisms for the Protectiveness of Whole Grains,” American Journal of Clinical Nutrition, Vol. 70, No. 3, 1999, pp. 459S-463S.
[16]	R. Giacco, G. Della Pepa, D. Luongo and G. Riccardi, “Whole Grain Intake in Relation to Body Weight: From Epidemiological Evidence to Clinical Trials,” Nutrition, Metabolism & Cardiovascular Diseases, Vol. 21, No. 12, 2011, pp. 901-908. doi:10.1016/j.numecd.2011.07.003
[17]	P. G. Williams, “Evaluation of the Evidence between Consumption of Refined Grains and Health Outcomes,” Nutrition Reviews, Vol. 70, No. 2, 2012, pp. 80-99. doi:10.1111/j.1753-4887.2011.00452.x
[18]	R. Giacco, G. Clemente, D. Cipriano, D. Luongo, D. Viscovo, L. Patti, L. Di Marino, A. Giacco, D. Naviglio, M. A. Bianchi, R. Ciati, F. Brighenti, A. A. Rivellese and G. Riccardi, “Effects of Regular Consumption of Whole meal Wheat Foods on Cardiovascular Risk Factors in Healthy People,” Nutrition, Metabolism & Cardiovascu lar Diseases, Vol. 20, No. 3, 2010, pp. 186-194. doi:10.1016/j.numecd.2009.03.025
[19]	J. A. Delcour, X. Rouau, C. M. Courtin, K. Poutanen and R. Ranieri, “Technologies for Enhanced Exploitation of the Health-Promoting Potential of Cereals,” Trends in Food Science & Technology, Vol. 25, No. 2, 2012, pp. 78-86. doi:10.1016/j.tifs.2012.01.007
[20]	Y. Hemery, X. Rouau, V. Lullien-Pellerin, C. Barron and J. Abécassi, “Dry Processes to Develop Wheat Fractions and Products with Enhanced Nutritional Quality,” Jour nal of Cereal Science, Vol. 46, No. 3, 2007, pp. 327-347. doi:10.1016/j.jcs.2007.09.008
[21]	A. Vrieze, F. Holleman, E. G. Zoetendal, W. M. de Vos, J. B. Hoekstra and M. Nieuwdorp, “The Environment with in: How Gut Microbiota May Influence Metabolism and Body Composition,” Diabetologia, Vol. 53, No. 4, 2010, pp. 606-613. doi:10.1007/s00125-010-1662-7
[22]	R. Burcelin, L. Garidou and C. Pomié, “Immuno-micro biota Cross and Talk: The New Paradigm of Metabolic Diseases,” Seminars in Immunology, Vol. 24, No. 1, 2012, pp. 67-74. doi:10.1016/j.smim.2011.11.011
[23]	J. M. Wong, A. Esfahani, N. Singh, C. R. Villa, A. Mir rahimi, D. J. Jenkins and C. W. Kendall, “Gut Microbiota, Diet, and Heart Disease,” Journal of AOAC International, Vol. 95, No. 1, 2012, pp. 24-30. doi:10.5740/jaoacint.SGE_Wong
[24]	J. Schrezenmeir and M. de Vrese, “Probiotics, Prebiotics, and Synbiotics-Approaching a Definition,” American Journal of Clinical Nutrition, Vol. 73, No. 2, 2001, pp. 361S-364S.
[25]	G. Kelly, “Inulin-Type Prebiotics—A Review: Part 1,” Alternative Medicine Review, Vol. 13, No. 4, 2008, pp. 315-329.
