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EFFECTS-OF-RED-PITAYA-FRUIT-HYLOCEREUS-POLYRHIZUS-CONSUMPTION-ON-BLOOD-GLUCOSE-LEVEL-AND-.pdf

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BORNEO SCIENCE 31: SEPTEMBER 2012
127
EFFECTS OF RED PITAYA FRUIT (
HYLOCEREUS POLYRHIZUS
) CONSUMPTION ON BLOOD GLUCOSE LEVEL AND LIPID PROFILE IN TYPE 2 DIABETIC SUBJECTS ¹Norhayati Abd Hadi, ¹Marhazlina Mohamad, ¹Mohd Adzim Khalili Rohin, & ²Rokiah Mohd Yusof
¹Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Kampus Kota, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu, Malaysia. ²Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
ABSTRACT.
This study was conducted to determine the effects of red pitaya fruit consumption on blood glucose level, lipid profile, body weight and total body fat in type 2 diabetic subjects. A total of 28 subjects were randomly divided into four groups; Group 1 were given 400g of red pitaya per day, Group 2 were given 600 g of red pitaya per day, Group 3 negative control; were diabetic patients and given a normal diet and Group 4  positive control; were healthy subjects and given a normal diet. Subjects were assigned to a  seven week study which consisted of three phases: phase 1: one week, phase 2: 4 weeks of treatment and phase 3: 2 weeks of wash-out. After four weeks of treatment, Group 1 showed a  significant increase in HDL-cholesterol level and a significant decrease in blood glucose,  LDL-cholesterol and triglyceride level. There was a significant increase in total cholesterol level on the seventh week of the study. Even though there was no significant difference in Group 2, there was still an increasing trend in HDL-cholesterol level and decreasing trend in blood glucose, total cholesterol, triglycerideand LDL-cholesterol levels, with a higher  percent of changes than Group 1. No significant differences were seen in body weight and total body fat in any groups.
 KEYWORDS.
Blood glucose, red pitaya fruit, type 2 diabetes mellitus, lipid profiles.
INTRODUCTION
Diabetes mellitus is the most common endocrine disorder which is characterized by disruption of carbohydrate, fat and protein metabolism, and electrolyte imbalance (Solomon
et al 
., 2002). Diabetes mellitus is one of the chronic diseases threatening 6.4 billion people worldwide. (International Diabetes Federation, 2003). Today, insulin and oral hypoglycemic agents are the main ways to treat diabetes mellitus and are effective in controlling hyperglycemia, but these kinds of chemically based drugs also have prominent side effects. For instance, tolbutamide which it is believed to have a toxic effect, which cannot be excreted by liver (Berger & Mühlauser, 2001). The fruits of
 Hylocereus
 
