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substrate oxidation13
Anna
Tagliabue,
and
Arne
Anne
Raben,
Louise
on energy
Heijnen,
Paul
Because
as glucose
in the
resistant
small
measured
5-h
by
is not absorbed
humans,
thermogenesis
calorimetry
after
consumption.
Our
results
and
ingestion
suggest
mogenic
effect and that its presence
of the thermic response
to digestible
seeds
Resistant
WORDS
substrate
g pre-
that
RS
has
no ther-
starch,
diet-induced
thermogene-
oxidation
by food
Until
recently
was
thought
to be
effluents
(7-1
(including
pletely
1) have
cereals,
digested
starch
shown
potatoes,
studies
degradation
of healthy
The
in the
have
starch
resistant
with pancreatic
starch
inhibitors
healthy
revealed
products
not
(14,
1070
bowel.
More-
processed
foods
of
the
meal,
starch,
in the
small
starch
15).
I) in partially
(RS
(eg, bread;
The
RS
function
may
balance.
starch
(17,
inhibitor
18).
Starch
in humans
It is also
that
a diet
high
and corn
both
gastroin-
rats
feeding
of
induced
in a significantly
(19).
possible
potato;
raw
malabsorption
also resulted
and
is generated
affect
In
grains
which
cooked
of food
energy
milled
III),
cooled,
content
and
type
by a glucosidase
prolonged
in RS may
transit
time
be useful
in the
treatment
of obesity
and diabetes
because
of the reduced
amount
of available
energy
present
in RS. However,
because
RS is not digested
and therefore
not absorbed
as glucose
in the
small intestine
of healthy
humans,
lower postprandial
energy
expenditure
can be expected
after the intake of RS as compared
with that of digestible
starch. It was observed
recently
that a
particular
type of RS obtained
by lintnerization
from an amylose-rich
starch
(70%
amylose)
has no thermogenic
effect
either alone or mixed with glucose
(20).
The present
study was performed
to obtain information
on
effect
(type
strate
of replacing
II) potato
oxidation
digestible
potato
starch on postprandial
in a group of healthy
starch
with
thermogenesis
male subjects.
resistant
and sub-
in humans
may
possible
lipid
cross-linking
or protein
carbohydrate-containing
contain
of B-type
RSs
the
starch
in the
foods,
most
RS
granules
human
diet
(type
(16).
are
raw
potato
types
This research
was a joint study within the European
FLAIR
(Food-Linked
Agro-Industrial
Research)
Concerted
Action
on
Resistant
Starch
(EURESTA)
framework.
Exactly
the same
experiment
was conducted
at the Departments
of Human
Nutrition of the University
of Pavia, Italy; The Royal Veterinary
(13).
and
the Department
Department
Veterinary
and
the
of Human
of Human
and
of
The experiments
1990-1994
trition,
of naturally
by physically
1995;61:1070-5.
University,
Human
performed
Research
Address
University
Centre
Nutrition,
of Pavia,
for Food
Italy;
Research,
Frederiksberg,
The
Denmark;
Agricultural
University
of
Netherlands.
the Danish
Nutrition,
Nutrition,
Agricultural
Department
Wageningen,
un-
of their
Am J C/in Nutr
From
Royal
interacand
Research
depend
structure,
food processthe presence
of amylase
and
Methods
intestine
(RS)
15).
banana
occurring
sources
is not corn-
small
as resistant
of starch
in modified
Among
content
rest
many
that many
absorbed
is defined
digestion
in the
substitutions
from
and legumes)
on several
factors,
including
physical
ing, chewing,
intestinal
transit time,
ripe
hydro-
to dispersion
in boiling
water
and to
amylase
(12). The sum of starch
and
individuals
incomplete
that
bananas,
or absorbed
in vitro
contain
hydrolysis
tions
completely
type
starch
and absorbed
studies
using
intubation
over,
starch
(RS
retrograded
processing
flakes;
the
Introduction
lyzed
vivo
Pasquali,
starch
and
testinal
substrate
of 50
1995;61:1070-5.
sis,
Elisabetta
inaccessible
postpran-
postprandial
indirect
(RS)
of healthy
gelatinized
(0% RS) and 50 g raw potato starch (54% type II
RS) in 15 healthy,
normal-weight
young males. The subjects
consumed
each starch (mixed
in diluted
fruit syrup) twice on
separate
days and in random
order. RS intake was followed
by
lower thermogenesis
(46.5 13.1 compared
with 115.4 10.4
kJ/5 h; P = 0.008), lower glucose
oxidation
(P < 0.0005),
and
greater
fat oxidation
(P
0.013)
than was pregelatinized
KEY
Deurenberg,
and
reprint
University
of Pavia,
February
Accepted
for
Research
to A Tagliabue,
Via
were
supported
programme
Medical
requests
Received
Printed
in Denmark
and Development
Bassi
from
Technology
grant
12-9537-3.
