These terms, along with identified outcomes, were used to conduct the literature search. During the question development ( Supplementary File S1), the workgroup identified key terms and outcomes. The PICOS criteria used to define the research questions were: Participants: Human subjects or in vitro human digestion simulation Intervention: Glycemic index gauging Comparison: Glycemic index of glucose or white bread Outcome measure: Glycemic impact Type of studies included: Scientific manuscripts and patents ( Supplementary File S1).Ī comprehensive literature search using the eligibility criteria defined by the workgroup using the mentioned databases was conducted. For scientific rigor, this systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist, as described in the Supplementary File S1 and Guidance of the European Food Safety Authority. The increasing demand for gluten-free products, primarily GF bread with a good nutritional profile and sensory quality, justify the importance and the need to evaluate the glycemic index of gluten-free bread and the main ingredients used in their formulations. In November 2020, we performed a systematic review to evaluate and compare the characteristics of GFBs’ GI and its main ingredients. This information will potentially allow health professionals and consumers to guide their diet to avoid health impairments. Therefore, this study aimed to perform a systematic review of the glycemic index of gluten-free bread and the main ingredients used in their formulations following PRISMA guidelines. Given the growing popularity of gluten-free products, it is necessary to best inform individuals with a GRD regarding the health implications of gluten-free food consumption, mainly of the risk for chronic diseases. However, most of these products’ present poor nutritional quality (highly starchy and fatty, and low in protein, fiber, and micronutrients) to compensate for the gluten absence and to achieve the sensorial and technological quality. Aiming to meet the need for gluten-free bread and the desires of people with a GRD, studies have been searching for a Gluten-Free Bread (GFB) with similar quality aspects to bread containing gluten. However, challenges regarding gluten replacement often lead to poor sensorial and technological quality. Among gluten-free products, bread is the most desired product by people with a GRD. Īmong foods with a high GI, bread is one of the most popular items in the consumer’s shopping basket, reaching the worldwide average consumption of 18 kg/year per capita. Therefore dietary guidelines suggest a diet with low GI foods (<55) to prevent chronic diseases. The GI is an essential tool in the evaluation of the nutritional quality of food since high or upper-limit moderate GI is related to the increasing prevalence of diabetes, being overweight, and cardiovascular diseases. Gluten-free starches and flours are traditionally low in fiber, micronutrients, protein, and, usually, present a higher glycemic index (GI). Unbalanced GFD is correlated to an increase in chronic diseases, highlighting the importance of improving the nutritional quality of gluten-free (GF) products. Despite the benefits of gluten-exclusion for those who need to follow strict GFD, there are divergences regarding the nutritional quality and unhealthy effects of gluten-free products. The gluten-free diet (GFD) has become more popular since it is the only treatment for individuals with gluten-related disorders (GRD). GFB tends to present high GI, impacting the development of chronic diseases when consumed. Lower GIs were found in formulations based on Colocasia esculenta flour or enriched with fiber, yogurt and curd cheese, sourdough, psyllium, hydrocolloids, enzymes, fructans, and resistant starch, highlighting the efficacy of these ingredients to lower GFBs’ GI. Meta-analysis presented moderate/low heterogenicity between studies ( I 2 = 61% and <1% for both high and low GIs) and reinforced the proportion of high GIs. Only 18.2% (95% CI: 11.7–27.2%) of the bread samples presented in the studies were classified as a low GI. The analysis showed that 60.7% (95% CI: 40.2–78.1%) of the samples presented high glycemic indexes, evidencing a high glycemic profile for GFB. Five articles tested GI in vivo, eleven in vitro and two studies tested both methods. Eighteen studies met the inclusion criteria evaluating 132 GFB samples. The systematic review followed PRISMA guidelines, using seven electronic databases (PubMed, EMBASE, Scopus, Science Direct, Web of Science, gray literature research with Google Scholar, and patents with Google Patent tool), from inception to November 2020. This study aimed to perform a systematic review and meta-analysis of the glycemic index (GI) of gluten-free bread (GFB) and its main ingredients.
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