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British Food Journal
Effect of low glycaemic index diets on satiety
Sonia Maria de Medeiros Batista Emilia Addison Machado Moreira Giovanna Medeiros Rataichesck Fiates
Maria Alice Altemburg de Assis Evanilda Teixeira
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Sonia Maria de Medeiros Batista Emilia Addison Machado Moreira Giovanna Medeiros Rataichesck Fiates
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British Food Journal, Vol. 116 Iss 8 pp. 1233 - 1246
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Effect of low glycaemic index
diets on satiety
Sonia Maria de Medeiros Batista,
Emilia Addison Machado Moreira,
Giovanna Medeiros Rataichesck Fiates,
Maria Alice Altemburg de Assis and Evanilda Teixeira
Nutrition Department, Postgraduate Program in Nutrition,
Federal University of Santa Catarina, Florianopolis, Brazil
Low glycaemic
index diets
1233
Received 23 August 2012
Revised 14 August 2013
Accepted 22 August 2013
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Abstract
Purpose – The purpose of the paper is to determine the effects of a hypocaloric diet with a
low-glycaemic index (GI) on weight loss and postprandial blood glucose and assess both the satiety
and palatability of the diet.
Design/methodology/approach – A clinical trial was conducted with ten women (mean age:
38.8711.3 years; body mass index: 27.273.5 kg/m2) submitted to a hypocaloric diet, assessments
were performed at baseline and after seven days of treatment.
Findings – Significant reductions were found in body weight (1.170.7 kg; p ¼ 0.001), triccipital
skinfold (2.8773.24 mm; p ¼ 0.021) and waist circumference (3.674.8 cm; p ¼ 0.041). Mean fasting
and postprandial blood glucose values were 88.776.1 mg/dL and 91.679.6 mg/dL, respectively.
Responses regarding satiety and palatability of the low-GI diet were predominantly “extremely
satisfied” and “I liked it very much,” respectively, for all meals and throughout all seven days of
the study.
Originality/value – The present study demonstrated the benefits of a low-GI diet with regard to
weight loss, blood glucose control and satiety. The diet proved to be palatable, which could favor
compliance with long-term treatment.
Keywords Adult, Low-glycaemic index diet, Palatability, Satiety, Weight loss
Paper type Research paper
Introduction
The glycaemic index (GI) is an indicator of the ability of carbohydrates (50 g) in a given
food to elevate postprandial blood glucose in comparison to a reference food, glucose or
white bread (Food and Agriculture Organization and World Health Organization
(FAO/WHO), 1998). The presence of soluble fiber, degree of food processing and
starch-protein and starch-fat interactions are among the factors that can affect the GI
( Jenkins et al., 1981).
The GI was initially proposed to control blood glucose in patients with diabetes
(Pi-Sunyer, 2005; Lin et al., 2010). For such, foods with a high GI (X70) should be
replaced with foods with a GI of p55 (low GI) (Brand-Miller and Foster-Powell, 2003).
Diets with a moderate to high GI are reported to increase body weight (Beulens et al.,
2007; Ding and Malik, 2008). While the American Diabetes Association (ADA) (2012)
recommends considering both the type and amount of carbohydrates in the diet of
The authors are grateful to the professors of the Sensory Analysis Laboratory of the Department
of Food Science and Technology of the Federal University of Santa Catarina (Brazil) for financial
support in the purchasing of the foods used in the diet analyzed and the volunteers who
participated in this study.
British Food Journal
Vol. 116 No. 8, 2014
pp. 1233-1246
r Emerald Group Publishing Limited
0007-070X
DOI 10.1108/BFJ-08-2012-0208
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1234
individuals with diabetes, a number of researchers have reaffirmed the contribution of
the GI for controlling weight (Sampaio et al., 2007; Ding and Malik, 2008; Brand-Miller
et al., 2009; Youn et al., 2012).
