European Journal of Clinical Nutrition (2012) 66, 10391043

& 2012 Macmillan Publishers Limited All rights reserved 0954-3007/12

www.nature.com/ejcn

ORIGINAL ARTICLE
Effects on cognitive performance of modulating the postprandial
blood glucose profile at breakfast
A Nilsson1, K Radeborg2 and I Bjo rck1

BACKGROUND/OBJECTIVES: Considering the importance of glucose as a brain substrate, the postprandial rate of
glucose delivery to the blood could be expected to affect cognitive functions. The purpose was to evaluate to what extent
the rate of glucose absorption affected measures of cognitive performance in the postprandial period. In addition, cognitive
performance was evaluated in relation to individual glucoregulation.
SUBJECTS/METHODS: A white wheat bread (WWB) enriched with guar gum (G-WWB) with the capacity to produce a low but
sustained blood glucose net increment was developed. The G-WWB was evaluated in the postprandial period after breakfast with
respect to effects on cognitive function (working memory and selective attention (SA)) in 40 healthy adults (4971 years, body
mass index 2029 kg/m2), using a high glycaemic index WWB for comparison in a randomised crossover design.
RESULTS: The G-WWB improved outcome in the cognitive tests (SA test) in the later postprandial period (75225 min) in
comparison with the WWB (Po0.01). Subjects with better glucoregulation performed superior in cognitive tests compared
with subjects with worse glucoregulation (Po0.05).
CONCLUSIONS: Beneficial effects on cognitive performance were observed with the G-WWB in the late postprandial
period. The positive effect is suggested to emanate from improved insulin sensitivity, possibly in a combination with an
enhanced neural energy supply. The results highlight the importance of carbohydrate foods that induces a low but
sustained blood glucose profile in enhancing postprandial cognitive functions.

European Journal of Clinical Nutrition (2012) 66, 10391043; doi:10.1038/ejcn.2012.80; published online 11 July 2012
Keywords: glycaemic index; cognitive functions; working memory; selective attention; glucose tolerance; insulin resistance

INTRODUCTION hypothetically may provide additional benefits on cognitive

The stores of glucose in the brain are limited, suggesting that the
brain glucose supply may affect cognitive outcome. Studies in
humans reveal that a period of intensive cognitive demand results
in a measurable decline in peripheral blood glucose concentra-
tions.1,2 The decline in blood glucose has been suggested to be
linked to increased neural energy expenditure. 1,3 Owing to
instable and fluctuating glucose concentrations within the brain
and an increase of brain glucose when glucose is exogenous
supplied4,5 there are several reasons to believe that peripheral
glucose concentrations may affect cognitive functions, and it may
in addition indicate that the postprandial rate of glucose delivered
to the blood could be important in this respect. After a high
glycaemic index (GI) meal, plasma glucose concentrations raise
rapidly causing a high peak glucose level and a concomitant high
insulin response, resulting in a rapid blood glucose disposal
which in turn may cause the blood glucose level to decrease to
below the fasting concentration in the later postprandial period. 6
On the contrary, low-GI foods result in more moderate peak blood
glucose increments, and may also maintain a prolonged net
increment in blood glucose above the fasting concentration. In
addition to the importance of an adequate glucose supply to the
brain, a postprandial blood glucose profile characterised by a low
peak but a sustained net increment of glucose above fasting
concentrations may acutely improve insulin sensitivity79 which
functions in the postprandial phase.10,11 It is evident from the
literature that type-2 diabetes1214 and the metabolic
syndrome15,16 are associated with an increased risk of cognitive
dysfunction. In fact, also a lowered glucose tolerance, albeit still
within the normal range, is accompanied by poorer cognitive
functions, for example, verbal recall, working memory (WM)
capacity and vigilance, where hippocampus-dependent
functions seems most vulnerable.17,18
Studies in healthy adults investigating the postprandial effects
on cognitive performance, as related to glycaemic properties of a
meal, are scarce and contradictive. Some studies show beneficial
effects on cognitive performance of low-GI foods,17,19 whereas
others show the opposite, no or conflicting effects. 20,21 Thus, the
aim of the present study was to evaluate cognitive performance in the
postprandial period after two realistic bread breakfasts resulting in
profoundly different postprandial glucose responses in the early as
well as in the later postprandial phase. For this purpose a white wheat
bread (WWB) enriched with guar gum (G-WWB) was developed with
the capacity to produce, not only a lower peak blood glucose
response, but also maintain a prolonged net increment in blood
glucose in the postprandial period. The G-WWB breakfast meal was
evaluated in healthy adults (4971 years, body mass index 2029
kg/m2) using a WWB breakfast as a reference in a randomised
crossover design. WM and selective

