Accumulating epidemiological evidence suggests that anthocyanin intake is associated with reduced risks of cardiometabolic disorders, highlighting the importance of incorporating the phytochemical in our diets. Numerous food-based intervention studies have examined, in controlled meal settings, the role of anthocyanin on cardiometabolic health; but their effects have not been systematically summarized. This study aims to systematically review and summarize the effects of anthocyanin consumption with composite meals on cardiometabolic health from randomized controlled feeding trials. A systematic literature search for relevant human nutritional intervention studies was performed using PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and Scopus databases. The Cochrane Risk of Bias tool was used to assess the study quality. Eighteen articles involving 371 participants were included in this review. Consistent improvements from anthocyanin intake were found in glycemic, gastric inhibitory peptide (GIP), interleukin-6 (IL-6), and oxygen radical absorbance capacity (ORAC) responses. Anthocyanin intake did not significantly affect other markers of energy metabolism, vascular functions, oxidative stress and antioxidant status, as well as inflammatory responses. Inconsistencies in successful outcomes between epidemiological studies and included interventions were largely attributed to matrix effects, which may impede the bioaccessibility of anthocyanins and consequently, limiting its health benefits when co-delivered with some foods.

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Objectives By incorporating black rice anthocyanins into a carbohydrate-rich food matrix, this project aims to assess the changes in in-vitro carbohydrate digestibility, and the glycemic index (GI) of the enriched carbohydrate-rich food. We hypothesize that the bread enriched with black rice anthocyanins will retard carbohydrate digestibility, and have a lower GI. Methods A simulated digestion model in-vitro was used to investigate the digestibility of bread enriched with black rice anthocyanin extract (BRAE). To assess the GI of the enriched bread, 24 healthy adults participated in a randomized, controlled crossover study with 3 intervention arms. Participants received 50-g glucose solutions as a reference; interventions included 50-g available carbohydrate (ACHO) servings of white bread (CON), bread enriched with 2% (BB-2) and 4% (BB-4) BRAE. Results In the simulated digestion model, the enrichment of BRAE was found to significantly reduce oral and intestinal digestion of bread. Relative to CON, the concentration of glucose released in the simulated oral digestion was reduced for BB-2 (P = 0.9529) and BB-4 (P = 0.0001). Relative to CON, the incremental area under the intestinal digestion curves (IAUC) were also reduced for BB-2 (P = 0.0001) and BB-4 (P < 0.0001). The rate constants of the modelled intestinal digestion profiles saw a dose-response reduction with BRAE enrichment. In the randomized controlled trial, there was up to a 27-point reduction in the GI of BRAE-enriched bread. Relative to CON, a significant difference in 2 h mean insulin concentration was also observed after BB-2 (P = 0.024). However, considerable inter-individual variation was also observed in postprandial measurements among the healthy participants. Conclusions These findings suggest that the enrichment of BRAE in bread slows carbohydrate digestibility, reduces GI, and improves postprandial insulinemic responses. BRAE may thus be a viable food-sourced ingredient for the enrichment of some carbohydrate-rich foods, as a dietary strategy to manage postprandial hyperglycemia. Funding Sources This research was co-funded by National University Health System and National University of Singapore as part of the grant awarded to the Health Innovation Program (CF/SCL/16/178) led by Prof. E Shyong Tai.

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