species, which is often called ‘the scaly fruit’ in Latin America or ‘dragon fruit’ in Asia, are medium
-large berries bearing large green or red scales (Nerd
et al.
, 1999). There are several varieties of pitaya fruit; red pitaya with white flesh (
 Hylocereusundatus
), red pitaya with red flesh (
 Hylocereuspolyrhizus
) which has been used in this study and another type is yellow pitaya with white flesh (
 Hylocereusmegalanthus
). Red pitaya has high moisture content and is rich in fiber, phophorus, vitamin C and calcium. According to Norhayati (2005), the crude dietary fiber in red pitaya is 10.1g per 100g of edible portion, in addition to the high content of antioxidant vitamins such as vitamin
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 Norhayati Abd Hadi, Marhazlina Mohamad, Mohd Adzim Khalili Rohin, & Rokiah Mohd Yusof
128
A, C and E which are 102.13 µg, 540.27 mg and 105.67 µg per 100 g dry weight, respectively. The aim of this study was to determine the effects of red pitaya fruit consumption on  blood glucose level, lipid profile, body weight and total body fat in subjects with type 2 diabetes mellitus.
MATERIALS AND METHODS
 Study Subjects
A total of 28 staff of Universiti Putra Malaysia, Serdang (14 males and 14 females), 21 of whom have type 2 diabetes mellitus, aged between 20 and 55 years old, taking oral antidiabetic medication instead of insulin injection, nonpregnant and non-drinkers, were included in the study. The diabetic subjects were recruited based on fasting blood glucose
level ≥6.1 mmol/L.
The study was supported by the local ethical board and all subjects gave their written consent after being fully informed about the nature of the study.
 Study Design
Subjects were randomly divided into four groups; Group 1 received 400g of red pitaya fruit  per day, Group 2 received 600g of red pitaya fruit per day, Group 3 was a negative control group (diabetic patients received normal diet) and Group 4 was a positive control group (healthy subjects received normal diet), with seven subjects in each group. Subjects were assigned to a seven week period of study which consisted of three  phases: Phase 1 (one week), Phase 2 (four weeks) and Phase 3 (two weeks). Phase 1 involved the screening session and the collection of basic study data. The treatment was carried out in Phase 2 which lasted four weeks. Phase 3 was a wash-out period when the treatment was completely stopped. Fasting blood samples and anthropometric measurements were taken four times throughout the study once during Phase 1 in the first week of the study period, twice during Phase 2 (in the third and fifth weeks of the study period) and once during Phase 3 (in the seventh week of the study period). All diabetic subjects were still taking their oral medication. Since dietary intake and  physical activity were not controlled in this study, all the subjects were requested to practice their normal daily lifestyle.
 Anthropometric Measurements
Height and body weight of the subjects were measured and Body Mass Index (BMI) computed as body weight/(height
2
). Waist-hipratiowas calculated by appropriate formula and total body fat for each subject was measured using OMRON body fat analyzer.
Nutritional Assessment
All enrolled subjects were asked to record their 24-hour dietary intake for 3 days including 2 weekdays and 1 weekend day. Records were then reviewed and analyzed with an appropriate software program, NutritionistPro. National composition food tables were used as reference. A Food Frequency Questionnaire (FFQ) was completed by each of the subjects on the same day when the first blood samplewas taken. The questionnaires were completed only once throughout the study. The Food Frequency Questionnaire (FFQ) was then analyzed using a 5-mark scale as follows: 5 = everyday; 4 = 2-3 times per week; 3 = onceper week; 2 = seldom; 1 = never.

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Effects of Red Pitaya Fruit (
 Hylocereus Polyrhizus
) Consumption on Blood Glucose Level and Lipid Profile in Type 2 Diabetic Subjects
129
 The score was calculated using an appropriate score formula (Chee
et al.,
1996) adapted from Reaburn
et al 
. (1979) and Zaitun & Terry (1990).
Biochemical Parameters
10 mL of blood were intravenously collected from each subject by qualified medical officers after an overnight fast (10 hr). During the study period, four blood samples were collected in the 1
st
, 3
rd
, 5
th
 and 7
th
 week of the study period. The blood samples were analyzed for blood glucose level and lipid profile using
chemical autoanalyzer
(Roche/Hitachi, Germany).
 Statistical Analysis
Experimental values were expressed as mean ± standard deviation (SD) using the Microsoft Office Excel 2003. Demographic data, body weight, total body fat and all biochemical  parameters were analyzed using the Statistical Package for Social Science for Windows (SPSS for Windows) version 12.0. One-way ANOVA test was performed to compare the means of each group during the different weeks of study and a
 P 
-value 0.05 was considered statistically significant.
RESULTS AND DISCUSSION
 Anthropometric Measurements
Results of the study showed mean body mass index (27.30±5.27 kg/m
2
), waist-hip ratio (0.89±0.07) and total body fat (30.61±5.71 %) (See Table 1).
 Table 1. Anthropometric measurements of respondents (n=28). Mean ± SD
Body Mass Index (kg/m)
 