1Division of Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden and 2Department of
Psychology, Lund University, Lund, Sweden. Correspondence: Dr A Nilsson, Division of Applied Nutrition and Food Chemistry, Department of Food Technology,
Engineering and Nutrition, Lund University, PO Box 124, Lund SE-221 00, Sweden.
E-mail: Anne.Nilsson@appliednutrition.lth.se
Received 12 December 2011; revised 6 June 2012; accepted 6 June 2012; published online 11 July 2012
 Postprandial blood glucose profile and cognition
A Nilsson et al
1040
attention (SA) were measured in the postprandial phase up to
240 min post breakfast. In addition, cognitive performance in
the postprandial period was evaluated in relation to individual
glucoregulation.
SUBJECTS AND METHODS
Evaluation and selection of bread products for
postprandial cognitive study
In a first set of experiment, three bread products were developed, and
their course of glycaemia measured and compared to that of a white
wheat flour based bread (WWB, reference product) in young healthy
subjects. The purpose was to select a low-GI test bread product that
resulted in profoundly different course of glycaemic response
compared with the WWB in the entire postprandial period, including
also the later phase (120240 min) which is beyond that used for GI
calculation. Supplementary Information regarding the composition
and glycaemic properties of all three test products and the WWB
reference bread, respectively, is available at the EJCN website.
A low-GI test bread made from white wheat flour supplemented with
guar gum (15% on dry weight basis) (G-WWB) was chosen for the
cognitive study due to eliciting low increase in blood glucose
concentrations in the early postprandial phase, and a low but sustained
net increment in blood glucose concentration in the late postprandial
phase. A WWB was used as a high-GI reference product. Both bread
products were composed of the same ingredients (white wheat flour,
water, salt and yeast), except for addition of guar gum in the G-WWB.
Influence of the postprandial glycaemia on cognitive function
in healthy mature adults
Subjects. Healthy subjects, 28 women and 12 men, aged 4971 years
(means.d.: 62.95.0 years), with normal fasting blood glucose
concentrations (p5.6 mmol/l), and with body mass index in the normal to
overweight range (body mass index 2029 kg/m2, means.d. 24.2 2.2)
were recruited. Exclusion criteria were fasting whole-blood glucose
concentrations 45.6 mmol/l. Approval of the studies was given by the
Regional Ethical Review Board in Lund, Sweden (protocol 2008/5).
Study design and protocol. The study had a crossover randomised
but balanced study design. Each subject served as his/her own reference
and participated in the study at three separate mornings. At 2100 hours
the evening before the test days, the subjects consumed a standardised
evening meal.
Visit no. 1: fasting glucose concentrations and individual
glucoregulation among the test subjects were determined following an
overnight fast. The subjects arrived at 0800 hours and finger-prick
capillary blood samples for determination of blood glucose were taken
before and at 15, 30, 45, 60, 90, 120 and 150 min after a glucose
drink (50 glucose in 250 ml water consumed within 5 min). The
subjects performed test versions of the cognitive tests to reduce
learning effects and stress during the subsequent cognitive test days.
Visit no. 2 and 3 (executions of cognitive tests, separated by at
minimum 1 week): the participants arrived at 0745 hours following an
overnight fast, and sat resting until 0800 hours when one of the
breakfasts was served (124 g WWB or 179 g G-WWB, providing 50 g
available starch), with 250 ml water. The start of the breakfast was set
to zero time. Twenty subjects (6 men and 14 women) consumed the
WWB breakfast on the first experimental day and the G-WWB on the
second occasion (WWB/G-WWB). Consequently, 20 subjects (6 men
and 14 women) had the breakfast order: G-WWB/WWB.
Cognitive tests.
Working memory The tests for WM was as originally described by
Daneman and Carpenter,22 requiring simultaneous storing and processing
of information, but with modifications according to Radeborg et al. 23 The
tests consisted of 12 sets of short declarative sentences (3, 4 or 5
sentences, four of each set) that could be either semantically meaningful
of the type the boy brushed his teeth, or nonsensical, such as the rabbit
struck the idea. The sentences were read one by one to the subjects, and
immediately after each sentence they had to indicate whether the
sentence was semantically meaningful or not. The subjects were blind to
the number of sentences in each set (35 sentences). After each set of