[26]	B. Watzl, S. Girrbachn and M. Roller, “Inulin, Oligo fructose and Immunomodulation,” British Journal of Nu trition, Vol. 93, No. 1, 2005, pp. S49-S55. doi:10.1079/BJN20041357
[27]	M. Roberfroid, G. R. Gibson, L. Hoyles, A. L. Mc Cartney, R. Rastall, I. Rowland, D. Wolvers, B. Watzl, H. Szajewska, B. Stahl, F. Guarner, F. Respondek, K. Whelan, V. Coxam, M. J. Davicco, L. Léotoing, Y. Wit trant, N. M. Delzenne, P. D. Cani, A. M. Neyrinck and A. Meheust, “Prebiotic Effects: Metabolic and Health Bene fits,” British Journal of Nutrition, Vol. 104, No. 2, 2010, pp. S1-S63. doi:10.1017/S0007114510003363
[28]	D. Meyer and M. Stasse-Wolthuis, “The Bifidogenic Ef fect of Inulin and Oligofructose and Its Consequences for Gut Health,” European Journal of Clinical Nutrition, Vol. 63, No. 11, 2009, pp. 1277-1289. doi:10.1038/ejcn.2009.64
[29]	M. A. Looijer-van Langen and L. A. Dieleman, “Prebiot ics in Chronic Intestinal Inflammation,” Inflammatory Bowel Diseases, Vol. 15, No. 3, 2009, pp. 454-462. doi:10.1002/ibd.20737
[30]	A. R. Lomax and P. C. Calder, “Prebiotics, Immune Function, Infection and Inflammation: A Review of the Evidence,” British Journal of Nutrition, Vol. 101, No. 5, 2009, pp. 633-658. doi:10.1017/S0007114508055608
[31]	K. E. Scholz-Ahrens, P. Ade, B. Marten, P. Weber, W. Timm, Y. Acil, C. C. Glüer and J. Schrezenmeir, “Pre biotics, Probiotics, and Synbiotics Affect Mineral Absorp tion, Bone Mineral Content, and Bone Structure,” Journal of Nutrition, Vol. 137, No. 3, 2007, pp. 838S-846S.
[32]	H. Tilg and A. Kaser, “Gut Microbiome, Obesity, and Metabolic Dysfunction,” Journal of Clinical Investigation, Vol. 121, No. 6, 2011, pp. 2126-2132. doi:10.1172/JCI58109
[33]	C. Cherbut, “Motor Effects of Short-Chain Fatty Acids and Lactate in the Gastrointestinal Tract,” Proceedings of the Nutrition Society, Vol. 62, No. 1, 2003, pp. 95-99. doi:10.1079/PNS2002213
[34]	T. Wolever, P. Spadafora and H. Eshuis, “Interaction between Colonic Acetate and Propionate in Humans,” American Journal of Clinical Nutrition, Vol. 53, No. 3, 1991, pp. 681-687.
[35]	C. J. Homko, P. Cheung and G. Boden, “Effects of Free Fatty Acids on Glucose Uptake and Utilization in Healthy Women,” Diabetes, Vol. 52, No. 2, 2003, pp. 487-491. doi:10.2337/diabetes.52.2.487
[36]	J. W. Anderson and S. R. Bridges, “Short-Chain Fatty Acid Fermentation Products of Plant Fiber Affect Glu cose Metabolism of Isolated Rat Hepatocytes,” Proceed ings of the Society for Experimental Biology and Medi cine, Vol. 177, No. 2, 1984, pp. 372-376. doi:10.3181/00379727-177-41958
[37]	R. Reimer and M. I. McBurney, “Dietary Fiber Modu lates Intestinal Glucagon Messenger Ribonucleic Acid and Postprandial Secretion of Glucagon-Like Peptide-1 and Insulin in Rats,” Endocrinology, Vol. 137, No. 9, 1996, pp. 3948-3956. doi:10.1210/en.137.9.3948
[38]	G. T. Macfarlane, H. Steed and S. Macfarlane, “Bacterial Metabolism and Health-Related Effects of Galacto-Oli gosaccharides and Other Prebiotics,” Journal of Applied Microbiology, Vol. 104, No. 2, 2008, pp. 305-344.