The lipid content is another important aspect to consider in dietary planning,
as the proportion of fat contributes to the daily caloric intake as well as the amount
of carbohydrates and/or protein. The lipid content also affects the palatability and
variety of foods. Thus, certain diets can be monotonous, which hampers compliance
with treatment and long-term weight loss (Rolls et al., 2005, 2007). An adequate balance
in the chemical composition of a diet is fundamental to the treatment of obesity (WHO,
2000; ADA, 2012). Diets with a low energy density (Food and Agriculture Organization,
1997) and adequate satiety and palatability lead to gradual weight loss (Sampaio et al.,
2007). Such diets also lead to an improvement in insulin resistance, which is generally
high in obese individuals due to the greater number of adipocytes (Lara-Castro and
Garvey, 2004; Kahn et al., 2006; Karpe et al., 2011). Given the benefits of low-GI
diets for patients with type II diabetes, cardiovascular disease and obesity,
the scientific community has been proposing strategies that contribute in reducing
the risk of such diseases (Thondre and Henry, 2011). The role of the food industry in
developing palatable foods with low GI must be recognized (Hall et al., 2005;
Brand-Miller et al., 2012).
Recommendations of several international organizations have also been
proposing the use of GI when planning diets for people with diabetes (Diabetes
and Nutrition Study Group (DNSG, 2000); Wolever et al., 2000; Connor et al., 2003,
ADA, 2008, Diabetes Australia (DA), 2012/2013), the description of GI values in food
labels (Henry et al., 2007), and development of food guides that offer guidance about
the inclusion low-GI foods in people’s daily meals (DA, 2012/2013, Canadian Diabetes
Association (CDA), 2013).
The aims of the present study were to determine the effects of a hypocaloric diet
with a low GI on weight loss and postprandial blood glucose and assess both the
satiety and palatability of the diet.
Materials and methods
Study design
A clinical trial was conducted at the Sensory Analysis Laboratory of the Food Science
and Technology Department of the Federal University of Santa Catarina (Brazil), with
assessments performed at baseline and after seven days of treatment. This study
received approval from the Human Research Ethics Committee of the university
( process number 094/04) and was carried out in compliance with the Declaration
of Helsinki of the World Medical Association (2008). All participants were aware
of the objectives and procedures of the study and agreed to participate by signing
a statement of informed consent.
Subjects
Ten women (mean age: 38.8711.3 years; mean body mass index (BMI): 27.27
3.5 kg/m2) were selected through convenience sampling following a verbal invitation to
participate voluntarily in the study. The following inclusion criteria were considered:
excess weight (BMI between 25 and 35 kg/m2) and fasting blood glucose between 70
and 100 mg/dL). The following exclusion criteria were considered: infectious disease,
cardiovascular disease, diabetes mellitus, neurological disease, kidney failure, current
pregnancy or nursing, current smoking habit, high-impact physical activity, use of
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drugs that modify food intake or eating behavior (antidepressant, appetite suppressor)
and use of anti-inflammatory or antibiotic agents (except oral birth control medication)
in previous six months.
Anthropometric evaluation
Anthropometric measurements were performed by a registered dietitian based on the
recommendations of the World Health Organization WHO (1995). Body weight was
assessed on a balance-beam platform scale (Martes SM 160, SP, Brazil) to the nearest
50 g. Stature was measured with a stadiometer (Alturaexatas, Belo Horizonte, MG,
Brazil) to the nearest 0.01 m. Arm circumference (AC) and waist circumference (WC)
were measured with an non-elastic 150 cm tape measure. Triceps skinfold (TSF) was
measured using a Lang Skinfold Calipers (Beta Technology, Santa Cruz, CA, USA).
Cut-off points for AC and TSF were established by gender and age (Frisancho, 1981)
and the cutoff point for WC was based on recommendations stated by the WHO (2000).
Nutritional status was categorized by the BMI (kg/m2) based on recommendations
stated by the WHO (2006).
Diet
The low-GI diet studied (55) was manufactured by Substâncias Foods (Porto Alegre,
RS, Brazil) (Foster-Powell et al., 2002). Meal distribution was planned as follows:
breakfast, mid-morning snack, lunch, afternoon snack, dinner and bedtime snack.
Except for dinner and bedtime snack, the remaining meals were all ingested at the
Sensory Analysis Laboratory of the Federal University of Santa Catarina. The mean
(7SD) caloric content of the diet was 1,130790 kcal, with the following chemical
composition (g7SD: 140.077.0 g of carbohydrates (49.372.4 percent), 70.073.8 g
of proteins (24.971.2 percent), 30.078.0 g of fat (25.875.9 percent) and 26.471.7 g of
fiber (USP), 2006. Foods and mixed dishes consumed at each meal are described below.