sentences, the subjects had to repeat, in any order, the first noun in each
European Journal of Clinical Nutrition (2012) 1039 1043
of the sentences. Eight different but comparable WM tests were included
in the study, with four WM tests included at each experimental day
(performed at 90, 135, 180 and 225 min). The WM tests were given in two
different orders (WM test no. 14 or no. 58), and the test order was
balanced. One WM test took B8 min to perform.
Selective attention The test for SA was computerised and primarily
measured the ability to sustain attention and to control and split the
attention to the entire picture on the computer screen. Alike the WM test,
the SA test also includes aspects of the WM. The storing time allotted was
however shorter compared with the WM test, whereas the time pressure
was higher. The SA test was performed as described previously, 17 but
instead of including 72 pictures the test included 96 pictures, each shown
for 2 s on the screen. The SA test was performed at 75, 120, 165 and 210
min after start of the breakfast and was scored with the number of correct
responses (total 95 credits), and for the reaction time needed to give the
answer (that is, press one of the keys). In addition, the test was divided
into two parts in the statistical calculations; the first half of the test (less
demanding) generated at maximum 47 credits and the second half (most
demanding part), at maximum 48 credits. One SA test took B10 min to
perform.
Calculations and statistical methods. The influence of the WWB and G-
WWB breakfast products on the cognitive tests was investigated by repeated
measures analysis of variances at the test points, with order of consumption of
the test meals and test meal as independent variables, and performance in WM
test and SA test as dependent variables. Statistical calculations were performed
in Stat View 5.0 and SuperAnova 1.11 (Abacus Concepts, Inc., Berkeley, CA,
USA). The blood glucose incremental area under the curve (IAUC) 090 min
after the 50 g glucose drink was taken as a measure of glucoregulation.
GraphPad Prism (version 4.03; GraphPad Software, San Diego, CA, USA) was
used for graph plotting and calculation of the areas. The median of the IAUC
was determined (n 40) and the 20 subjects with an IAUC above the median
were classified as with worse glucoregulation and the 20 subjects beneath with
better glucoregulation. The effects on cognitive performance of better versus
worse glucoregula-tion (as defined) was investigated by analysis of variance
with order of test meals and better versus worse glucoregulation as
independent variables, and performance on cognitive tests as dependent
variables. Correlations were calculated with Pearsons correlation in MINITAB
Statistical Software (release 13.32; Minitab Inc., State College, PA, USA). The
significance level was set at Po0.05. The results are expressed as
meanss.e.m.
RESULTS
Glycaemic properties of the reference and test bread
products in young healthy adults
The G-WWB resulted in significantly lower postprandial incre-mental
blood glucose area (IAUC) 0240 min compared with the WWB
(Po0.001, Figure 1). The 0120 min IAUC following the WWB and the
G-WWB were 17725 and 729 mmol min/l, respectively (Po0.0001).
Using the WWB as a reference (GI 100), the GI of the G-WWB was
45. In the late postprandial phase (at 210 and 240 min, respectively),
the G-WWB resulted in significantly higher blood glucose
concentrations compared with the WWB (Po0.01).
Outcome of the cognitive tests in the postprandial
period after breakfast in healthy mature adults
Outcome of the cognitive tests in relation to the test products.
There was a significant (breakfast time) interaction (Po0.05) in the SA
test, revealing a significantly better performance in the SA test at 120
min following the G-WWB compared with after the WWB (77.32.0
and 73.02.5 credits, respectively, Po0.01) (Table 1).
When only the last half of the SA test was considered (the most
demanding part), the differences in cognitive performance depending
on type of breakfast became more pronounced. Consequently, a main
effect over the entire test period (75235 min) was observed, showing
better performance after the G-WWB breakfast compared with the
WWB breakfast (SA test 14: 36.80.6 and 35.50.6 credits after G-
WWB and WWB, respectively, Po0.01) (Table 1). There was a
significant time effect in the SA tests,
& 2012 Macmillan Publishers Limited
 Postprandial blood glucose profile and cognition
A Nilsson et al
1041
3.5
Table 2. Outcome in the WM tests following a low-GI breakfast with a
WWB sustained net increment in blood glucose above the fasting value (G-
3.0
WWB) or a high-GI (WWB) reference breakfasta
Blood glucose (mmol/L)

