rnRevista de NutriçãoRev Nutr1415-52731678-9865Pontifícia Universidade Católica de Campinas0270110.1590/1678-9865202538e240062ORIGINAL | Maternal and Infant NutritionEffect of bread incorporated with flaxseed powder on postprandial glycemia and palatability in healthy individualsEfeito do pão incorporado com pó de linhaça na glicemia pós-prandial e na palatabilidade em indivíduos saudáveis0009-0009-7148-9839KhanImranConceptualizationInvestigationFormal analysisWriting–original draftWriting–review and editing10009-0006-7511-6173MirBisma ManzoorConceptualizationInvestigationFormal analysisWriting–original draftWriting–review and editing20000-0002-9489-9437HajiraBibiInvestigationFormal analysisWriting–review and editing30000-0001-6935-215XAhmadJamilConceptualizationInvestigationFormal analysisWriting–review and editing20000-0001-8357-797XJohnsonStuart K.Writing–review and editing40000-0001-7507-5646AlmajwalAli MadiWriting–review and editing5Sultan Qaboos UniversityCollege of Agricultural and Marine SciencesDepartment of Food Science and NutritionMuscatOmanSultan Qaboos University, College of Agricultural and Marine Sciences, Department of Food Science and Nutrition. Muscat, Oman.The University of Agriculture PeshawarDepartment of Human NutritionPeshawarPakistanThe University of Agriculture Peshawar, Department of Human Nutrition. Peshawar, Pakistan.Khyber Medical UniversityInstitute of Basic Medical SciencesPeshawarPakistanKhyber Medical University, Institute of Basic Medical Sciences. Peshawar, Pakistan.Curtin UniversitySchool of Public HealthCurtin Health Innovation Research InstitutePerthAustraliaCurtin University, School of Public Health, Curtin Health Innovation Research Institute, Faculty of Health Sciences. Perth, Australia.King Saud UniversityCollege of Applied Medical SciencesDepartment of Community Health SciencesRiyadhSaudi ArabiaKing Saud University, College of Applied Medical Sciences, Department of Community Health Sciences. Riyadh, Saudi Arabia.Correspondence to: I KHAN. E-mail: i.khan1@squ.edu.om.
Alceu Afonso Jordão and Anderson Marliere Navarro
The authors declare that there is no conflicts of interest.
002025202538e240062130520242502202523042025This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.ABSTRACTObjective
The objective of this study was to investigate the effect of bread incorporated with flaxseed powder on glycemic response and palatability.
Methods
In a cross-over study, 20 healthy participants were randomly assigned to consume one of two iso-caloric test foods: control bread, made from 100% plain wheat flour or bread containing flaxseed powder (10% w/w), as breakfast, 1-2 weeks apart. The portion size of bread consumed was calculated based on providing 50 g available carbohydrates. Capillary blood samples were collected to determine blood glucose at fasting and postprandially for 2 hours. Palatability of the test bread was assessed using a 9-point hedonic scale.
Results
Consumption of FSB resulted in a significant decrease in blood glucose at 30 min (p=0.003) and 45 min (p=0.004) compared to control bread. The incremental area under the curve (iAUC) for blood glucose was also decreased (p=0.006) after consumption of FSB compared to control bread. The glycemic index of flaxseed powder (57.79), falling within the medium category, was significantly lower (p0.05) compared to control bread (71). Palatability parameters did not differ between the test breads (p0.05).
Conclusion
In conclusion, the consumption of bread incorporated with flaxseed powder decreased blood glucose level, suggesting that adding flaxseed to staple foods could help in better glycemic control.
RESUMOObjetivo
O objetivo deste estudo foi investigar o efeito do pão incorporado com pó de linhaça na resposta glicêmica e palatabilidade.
Métodos
Em um estudo cruzado, 20 participantes saudáveis foram aleatoriamente designados para consumir um dos dois alimentos testados iso-calóricos: pão controle, feito de 100% farinha de trigo comum, ou pão contendo pó de linhaça (10% p/p), como café da manhã, com 1-2 semanas de intervalo. O tamanho da porção de pão consumido foi calculado com base em fornecer 50 g de carboidratos disponíveis. Amostras de sangue capilar foram coletadas para determinar a glicose no sangue em jejum e pós-prandial por 2 horas. A palatabilidade do pão de teste foi avaliada usando uma escala hedônica de 9 pontos.
