nik shanita safii - glycemic index practices among malaysia athletes

NIK SHANITA SAFII, PHD

DIETETICS PROGRAM SCHOOL OF HEALTHCARE SCIENCES

FACULTY OF HEALTH SCIENCES UNIVERSITI KEBANGSAAN MALAYSIA

GLYCEMIC INDEX PRACTICES AMONG MALAYSIAN ATHLETES

CONTENT OF PRESENTATION:

▪ Sports Scenario in Malaysia

▪ Introduction To The Glycemic Index (GI)

▪ Overview on glycemic index and exercise performance

▪ The experience of doing research Among Athletes

▪ GI practices among athletes: Before and Current Findings

▪ Conclusion

Inspiring Futures, Nurturing Possibilities

2 MDA Scientific Conference_22 June 2013


SPORTS SCENARIO IN MALAYSIA

• 1) 1971 – NATIONAL SPORT COUNCIL OF MALAYSIA WAS ESTABLISHED:

• to promote locally & internationally as well as participate in the development of sports in Malaysia.

• 2) 1983 – CONCEPT PAPER ON THE ESTABLISHMENT OF NATIONAL

SPORTS INSTITUTE (ISN).

• 3) 1992 – ISN OFFICIALLY OPENED AND BECAME A CRUCIAL ENTITY TO THE PREPARATION OF ATHLETES FOR THE XVI

• COMMONWEALTH GAMES.

4) 1998 – MALAYSIA, THE 1ST ASIA COUNTRY TO HOST THE XVI COMMONWEALTH GAMES.


SPORTS SCENARIO IN MALAYSIA

5) 2006-2007 – EXPANSION TO THE ISN BUILDING:

to accommodate the increased number of staff & sport science laboratories.

to meet the needs and requirements of the national athletes.

6) 25 MAY 2007 – THE MINISTER OF YOUTH & SPORTS DECIDED ON NEW FUNCTION OF ISN:

the entity that focuses in sports research, sports medicine and sports science in Malaysia.

to provide support services from elite level to grassroots level through scientific approach.


INTRODUCTION TO THE GLYCEMIC INDEX

What Is Glycemic Index?

The concept of GI has been

introduced by Jenkins et al. in early

1980s.

DEFINITION:

GI – a way of ranking foods based on

the actual postprandial blood glucose

response compared to a reference

food, either glucose or white bread.

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…DEFINITION

IOM (2002):

CHO-containing foods - have a wide range of

effects on blood glucose concentration during the

course digestion (glycemic response).

High GI food resulting in a rapid rise followed by a

rapid fall in blood glucose concentration.

Low GI food result in a slow extended rise and a

slow extended fall.

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The GI – calculated by measuring the incremental area

under the blood glucose curve (IAUC) following ingestion of

a test food providing 50 g available CHO, compared with

the IAUC after consumption of an equal CHO intake from

reference food.

GI = IAUC test food x 100

IAUC reference food

DETERMINANT:

GI Category

≥ 70 = high GI

55 - 69 = moderate GI

< 55 = low GI

(Brand - Miller et al. 1996)


Glucose (reference food)

Doughnut (test food)

57%

100%

Blood glucose level is plotted on a graph & the IAUC

is calculated using a computer program Lotus 123

(Wolever et al. 1991)

… Measuring the GI of the food

IAUC CALCULATION USING LOTUS 123 PROGRAM

▪ GI on Carbohydrate (CHO) Feeding Before Exercise

▪ GI and CHO Intake During Exercise

▪ GI and Post-Exercise Nutrition


OVERVIEW ON GLYCEMIC INDEX / GLYCEMIC LOAD AND EXERCISE PERFORMANCE

GI ON CARBOHYDRATE (CHO) FEEDING BEFORE EXERCISE


Study 1: Indicated higher blood glucose & [FFA] at

the end of exercise & a 20 min longer time to

exhaustion in the LGI than in

the HGI trial.

3 other studies: have found an improvement in endurance

performance with

the consumption of LGI & moderate-GI CHO


… GI ON CARBOHYDRATE (CHO) FEEDING BEFORE EXERCISE

Many studies found that ingesting LGI foods or meals more than

1 hr before exerise results in higher [blood glucose] & higher

[FFA] than when HGI CHO is ingested (Chen et al 2008; Stannard et al 2000;

Stevenson et al 2006; Stevenson et al 2005; Wee at al 2005; Wong et al 2008; Wu et al 2003; Wu

& Williams 2006)

Wong et al (2008): found a 2.8% improvement in half-marathon

times after the consumption of LGI CHO.


GI and CHO Intake During Exercise

▪ Ingesting CHO during prolonged exercise

(>90 min) at moderate to high intensities

(50-80% VO2max) improves performance (Coyle et al 1986, 1983).