Council,
Department
21, 27100
by grants
for Food
Pavia,
of Human
Nu-
Italy.
2, 1994.
publication
in USA.
January
1995
5, 1995.
American
Society
for Clinical
Nutrition
oxidation
starch
intestine
dial thermogenesis
should
compared
with digestible
starch
expenditure
Astrup
ABSTRACT
we
Marie
starch
RESISIANI
and
Agricultural
the
University
Agricultural
SIARCH-INDUCED
of Frederiksberg,
University
Denmark;
of Wageningen,
and
in meal
Netherlands.
the past
past
6 mo.
impedance
3 mo;
Body
and
they
had
composition
analysis
(21).
taken
was
Females
were
tee
study
was
approved
of Copenhagen
on Human
and
by the Municipal
Frederiksberg
Experimentation
Wageningen
volunteers
gave
and
by the
of the
written
Helsinki
informed
1.
Commit-
of Pavia
before
the
All
study.
was
contains
ie, raw
starch
digestible)
chosen
as the test
a large
amount
granules).
was
used
substance
(54%
by wt)
Pregelatinized
as the
control
because
potato
treatment.
starch
starch
and
is
commercially
France).
Analyses
gestible,
slowly
Dunn
Clinical
Nutrition
Raw
and
(Roquette,
prege-
(total
starch,
and
were
performed
RS)
Cambridge,
by Englyst
UK,
et al (15)
de la
popotato
rapidly
containing
as meal
a hand
mixture.
For
whereas
meal
raw
and
A and meal
pregelatinized
mixer
at the
meal
A this
B was
starch
B, respectively,
lowest
and were
Fifty
gram
unsweetened
TABLE
A and
speed
resulted
to avoid
heating
in a drinkable
a porridge-like
gel
B differed
slightly
within
24,
center
measurements.
voided
and
a comfortable
bed
of relaxation,
25),
the
and
and
30 mm before
Soon
were
RMR
the measurements
after
weighed.
their
Afterward
bioelectrical
impedance
was
measured
for 45 mm.
began
subjects
15 mm, and
for 5 h. Two
were
allowed
to
and to void.
under
the ventilated
videotapes.
hood,
A subgroup
participants
of
the
were
permitted
subjects
underwent
that
was
Energy
EE was measured
where
mixture,
with
in total
starch
expenditure
ventilated
of the
eaten
(26).
(30).
hood.
(27-29).
RMR
by open-circuit
The
systems
EE was
and
PMR
indirect
were
calculated
were
con-
calorimetry
described
by using
measured
for
respectively.
Postprandial
or diet-induced
thermogenesis
h was obtained
for each subject
as the sum
lated for 30-mm
intervals
as follows:
Italy
(n = 5)
1.9
21.2
0.7
23.2
1.80
0.01
1.78
0.02
(kg)
71.2
3.0
74.0
(kg/m2)
22.0
1.1
(m)
Fat (% of wt)
(kJ/min)2
I SEM.
RMR,
2 Mean of the four
individuals;
to the research
(RMR)
25.6
(n = 5)
Denmark
RMR
out at a cornfalls
with
in detail
the Weir
45
mm
else-
formula
and
h,
5
of the subjects
(y)
BMI
carried
Characteristics
Weight
were
energy
30 mm
around
2 d from
pre-
of each starch
fruit syrup
by
composition
and energy
content
of the two test
meals
is shown
in Table
2. The raw and pregelatinized
starches
differed
in water content
(16.6%
and 4.9%, respectively)
and
meals
for
12 h before
were
The
therefore
rate
on
4 h after
rately
identified
starch
blood
sampling
during
the measurements.