Resultados
O consumo de FSB resultou em uma diminuição significativa na glicose sanguínea aos 30 min (p=0.003) e 45 min (p=0.004) em comparação com pão controle. A área incremental sob a curva (iAUC) para a glicose no sangue também foi diminuída (p=0.006) após o consumo de pó de linhaça em comparação com pão controle. O índice glicêmico do pó de linhaça (57.79), que se enquadra na categoria média, foi significativamente menor (p<0.05) em comparação com o pão controle (71). Os parâmetros de palatabilidade não diferiram entre os pães testados (p<0.05).
Conclusão
Em conclusão, o consumo de pão incorporado com pó de linhaça diminuiu o nível de glicose no sangue, sugerindo que adicionar linhaça aos alimentos básicos poderia ajudar no melhor controle glicêmico.
KeywordsBreadFlaxseedGlycemic ControlPerceptionPalavras-chavePãoÓleo de linhaçaControle GlicêmicoPercepçãoKing Saud UniversityORF-2025-502The authors extend their appreciation to the Ongoing Research Funding Program (ORF-2025-502), King Saud University, Riyadh, Saudi Arabia.INTRODUCTION
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from either inadequate insulin secretion, insulin resistance or both [1]. Presently, diabetes affects more than 537 million people globally, and this figure is estimated to rise substantially to 783 million by 2045, particularly in middle-income countries [2].
Diet plays a vital role in the development of type 2 diabetes; hence, changing the diet may help to prevent its development. More specifically, the quality and quality of dietary carbohydrates have been shown to play a key role in developing impaired glucose tolerance and insulin resistance and increase the risk of type 2 diabetes [3]. Foods with high glycemic index (GI) have been shown to increase postprandial blood glucose and insulin demand and could possibly contribute to insulin resistance in the long term [4].
White bread is the most frequently consumed food all over the world, particularly in developing countries. It is considered a major source of rapidly digestible carbohydrates, contributing to high postprandial blood glucose and hence its frequent consumption increases the risk of developing chronic diseases, particularly type 2 diabetes [5,6]. In addition, the consumption of ultra-processed foods has been shown to be strongly associated with a higher risk of type 2 diabetes [7,8]. Therefore, different sources of functional food ingredients such as herbs, seeds, and underutilized cereal have been incorporated into bread to reduce its glycemic impact [5,9,10].
Flaxseed (Linum usitatissimum L.), also known as linseed, is a member of the Linaceae family. It is considered a potential functional food ingredient due to the presence of high amounts of alpha-linolenic acid, dietary fiber, phenolic compounds, high-quality protein and phytoestrogens [11]. The potential of flaxseed in reducing the glycemic response has been highlighted in numerous studies. For example, an in vitro study revealed that polyphenolic compounds in flaxseed may inhibit the activities of starch hydrolyzing enzymes like α-amylase and β-glucosidase, resulting in notable effects on reducing fasting blood levels [12]. Another study in broiler chicken demonstrated that the linoleic component of flaxseed regulates the α-amylase activity and linolenic and oleic components inhibit the β-glucosidase activity in the experimental group compared to the control group [13]. In a systematic review, the consumption of ground flaxseed was shown to improve glycemic control and insulin resistance in individuals with prediabetes and type 2 diabetes [14]. In a randomized controlled study, consumption of 30 g/day milled flaxseed powder together with lifestyle modification for 12 weeks in women with polycystic ovary syndrome improved the glycemic indices, lipid profile and inflammatory markers in treatment group compared to control group [15].
Although several clinical studies have been conducted on investigating the impact of flaxseed on glycemic control and related parameters [16-19], no study has yet determined the acute effect of bread incorporating brown flaxseed powder on blood glucose in healthy individuals. Therefore, the objective of the current study was to determine the acute effect of incorporating flaxseed into bread on postprandial glycemic response whilst maintaining product palatability. It was hypothesized that bread incorporated with flaxseed powder would reduce postprandial glycemic response in healthy individuals.
METHODSStudy participants
Healthy individuals of both genders aged 18-60 years were recruited through posted flyers and direct personal communication. After obtaining written informed consent, a health questionnaire was used to assess individuals’ eligibility for inclusion in the study. Participants with a history of diabetes, cardiovascular diseases, gluten allergy, respiratory problems, and major gastrointestinal problems, breakfast skipping, or being currently on weight loss were excluded. In addition, participants using medications with effects on the metabolism of glucose, satiety sensation, body weight, and smoking were also excluded. In addition, participants with a blood glucose concentration of ≥5.6 mmol/l were also excluded. The study was performed on twenty healthy individuals. The sample size was calculated based on a previous study of Khan et al. [20] using blood glucose as the main outcome variable. It was found that 20 subjects were sufficient to detect a 20% reduction in blood glucose, with a power of 80%, and at a 5% confidence level. This study was approved by the Human Research Ethics Committee of the department of Human Nutrition (HN-HREC/2018-0027), The University of Agriculture Peshawar and was conducted according to the guidelines of Helsinki Declaration.
