cinnamon present

8/3/2019 Cinnamon Present

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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
http://www.bing.com/images/search?q=obeshttp://www.bing.com/images/search?q=gastric+emptying+rathttp://www.bing.com/images/search?q=obes


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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/


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CINNAMON 3 GR + + CINNAMON 1 GR

GLUCOSE PP

INSULIN

GIPGLP-1

GER

SATIETY
http://www.bing.com/images/search?q=gastric+emptying+rat


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INSULIN

RESPON

GIP, GLP-1,

GHRELIN RESPON

CHANGE

GER INSULIN

SECRETION

GLUCOSEPP
http://www.bing.com/images/search?q=gastric+emptying+rat


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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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19/391

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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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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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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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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cinnamon present

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