[39]	FAO/WHO, “Report on Joint FAO/WHO Expert Consul tation on Evaluation of Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria,” 2001. www.who.int/foodsafety/publications/fs_management/en/probiotics.pdf
[40]	S. Chen, Q. Zhao, L. R. Ferguson, Q. Shu, I. Weir and S. Garg, “Development of a Novel Probiotic Delivery Sys tem Based on Microencapsulation with Protectants,” Ap plied Microbiology and Biotechnology, Vol. 93, No. 4, 2012, pp. 1447-1457. doi:10.1007/s00253-011-3609-4
[41]	F. Nazzaro, P. Orlando, F. Fratianni and R. Coppola, “Microencapsulation in Food Science and Biotechnol ogy,” Current Opinion in Biotechnology, Vol. 23, No. 2, 2012, pp. 182-186. doi:10.1016/j.copbio.2011.10.001
[42]	R. Tallon, S. Arias, P. Bressollier and M. C. Urdaci, “Strain and Matrix-Dependent Adhesion of Lactobacil lus plantarum Is Mediated by Proteinaceous Bacterial Compounds,” Journal of Applied Microbiology, Vol. 102, No. 2, 2007, pp. 442-451. doi:10.1111/j.1365-2672.2006.03086.x
[43]	M. de Vrese and J. Schrezenmeir, “Probiotics, Prebiotics, and Synbiotics,” Advances in Biochemical Engineering/ Biotechnology, Vol. 111, 2008, pp. 1-66. doi:10.1007/10_2008_097
[44]	S. Kolida and G. R. Gibson, “Synbiotics in Health and Disease,” Annual Review of Food Science and Technol ogy, Vol. 2, 2011, pp. 373-393. doi:10.1146/annurev-food-022510-133739
[45]	P. D. Cani and N. M. Delzenne, “The Gut Microbiome as Therapeutic Target,” Pharmacology & Therapeutics, Vol. 30, No. 2, 2011, pp. 202-212. doi:10.1016/j.pharmthera.2011.01.012
[46]	J. Salmerón, J. E. Manson, M. J. Stampfer, G. A. Colditz, A. L. Wing and W. C. Willett, “Dietary Fiber, Glycemic Load, and Risk of Non-Insulin-Dependent Diabetes Mel litus in Women,” JAMA, Vol. 77, No. 6, 1997, pp. 472 477. doi:10.1001/jama.1997.03540300040031
[47]	J. Salmerón, A. Ascherio, E. B. Rimm, G. A. Colditz, D. Spiegelman, D. J. Jenkins, M. J. Stampfer, A. L. Wing and W. C. Willett, “Dietary Fiber, Glycemic Load, and Risk of NIDDM in Men,” Diabetes Care, Vol. 20, No. 4, 1997, pp. 545-550. doi:10.2337/diacare.20.4.545
[48]	S. Liu, W. C. Willett, M. J. Stampfer, F. B. Hu, M. Franz, L. Sampson, C. H. Hennekens and J. E. Manson, “A Pro spective Study of Dietary Glycemic Load, Carbohydrate Intake, and Risk of Coronary Heart Disease in US Wo men,” The American Journal of Clinical Nutrition, Vol. 71, No. 6, 2000, pp. 1455-1461.
[49]	G. Riccardi, G. Clemente and R. Giacco, “Glycemic In dex of Local Foods and Diets: The Mediterranean Ex perience,” Nutrition Reviews, Vol. 61, No. 5, 2003, pp. S56-S60. doi:10.1301/nr.2003.may.S56-S60
[50]	H. Makelainen, H. Anttila, J. Sihvonen, R. M. Hietanen, R. Tahvonen, E. Salminen, M. Mikola and T. Sontag Strohm, “The Effect of Beta-Glucan on the Glycemic and Insulin Index,” European Journal of Clinical Nutrition, Vol. 61, No. 6, 2007, pp. 779-785. doi:10.1038/sj.ejcn.1602561
[51]	L. Tappy, E. Gügolz and P. Würsch, “Effects of Breakfast Cereals Containing Various Amounts of Beta-Glucan Fi bers on Plasma Glucose and Insulin Responses in NIDDM Subjects,” Diabetes Care, Vol. 19, No. 8, 1996, pp. 831-834. doi:10.2337/diacare.19.8.831
[52]	K. L. Stanhope and P. J. Havel, “Fructose Consumption: Recent Results and Their Potential Implications,” Annals of the New York Academy of Sciences, Vol. 1190, 2010, pp. 15-24. doi:10.1111/j.1749-6632.2009.05266.x
[53]	A. L. Jenkins, D. J. Jenkins, U. Zdravkovic, P. Würsch and V. Vuksan, “Depression of the Glycemic Index by High Levels of Beta-Glucan Fiber in Two Functional Foods Tested in Type 2 Diabetes,” European Journal of Clinical Nutrition, Vol. 56, No. 7, 2002, pp. 622-628. doi:10.1038/sj.ejcn.1601367
[54]	H. N. Larsen, O. W. Rasmussen, P. H. Rasmussen, K. K. Alstrup, S. K. Biswas, I. H. Tetens, S. H. Thilsted and K. Hermansen, “Glycaemic Index of Parboiled Rice De pends on the Severity of Processing: Study in Type 2 Diabetic Subjects,” European Journal of Clinical Nutri tion, Vol. 54, No. 5, 2000, pp. 380-385. doi:10.1038/sj.ejcn.1600969
[55]	H. N. Larsen, C. Christensen, O. W. Rasmussen, I. H. Tetens, N. H. Choudhury, S. H. Thilsted and K. Herman sen, “Influence of Parboiling and Physico-Chemical Cha racteristics of Rice on the Glycaemic Index in Non-Insu lin-Dependent Diabetic Subjects,” European Journal of Clinical Nutrition, Vol. 50, No. 1, 1996, pp. 22-27.