Details
of blood
sampling
and biochemical
results
are being published
sepa-
pared
immediately
before
feeding.
was mixed
into 500 g diluted
(1:3)
spoon.
measured
to watch
(22).
meals
using
rested
was
for
#{176}C
(which
clothed
admitted
the participants
While
and
meals
The
were
arrival
move
to
Englyst
of that
of 50-60%.
metabolic
they
); abstain
fast
22-25
for
resting
and
the
according
and
fiber/MJ
temperature,
humidity
After
di-
at
g dietary
Lestrem,
fractions
Center,
described
Cummings
available
of starch
digestible,
the procedures
Height
3.5
zone
Subjects
II,
(100%
latinized
starches
were supplied
by the Institut
National
Recherche
Agronomique
(Nantes,
France).
Pregelatinized
tato starch is obtained
by drum-drying
rehydrated
raw
Age
fat,
room
relative
the
of RS (type
of the raw
Netherlands
(n = 5)
All
(n = 15)
23.3
0.8
1.83 0.03
1.80
0.01
3.5
71.7
3.0
72.3
1.7
23.1
0.6
21.4
0.7
22.2
0.5
18.6 2.4
20.8
1.3
16.2 1.1
18.5 1.0
4.81
4.98
4.61
4.80
0.19
resting
metabolic
rate.
measurements
per subject.
0.19
1.0
0.27
0.12
starch
type
A was 30%
content
physical
activity;
and
(EE) measurements.
center the measurements
thermoneutral
Potato
Test
28%
fortable
Starches
raw
in meal
energy
protocol
strenuous
expenditure
In each
and
II declaration.
consent
tein,
Committees
of the Universities
in observance
to avoid
Ethical
starch
metabolizable
for
of digestible
B. The
Experimental
by bioelectrical
excluded
possible
periodicity
in energy
expenditure
cycle. The characteristics
of the volunteers
The
no medication
assessed
1071
was supposed
to derive exclusively
from the in vitro digestible
starch,
ie, fermentation
was not taken into account.
This was
decided
because
fermentation
from raw potato starch has been
demonstrated
to occur only 9 h after ingestion
(23).
Subjects
stable
ThERMOGENESIS
1072
IAGLIABUE
TABLE
Composition
starch
and energy
500
mL
content
diluted
fruit
of test meals
syrup)
Total
starch
(g)
Meal
40.6
27.0
SDS
10.6
2.6
Fruit
8.4
8.4
(g)
2.9
2.9
Fructose
(g)
4.4
4.4
Sucrose
(g)
energy
1.1
A, raw
resistant
starch;
(kJ)3
potato
RDS,
meal
rapidly
There
946
B, pregelatinized
digestible
starch;
potato
SDS,
starch;
slowly
RS,
digestible
starch.
2
Heat
Calculated
of combustion
intestine
DII
(kJ/30
(17.5
the amount
and does
mm)
and glucose
of carbohydrate
not take
PMR
kJ/g)
into
(15.7
digested
account
(kJ/30
mm)
used
includes
package
in the
by
SEM
between-country
version
statistical
induced
mean
3. 1 (SPSS
Inc,
calculations.
intestinal
in
fermentation.
RMR
kJ/g).
and absorbed
three
were
with
among
regard
the participants
from the
=
0.09), weight
(P =
to age
(P
y). Because
y old), this
this difference
age difference
was mainly
was not taken
in the subsequent
statistical
analyses.
One subject had a clearly
higher body fat content
that exceeded
the normal range of the
total group, and one subject
had a low RMR, which could be
attributed
to low
ferences
in the data
1), it was
(kJ/30min)
no differences
countries
body
weight.
Given
between
decided
the
generally
the participating
to treat
the data
small
countries
as one
dif(Table
entity.
(1)
Energy
Total
postprandial
percentage
thermogenesis
of metabolizable
was
energy
also
expressed
as a
as follows:
NS).
DIT(%)
DIT (kJ/5
h)/metabolizable
energy
of the meal
(Id)
X 100
(2)
Substrate
oxidation
Substrate
oxidation
conditions
Ferranini
after
in the
the
two
postabsorptive
meals
was
and
calculated
G (from
glycogen,
CO2
4.55
g/min)
3.21
4.09
02
according
CO2
2.87
2.88
to
UN
02
(3)
2.59
UN
(4)
F (g/min)
1.67
02
F is fat,
ments
analysis
Duncans
weight,
between
1.92
(5)
UN
(6)
UN
(Lfmin),
CO2
is CO2
produced
and UN is urinary
nitro-
test,
of variance
were
used
height,
body mass
countries.