Breakfast: coffee with skim milk, linseeds, whole-grain bread, white cheese, lean ham
or muffin (oatmeal, honey and whole-grain flour). Morning snack: fruit (orange,
banana, pear, apple or peach). Lunch and dinner: raw vegetables (lettuce, tomatoes,
carrots, beets), cooked vegetables (carrots, spinach, broccoli, eggplant), rice and
legumes (beans, peas or lentils) or whole-grain pasta, beef, chicken or fish. Afternoon
snack and bedtime snack: cereal bar, yogurt, whole-grain bread and white cheese.
The meals were thawed in a microwave oven (Consul Facilite Middis 18L, Manaus,
AM, Brazil) just prior to eating. The foods were cleaned at the Sensory Analysis
Laboratory of the university and stored at 201C (Consuls S~ao Paulo, SP, Brazil) until
served. The vegetables were served either raw or cooked and the fruits were served
“in natura.”
Assessment of fasting and postprandial blood glucose
Blood collection was performed when the women were not menstruating. Blood
glucose was determined after ten hours of fasting at baseline and at the end of the
study. Postprandial blood glucose was determined two hours after breakfast, lunch and
dinner every day, with the subsequent calculation of the mean value. Blood was
collected from the index finger of the right hand through a perforation with the aid of
an automatic lancet with a disposable tip (Accu-Check Active, Roches Diagnostics
GmbH, Mannheim, Germany). Blood glucose was evaluated using a specific reagent
strip and portable blood glucose reader (Accu-Check Active, Roches Diagnostics
GmbH, Mannheim, Germany) (FAO/WHO, 1998).
Low glycaemic
index diets
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Assessment of satiety and palatability
The perception of satiety and palatability was assessed based on the method
described by Holt et al. (1995) immediately following breakfast, lunch and dinner
throughout the seven days of the study. A seven-point visual analog scale was used,
with the terms “extremely hungry” and “extremely satisfied” at the two ends of the
scale for the determination of satiety and the terms “I liked it very much” and
“I disliked it very much” at the two ends of the scale for the determination of
palatability.
Statistical analysis
The results were expressed as mean7standard deviation (SD) of the mean. The
paired Student’s t-test was used to determine differences in weight, WC and fasting
blood glucose between baseline and the final evaluation. Postprandial blood glucose
was compared between the first and second days as well as the first and fourth days
of the study. The Wilcoxon test was used to determine differences in satiety and
palatability among the different days of the study. The level of significance was set
to 5 percent ( po0.05). The Statistical Package for the Social Sciencess (SPSS Inc.,
2006, Chicago, IL, USA) for Windows (version 16.0) was employed for the data
analysis.
Findings
Mean age (7SD) of the participants was 38.8711.3 years (range: 23-50 years). Initial
mean weight was significantly higher than mean weight at the end of the study
(67.4711.3 kg and 66.3711.0, respectively) ( p ¼ 0.001), with a mean weight loss of
1.170.7 kg. Mean initial BMI (7SD) was higher than the final BMI (28.1273.50 kg/m2
and 27.9573.69 kg/m2, respectively), but this difference did not achieve statistical
significance ( p ¼ 0.375). Mean initial TSF (7SD) was significantly higher than the
final mean TSF (22.6576.78 mm and 19.7876.25, respectively) ( p ¼ 0.021). Mean
initial WC (7SD) was significantly higher than final WC (86.70711.69 cm and
83.05708.64 cm, respectively) ( p ¼ 0.041). No statistically significant difference was
found in mean AC between the baseline and final evaluations (31.8073.39 cm and
30.1172.47 cm, respectively) ( p ¼ 0.046).
Mean fasting blood glucose (7SD) was similar at baseline and at the end of the
study (88.776.0 mg/dL and 86.975.6, respectively ( p ¼ 0.343), ranging from 75 mg/dL to
91 mg/dL. Postprandial blood glucose (7SD) was also in the normal range (below 140
mg/dL) throughout the study (mean: 91.679.6 mg/dL; range: 115 mg/dL to 77 mg/dL)
(Table I).