▪ The CHO & fluid requirements of athletes during

exercise vary depending on intensity & duration

of the event @ training session & climatic conditions.

▪ Solid foods & foods with a high fructose content (LGI) are generally avoided by athletes due to gastrointestinal side effect during exercise (Murray et al 1989).


GI and Post-Exercise Nutrition

▪ Nutrition (amount, timing & frequency of

CHO ingestion) is one of the most

important aspects of recovery, which

involve in synthesis of muscle glycogen

to replace stores lost during exercise

(Jentjens & Jeukendreup 2003).

▪ Initial research suggested that

consuming HGI CHO during recovery

increased muscle glycogen synthesis

post exercise.

Current IOC guidelines advocate the

ingestion of protein after exercise

(as this is when maximal stimulation of

muscle protein synthesis is required)

(Slater & Phillips 2011).

The IOC recommends that 20-25 g of high

quality/or high biological value protein is

included after resistance exercise (Phillips & Van

Loon 2011) .

The combination of carbohydrates and

protein post exercise is important to restore

muscle glycogen and promote protein

synthesis (Slater & Phillips 2011).

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THE EXPERIENCE OF DOING RESEARCH AMONG ATHLETES

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RESEARCH:

1) Clearly documented the beneficial effects of

NUTRITION on physical performance.

2) UNDERNUTRITION @ suboptimal eating habits

will result on persistent fatigue, poor recovery,

illness & unwanted weight loss.


DETERMINATION OF GI IN SELECTED HIGH-CONSUMPTION MALAYSIAN FOODS

▪ Atkinson et al (2008) have systematically tabulated published & unpublished sources of reliable GI values from 1981–2007. Over 2480 individual food items available on-line http://dx.doi.org/10.2337/dc08-1239

▪ To date, not much data available on GI of Malaysian local foods.

▪ Few studies looked at:

The glycemic & insulin responses (rather than the GI) of tradisional Malaysian meals i.e. Nasi Lemak, Roti Telur, Soup Noodle (Khalid et al. 1996) & Fried Noodle (Hapizah et al. 2000).

Development and determination of glycemic index and types of carbohydrate in endurance athletes’ food choices (Nik Shanita S 2004)

A Study of Blood Glucose Response Following Temperate and Tropical Fruit Ingestion in Healthy Adults (Barakatun Nisak et al. 2005)

Glycaemic Index of Eight Types of Commercial Rice in Malaysia (Barakatun Nisak et al. 2006).

Determination of glycemic index of selected Malaysian foods (Daniel Robert et al 2006).

Glycemic index of common Malaysian fruits (Daniel Robert et al 2008).

Amylose and Amylopectin in Selected Malaysian Foods and its Relationship to Glycemic

index (Nik Shanita et al 2011).

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Normal

Pre obese

Obese

Subjects characteristics

Development and determination of glycemic index and types of carbohydrate in

endurance athletes’ food choices (Nik Shanita S 2004)


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Wet Wt Energy

g (kcal) g % en g % en g % en

1 Roti canai & dhal 146 372 50 54 9 10 15 34

2 Sardine Sandw ich 121 327 50 61 11 14 9 25

3 Karipap 120 356 50 57 9 11 13 33

4 Mihun goreng 225 392 51 52 9 9 17 39

5 Makaroni goreng 206 369 51 55 11 12 13 33

6 Doughnut 108 351 50 57 10 11 13 32

7 Nasi lemak 215 413 51 50 15 15 16 36

8 Nasi goreng 250 379 50 53 11 11 15 36

9 Teh tarik (sw eetened creamer) 100 357 50 56 10 11 13 33

Range of macronutrient (g)

Test Food

50 - 51 9 - 15 9 -17

CHO Protein Fat

Test foods – based on Malaysian hockey players & cyclist food choices

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Test Food Mean GI Glycemic Index category

Teh tarik: TT (n=6) 74 ± 6.4 HIGH

Nasi lemak: NL (n=6) 66 ± 5.1 INTERMEDIATE

Nasi goreng: NG (n=5) 59 ± 4.4 INTERMEDIATE

Sardine sandwich: SS (n=6) 73 ± 2.9 HIGH

Roti canai & dhal: RC (n=5) 71 ± 4.6 HIGH

Karipap: K (n=5) 54 ± 1.4 LOW

Mihun goreng: MG (n=6) 98 ± 7.6 HIGH

Makaroni goreng: MC (n=4) 76 ± 3.7 HIGH

Doughnut: D (n= 6) 57 ± 2.8 INTERMEDIATE

RESULTS

Classification of GI: HIGH (> 70), INTERMEDIATE (55-70), LOW (< 55) Source: Brand-Miller et al. (1996)

CURRENT NUTRITION SCENARIO AMONG MALAYSIAN ATHLETES

▪ Less emphasis on nutrition.