27.30±5.27
 
Total body fat (%)
 
30.61±5.71
 
Waist-hip ratio
 
0.89±0.07
 
Nutritional Assessment
Table 2 shows the mean nutrient intake during the period of treatment collected from the 24-hour dietary records. Since the dietary intake was not controlled in this study, all respondents consumed their normal food. For caloric intake, respondents consumed an average of 2,072.30±638.79 kcal per day. The mean intake of the major nutrients such as carbohydrate, protein and fat, was 280.12±91.79 g, 88.08±27.91 g and 66.48±24.18 g respectively. Average cholesterol intake  per day was estimated to be around 206.78±142.78 mg. For the minor nutrients intake, the mean of vitamin A intake was 7838.72±3208.15IU, vitamin C was 124.25±71.80 mg, calcium was 595.61±164.95 mg and iron was 23.69± 11.22 mg. While for the average dietary fiber intake, respondents consumed 29.89±8.62 g per day. Caloric intake and distribution of macro and micronutrients were similar for both genders. When compared to the RNI (Recommended Nutrient Intake) value (NCCFN, 2005), respondents
’
 intake of protein and vitamin C were exceeded the recommended, whereas the caloric and calcium intake was lower than recommended. However, respondents
’
 intake of fat and dietary fiber reached the recommendation of RN
I and ‘Malaysian Dietary Guidelines’ (NCCFN, 1999), respectively.
 On the other hand, daily iron intake was higher than recommended in males and did not reach the recommended level in females.

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 Norhayati Abd Hadi, Marhazlina Mohamad, Mohd Adzim Khalili Rohin, & Rokiah Mohd Yusof
130
Table 2. Average nutrient intake during treatment period determined from 3-day dietary records compared to recommended values (n=28). Mean ± SD Recommended value
Energy (kcal)*
 
2,072.30±638.79
 
M (2460)
 
F (2180) Carbohydrate (g)
 
280.12±91.79
 -
Protein (g)*
 
88.08±27.91
 
M (62)
 
F (55)
 
Fat (g)º
 
66.48±24.18
 
M (54-82)
 
F (46-70) Cholesterol (mg)
 
206.78±142.78
 -
Vitamin A (IU)
 
7,838.72±3208.15
 -
Vitamin C (mg)*
 
124.25±71.80
 
M (70)
 
F (70)
 
Calcium (mg)*
 
595.61±164.95
 
M (800)
 
F (800)
 
Iron (mg)*
 
23.69±11.22
 
M (14)
 
F (29)
 
Dietary fiber (g)
 
29.89±8.62 M & F (20-30) RNI value for age 30-50 º RNI value for age 19-59 Value from
‘Malaysian Dietary Guidelines’
 M = male; F= female Scores determined from Food Frequency Questionnaire are presented in Table 3. The most food consumed was rice, moderately consumed foods (were cabbage, string beans, sweetened condensed milk, anchovy, skinless chicken, white bread, table sugar, hen eggs and
‘
nasi lemak 
’
) and the less consumed foods (were halwa, mutton, cheese, pickled fruits, Chinese cabbage and UHT milk).
Table 3. Food Frequency Questionnaire score (n=28).
Score A. Highly consumed food (80-100)
 Rice 98.33
B. Moderately consumed foods (60-79.9)
Table sugar 
 
Anchovy
 
Cabbage
 
Sweetened condensed milk 
 
Skinless chicken
 
String bean
 
Hen egg
 
White bread
 
‘Nasilemak’
 
73.34 73.33 69.99 68.33 66.67 65.01 65.01 65.00 65.00
C. Less consumed foods (20-59.9)
Chinese cabbage
 
UHT milk 
 
Mutton
 
Cheese
 
Pickled fruits
 
Halwa
 
31.66 31.66 30.00 30.00 30.00 26.67
Effects of Red Pitaya Fruit Consumption on Blood Glucose Level

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