G-WWB
2.5
WM test (max 48 CR) Treatment
2.0
G-WWB WWB
1.5
WM:1 (90 min) 31.00.9 30.50.5
1.0 WM:2 (135 min) 31.10.9 31.40.9
WM:3 (180 min) 29.40.9 29.10.9
0.5 WM:4 (225 min) 30.11.0 30.50.9
WM:14 (mean) 30.40.8 30.40.8
0.0
60 120 180 240 Abbreviations: CR, correct responses; GI, glycaemic index; G-WWB, WWB
-0.5 enriched with guar gum; SA, selective attention; WM, working memory;
Time after start of the test meals (min) WWB, white wheat bread. aData are given as means per treatments.e.m.
Figure 1. Incremental changes (D) in blood glucose concentrations
after breakfasts composed of breads based on white wheat flour
(WWB), and white wheat flour supplemented with guar gum (G- Table 3. Performance in the SA tests after the low-GI (G-WWB)
WWB). A significant treatment (type of breakfast) effect (Po0.0001) and high-GI (G-WWB) test breakfasts depending on individual
and a significant treatment time interaction (Po0.0001) were found
glucoregulationa,b
over the 240-min test period. The interaction revealed that the blood
glucose concentrations were higher after WWB compared with G-
SA testc, correct responses Glucoregulation
WWB between 15 (Po0.01) and 60 min (Po0.0001 for the other test
(max 95 CR)
points in this interval). However, in the late postprandial phase
consumption of the G-WWB resulted in higher blood glucose
Better (n 20) Worse (n 20)
concentrations compared with the WWB (at 210 and 240 min,
Po0.01). analysis of variance followed by Tukeys test. The evaluation Treatment: WWB
was performed in healthy young adults, n 12 (means.d.: 23.12.3 SA:1 (75 min) 74.63.3 65.23.4
years, body mass index: 22.11.5 kg/m 2). SA:2 (120 min) 78.73.2 67.63.5
SA:3 (165 min) 81.12.3 70.33.1*
SA:4 (210 min) 82.92.2 71.32.9*
SA: 14 (mean) 31711 27413*
Table 1. Results in the SA tests following the complete tests and in the
second half of the tests after a low-GI breakfast with a sustained net Treatment: G-WWB
increment in glucose above the fasting value (G-WWB) or a high-GI SA:1 (75 min) 72.73.3 65.93.7
(WWB) reference breakfasta SA:2 (120 h) 79.42.7 75.52.8
SA:3 (165 min) 78.33.0 75.32.8
Treatment SA:4 (210 min) 80.52.6 73.03.6
d
SA: 14 (mean) 313 11 288 13
G-WWB WWB
Abbreviations: GI, glycaemic index; G-WWB, WWB enriched with guar gum;
The complete SA testsb (max 95 CR) SA, selective attention; WWB, white wheat bread. aData are given as means
SA:1 (75 min) 69.42.5 70.02.5 per treatments.e.m. bThe blood glucose incremental area under the curve
SA:2 (120 min) 77.32.0 73.02.5** (IAUC; 090 min) after the bolus glucose drink (50 g) was taken as a
SA:3 (165 min) 76.82.0 75.72.1 measure of the efficiency in glucoregulation. The median of the glucose IAUC
SA:4 (210 min) 76.72.3 77.12.1 was determined (n 40) and the 20 subjects with an IAUC above the
SA: 14 (mean) 75.11.1 74.01.2 median were classified as with worse glucoregulation and the 20 subjects
beneath with better glucoregulation. cSA:1 and SA:2; n 39, SA:3 and
The last half of the SA tests (max 48 CR) SA:4; n 40. dThere was a tendency toward better performance in the total
SA:1 (75 min) 34.11.3 34.01.2 SA test (SA: 14) after the G-WWB in the subject group classified with better
SA:2 (120 min) 37.61.1 34.91.4** glucoregulation (P 0.092). *Po0.05.
SA:3 (165 min) 37.41.1 35.91.2
SA:4 (210 min) 37.41.1 37.01.0
SA: 14 (mean) 36.80.6 35.50.6**
Abbreviations: CR, correct responses; GI, glycaemic index; G-WWB, between the subjects classified with better or worse glucoregula-
WWB enriched with guar gum; SA, selective attention; WWB, white tion (means.d.: 61.94.4 and 64.05.4 years, respectively, P
wheat bread. **Po0.01. aData are given as means per treatments.e.m. 0.19). Subjects with better glucoregulation performed superior in
b the SA test (correct responses) after the WWB compared with
SA:1 and SA:2; n 39, Sa:3 and SA:4; n 40.
subjects with worse glucoregulation (SA test 14; Po0.05, Table
showing an improvement in the performance along the test period 3). There were also tendencies towards better performance in the
(Po0.001). There was no significant main effect depending on the SA test in the group with better glucoregulation in the case of the
order of consumption of the breakfasts (WWB/G-WWB or G- G-WWB (SA test 14; P 0.092). Both after the WWB and after
WWB/ WWB), but a significant (order of consumption breakfast) the G-WWB breakfasts, subjects with better glucoregulation
interac-tion was observed (Po0.001), revealing better showed faster reaction time (Po0.05, Table 4). Inverse
performance during the second test day. No significant correlations between blood glucose IAUC and performance in SA
differences depending on breakfast or time were observed in tests (correct responses Po0.05) and positive correlations
reaction time (data not shown) or in the WM tests (Table 2). between glucose IAUC (090 min) and reaction times (Po0.05)
were observed after the WWB as well as after the G-WWB,
Outcome of the cognitive tests in relation to the individual indicating superior performance and faster reaction time in
glucoregulation. There were no significant differences in age subjects with better glucoregulation (Table 5).