• Energy intake (EI) not compatible with energy expenditure (EE) ie. NEGATIVE ENERGY BALANCE (EB)

• Inconsistent meal patterns.

• Meal skipping.

• No meal before training.

• Resistance from coach, manager & athletes.

▪ Misuse of supplements.

▪ High dependency

▪ Replace with meals

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1) Energy requirements of national athletes, SEA Games KL. 1991 - Ismail et al (1997) Mal. J. Nutr 3:71-81

2) Commonwealth Games, KL. 1998 – Ismail & Arumugam (1998)

3) National Rugby Team – Ismail & Zawawi (1999) 4) Nutritional Status of National Netball players – Nik Shanita & Hera (1999) 5) Energy balance among adolescent divers & gymnasts – Ismail & Poo (2000) 6) National Footballers below 16 years old – Ismail & Azdie (2000) 7) Nutritional status of National Hockey player, SEA Games KL, 2001 – Nik Shanita et al

(2002) 8) Energy balance among Malaysian cyclist – Nik Shanita et al (2004)

SOME LOCAL STUDIES ABOUT NUTRITIONAL STAUS OF MALAYSIAN ATHLETES

OVERALL: 49 out of 194 = 25%!!

ARE THE NATIONAL ATHLETES ENERGY REQUIREMENT (ER) MET ?

Gender/type of sports No of athlete % achieved ER

Male athletes 18 / 84 21

Female athletes 7 / 24 29

Boxers 0 / 17 None

Rugby players 2 / 15 13

Diver (male) 5 / 7 71

Diver (female) 2 / 6 33

Rythmic gymnast 0 / 8 None

Footballers 13 / 24 54

Cyclist 2 / 9 22

▪ 125 national athletes

92 males, 33 females, aged 18-31y

▪ 15 sports:

racquet (squash, badminton), combat (boxing, karate, taekwondo, silat, wushu), aquatic (diving), gymnastics (artistics, rhythmic), skilled (fencing, archery, weightlifting), team (football, hockey)

▪ BMR measured ventilated hood system (Deltatrac Metabolic Monitor MBM-200)

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PHYSICAL CHARACTERISTICS OF ATHLETES

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BMR EQUATION SPECIFIC FOR MALAYSIAN ATHLETES

BMR (kcal/day) = 669 + 13 weight + 192 sex (1 m, 0 f)

▪ Compared to Deltatrac measurement (Measured-Estimated):

Male (n=92) Female (n=33)

Diff (kcal) RMSPE Diff (kcal) RMSPE

FAO/WHO/UNU (1985) 25 ± 18 172 71 ± 24 154

Harris & Benedict (1919) 31 ± 18 170 -2 ± 23 131

Cunningham (1980) -45 ± 18 178 -67 ± 22 141

Ismail et al (1998) 253 ± 18 304 199 ± 24 240

De Lorenzo (1999) -19 ± 17 168 - -

Wong et al. (2012) -4 ± 18 172 -20 ± 24 135

RMSPE = root mean squared prediction errors = the smaller the better

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GI PRACTICES AMONG ATHLETES: BEFORE AND CURRENT FINDINGS

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…GI PRACTICES AMONG ATHLETES: 21ST SEA GAMES (2001)

▪ 19 Male National Cyclists

▪ Underwent General Preparation (GPP) training for 21st SEA Games

▪ Objective was to investigate knowledge, attitude, practices (KAP) about nutrition and their food choices before training / competition.

Method: KAP using validated Nutrition KAP questionnaire and antropometric measurements using Seca Beam balance & BIA.

Results:

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• Nutrition knowledge level of cyslist was categorised as good.

• About 55% cyclists consumed CHO containing food 3-4 hour before training.

• Only, 23% of them consumed either fluid or food 30 min after their training session.

▪ For GI practices, results revealed that 59% of the cyclist chose high GI food while 24% preferred intermediate GI and only 17% correctly selected low GI food as their pre-exercise meal.


MALAYSIAN ATHLETES GI PATTERN : GI FOOD PRACTICES FOR ELITE ATHLETES MOHD IZHAM M. NATIONAL SPORTS INSTITUTE


STUDY BACKGROUND

▪ 6 Male Elite Track Athletes

▪ Undergone General Preparation (GPP) training after World Championship. Mainly focus for endurance (800 – 700km per weeks) and gym (2 times per weeks) training

▪ Objective is to investigate GI food pattern among elite track cyclist undergo general preparation phase (GPP).