Test breads
Brown flaxseed was obtained in bulk (5 kg) from the Department of Horticulture, the University of Agriculture, Peshawar, Pakistan. The seeds had 6.8 % moisture content, with a smooth glossy texture and light brown colour. The seeds were cleaned to discard stones and foreign objects. Afterwards, the seeds were ground into powder using a knife grinder (Grindomix GM-200, Retsch, Germany; Haan, 1000 W, 3000 rpm) and stored in polythene bags until utilization. In the current study, there were two types of breads. Formulations consisted of 100% all-purpose wheat flour for Control Bread (CB) or replacement of wheat flour with flaxseed powder at 10% (w/w) for preparation of Flaxseed Bread (FSB). This incorporation level of flaxseed was selected based on a pilot consumer evaluation study (data not shown). The bread was prepared in the department of Human Nutrition laboratory following a standard procedure as described by Marpalle et al. [21]. First the wheat flour and flaxseed powder were extensively mixed to obtain a homogenous mixture. All other ingredients used in the preparation of bread included 6 g sugar, 1 g salt, 5 g canola oil, 70 ml water and 2 g instant dry yeast per 100 g. The mixture was kneaded manually for 10 to 15 min to obtain a homogenous dough. The dough was placed in a baking pan and fermented for 40 min in a slightly warm room (30 °C) until it doubled in size. Subsequently, the bread was baked in an electric oven (Panasonic digital oven) at 220 ºC for 30 min. After baking, the bread was cooled and stored in a refrigerator until it was required to be consumed by the participants.
Study design and protocol
A randomized, controlled cross-over trial was used for the current study. Each participant attended two testing sessions with a washout period of about 1-2 weeks apart, to minimize the carryover effects. At each testing session, participants were served either control or treatment bread as breakfast. Composition of test meals is given in Table 1. Drinking water was used to equalize the weight of the test breakfasts. Participants were instructed to avoid strenuous physical activity and to record their evening meal the day before each testing session. After fasting for a period of 10-12 hours, participants arrived in the laboratory at 8:00 am to attend the study session. Baseline measurements including weight, height, and waist circumference were recorded before starting the session. After 5 minutes of rest, the fasting blood glucose was measured using finger prick method. Afterward, participants consumed the test bread within 10 minutes, during which time they rated the palatability of the bread using a 9-hedonic scale. Blood glucose was measured again at 15, 30, 45, 60, 90, and 120 minutes after eating the test bread. The participants were prohibited from drinking, eating, or performing any other activity apart from reading or using a laptop.
Composition of test meals.
Ingredients
Control bread
Flaxseed bread
Bread (g)
103
109
Water (g)
247
241
Total weight (g)
350
350
Energy (Kcal)
260.46
284.13
Available carbohydrates (g)
50
50
Protein (g)
7.96
9.41
Fats (g)
3.18
5.17
Dietary fiber (g)
1.21
3.85
Baseline measurements
Baseline measurements such as weight, height, and waist circumference were assessed using standard scales. A stadiometer was used to record height. A digital laboratory scale was used to record weight. Subjects were asked to remove their shoes and heavy clothing before weighing. Height and weight were used to calculate Body Mass Index (BMI). Waist circumference was measured using non-stretchable measuring tape between the lower rib and crest sections and was measured to the nearest 0.1 cm. Blood pressure was assessed using a portable manual mercurial monitor.
Blood glucose analysis
Blood glucose was analyzed using the finger-prick method. Before pricking, the participant’s finger was cleaned with the help of alcoholic swabs. The finger was allowed to dry before pricking to avoid contamination of blood with alcohol. Then, the finger was pricked with an automatic lancet device. Finally, blood glucose was measured using a glucometer (Accu check Performa Nano, Roche, São Paulo, Brazil). A single glucometer was used throughout the study to avoid variations.
Palatability of test bread
The palatability of the bread was tested in terms of appearance, flavor, texture, and overall acceptability using a 9-point hedonic scale [22]. The subjects filled the scale anywhere from extremely disliked to extremely like, representing their perception of the bread.