& 2012 Macmillan Publishers Limited European Journal of Clinical Nutrition (2012) 1039 1043
 Postprandial blood glucose profile and cognition
A Nilsson et al
1042
absorption rate differ, for example, energy intake and macro
Table 4. Outcome in the SA tests measuring reaction time after the
nutrient content, making it difficult to draw conclusions regarding
low-GI (G-WWB) and high-GI (G-WWB) test breakfasts in relation
solely effects of the glycaemic properties of the meal. 2426
to the individual glucoregulationa,b
The differences in cognitive performance were observed in the
SA test, reaction time (ms)c Glucoregulation
later postprandial period. This finding is in concordance with our
previous observations where we provided a glucose solution
(glucose 50 g) to healthy volunteers through either a bolus or
Better (n 20) Worse (n 20) sipping regimen to simulate a high-GI or a low-GI breakfast,
Treatment: WWB respectively.17 Consequently, the present study provide evidence
SA:1 (75 min) 117328 126139 that real breakfast products may affect cognition differently, linked
SA:2 (2 h) 111523 122033 to differences in rate of glucose delivery to the blood, and that the
SA:3 (2 h 45 min) 107225 120740* differences appears to be revealed in the late postprandial phase.
SA:4 (3 h 30 min) 105027 117132* It is noteworthy that most studies evaluating the impact of the
SA: 14 (mean) 110423 121433* course of glycaemia on measures of cognitive functions in the
Treatment: G-WWB postprandial phase have mainly focused on the earlier post-meal
SA:1 (75 min) 119935 125329* period. However, when examining available
SA:2 (2 h) 112633 117827* reports, significant improvements of cognitive functions after low-
SA:3 (2 h 45 min) 110436 111630 GI meals predominantly occur in the later phase. 17,19,27 Thus,
SA:4 (3 h 30 min) 107137 112732 the results in the present study, showing benefits on measures of
SA: 14 (mean) 112834 116726 cognitive function in the postprandial period between 75 and 235
Abbreviations: GI, glycaemic index; G-WWB, WWB enriched with guar gum; min, are in concordance with other studies performed within this
SA, selective attention; WWB, white wheat bread. aData are given as means time frame. The present and previous studies suggest that a
per treatments.e.m. bThe blood glucose incremental area under the curve smoother blood glucose profile, and/or a sustained net increment
(IAUC; 090 min) after the bolus glucose drink (50 g) was taken as a in blood glucose above fasting concentrations after the G-WWB
measure of the efficiency in glucoregulation. The median of the glucose IAUC bread, may have contributed to the improved cognitive perfor-
was determined (n 40) and the 20 subjects with an IAUC above the mance in the current study, meaning that the overall postprandial
median were classified as with worse glucoregulation and the 20 subjects
blood glucose profile probably is an important determinant of
beneath with better glucoregulation. cSA:1 and SA:2; n 39, SA:3 and
cognitive performance.
SA:4; n 40. *Po0.05.
A glucose profile characterised by less oscillating glucose
concentrations has proven beneficial with respect to acute
Table 5. Relations between glucoregulation (IAUC 090 min) and postprandial insulin resistance.8,9,28 Several studies have thus
performance in the SA tests (correct response and reaction time)a shown that a breakfast meal may have effects on the glucose
tolerance at the next meal (lunch), and a low but sustained
Blood glucose IAUC (090 min) increase in blood glucose concentration has proven superior in
SA:1 SA:2 SA:3 SA:4 SA:14 this context.8,9,28 Insulin and insulin receptors within the brain are
(75 min) (120 min) (165 min) (210 min) (75210 min) important for learning and memory. Insulin resistance results in
reduced insulin signalling in the brain, altering a variety of insulin-
Treatment: WWB mediated events of importance for memory functions. 11
Correct response Considering that insulin resistance appears to be a peripheral
r 0.19 0.26 0.37 0.42 0.29 postprandial phenomenon,17,19,24,29,30 it can be speculated that
P 0.24 0.10 0.019 0.007 0.073 the improvement seen in the cognitive tests after the G-WWB
may be a consequence of an acutely improved insulin sensitivity
Reaction time
within the brain. In an animal model, there was a failure in insulin
r 0.16 0.28 0.37 0.36 0.31
resistant and obese rats to enhance plasma membrane GLUT4
P 0.33 0.084 0.018 0.021 0.051
translocation in hippocampus, despite elevation in plasma
Treatment: G-WWB glucose; and no changes were found in the density of insulin
Correct response receptors and in total GLUT4.31 In the same study, it was
r 0.31 0.31 0.23 0.38 0.28 observed that cognitive functions were impaired in hippocampus
P 0.056 0.052 0.16 0.015 0.076 depending performance. The authors concluded that insulin
resistance and/or abnormal insulin receptor signalling contributed
Reaction time to the memory deficits observed.
r 0.29 0.29 0.16 0.35 0.28 The results from the present study allow us to hypothesise that
P 0.074 0.072 0.33 0.026 0.082 negative effects on insulin receptors in the brain can occur
Abbreviations: G-WWB, WWB enriched with guar gum; IAUC, postprandially after a single meal, for example, after a high-GI
incremental area under the curve; SA, selective attention; WWB, white meal as opposed to the low-GI G-WWB product. However,
hyperglycaemia, as may occur, for example, after a high-GI meal,
wheat bread. aSA:1 and SA:2; n 39, SA:3 and SA:4; n 40. is also associated with several other physiological conditions with
potential negative impact on the brain; for example, increased
DISCUSSION oxidative stress,32,33 increased inflammatory markers (IL-6)34,35
The G-WWB breakfast, resulting in a low postprandial blood and increased cortisol concentrations. 36 In addition, acute hyper-
glucose peak followed by a low but sustained net increment in glycaemia in normal subjects may result in vasoconstriction.32
glucose above the fasting value, significantly improved perfor- Cortisol has been shown to correlate negatively with cognitive
mance in the SA test in the later postprandial period (75225 min) performance, predominantly hippocampus abilities. 37 Cortisol,
in comparison with the WWB reference breakfast, characterised which may promote peripheral insulin resistance, may also impair
by a high peak blood glucose response of short duration. Studies insulin signalling in hippocampus, as shown in rats, and reduce
investigating the effects of differences in glycaemic properties of GLUT4 concentrations and translocation to hippocampal plasma
test meals on cognitive performance are scarce. In contrast to the membranes.38 The negative effects of cortisol in the brain can
present study, usually also other food factors in addition to thus be suggested to result in cognitive deficits due to