Results
obtained
meals
(A:
significantly
two
on each
subject
(ANOVA)
to test
for
techniques,
includ-
differences
in age,
index,
fat percentage,
of duplicate
respiratory
with
each
starch
were
and RMR
measureaveraged
of EE after
A significant
the two
increase
0.001,
P
greater
(interaction
18.0 kJ/5
B:
after
pregelatinized
meal
This
B than
increase
after
in
both
test
test
was
meal
starch,
yielding
a difference
between
the
22.2 kJ/5 h (P = 0.008).
DIT expressed
of metabolizable
energy
did not differ between
the meals
(A:
12.6
Substrate
oxidation
4.9%,
B:
Values
for the respiratory
did not differ before the two
test
(A:
are shown
after
of 68.8
as a percentage
increase
meals
observed
0.001).
test
test
was
meals
in respiratory
P = 0.008;
however,
quotient
quotient
B: P
significantly
12.2
greater
and
meals
<
1.3%;
NS).
substrate
(Table
was observed
0.0005).
The
after
test
oxidation
3). A significant
meal
after
both
test
increase
was,
B (interaction
meal
X time: P = 0.002)
(Figure
ib).
Mean
postprandial
substrate
oxidation
over 5 h is shown in Table 3. A significant
time effect in fat oxidation
was observed
after both test meals
(A:
analysis
One-way
ing
6.25
P is protein,
(L/min),
02 is 02 consumed
gen (g/min).
Statistical
CO2
courses
la.
meals
P (g/min)
G is glucose,
1.67
Time
Figure
h after
postprandial
(31):
G (g/min)
where
expenditure
0.05;
B:
0.005);
there
was
also
a significant
difference
in the oxidation
pattern between
the meals (interaction meal X time: P < 0.0005)
(Figure
ic). Total postprandial
fat oxidation
averaged
15.0 1.0 g/5 h after meal A and 12.9
0.9 g/5 h after meal B (P = 0.013).
These
values
correspond
with 37.7 1.9% and 31.2 1.7% of 5-h EE, respectively
(P
0.001).
greater
B (-0.17
Postprandial
after
Net
after
postprandial
test meal
1.08
g/5
A (1.59
h) (P
fat oxidation
was significantly
0.74 g/5 h) than after test meal
=
0.033).
carbohydrate
both
test meals
significantly
greater
oxidation
increased
significantly
(A and B: P = 0.002),
but the increase
was
after
pregelatinized
starch (interaction
meal X time: P
postprandial
carbohydrate
oxidation
starch
than
0.002)
(Figure
(expressed
after raw
ld). Total
as
glucose
the small
of starch
from
was
as
Subjects
946
370
starch;
Chicago)
SEM
statistical
oxidation
expressed
Results
1.1
843
energy
Meal
(g)
(J)2
Metabolizable
1
syrup
44.0
Glucose
Gross
from
SPSS
were
0.0
3.0
sugars
variability.
and substrate
46.5
RS (g)
RDS (g)
(g)
AL
postprandial
thermogenesis
the two meals.
All results
unless
otherwise
specified.
Meal
El
RESISIANI
STARCH-INDUCED
ThERMOGENESIS
1073
Energy
expenditure
(kJ/min)
Respiratory
a)
5.9
-a-
5.7
-4-
quotient
1.00
5.5
b)
0.95
53
0.90
5.1
4.9
0.85
4.7
0.80
4.5
60
120
180
240
300
60
120
180
240
300
Fat oxidation
(g/30 mm)
Carbohydrate
c)
2.2
(g/30
2.0
oxidation
mm)
6.5
1.8
1.6
5.0
1.4
1.2
3.5
1.0
0.8
2.0
0.6
0
60
120
Minutes
FIGURE
1. Postprandial
pregelatinized
b, meal
(meal
effect:
interaction
equivalents)
1.7 g/5
spond
<
meal
180
0.0005,
expenditure
interaction
starch
meal
(a),
after
The
total
quotient
(meal
A). i SEM;
time:
P = 0.002;
44.0
meal
balance
between
carbohydrate
c, meal
effect:
and
53.6
2.0%
2.0
g/5
digestible
oxidation
after
was
meal
h, P
<
0.0005).