Calculation and statistical analysis
Incremental blood glucose values for each test bread were calculated by subtracting fasting value of each participant from the corresponding postprandial value. Blood glucose response curves were constructed using the incremental blood glucose values. Trapezoidal method was used to calculate incremental area under the curves (iAUCs, incremental Area Under the Curves) for blood glucose. Peak time taken as the time during which blood glucose was highest. Incremental peak glucose was the highest glucose value during the 2 hours time. Glycemic profile was obtained by dividing the total time in minutes during which blood glucose concentration was higher than baseline by IPG value. Glycemic index was calculated using the formula; iAUCs of flaxseed bread divided by iAUCs of control bread × 100. Statistical software IBM®SPSS® (SPSS Inc., Chicago. IL) was used for data analysis. The effect of time, treatment, and their interaction (time x treatment) on blood glucose was determined by two-way repeated Analysis of Variance (ANOVA) with Bonferroni adjustment. Differences between treatments at each point were assessed using paired t-test. Peak time, incremental peak glucose, glycemic profile and glycemic index between the breads were compared using paired t-test. Palatability parameters between the two breads were compared by paired t-test. Statistical significance was set at p<0.05.
RESULTSBaseline characteristics
All the twenty subjects completed the two testing sessions. Their baseline characteristics are presented in Table 2.
Baseline characteristics of study subjects (n=20)<xref ref-type="table-fn" rid="TFN01">*</xref>.
Characteristics
N/ Mean±SEM
Male/Female
10/10
Age (years)
23.25±0.33
Weight (kg)
60.45±2.35
Height (m)
160.10±1.59
Body mass index (kg/m2)
21.95±0.88
Waist circumference (cm)
76.00±1.75
Fasting plasma glucose (mg/dl)
90.02±1.84
Systolic blood pressure (mm Hg)
112.75±2.32
Diastolic blood pressure (mm Hg)
71.20±2.13
Note:
Values are means±SEM.
Blood glucose response
The postprandial blood glucose changes after test bread consumption with the corresponding iAUC are shown in Figure 1 (a and b). There was a significant effect of time (p<0.001) and treatment (p=0.002) on postprandial blood glucose after consumption of FSB, while their interaction (time × treatment) was non-significant (p=0.108). Post-hoc analysis revealed that FSB significantly reduced blood glucose level at time points 30 min (p=0.003) and 45 min (p=0.004) compared to CB. In addition, the blood glucose iAUC was significantly lowered for FSB compared to CB (p=0.006).
Blood glucose response.
Note: (a & b): Mean (±SEM) changes from baseline in blood glucose and incremental areas under the curves (iAUCs) in healthy individuals (n=20) after consumption of test breads (CB: Control Bread; FSB: Flaxseed Bread). Values with different superscript letters are significantly different at each time point: two-way repeated measure ANOVA with Bonferroni adjustment, followed by paired t-test (p<0.05). Vertical bars with different letters are significantly different, p<0.05 (paired t-test).Peak time, incremental peak glucose, glycemic profile and glycemic index of test breads
Peak time, peak incremental glucose, glycemic profile and glycemic index of test breads are shown in Table 3. Peak time was not significantly different between FSB and CB (p=0.412), whereas incremental peak glucose level was significantly lower after consumption of FSB compared to CB (p<0.001). The glycemic profile was significantly higher after consumption of FSB compared to CB (p=0.001). The glycemic index of FSB on both bread and glucose scale was significantly lower compared to CB p=0.029).
Peak time, incremental peak glucose, glycemic profile and glycemic index of test breads<xref ref-type="table-fn" rid="TFN02">*</xref>.
Test bread
Peak time
IPG
GP
GI (bread scale)
GI (glucose scale)
Mean±SEM
Control bread
40.50±2.45
48.80±2.24a
2.37±0.12b
100.00±0.00a
71.00±0.00a
Flaxseed bread
44.25±4.28
39.05±2.50b
3.36±0.25a
81.65±6.77b
57.79±4.81b
Note:
All values are mean±SEMs (n=20).
Values in the same column with different superscript letters are significantly different from each other, p<0.05 (paired t-test). GI: Glycemic Index; GP: Glycemic Profile; IPG: Incremental Peak Glucose.
Palatability of test breads
The palatability of test bread measured in terms of appearance, texture, flavor and overall acceptability is shown in Table 4. No significant differences were observed between the test breads in terms of appearance (p=0.470), texture (p=0.577), flavor (p=0.603), and overall acceptability (p=0.776).
Test breads’ palatability*.