European Journal of Clinical Nutrition (2012) 1039 1043 & 2012 Macmillan Publishers Limited

substrate depletion during cognitive tasks, similar to the situation
in the late postprandial phase following high-GI foods.
It is well established that type-2 diabetes and the metabolic
syndrome is associated with an increased risk of cognitive
dysfunction.1216 In the present study in a healthy subject
population, subjects with better glucose regulation performed
superior compared with subjects with worse glucoregulation,
indicating the lack of well-defined cut-off values for the impact
of glucose tolerance on cognitive performance. In the
evaluation of effects of glucoregulation on cognitive functions,
a median split approach was applied, dividing the subjects
into two groups depending on glucoregulation as defined in
the present study (IAUC). It must be noted that the reason for
this approach is to categorise the subjects within the group,
not to state clinical glucose intolerance.
In summary, the results in the present study indicate that a
smooth postprandial blood glucose profile, as seen after the
G-WWB, is superior for cognitive performance in comparison
with a blood glucose profile resulting from a high-GI meal,
especially in the late postprandial phase. The positive effect
may emanate from improved insulin sensitivity, possibly in a
combination with an enhanced neural energy supply.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
ACKNOWLEDGEMENTS
This work has been supported by the Antidiabetic Food Centre (AFC), a
VINNOVA VINN Excellence Center at Lund University, Sweden.
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