Variables
Mean7SD
Baseline fasting blood glucose
Final fasting blood glucose
Postprandial blood glucose – Day
Postprandial blood glucose – Day
Postprandial blood glucose – Day
Postprandial blood glucose – Day
88.776.0
86.975.6
88.678.8
89.8712.7
94.579.7
93.577.3
1
2
4
7
p
0.343a
0.761b
Table I.
0.062c
Comparative analysis of
0.048d
fasting and postprandial
blood glucose at baseline Notes: a ¼ (baseline vs final); b ¼ (Day1 vs Day 2); c ¼ (Day 1 vs Day 4); d ¼ (Day 1 vs Day 7).
and at the end of the study Wilcoxon test
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Responses regarding satiety after the three meals were predominantly “extremely
satisfied” and “satisfied” throughout the seven days of the study. Two participants
reported being “hardly satisfied” after breakfast on Days 2 and 6, and one
participant reported feeling “a little hungry” after breakfast on Day 4. One of
the participants reported being “hardly satisfied” after lunch on Days 4, 5 and 6.
One participant reported feeling “partially satisfied” and another reported feeling
“a little hungry” after dinner on Day 1; one reported feeling “a little hungry” on Days 3
and 6; and one participant reported feeling “hungry” and another reported feeling
“a little hungry” after dinner on Day 7. No statistically significant differences in satiety
were found among the six times of the day at which the participants had meals or
snacks throughout the study (Figure 1).
Responses regarding the palatability of the meals were predominantly “I liked it
very much” and “I liked it” for all meals throughout the seven days of the study.
A statistically significant difference in palatability was found for breakfast between
Days 1 and 4. Palatability of the lunch was significantly higher on Day 1 in comparison
to Days 6 and 7. Statistically significant differences in the palatability of dinner were
found between Days 1 and 5, Days 1 and 6 and Days 4 and 6. There were no responses
of “I disliked it very much” or “I disliked it” for any of the meals throughout the entire
seven days of the study (Figure 2).
Discussion
The hypocaloric diet with a low GI contributed to weight loss at the end of the study.
Similar findings were reported in a study involving ten individuals, in which two
diets were analyzed over a 12-month period: one with a low GI and another with only
a reduced lipid content. The reduction in calories was not restricted and the results
demonstrated that the low-GI group achieved a greater reduction in BMI and
percentage of body mass than the group with reduced fat intake alone (Ebbeling et al.,
2003). Other recent studies comparing the effects of low- and high-GI diets on body
weight reported that a low-GI diet contributes to weight loss, greater satiety
and lower postprandial blood glucose (Perälä et al., 2011; Youn et al., 2012; Dong
et al., 2012).
A significant reduction in WC was found after seven days of consuming the low-GI
diet. This is an important finding, as a higher WC is risk factor for the development
of cardiovascular disease and type 2 diabetes mellitus (FAO/WHO, 1998; Pitanga
and Lessa, 2005; Rosini et al., 2006). Previous studies reported similar findings
in adults without diabetes (McMillan-Price et al., 2006), diabetic adults (Karter et al.,
2005; Schulz et al., 2006; Hare-Bruun et al., 2006; Jiménez-Cruz et al., 2005; Rosini et al.,
2006) and obese adolescents (Buyken et al., 2001) due either to the effect of the
low GI alone or the fact that the majority of such foods have a high-fiber content
(Sartorelli and Cardoso, 2006).
Fasting and postprandial blood glucose remained below 100 mg/dL among all
participants throughout the entire study, which is similar to findings reported in
previous studies (Bellisle et al., 2007; Esposito et al., 2010; Perälä et al., 2011). This may
be due to the predominance of low-GI foods (fiber-rich whole grains), despite the
ingestion of foods with a medium to high GI. The predominance of foods with a low GI
lowers the GI of the overall diet, thereby slowing the increase in postprandial blood
glucose (Batista et al., 2007; Gellar and Nansel, 2009; Perälä et al., 2011; Brand-Miller
et al., 2012). The FAO/WHO (1998) recommend balanced dietary planning with regard
to the GI for better control and prevention of chronic diseases. Reduced frequency of
Low glycaemic
index diets
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1238
(a)
10
No. of participants
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8
6
4
2
0
Day 1
Day 2
Day 3
Day 4
No particular feeling
Satisfied
Day 5
Day 6
Day 7
Partially satisfied
Extremely satisfied
(b)
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No. of participants
10
8
6
4
2
0
Day 1
Day 2
Partially satisfied
No. of participants
(c)
Day 3
Day 4
Satisfied
Day 5
Day 6
Day 7
Extremely satisfied
10
8
6
4
2
0
Day 1
Figure 1.