Test bread
Appearance
Texture
Flavor
Overall acceptance
Mean±SEM
Control bread
6.40±0.22
6.00±0.19
6.10±0.17
6.35±0.22
Flaxseed bread
6.65±0.27
6.15±0.28
5.95±0.25
6.25±0.40
Note:
All values are mean±SEMs (n=20).
p<0.05 (paired t-test).
DISCUSSION
The current study provides evidence that FSB has the potential to significantly reduce postprandial blood glucose compared to CB. There was a mean difference of 13.5 mg/dl in peak blood glucose values between FSB and CB. Both the breads were liked equally by the study individuals.
The potential of flaxseed in lowering glycemia has been reported in a recent study in which flaxseed supplementation for 4-12 weeks improved glycemic response and insulin sensitivity in healthy and diabetic individuals [23]. However, limited studies have examined the acute response of flaxseed as the first meal of the day. For example, acute postprandial blood glucose response has been investigated in randomized controlled trials in healthy adults, in which consumption of flaxseed enriched bars (comprising 50 g available carbohydrate) significantly reduced postprandial blood glucose level compared to glucose solution (comprising 250 ml of water with 50 g of dissolved sugar) while simultaneously raised satiety level to a greater extent compared to saltine crackers [18]. In another randomized cross-over trial, muffins containing 10 g flaxseed as three meals a day provided promising results in reducing and maintaining blood glucose levels related to control muffins [24]. In a recent systematic review and meta-analysis comprising of seven randomized control trials, flaxseed supplementation exhibited a considerable reduction in fasting blood glucose variables with an improvement in insulin sensitivity in pre-diabetic and type-2 diabetic adults [14]. Similarly, ingestion of 15 g raw flaxseed powder before breakfast by type-2 diabetic males significantly reduced the acute postprandial blood glucose level compared to control breakfast [25]. Furthermore, the consumption of cookies containing 10 g of flaxseed by type-2 diabetic patients with constipation revealed a significant reduction in fasting blood glucose response compared to the placebo group [26]. Most of the clinical trials utilized 30 g of flaxseed to demonstrate the acute hypoglycemic response of ground flaxseed in healthy subjects [27]. However, in our study, bread containing 10% flaxseed powder significantly reduced postprandial blood glucose levels in healthy subjects, and had a significant impact on the incremental peak, glycemic profile and glycemic index. The glycemic index of bread decreased from 71.0 to 57.79 on glucose scale, which reveals that glycemic index was reduced from high-category to low-category with the incorporation of flaxseed.
The reduction in postprandial blood glucose concentration after FSB intake may be attributed to the presence of bioactive components in flaxseed, such as α-linolenic acid, linoleic acid, mucilage, phytoestrogenic lignans, cyclic peptides and dietary fibers [28]. For instance, foods with high dietary fiber content, primarily soluble dietary fiber, have been shown to reduce blood glucose levels in diabetic and healthy adults [29]. In this context, it has been reported that flaxseed mucilage or flaxseed gum has the ability to delay the digestion of food, increase food viscosity, slow the nutrient and digestive enzyme interactions, decrease absorption from the gastrointestinal tract, and reduce the permeability of the intestine, which results in lowered glycemic response [30]. The reduction in postprandial blood glucose level after the ingestion of FSB may also be due to the presence of polyphenols in flaxseed, which have been shown to inhibit the activities of carbohydrate digesting enzymes including α-amylase and α-glucosidase [12]. Furthermore, alpha-linolenic acid, a polyphenol in flaxseed, has shown the capability to improve insulin sensitivity by controlling intestinal hormone secretion, thus elevating insulin signal and producing insulin secretion from beta cells to upgrade glucose utilization [12].
The current study has certain limitations, including its acute experimental design and the inclusion of healthy subjects only. Therefore, more extensive studies are required to verify the effect of FSB on postprandial blood glucose levels in both obese and/or diabetic individuals. Further, the effect of FSB consumption on satiety, energy intake, gastric emptying rate, satiety-related hormones, colonic fermentation and oral exposure time were not measured and should be investigated in future studies to better understand the mechanisms underlying the hypoglycemic effect of FSB.
CONCLUSION
In conclusion, the present study showed that the consumption of bread incorporated with flaxseed powder resulted in a lower glycemic response, which may offer potential benefits for type 2 diabetes, obesity and cardiovascular diseases. Long-term mechanistic studies are now needed to further investigate the effects of flaxseed on blood glucose levels, insulin sensitivity and energy homeostasis in both diabetic/obese and healthy individuals.
