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Ghrelin, lipolysis, short-chain fatty acids, skeletal muscle, insulin sensitivity
INTRODUCTION
Am J Clin Nutr 2005;82:559 67. Printed in USA. 2005 American Society for Clinical Nutrition
559
ABSTRACT
Background: Resistant starch may modulate insulin sensitivity,
although the precise mechanism of this action is unknown.
Objective: We studied the effects of resistant starch on insulin
sensitivity and tissue metabolism.
Design: We used a 4-wk supplementation period with 30 g resistant
starch/d, compared with placebo, in 10 healthy subjects and assessed
the results by using arteriovenous difference methods.
Results: When assessed by euglycemic-hyperinsulinemic clamp,
insulin sensitivity was higher after resistant starch supplementation
than after placebo treatment (9.7 and 8.5 102 mg glucose kg1
min1 (mU insulin/L)1, respectively; P 0.03); insulin sensitivity during the meal tolerance test (MTT) was 33% higher (P 0.05).
Forearm muscle glucose clearance during the MTT was also higher
after resistant starch supplementation (P 0.03) despite lower insulin concentrations (P 0.02); glucose clearance adjusted for insulin was 44% higher. Subcutaneous abdominal adipose tissue nonesterified fatty acid (NEFA; P 0.02) and glycerol (P 0.05)
release were lower with resistant starch supplementation, although
systemic NEFA concentrations were not significantly altered. Shortchain fatty acid concentrations (acetate and propionate) were higher
during the MTT (P 0.05 and 0.01, respectively), as was acetate
uptake by adipose tissue (P 0.03). Fasting plasma ghrelin concentrations were higher with resistant starch supplementation (2769
compared with 2062 pg/mL; P 0.03), although postprandial suppression (40 44%) did not differ significantly. Measurements of
gene expression in adipose tissue and muscle were uninformative,
which suggests effects at a metabolic level. The resistant starch
supplement was well tolerated.
Conclusion: These results suggest that dietary supplementation
with resistant starch has the potential to improve insulin sensitivity.
Further studies in insulin-resistant persons are needed.
Am J
Clin Nutr 2005;82:559 67.
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ROBERTSON ET AL
FIGURE 1. Study protocol for 10 healthy subjects. Study days 1 and 3, hyperinsulinemic-euglycemic clamp; study days 2 and 4, arteriovenous meal
tolerance test. The order of the dietary intervention periods was randomized between subjects.
week, the subjects attended for a full-day MTT with arteriovenous blood sampling across both skeletal muscle and subcutaneous abdominal adipose tissue. The subjects avoided vigorous
exercise and alcohol for 48 h before each test and were provided
with a low-fat, low-fiber evening meal (pasta and tomato sauce)
before each study day to reduce variability (14). This study was
approved by the Oxfordshire Clinical Research Ethics Committee, and all subjects gave written informed consent. For clarity of
presentation in the results and discussion sections, the high-RS
supplement (Hi-Maize 260) will be referred to as RS and the
RS-free supplement (Amioca) as placebo.
Metabolic investigations
Euglycemic-hyperinsulinemic clamp
This was performed as described by DeFronzo et al (15).
Beginning at 0700 after the subjects had fasted for 12 h overnight,
an antecubital vein was cannulated for the infusion of both a 20%
glucose solution and insulin [Actrapid (Novo Nordisk, Bagsvaerd, Denmark) in a solution of 0.9% saline containing 2 mL of
the subjects blood to prevent adhesion of insulin to plastics]. A
hand vein was cannulated retrogradely, and the hand was placed
in a heated box (55 C) for sampling of arterialized blood. After
fasting measurements were made, the insulin infusion was
started at a rate of 35 mU insulin m2 min1. The glucose
concentration of whole blood was measured every 5 min by use
of a glucose analyzer (Hemocue B-glucose analyzer; Hemocue
Ltd, Sheffield, United Kingdom), and the infusion of 20% glucose was adjusted as needed to maintain blood glucose concentrations at 5 mmol/L. Blood was drawn every 10 min during the
clamp for the measurement of plasma insulin, nonesterified fatty
acids (NEFAs), C-peptide, and ghrelin. The insulin infusion was
continued for 120 min to obtain a measure of the rate of insulinstimulated glucose disposal during the last 30 min of the clamp.
Meal tolerance test with tissue-specific arteriovenous
sampling
To assess the metabolism of adipose tissue and skeletal muscle
in vivo in humans, we measured arteriovenous differences across
these tissues. Serial blood samples were taken with the subjects
in the fasting state and for 5 h after a liquid MTT (60 g carbohydrate, 21 g fat, 500 kcal).
Arterialized blood was obtained from a vein draining a heated
hand. Venous blood from muscle was taken from a vein draining
Biochemistry
Whole blood for metabolite and insulin measurement was
collected into heparin-containing syringes (Sarstedt, Leicester,
United Kingdom). Plasma glucose, triacylglycerol (Instrumentation Laboratory, Warrington, United Kingdom), and NEFA
concentrations (Wako Chemicals, Neuss, Germany) were measured enzymatically with an Instrumentation Laboratory Monarch automated analyzer. Whole blood for 3-hydroxybutyrate
and glycerol measurement was deproteinized with 7% (wt:vol)
perchloric acid, and concentrations were measured enzymatically. Metabolites from the placebo and the RS study arms were
analyzed together, and the intra-assay variation was 2.5%.