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METHOD

Anthropometry

▪ Body weight and skinfold thickness were obtained using a digital scale (SECA) and skinfold calipers using ISAK measurement

Dietary assessment

▪ Participants recorded food intake over three days (2 days training and 1 days rest). Average dietary intakes were measured using Nutrimart.

▪ Frequency GI food intake where calculated and category based on International Table of Glycemic Index and Glycemic Load Values.

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RESULT Macronutrient Intakes Percentage Food Selection

Energy (kcal) CHO (g) Protein

(g) Fat (g) Low GI (%)

High GI (%)

Moderate GI (%)

Others** (%)

Pre Training 618 58 21 7 47* 34 8 11

During Training 895 157 31 4 17 70* 13 0

After Training 548 29 44 0 25 63* 13 0

Breakfast 667 22 23 8 44 0 44 11

Lunch 443 35 48 18 50* 0 8 42

Evening Tea 174 18 3 8 100* 0 0 0

Dinner 733 98 34 28 33 39* 17 11

* Higher intakes on GI foods ** Others mean beside CHO food 33

CONCLUSION

▪ Gel, sport drinks, banana, rice and juice were top 5 high GI food consumed while whole meal bread, muesli, sports bars, full cream milk, and recovery drink were top 5 low GI food consumed.

▪ Majority subjects apply low GI food before training while high GI food during and immediately after training.

▪ Future case study will be conducted to estimate GI and GL intake from diet record.

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DEVELOPMENT & VALIDATION OF SPORTS NUTRITION KNOWLEDGE, ATTITUDE & PRACTICE (KAP). TAN MT, UKM, KL

Objective: To develop and validate a sports nutrition KAP questionnaire.

Method: Developmental Phase

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Development of Sport Nutrition KAP Questionnaire • Questions related to sport nutrition were adapted and

modified based on meta-analysis of several literature reviews


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KNOWLEDGE

• Development food portion size booklet for athletes (Aainaa et al. 2007) and development food source booklet for athletes(Norhasniza et al. 2007).

• Development of a general nutrition knowledge questionnaire for adults (Parmenter & Wardle 1999).

• The Female Collegiate Cross-Country Runner: Nutritional Knowledge and Attitudes (Zawila et al. 2003).

• Nutrition Knowledge, Practices, Attitudes and Information Sources of Mid-American Conference College Softball Players (Hornstrom et al. 2011)

ATTITUDE

• Theory Planned Behaviour (TPB) questionnaire.

• The Female Collegiate Cross-Country Runner: Nutritional Knowledge and Attitudes (Zawila et al. 2003).

• Modification of a Nutritional Questionnaire for Older Adults and the Ability of Its Knowledge and Attitude Evaluations to Predict Dietary Adequacy (Thomas et al.1990)

PRACTICE

• KAP study. Technical Working Group (Research), the National Coordinating Committee on Food and Nutrition (NCCFN) Ministry of Health Malaysia 1997.


Validation Phase

Results: Reliability tests on

Knowledge with Cronbach’s alpha – 0.75-0.86

Attitude – 0.71-0.77

Practice – 0.71-0.85

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Subjects : 38 football athlete, aged 17-23 years

(21 athlete from Harimau B, 17 athlete from Harimau C)

Study location : ISN and MSN Bukit Jalil


No. Question Score

Correct (n) Wrong (n)

1. Ingesting high glycemic index (GI) food before exercise will provide constant fuels through out the exercise duration.

3(7.9%) 35(92.1%)

2. The glycemic index (GI) values for fructose and galactose are lower than glucose.

21(55.3%) 17(44.7%)

3. A low glycemic load (GL) diet can be achieved by choosing foods with low glycemic index (GI) types of foods.

22(57.9%) 16(42.1%)

4. Increased acidity in the food may increase the value of the glycemic index (GI) of that particular food

14(36.8%) 24(63.2%)

5. High glycemic index foods eg. white rice is suitable to be taken after exercise. 34(89.5%) 4(10.5%)

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RESULTS: GLYCEMIC INDEX KNOWLEDGE

89.5% - High glycemic index foods eg. white rice is suitable to be taken after exercise.

36.8% - Increased acidity in the food may increase the value of the glycemic index (GI) of that particular food

Only 7.9% - disagree that ingesting high glycemic index (GI)

food before exercise will provide constant fuels through out the exercise duration.


CONCLUSION

▪ More study on the GI of typical Malaysian foods, knowledge and attitudes of athletes.

▪ Future research will need to carefully designed to support the evidence that the GI of foods may play a role in planning of diets and to unwind the complexities of GI, nutrition and physical performance.

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nik shanita safii - glycemic index practices among malaysia athletes

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