ACKNOWLEDGEMENTS
The authors extend their appreciation to the Ongoing Research Funding Program (ORF-2025-502), King Saud University, Riyadh, Saudi Arabia.
How to cite this article: I khan I, Mir BM, Hajira B, Ahmad J, Johnson SK, Almajwal AM. Effect of bread incorporated with flaxseed powder on postprandial glycemia and palatability in healthy individuals. Rev Nutr. 2025;38:e240062. https://doi.org/10.1590/1678-9865202538e240062
REFERENCESDomingo-Lopez DA, Lattanzi G, Schreiber LH, Wallace EJ, Wylie R, O’Sullivan J, Duffy GP. Medical devices, smart drug delivery, wearables and technology for the treatment of Diabetes Mellitus. Adv Drug Deliv Rev. 2022;114280.Domingo-LopezDALattanziGSchreiberLHWallaceEJWylieRO’SullivanJDuffyGPMedical devices, smart drug delivery, wearables and technology for the treatment of Diabetes MellitusAdv Drug Deliv Rev2022114280280Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.SunHSaeediPKarurangaSPinkepankMOgurtsovaKDuncanBBIDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045Diabetes Res Clin Pract2022183109119109119Akhoundan M, Shadman Z, Jandaghi P, Aboeerad M, Larijani B, Jamshidi Z, et al. The association of bread and rice with metabolic factors in type 2 diabetic patients. Plos One. 2016;11(12):e0167921.AkhoundanMShadmanZJandaghiPAboeeradMLarijaniBJamshidiZThe association of bread and rice with metabolic factors in type 2 diabetic patientsPlos One20161112e0167921Khosravi-Boroujeni H, Sarrafzadegan N, Mohammadifard N, Sajjadi F, Maghroun M, Asgari S, et al. White rice consumption and CVD risk factors among the Iranian population. J Health Popul Nutr. 2013;31(2):252.Khosravi-BoroujeniHSarrafzadeganNMohammadifardNSajjadiFMaghrounMAsgariSWhite rice consumption and CVD risk factors among the Iranian populationJ Health Popul Nutr2013312252252Amini Khoozani A, Kebede B, Birch J, Bekhit AEDA. The effect of bread fortification with whole green banana flour on its physicochemical, nutritional and in vitro digestibility. Foods. 2020;9(2):152.Amini KhoozaniAKebedeBBirchJBekhitAEDAThe effect of bread fortification with whole green banana flour on its physicochemical, nutritional and in vitro digestibilityFoods202092152152Blaak EE, Antoine JM, Benton D, Björck I, Bozzetto L, Brouns F, et al. Impact of postprandial glycaemia on health and prevention of disease. Obes Rev. 2012;13(10):923-84.BlaakEEAntoineJMBentonDBjörckIBozzettoLBrounsFImpact of postprandial glycaemia on health and prevention of diseaseObes Rev20121310923984Srour B, Fezeu LK, Kesse-Guyot E, Allès B, Debras C, Druesne-Pecollo N, et al. Ultraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-Santé prospective cohort. JAMA Intern Med. 2020;180(2):283-91.SrourBFezeuLKKesse-GuyotEAllèsBDebrasCDruesne-PecolloNUltraprocessed food consumption and risk of type 2 diabetes among participants of the NutriNet-Santé prospective cohortJAMA Intern Med20201802283291Levy RB, Rauber F, Chang K, Louzada ML, Monteiro CA, Millett C, et al. Ultra-processed food consumption and type 2 diabetes incidence: a prospective cohort study. Clin Nutr. 2021;40(5):3608-14.LevyRBRauberFChangKLouzadaMLMonteiroCAMillettCUltra-processed food consumption and type 2 diabetes incidence: a prospective cohort studyClin Nutr202140536083614Amoah I, Cairncross C, Osei EO, Yeboah JA, Cobbinah JC, Rush E. Bioactive properties of bread formulated with plant-based functional ingredients before consumption and possible links with health outcomes after consumption: a review. Plant Foods Hum Nutr. 2022;77(3):329-39.AmoahICairncrossCOseiEOYeboahJACobbinahJCRushEBioactive properties of bread formulated with plant-based functional ingredients before consumption and possible links with health outcomes after consumption: a reviewPlant Foods Hum Nutr2022773329339Schadow AM, Revheim I, Spielau U, Dierkes J, Schwingshackl L, Frank J, et al. The effect of regular consumption of reformulated breads on glycemic control: a systematic review and meta-analysis of randomized clinical trials. Adv Nutr. 2023;14(1):30-43.SchadowAMRevheimISpielauUDierkesJSchwingshacklLFrankJThe effect of regular consumption of reformulated breads on glycemic control: a systematic review and meta-analysis of randomized clinical trialsAdv Nutr20231413043Priyanka K, Alka S, Sood DR. Flaxseed: a potential functional food source. J Food Sci Technol (Mysore). 