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Effects of 1 and 3 g cinnamon on gastricemptying, satiety, and postprandial blood
glucose, insulin, glucose-dependentinsulinotropic polypeptide, glucagon-likepeptide 1, and ghrelin concentrations in
healthy subjectsOleh:
Agustinus I Wayan Harimawan (C117210105)
Pembimbing :
DR.dr. R.Satriono,M.Sc,SpA(K),SpGK
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Background: A previous study of healthy subjects showedthat intake of 6 g cinnamon with rice pudding reduced
postprandial blood glucose and the gastric emptying rate
(GER) without affecting satiety.
Objective: The objective was to study the effect of 1 and 3 gcinnamon on GER, postprandial blood glucose, plasma
concentrations of insulin and incretin hormones [glucose-
dependent insulinotropic polypeptide (GIP) and glucagon-
like peptide 1 (GLP-1)], the ghrelin response, and satiety in
healthy subjects.
Design: GER was measured by using real-time
ultrasonography after ingestion of rice pudding with and
without 1 or 3 g cinnamon. Fifteen healthy subjects were
assessed in a crossover trial.
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Results: The addition of 1 or 3 g cinnamon had no significant effect on
GER, satiety, glucose, GIP, or the ghrelin response. The insulin response
at 60 min and the area under the curve (AUC) at 120 min were
significantly lower after ingestion of rice pudding with 3 g cinnamon (P =
0.05 and P = 0.036, respectively, after Bonferroni correction). The change
in GLP-1 response (AUC) and the change in the maximum concentration
(Cmax) were both significantly higher after ingestion of rice pudding
with 3 g cinnamon (P = 0.0082 and P = 0.0138, respectively, after
Bonferroni correction).
Conclusions: Ingestion of 3 g cinnamon reduced postprandial seruminsulin and increased GLP-1 concentrations without significantly
affecting blood glucose, GIP, the ghrelin concentration, satiety, or GER in
healthy subjects. The results indicate a relation between the amount of
cinnamon consumed and the decrease in insulin concentration.
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LIFESTYLE
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GD-PP
HUNGER
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Cinnamon has been shown to improve the insulinreceptor function in rats, which leads to enhancedcellular glucose uptake (10, 11).
A recent short-term study in healthy subjects showed
lower postprandial blood glucose concentrations andimproved insulin sensitivity when 5 g cinnamon waseaten 12 h before, or ingested at the same time as, anoral-glucose-tolerance test was performed (12).
A long-term study of nondiabetic women with
polycystic ovary syndrome also showed a significantreduction in insulin resistance after the intake of 1 gcinnamon/d for 8 wk before an oral-glucose-tolerancetest was performed (13).
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Ingestion of 6 g cinnamon together with ricepudding has been shown to reduce postprandial
blood glucose concentrations and GER in healthy
subjects, although the reduction in blood glucose
concentrations was much more pronounced than
the lowering of GER, which was unexpected (15).
Six grams of cinnamon is not a quantity ordinarily
used in food.
http://grafik.pptx/http://grafik.pptx/8/3/2019 Cinnamon Present
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CINNAMON 3 GR + + CINNAMON 1 GR
GLUCOSE PP
INSULIN
GIPGLP-1
GER
SATIETY
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INSULIN
RESPON
GIP, GLP-1,
GHRELIN RESPON
CHANGE
GER INSULIN
SECRETION
GLUCOSEPP
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SUBJECT15 (9-m & 6-f)
8-h FAST
GER15, AND 90
VENOUS BLOOD(0,15,30,45,60,90,120,150)
GLUCOSE, INSULIN, GIP,
GLP-1, GHRELIN
SATIETY(0, 15,30,45,60,90,120)
SATIETY SCORES by
Habers Method
300 g RICE + 1 g CINNAMON + 3 g CINNAMON
FASTING BLOOD GLUCOSE
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This study showed that the ingestion of 3 g cinnamonreduces postprandial insulin and increases GLP-1concentrations without significantly affecting satiety, GER,or concentrations of blood glucose, GIP or ghrelin inhealthy subjects.
The reduction in postprandial insulin response after theingestion of 3 g cinnamon was more pronounced than thatafter the ingestion of 1 g cinnamon.
Our finding that cinnamon decreases the insulin demand,
despite the lack of change in blood glucoseconcentrations, was probably due to enhanced glucoseuptake via stimulation of the insulin receptor. This findingis consistent with the results of previous studies.
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Various herbs and medicinal plants have beeninvestigated, and cinnamon has been shown to be one ofthe most effective at regulating blood glucose (22).