Concentrations of insulin, C-peptide, and leptin were measured
by radioimmunoassay with commercially available kits (Linco,
St Louis, MO). Blood for total ghrelin analysis was collected into
potassium-EDTA containing 200 Kallikrein inhibiting units
aprotinin/mL (Bayer, Newbury, United Kingdom). For the ghrelin radioimmunoassay (Linco), antibodies were raised against
the C-terminal region (acylated and des-acylated ghrelin) and
showed no detectable cross-reactivity with motilin-related peptide. The sensitivity of this assay was 10 pg/mL. Glucagon-like
peptide 1 (GLP-1) was assayed as described previously (21). The
GLP-1 radioimmunoassay detected changes of 7.5 pmol/L, with
an intraassay CV of 6.1%. The GLP-1 antibody was specific for
the N-terminal amidated GLP-1.
SCFAs were analyzed by gas-liquid chromatography.
Heparin-treated plasma was deproteinized with 16% metaphosphoric acid and denatured for 30 min at 60 C before splitless
injection of 1 L of the supernatant portion onto an FFAP column
(Agilent Technologies, Palo Alto, CA) (22). Measurements were
made with a flame ionization detector, and isovaleric acid was
used as the internal standard.
the deep tissues of the contralateral forearm. To prevent contamination of the blood from the forearm vein with blood from the
hand, a wrist cuff was inflated to 200 mm Hg for 3 min before the
samples were taken. Venous blood from adipose tissue was obtained from the superficial epigastric vein (16). This vein drains
subcutaneous abdominal adipose tissue with negligible contribution from other tissues (17). Oxygen saturation and ultrasound
were used to assess correct positioning of the cannulae. Simultaneous sampling from 3 sites began at 0700 after the subjects had
fasted for 12 h overnight. Two sets of baseline samples were
taken 30 min apart. Subjects then ingested the test meal as described previously (8), and further blood samples were taken for
5 h after the meal.
Subcutaneous abdominal adipose tissue blood flow was measured by 133Xe washout (18). Forearm muscle blood flow was
assessed by occlusion strain-gauge plethysmography (19).
Skeletal muscle and adipose tissue biopsies were performed
under local anesthesia (1% lignocaine) 5.5 h after the meal.
Subcutaneous abdominal adipose tissue was biopsied with a 12gauge needle, and muscle biopsy samples were taken from the
vastus lateralis muscle by using a percutaneous needle technique.
Samples were snap frozen in liquid nitrogen and stored at 70 C
for later RNA quantification. Total RNA was prepared from the
frozen tissue according to an established procedure (20), with
total RNA solutions stored at 80 C.
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ROBERTSON ET AL
TABLE 1
Anthropometric measurements taken after 4 wk of supplementation with either placebo or resistant starch1
Placebo
Resistant starch
70.6 3.74
23.7 1.33
19.2 2.05
51.4 3.03
118 3.07
74.4 1.78
71.0 3.88
23.8 1.40
18.5 2.36
52.5 3.08
117 4.08
74.7 3.39
P
NS
NS
NS
0.003
NS
NS
1
All values are x SEM; n 10. All measurements were taken in the morning after the subjects had fasted for 12 h. The placebo contained 0 g resistant
starch and 20 g rapidly digestible starch; the resistant starch supplement contained 30 g resistant starch and 20 g rapidly digestible starch. Comparisons were
made with the paired t test.
2
Measured by using foot-to-hand bioimpedance (Bodystat 1500; Bodystat, Isle of Man, United Kingdom).
3
Mean of 3 readings taken with the subject in a sitting position.
P 0.05 were taken as significant. Values in the text are displayed as means with ranges or SEMs. Gene expression data
were analyzed by using the nonparametric Wilcoxons test to
compare mRNA levels between the placebo and RS diets.
0.003) averaging 1.1 kg (0.6 1.6 kg) over the 4-wk period of RS
supplementation (Table 1).