2015;52(4):1857-73.PriyankaKAlkaSSoodDRFlaxseed: a potential functional food sourceJ Food Sci Technol (Mysore)201552418571873Mechchate H, Es-Safi I, Conte R, Hano C, Amaghnouje A, Jawhari FZ, et al. In vivo and in vitro antidiabetic and anti-inflammatory properties of flax (Linum usitatissimum L.) seed polyphenols. Nutrients. 2021;13(8):2759.MechchateHEs-SafiIConteRHanoCAmaghnoujeAJawhariFZIn vivo and in vitro antidiabetic and anti-inflammatory properties of flax (Linum usitatissimum L.) seed polyphenolsNutrients202113827592759Popescu RG, Voicu SN, Gradisteanu Pircalabioru G, Gharbia S, Hermenean A, Georgescu SE, et al. Impact of dietary supplementation of flaxseed meal on intestinal morphology, specific enzymatic activity, and cecal microbiome in broiler chickens. Appl Sci. 2021;11(15):6714.PopescuRGVoicuSNGradisteanu PircalabioruGGharbiaSHermeneanAGeorgescuSEImpact of dietary supplementation of flaxseed meal on intestinal morphology, specific enzymatic activity, and cecal microbiome in broiler chickensAppl Sci2021111567146714Villarreal-Renteria AI, Herrera-Echauri DD, Rodríguez-Rocha NP, Zuñiga LY, Muñoz-Valle JF, García-Arellano S, et al. Effect of flaxseed (Linum usitatissimum) supplementation on glycemic control and insulin resistance in prediabetes and type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2022;102852.Villarreal-RenteriaAIHerrera-EchauriDDRodríguez-RochaNPZuñigaLYMuñoz-ValleJFGarcía-ArellanoSEffect of flaxseed (Linum usitatissimum) supplementation on glycemic control and insulin resistance in prediabetes and type 2 diabetes: a systematic review and meta-analysis of randomized controlled trialsComplement Ther Med2022102852Haidari F, Banaei-Jahromi N, Zakerkish M, Ahmadi K. The effects of flaxseed supplementation on metabolic status in women with polycystic ovary syndrome: a randomized open-labeled controlled clinical trial. Nutr J. 2020;19:1-11.HaidariFBanaei-JahromiNZakerkishMAhmadiKThe effects of flaxseed supplementation on metabolic status in women with polycystic ovary syndrome: a randomized open-labeled controlled clinical trialNutr J202019111Cohen L, Meira J, Cosendey GM, de Souza AFP, Mattos F, Carneiro JRI, Rosado EL. Evaluation of the influence of whole and defatted flaxseed on satiety, glucose, and leptin levels of women in the late postoperative stage of bariatric surgery. Obes Surg. 2013;23:157-66.CohenLMeiraJCosendeyGMde SouzaAFPMattosFCarneiroJRIRosadoELEvaluation of the influence of whole and defatted flaxseed on satiety, glucose, and leptin levels of women in the late postoperative stage of bariatric surgeryObes Surg201323157166Kristensen M, Savorani F, Christensen S, Engelsen SB, Bügel S, Toubro S, et al. Flaxseed dietary fibers suppress postprandial lipemia and appetite sensation in young men. Nutr Metab Cardiovasc Dis. 2013;23(2):136-43.KristensenMSavoraniFChristensenSEngelsenSBBügelSToubroSFlaxseed dietary fibers suppress postprandial lipemia and appetite sensation in young menNutr Metab Cardiovasc Dis2013232136143Sun J, Liu X, Xu Q, Zong M, Zhang Y, Xiao F, et al. Acute effect of flaxseed-enriched snack bars on glycemic responses and satiety in healthy individuals. Asia Pac J Clin Nutr. 2022;31(3):371-7.SunJLiuXXuQZongMZhangYXiaoFAcute effect of flaxseed-enriched snack bars on glycemic responses and satiety in healthy individualsAsia Pac J Clin Nutr2022313371377Hutchins AM, Brown BD, Cunnane SC, Domitrovich SG, Adams ER, Bobowiec CE. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutr Res. 2013;33(5):367-75.HutchinsAMBrownBDCunnaneSCDomitrovichSGAdamsERBobowiecCEDaily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized studyNutr Res2013335367375Khan I, Johnson SK, Yousif AM, Gamlath S, Ahmad J, Almajwal AM. Effect of sorghum flour-containing pasta on postprandial glycemia, appetite and energy intake in healthy individuals. Eur J Clin Nutr. 2024;1-8.KhanIJohnsonSKYousifAMGamlathSAhmadJAlmajwalAMEffect of sorghum flour-containing pasta on postprandial glycemia, appetite and energy intake in healthy individualsEur J Clin Nutr202418Marpalle P, Sonawane SK, Arya SS. Effect of flaxseed flour addition on physicochemical and sensory properties of functional bread. LWT-Food Sci Technol. 2014;58(2):614-19.MarpallePSonawaneSKAryaSSEffect of flaxseed flour addition on physicochemical and sensory properties of functional breadLWT-Food Sci Technol2014582614619Meilgaard MC, Carr BT, Civille GV. Sensory evaluation techniques. Boca Raton, FL: CRC Press; 1999.MeilgaardMCCarrBTCivilleGVSensory evaluation techniquesBoca Raton, FLCRC Press1999Soltanian N, Janghorbani M. A randomized trial of the effects of flaxseed to manage constipation, weight, glycemia, and lipids in constipated patients with type 2 diabetes. Nutr Metab. 2018;15(1):1-9.SoltanianNJanghorbaniMA randomized trial of the effects of flaxseed to manage constipation, weight, glycemia, and lipids in constipated patients with type 2 diabetesNutr Metab201815119Almehmadi A, Lightowler H, Chohan M, Clegg ME. The effect of a split portion of flaxseed on 24-h blood glucose response. Eur J Nutr. 2021;60:1363-73.AlmehmadiALightowlerHChohanMCleggMEThe effect of a split portion of flaxseed on 24-h blood glucose responseEur J Nutr20216013631373Moreira FD, Reis CEG, Welker AF, Gallassi AD. Acute flaxseed intake reduces postprandial glycemia in subjects with type 2 diabetes: a randomized crossover clinical trial. Nutrients. 2022;14(18):3736.MoreiraFDReisCEGWelkerAFGallassiADAcute flaxseed intake reduces postprandial glycemia in subjects with type 2 diabetes: a randomized crossover clinical trialNutrients2022141837363736Nowak W, Jeziorek M. The role of flaxseed in improving human health. Healthcare. 2023;11(3):395.NowakWJeziorekMThe role of flaxseed in improving human healthHealthcare2023113395395Vuksan V, Choleva L, Jovanovski E, Jenkins AL, Au-Yeung F, Dias AG, et al. Comparison of flax (Linum usitatissimum) and Salba-chia (Salvia hispanica L.) seeds on postprandial glycemia and satiety in healthy individuals: a randomized, controlled, crossover study. Eur J Clin Nutr. 2017;71(2):234-8.VuksanVCholevaLJovanovskiEJenkinsALAu-YeungFDiasAGComparison of flax (Linum usitatissimum) and Salba-chia (Salvia hispanica L.) seeds on postprandial glycemia and satiety in healthy individuals: a randomized, controlled, crossover studyEur J Clin Nutr2017712234238Mueed A, Shibli S, Korma SA, Madjirebaye P, Esatbeyoglu T, Deng Z. Flaxseed bioactive compounds: chemical composition, functional properties, food applications and health benefits-related gut microbes. Foods. 2022;11(20):3307.MueedAShibliSKormaSAMadjirebayePEsatbeyogluTDengZFlaxseed bioactive compounds: chemical composition, functional properties, food applications and health benefits-related gut microbesFoods2022112033073307Kimura Y, Yoshida D, Hirakawa Y, Hata J, Honda T, Shibata M, et al. Dietary fiber intake and risk of type 2 diabetes in a general Japanese population: the Hisayama Study. J Diabetes Investig. 2021;12(4):527-36.KimuraYYoshidaDHirakawaYHataJHondaTShibataMDietary fiber intake and risk of type 2 diabetes in a general Japanese population: the Hisayama StudyJ Diabetes Investig2021124527536Kajla P, Sharma A, Sood DR. Flaxseed: a potential functional food source. J Food Sci Technol. 2015;52:1857-73.KajlaPSharmaASoodDRFlaxseed: a potential functional food sourceJ Food Sci Technol20155218571873