Awater-soluble polyphenol type-A polymer isolated from
cinnamon has been shown to enhance insulin activity (23). There seems to be a relation between the amount of
cinnamon consumed, the delay in gastric emptying, andthe reduction in postprandial blood glucoseconcentrations
Gastric emptying, as well as other factors, regulates thepostprandial blood glucose response, and a delay ingastric emptying leads to a lower postprandial bloodglucose concentration (30, 31).
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The late phase of the GLP-1 response was clearly
stimulated by cinnamon. Surprisingly, the increase
in GLP-1 concentrations after the ingestion of
cinnamon, seen in this study did not stimulate insulin
release or slow gastric emptying.
We, and others, have failed to observe stimulatoryeffects of GLP-1 on postprandial insulin (6, 3235).
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Our findings that cinnamon increases GLP-1
concentrations and decreases insulin
concentrations, despite the lack of change in
blood glucose concentrations or gastric emptying,support the previously described stimulation of
the insulin receptor by cinnamon.
The stimulatory effects of cinnamon on GLP-1
could be due to a direct effect on the L cells in the
intestine. Unfortunately, postprandial glucagon
concentrations were not measured in the present
study
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Treatment of type 2 diabetes mellitus based on
enhanced glucose uptake by stimulation of the
insulin receptor with cinnamon may improve
glycemic control and decrease the insulin demand,with secondary effects on the b cell mass and
prevention of the loss of b cell function.
Clearly, a long-term clinical trial involving a largernumber of diabetes patients is needed to evaluate
the effects of cinnamon supplementation in type 2
diabetes
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This study showed that the ingestion of 3 gcinnamon reduced postprandial serum insulinand increased GLP-1 concentrations but hadno effect on postprandial GER, satiety or bloodglucose, GIP, or ghrelin concentrations inhealthy subjects.
A relation between the amount of cinnamonconsumed and the decrease in insulinconcentrations in healthy subjects was alsoshown in this study. Higher doses of cinnamonare apparently required to influence GER andpostprandial blood glucose concentrations.
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INSULINRECEPTOR
INSULINRECEPTOR
KINASE
SENSITIVITY
INSULIN
INSULIN
RECEPTORPOSPHATASE
INSULIN
L CELL
INTESTINE
GLP-1
CINNAMON(POLYMER POLYPHENOL
TYPE-A)
(23)
UPTAKE
GLUCOSE
INSULIN
DEMAND
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Effects of 1 and 3 g cinnamon on gastricemptying, satiety, and postprandial bloodglucose, insulin, glucose-dependentinsulinotropic polypeptide, glucagon-like peptide1, and ghrelin concentrations in healthysubjects
Joanna Hlebowicz, Anna Hlebowicz, Sandra Lindstedt, Ola Bjorgell,Peter Hoglund, Jens J Holst, Gassan Darwiche, and Lars-Olof Almer
Am J Clin Nutr 2009;89:81521. Printed in USA. 2009 American Society for Nutrition
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UMUM
PENILAIAN CHECK LIST YA TIDAK
Judul Apakah judul tidak terlalu panjang atau terlalu
pendek ?
Apakah judul menggambarkan isi utamapenelitian ?
Apakah judul cukup menarik ?
Apakah judul tidak menggunakan singkatanselain yang baku ?
Abstrak Apakah merupakan abstrak satu paragraf atauabstrak terstruktur ?
terstr
uktur
Apakah sudah tercakup komponen IMRAC(Introduction, Methods, Result, Conclusion) ?
Apakah secara keseluruhan abstrak informatif ?
Apakah abstrak lebih dari 200 kata dan kurang
dari 250 kata?
(244)
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PENILAIAN CHECK LIST YA TIDAKPendahuluan Apakah mengemukakan alasan
dilakukannya penelitian ?
Apakah menyatakan hipotesis atautujuan penelitian ?
Apakah pendahuluan didukung olehpustaka yang kuat dan relevan ?
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PENILAIAN CHECK LIST YA TIDAK
Metode Apakah disebutkan desain, tempat dan waktu penelitian ?
Apakah disebutkan populasi sumber (populasi terjangkau) ?
Apakah kriteria pemilihan (inklusi dan eksklusi) dijelaskan ?
Apakah cara pemilihan subyek (teknik sampling) disebutkan?
Apakah perkiraan besar sampel disebutkan dan disebut pulaalasannya?
Apakah perkiraan sampel dihitung dengan rumus yangsesuai ?
Apakah observasi, pengukuran serta intervensi dirincisehingga orang lain dapat mengulanginya ?