Glucose metabolism and insulin sensitivity
TABLE 2
Indexes of insulin sensitivity after 3 or 4 wk of a highresistant starch (RS) supplement (30 g RS/d) or placebo (0 g RS/d)1
Placebo
Hyperinsulinemic-euglycemic clamp (week 3)
M/I
MTT (week 4)
HOMA %S
HOMA %B
Fasting plasma glucose (mmol/L)
Plasma glucose AUC (mmol 300 min/L)
Fasting plasma insulin (pmol/L)
Plasma insulin AUC (pmol 300 min/L)
C-peptide/insulin AUC
Oral SI
Total glucose uptake by AT (mol/100 mL tissue)
8.5 10
Resistant starch
3
8.7 10
77.4 5.55
128 9.21
5.04 0.118
1890 27.7
79.8 16.0
63 000 10 600
6.08 0.523
1.36 103 1.9 104
54.4 62.5
9.7 10
P
2
1.09 10
76.75 6.72
138 8.83
5.06 0.139
1830 28.9
84 17.4
55 200 10 500
7.48 0.734
1.82 103 3.6 104
141 59.3
0.027
NS
NS
NS
NS
NS
0.024
0.034
0.050
0.007
All values are x SEM; n 10. The total uptake of glucose across adipose tissue (AT) is the arteriovenous difference times the AT plasma flow calculated
as an area under the curve (AUC) between 0 and 300 min. M/I, glucose infusion rate during steady state (mg kg1 min1) divided by the prevailing plasma
insulin concentration (mU insulin/L); MTT, meal tolerance test; HOMA S and HOMA B, insulin sensitivity and cell function, respectively, assessed
by homeostatic model assessment; SI, insulin sensitivity assessed during the meal tolerance test [(dL kg1 min1)/(U/mL)]. Comparisons were made with
the paired t test.
1
RESULTS
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ROBERTSON ET AL
TABLE 3
Plasma acetate and propionate concentrations and flux rates after 4 wk of a highresistant starch (RS) supplement (30 g RS/d) or placebo (0 g RS/d)1
Plasma acetate
Fasting (mol/L)
AUC (mol 300 min/L)
Fractional extraction across muscle (%)
Net uptake by muscle (nmol/100 g tissue)
Fractional extraction across AT (%)
Net uptake by AT (nmol/100 mL tissue)
Plasma propionate
Fasting (mol/L)
AUC (mol 300 min/L)
Fractional extraction across muscle (%)
Net uptake by muscle (nmol/100 g tissue)
Fractional extraction across AT (%)
Net uptake by AT (nmol/100 mL tissue)
Placebo
Resistant starch
212 23.7
53 800 4260
15.7 4.33
14 600 4400
8.62 2.88
8200 2890
217 18.2
69 200 5970
24.2 3.68
25 900 5900
14.6 2.34
18 200 3640
NS
0.037
0.05
0.064
NS
0.034
5.74 1.26
1490 155
25.2 12.8
846 453
14.1 9.05
791 424
9.09 2.48
2690 320
39.3 7.98
1100 310
35.3 13.5
1530 495
NS
0.012
NS
NS
0.048
NS
FIGURE 4. Mean (SEM) arterialized short-chain fatty acid concentrations after a meal tolerance test (at time 0) in healthy subjects after a 4-wk
intervention of 30 g resistant starch (RS)/d (E) compared with placebo (F).
n 10. Repeated-measures ANOVA showed significant effects of the RS
intervention for both acetate (P 0.048) and propionate (P 0.009), with
a significant effect of time after meal for acetate (P 0.036) but not for
propionate (P 0.069).
Hormones
RS supplementation resulted in a significant increase in fasting plasma ghrelin concentrations, although the degree of postprandial suppression during the MTT (40 44%) remained unchanged (Figure 5). The postprandial AUC for ghrelin was
significantly correlated with both BMI (r 0.523, P 0.021)
and M/I (r 0.496, P 0.03). There was no significant effect of
RS supplementation on plasma leptin or GLP-1 concentrations
(data not shown).
1
All values are x SEM; n 10 for muscle and n 8 for adipose tissue (AT). The fractional extraction across both muscle and AT is calculated as the
arteriovenous difference across the individual tissue divided by the arterialized concentration and is expressed as a percentage. The total uptake of fatty acid
across tissue is the arteriovenous difference across the individual tissue times the tissue plasma flow calculated as an area under the curve (AUC) between 0
and 300 min. Comparisons were made with the paired t test.
Gene expression
In adipose tissue, there was no significant change in the expression of the following genes after RS supplementation: hexokinase II, CD36, lipoprotein lipase, peroxisome proliferator
activated receptor , phosphatidyl-inositol-3 kinase, glucose
transporter 4, or leptin. There was, however, significantly greater
expression of hormone-sensitive lipase (35.7 5.5 to 45.8 7.7
amol/g total RNA; P 0.036) and lower expression of insulin
receptor substrate 1 (11.2 1.5 to 8.8 1.4 amol/g total RNA;
P 0.016) after RS supplementation than with placebo. In skeletal muscle samples, however, there was no significant effect of
dietary period on the expression of any of the genes measured
(hexokinase II, CD36, lipoprotein lipase, insulin receptor substrate 1, phosphatidyl-inositol-3 kinase, or glucose transporter 4;
data not shown).
DISCUSSION
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ROBERTSON ET AL
We thank Jenny Currie and Sandra Ellis for technical assistance and all the
volunteers for giving their time so freely.
MDR was involved in designing the protocol, recruiting volunteers, conducting much of the practical work, and writing the first draft of the paper.
ASB and ALD were involved in managing the clinical studies; HV conducted
the studies of gene expression; and KNF helped to design the study and write
the paper. All authors helped to refine the paper. None of the authors had
personal or financial conflicts of interest.
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