Satiety after breakfast,
lunch and dinner
throughout the study
Day 2
Day 3
Day 4
Day 5
Day 6
Hungry
Partially hungry
Partially satisfied
Satisfied
Day 7
Extremely satisfied
Notes: (a) Distribution of participants according to satiety after breakfast; (b) distribution
of participants according to satiety after lunch; and (c) distribution of participants
according to satiety after dinner
consumption of high GI foods and their substitution for low GI ones has been
a recommended strategy in order to reduce the meals’ GI and consequently achieve
the health benefits proportioned by low-GI foods, according to the CDA (2013). The
scientific community has published works with the aim of alerting government
agencies for the need of planning public policies regarding the practical use of GI in
individuals’ food plans, and the inclusion of GI values on food labels. Countries
that already adopt this strategy are Canada, Australia, UK, China and the USA
Low glycaemic
index diets
1239
8.0
Day 1
Palatability scale
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(Thondre and Henry, 2011). Researchers have also been investing in divulging the
benefits of low-GI foods publishing books to the general population, that include
orientation about foods’ GI, recommended frequency of ingestion and recipes that can
improve palatability and increase satiety (Brand-Miller et al., 2003). In Brazil, some
studies have determined the GI of typical foods, listing 41 of them in the Brazilian Food
Composition Table (USP, 2000), and exploring their benefit in the prevention of chronic
non-transmissible diseases (Menezes et al., 1996, 2002, 2009, 2011). Some low-GI foods
that have been studied are “carioca” beans (GI 38), rice and beans (GI 55), chickpea
(GI 24), apple (GI 25), banana (GI 27), manioc (GI 40), manioc flour (GI 52), oat flakes
(GI 39), corn on the cob (IG 55) (TACO/USP, 1998; Menezes et al., 1996). Thus, foods
with a high GI do not need to be excluded from the diet, but rather consumed as part
of a diet in which the total caloric intake allows a lower and gradual blood
glucose response.
Ludwig et al. (1999) compared three types of low-calorie meals made up of foods
with low, medium and high GIs and found an 81 percent increase in calorie intake
following a meal with a high GI in comparison to meals with a medium or low GI.
In studies carried out to assess the association between weight and foods with a low
GI in Mexico, one investigation found reductions in body weight, total cholesterol and
low-density lipoproteins among a group of volunteers over a three-week period
( Jiménez-Cruz et al., 2003) and another investigation found a reduction in body
weight and an increase in satiety among a groups of adults evaluated on a single
occasion ( Jiménez-Cruz et al., 2005). Other studies confirm these findings and report
that foods with a predominance of carbohydrates with a low GI have a greater effect
on reducing one’s appetite, with a consequent reduction in calorie intake (Burani
and Longo, 2006; McMillan-Price and Brand-Miller, 2006; Nilsson et al., 2008;
Sieri et al., 2010).
Greater loss of adiposity and body weight among adults on a low-GI diet
associated with a lesser sensation of hunger and/or greater satiety is reported to be
due to the lesser calorie intake (Ebbeling et al., 2003; Hare-Bruun et al., 2006). Warren
et al. (2003) studied the effect of GI on satiety analyzing three meals involving
foods with different GIs (55, 75 and 100) and found that the calorie intake in the
following meal was lower after a meal with a low GI in comparison to a meal with
a high GI. In another study, lower calorie intake was found at a time following the
ingestion of a low-GI diet in comparison to a high-GI diet; in the comparison of two
different types of muffins (one with a low GI and one with a high GI), lower blood
glucose responses and greater satiety were found after the ingestion of the muffins
Day 2
Day 3
6.0
Day 4
Day 5
Day 6
Day 7
4.0
A
B
C
D
E
F
G
Volunteers
H
I
J
Figure 2.