carbohydrate
negative
B (10.5
oxidation
2.7 g/5 h)
(b),
fat
oxidation
(c),
meal
0.013,
and
effect:
interaction
meal
intake
after
of ingested
12.2%
digestible
meal
1.7 g, P
and
5-h
A (-15.7
<
0.0005).
thermogenic
effect
of the meal containing
50 g pregepotato
starch
amounted
to 1 15 kJ in 5 h, equivalent
to
starch
effect
from
Both
180
240
300
carbohydrate
oxidation
0.024,
X time:
(d)
after
the
interaction
meal
X time:
0.0005;
d, meal
effect:
<
(Table
sugars
14 kJ/5
induced
h was
contained
Substituting
RS
(Table
2).
intake
of
P = 0.006;
P < 0.0005,
starch
the value
esis
U)
10%
from
that
of their
the
would
and 46.5
the
syrup.
of the
thermogenic
thermic
effect
content
(32-34),
Therefore,
1 15
14
starch
the
energy
be
of pregelatinized
by its digestible
two-thirds
If it is supposed
derived
Dividing
about
2) reduced
the same
represents
thermogenesis
pregelatinized
(101
energy.
with
1 15 to 46 kJ over
meals
sugars
those
Discussion
The
latinized
120
P = 0.002.
2.1%
A (2.4
60
15. By ANOVA-a,
averaged
39.2 2.1 g/5 h after meal A and 49.5
h after meal
B (P < 0.0005).
These
values
corre-
with
Minutes
respiratory
tively
(P < 0.0005).
Net postprandial
carbohydrate
was significantly
greater
after test meal B (12.0
than
300
energy
X time:
240
32.5
14
(46.5
starch-
starch-induced
content
pure
of
starch.
thermogeng), we obtain
TAGLIABUE
1074
TABLE
El
AL
Fasting
and postprandial
values
for
respiratory
quotient
and substrate
oxidation
in 15 subjects
Fasting
Meal
Respiratory
Protein
(mg/mm)
Carbohydrates
.1 SEM. Meal
of 5 h.
A, raw
potato
Meal
0.85
0.01
0.85
0.01
0.84
3.99
43.66
5.47
50.08
49.15
122.94
(mg/mm)
Meal
44.77
quotient
Fat (mg/mm)
Postprandial2
starch;
3.24
46.91
9.35
124.78
meal
B, pregelatinized
potato
2.93
10.96
Meal
o.Oi
0.01
0.87
3.26
43.10
2.97
49.15
3.24
46.91
2.93
130.85
6.98
164.93
5.62
starch.
2 Mean
3
Significantly
different
from
postprandial
values
tion and
facultative
storing
(obligatory
thermogenesis),
thermogenesis
that is at least partly
mediated
36). The
activation
of the sympathetic
energy
cost of storing
glucose
to be 0.2 kcal/g
established,
however,
in excess
baud
of this
of
effect
observed
containing
should
is quite
h. These
and
absorbing
digestible
No
difference
genic
was
DIT
These
reductions
atory
thermogenesis
in high-fiber
respects
but
not
add
that differed
show
meal.
starch
been
we
lower
postprandial
due
state,
The
present
fiber
studies.
RS
to a meal,
but
in the percentage
conditions
expressed
in DII
low-fiber
explained
composed
(367
because
U).
increase
lowed
respiratory
energy
In particular,
(at
30
in oblig-
study
differs
in at least
In fact,
we
of pure
tested
had
did
use
amounts
noted
that
the
meal
A produced
decrease,
so that
quotient
significantly
was
lower
mean
after
After
have
small
of the
provided
A was
the
stomach
more
absorption
energy
content
in the in-
of the meal
of fat oxidation,
could
as occurs
possibly
useful
is the
effects
reduced
of increasing
energy
during
the
density
almost
the
same
gross
energy
that
intake
RS (Table
2); the 100-kJ
difference
was
moisture
content
of RS. On the contrary,
metabolizable
drate
Table
energy
calculated
from
amount
would
containing
resulting
FAs)
large
be
RS
from
starch
The
or without
to
the
the
higher
difference
amount
in
of carbohy-
is rather
large
(576
kJ;
energy
of the meal
should
be increased
by the energy
contribution
the absorption
of short-chain
fatty
acids
(SC-
produced
intestine
potato
with
due
the
absorbed
in the small intestine
2). However,
the metabolizable
by fermentation
(41). An increase
has been
of undigested
starch
in the
in breath hydrogen,
indicative
observed
h after
ingestion
of raw
(23).
energy
contribution
supplied
by intestinal
fermentation
of RS was estimated
at 8 kJ/g (2 kcal/g; 42). On the basis of
this assumption,
the difference
in metabolizable
energy
between the two test meals would
be reduced
to only 350 kJ.