[56]	M. Parillo, R. Giacco, G. Riccardi, D. Pacioni and A. A. Rivellese, “Different Glycaemic Responses to Pasta, Bread, and Potatoes in Diabetic Patients,” Diabetic Medi cine, Vol. 2, No. 5, 1985, pp. 374-377. doi:10.1111/j.1464-5491.1985.tb00655.x
[57]	R. Giacco, F. Brighenti, M. Parillo, M. Capuano, A. V. Ciardullo, A. Rivieccio, A. A. Rivellese and G. Riccardi, “Characteristics of Some Wheat-Based Foods of the Ital ian Diet in Relation to Their Influence on Postprandial Glucose Metabolism in Patients with Type 2 Diabetes,” British Journal of Nutrition, Vol. 85, No. 1, 2001, pp. 33-40. doi:10.1079/BJN2000218
[58]	M. De Angelis, C. G. Rizzello, G. Alfonsi, P. Arnault, S. Cappelle, R. Di Cagno and M. Gobbetti, “Use of Sour dough Lactobacilli and Oat Fibre to Decrease the Gly caemic Index of White Wheat Bread,” British Journal of Nutrition, Vol. 98, No. 6, 2007, pp. 1196-1205. doi:10.1017/S0007114507772689
[59]	US Food and Drug Administration, “FDA Final Rule for Federal Labelling: Health Claims: Oats and Coronary Heart Disease,” Federal Register, Vol. 62, No. 3, 1997, pp. 3584-3681.
[60]	S. M. Haffner, S. Lehto, T. Rnnemaa, K. Pyarala and M. Laakso, “Mortality from Coronary Heart Disease in Sub jects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction,” The New England Journal of Medicine, Vol. 339, No. 4, 1998, pp. 229-234. doi:10.1056/NEJM199807233390404
[61]	Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, “Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),” JAMA, Vol. 285, No. 19, 2001, pp. 2486-2497. doi:10.1001/jama.285.19.2486
[62]	D. J. Jenkins, K. Srichaikul, A. Mirrahimi, L. Chiavaroli and C. W. Kendall, “Functional Foods to Increase the Ef ficacy of Diet in Lowering Serum Cholesterol,” Canadian Journal of Cardiology, Vol. 27, No. 4, 2011, pp. 397-400. doi:10.1016/j.cjca.2011.03.008
[63]	D. J. Jenkins, C. W. Kendall, A. Marchie, D. A. Faulkner, J. M. Wong, R. de Souza, A. Emam, T. L. Parker, E. Vidgen, K. G. Lapsley, E. A. Trautwein, R. G. Josse, L. A. Leiter and P. W. Connelly, “Effects of a Dietary Port folio of Cholesterol-Lowering Foods vs Lovastatin on Serum Lipids and C-Reactive Protein,” JAMA, Vol. 290, No. 4, 2003, pp. 502-510. doi:10.1001/jama.290.4.502
[64]	US Food and Drug Administration, “Food Labelling: Health Claims; Soluble Fiber from Certain Foods and Coronary Heart Disease,” Federal Register, Vol. 63, No. 68, 1998, pp. 17327-17329.
[65]	D. J. Jenkins, C.W. Kendall, V. Vuksan, E. Vidgen, T. Parker, D. Faulkner, C. C. Mehling, M. Garsetti, G. Testolin, S. C. Cunnane, M. A. Ryan and P. N. Corey, “Soluble Fiber Intake at a Dose Approved by the US Food and Drug Administration for a Claim of Health Benefits: Serum Lipid Risk Factors for Cardiovascular Disease Assessed in a Randomized Controlled Crossover Trial,” The American Journal of Clinical Nutrition, Vol. 75, No. 5, 2002, pp. 834-839.