Distribution of
participants according
to palatability of the
diet throughout the
seven days of the study
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1240
with a low GI (Quilez et al., 2007). The choice of a low-GI diet over a high-GI diet is
a strategy that benefits health, as such foods enhance satiety and reduce both hunger
and voluntary ingestion. There is a consensus among researchers that a change
in eating behavior can lead to a reduction in the risk of overweight and obesity
as well as the consequences of these conditions, such as type 2 diabetes mellitus
(McMillan-Price et al., 2006; Esposito et al., 2010; Louie et al., 2012).
Quite satisfactory results were achieved with regard to palatability, as responses
of “I like it very much” and “I like it” predominated throughout the study. Palatability
was directly associated with satiety, for which responses of “extremely satisfied”
and “satisfied” predominated. The composition of the diet was similar from day to day,
with the maintenance of the same percentage of macronutrients and calories. These
data are in agreement with those reported in previous studies, which also
demonstrated satisfactory satiety when diets offered the same caloric density and
palatability, suggesting that calorie intake is influenced more by the caloric density
of the diet than its chemical composition (McCrory et al., 2006; Rumpler et al., 2006).
Regarding the influence of chemical components on palatability, studies have
shown that individuals have a lesser sensation of hunger, lower calorie intake and
greater satiety after ingesting protein in comparison to the ingestion of carbohydrates
and lipids (Maarmonier et al., 2000; Hermsdorff et al., 2007).
Rumpler et al. (2006) report findings similar to those described in other studies,
supporting the hypothesis that foods with a low GI have a positive effect on satiety,
allow greater postprandial blood glucose control, assist in reducing body weight
and also exhibit a high degree of palatability (Bao et al., 2011; Brand-Miller et al.,
2012). The main characteristics of foods with a low GI are low calorie density and
high-fiber and protein content (Holt et al., 2001; Pai et al., 2005; Jiménez-Cruz et al.,
2005; Feskens and Du, 2006; Beulens et al., 2007; Sampaio et al., 2007).
Several factors contribute to the different findings found in the assessment of
the effects of diet on satiety and appetite, such as palatability, the composition of
macronutrients, energy density and the volume of food offered. However, conflicting
findings are reported in investigations regarding the influence of macronutrients
on calorie intake and the GI of foods ( Jiménez-Cruz et al., 2005; Bellisle et al., 2007;
Yeomans and Chambers, 2011).
Conclusion and practical implications
The foods that made up the meals of the diet evaluated in the present study are
easily found in the market and most of them are part of the Brazilian eating
habits. This favors the development of public policies that stimulate the consumption
of such foods to prevent and control the occurrence of non-transmissible chronic
diseases in the general population. In the long run, such policies could positively
affect people’s life quality. From a clinical standpoint, the diet’s palatability could
favor compliance with treatment aimed at weight reduction and long-term follow up.
Study’s participants could experience aspects that contradict myths regarding “weight
loss diets.” They showed good compliance to the non-restrictive dietetic plan proposed
during the seven consecutive days. Brazilian public policies could emphasize the
importance of ingesting accessible low-GI foods such as the ones mentioned in this
manuscript. The government could also sponsor research to determine GI values
of other foods usually ingested, promoting a healthier diet and better quality of life
for the individuals.
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About the author
Professor Sonia Maria de Medeiros Batista received as Undergraduate Degree in Nutrition from
the Federal University of Rio Grande do Norte (1981); a Master’s Degree (1995) and a Doctoral
Degree (2008) in Food Science from the Federal University of Santa Catarina. Batista since 1986,
is a Nutrition Professor at the Federal University of Santa Catarina, teaching diet therapy
and supervising practical training in clinical nutrition. Batista has experience in clinical
nutrition, with an emphasis on non-communicable chronic diseases and conducts research and
extension projects on diabetes mellitus, obesity and hypertension. Sonia Batista published works
in Brazilian and foreign scientific journals. Professor Sonia Maria de Medeiros Batista can be
contacted at: [email protected]
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