Bila teknik pengukuran tidak dirinci, apakah disebutkan
rujukannya ?Apakah defenisi istilah dan variabel penting dikemukakan ?
Apakah ethical clearance diperoleh ?
Apakah disebutkan rencana analisis, batas kemaknaan dan
power penelitian ?
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PENILAIAN CHECK LIST YA TIDAK
Hasil Apakah disertakan tabel deskripsi subyekpenelitian ?
Apakah karakteristik subyek yang penting (data
awal) dibandingkan kesetaraannya ?
Apakah dilakukan uji hipotesis untuk kesetaraanini ?
Apakah disebutkan jumlah subyek yang diteliti ?
Apakah dijelaskan subyek yang drop out denganalasannya ?
Tdk ada DO
Apakah semua hasil di dalam tabel disebutkandalam naskah ?
Apakah semua outcome yang penting disebutkandalam hasil ?
Apakah disertakan hasil uji statistik (x2,t) derajatkebebasan (degree of freedom), dan nilai p ?
Apakah dalam hasil disertakan komentar dan
pendapat ?
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PENILAIAN CHECK LIST YA TIDAK
Diskusi Apakah semua hal yang relevan dibahas ?
Apakah dibahas keterbatasan penelitian dankemungkinan dampaknya terhadap hasil ?
Apakah disebutkan kesulitan penelitian,penyimpangan dari protokol dan kemungkinandampaknya terhadap hasil ?
Apakah pembahasan dilakukan denganmenghubungkannya dengan teori dan hasil
penelitian terdahulu ?
Apakah dibahas hubungan hasil dengan praktekklinis ?
Apakah disertakan kesimpulan utama penelitian ?
Apakah kesimpulan didasarkan pada data
penelitian ?
Apakah disebutkan hasil tambahan selamadiobservasi ?
Apakah disebutkan generalisasi hasil penelitian ?
Apakah disertakan saran penelitian selanjutnya,dengan anjuran metodologis yang tepat ?
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Validity
Apakah awalpenelitian
didefenisikan dengan
jelas ? (pertanyaan
atau tujuan penelitian)
Ya, The primary objective of this study was todetermine whether adding 1 and 3 g cinnamon
to a meal would change GER, satiety, or
postprandial blood glucose, insulin, GIP, and
GLP-1 concentrations
Apakah desain
penelitian dinyatakan
dengan jelas ?
Ya, Fifteen healthy subjects were assessed in a
crossover trial.
Apakah ada
pembanding yang
jelas ?
Ya, subjek penelitian sekaligus sebagai
pembanding
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Validity
Apakah follow uppasien dilakukan
cukup panjang danlengkap ?
Ya. The study started on 29 May 2007 and ended on 12
December 2007.
Apakah faktor kausaldikemukakan ?
Ya, A previous study of healthy subjects showed that
intake of 6 g cinnamon with rice pudding reduced
postprandial blood glucose and the gastric emptying
rate (GER) without affecting satiety. Six grams of
cinnamon is not a quantity ordinarily used in food.
Apakah kelompok-kelompok yangdibandingkansebanding pada
tahap awal ?
Ya, . Fifteen healthy subjects [9 men and 6 women;
age: 24. 1.9 y (range: 2027 y); body mass index : 22.5
2.7 (range: 19.327.5)] with no symptoms and no
history of gastrointestinal disease, abdominal surgery,
or diabetes mellitus were included in this crossoverstudy. The subjects had no connective tissue disease or
cerebrovascular or endocrine disease, and none was
taking any medications other than oral contraceptives
(n = 1 woman). Two subjects were smokers, and one
was a snuff user. All subjects were recruited from the
population of southern Sweden.
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IMPORTANT
Apakah outcome/hasildipaparkan secara jelas(hasil uji statistik dengan nilaip) ?
Ya. Sebagaimana yang telah ditampilkan pada
tabel 1, 2 dan 3, serta gambar 1-7.
Seberapa besarkahketepatan estimasi outcomeyang didapat dengan nilaiOR, dengan nilai korelasi95%CI ?
Tidak debutkan
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Applicability
Apakah pasien kita miripdengan subyek yang diteliti ?
Tidak, subjek penelitian ini adalah orang sehat
namun manfaat dari cinnamon dalam
mengontrol gula darah dapat diberikan pada
pasien DM
Apakah bukti ini akanmempunyai pengaruh yangpenting secara klinisterhadap kesembuhan
pasien kita tentang apa yangtelah ditawarkan/diberikankepada pasien kita ?
Ya, dengan dukungan nutrisi yang
mengandung cinnamon (R/ susu dianeral) akan
dapat mengontrol gula darah.
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