However,
the value
(acetate,
propionate,
tation
arising
the
of 2 kJ/g
exact
energy
At present,
contribution
our data
no thermogenic
it does
response
on the ratio
resulting
from
not
seem
We thank
Claudia
tion,
Pavia,
Italy);
the experiments;
Italy)
Narciso
during
Cazzato,
and
and
the
that
5 h after
the
RS (type
its intake,
size
of the
II)
and
thermic
U
Hellas
Cristina
Deborah
Mamini
Bobbio
Pallavicini
Jensen,
(Frederiksberg,
for statistical
Cena,
Caterina
Hellemkjaer
staff
us to conclude
to influence
Franco
Lene
pattern
of SCFAs
RS types,
to learn
starch.
Trentani
Italy);
of SCFAs
the fermen-
it provides.
allow
effect
to digestible
tians
Pavia,
RS depends
and butyrate)
(42). More
studies
are needed
on the
from in vivo fermentation
of various
Pavia,
than
attribut-
Meal
from
carbohydrate
low
probably
meals.
achieved.
This could
be useful
in the prevention
and treatment
of obesity
and diabetes
(20).
In the present
experiment,
the
same
amount
of food (50 g starch
+ 500
mL diluted
syrup)
an early
meal
the
was
two
emptied
in faster
in foods
ib),
fol-
have
30 mm,
rise
of fasting.
On the other
hand,
the greater
carbohydrate
of meal B maintained
an elevated
respiratory
quotient
RS
that
obthan
initial
of the
led to a resumption
One
of
could
resulting
testine.
we
postprandial
this
rapidly,
has
very
(Figure
and
apparent
the possibility
of the fasting
A was
viscous
these
starch
of meal
by a subsequent
we
Under
on
exclude
extension
quotient
mixed
of starch
starch.
effect
in respiratory
two
carbohydrates;
equal
no
not
less
of fermentation,
content
we
mm)
thermo-
nutrient
of digestible
RS
the
by differences
starch.
We cannot
might
depend
on an
the
to lower
energy;
in other words,
of digestible
carbohy-
in different
meals
pregelatinized
this effect
U/S
in the present
availability
of
availability
of digestible
carbohydrates.
Furthermore,
served
greater
fat oxidation
after ingestion
of raw
after
that
starch
kJ in 5 h,
of 32.5
is probably
when
rather
experimental
to our
RS has no thermo-
The
viscosity
the
additional
value
that
of ingested
the amount
and/or
these
is close
be 30
3). This
different
up to 120 mm.
by 50 g raw
then
B (Table
to the
kcal/g).
starch,
the
meal
able
periods
content
nutrient.
smaller
reductions
high-fiber
with
meals.
from
meals,
did
found
have
Thie-
after
thermic
effect
as a percentage
was proportional
to
drates.
Similar
but
in studies
comparing
which
the measured
by raw
obligatory
thermogenesis
ulation
after the ingestion
nutrient.
38).
(0.4
includes
would
in the
induced
kJ/g
is well
the
in the amount
used
does
not affect
the
carbohydrate
thermogenesis
1 .7
induced
calculations
(36,
1. 1 1 g glucose/g
the
with
at least
not
and probably
be
(35,
been
It is well
in EE
value
latter
starch
comparable
theoretical
genic
effect,
experiment,
The
(37).
estimated
be 1 .9 kJ/g,
thermogenesis
14 g digestible
which
to
kJ/g.
expected
increase
yields
of 2.2
of digesting
The
by Flatt
glucose
of starch
value
kJ/g)
measured
et al (36)
of starch
as well
as the
due to insulin-
nervous
system
as glycogen
has
calculated
Acheson
hydrolysis
thermic
cost
and
intravenous
Because
the
theoretically
et al (38)
effect
(0.8
that
0.05.
<
John
Denmark)
Montomoli
assistance.
Terracina;
(Department
(Policlinico
Lind.
Nutri-
San
Matteo,
Inger-Lise
for their
(Department
the dieti-
Human
help
Gr#{248}nfeldt,
in conducting
of Bio
Statistics,
calculated
A, P
for meal
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