a

ISSN 0101-2061 Food Science and Technology

DDOI: http://dx.doi.org/10.1590/1678-457X.6449

Glycemic index and glycemic load of tropical fruits and

the potential risk for chronic diseases
Tatiana Uchôa PASSOS1*, Helena Alves de Carvalho SAMPAIO1, Maria Olganê Dantas SABRY1,
Maria Luisa Pereira de MELO1, Maria Auristela Magalhães COELHO1, José Wellington de Oliveira LIMA1

Abstract
The objective was to determine the glycemic index and glycemic load of tropical fruits and the potential risk for chronic diseases.
Nine fruits were investigated: coconut water (for the purpose of this study, coconut water was classified as a “fruit”), guava,
tamarind, passion fruit, custard apple, hog plum, cashew, sapodilla, and soursop. The GI and GL were determined according
to the Food and Agriculture Organization protocol. The GL was calculated taking into consideration intake recommendation
guidelines; 77.8% of the fruits had low GI although significant oscillations were observed in some graphs, which may indicate
potential risks of disease. Coconut water and custard apple had a moderate GI, and all fruits had low GL. The fruits evaluated
are healthy and can be consumed following the daily recommended amount. However, caution is recommended with fruits
causing early glycemic peak and the fruits with moderated GI (coconut water and custard apple).
Keywords: glycemic response; fruits; dietary assessment; chronic diseases.

1 Introduction
Chronic non-communicable diseases (CNDs) are increasingly food, which can be calculated as its carbohydrate content (g)
prevalent worldwide causing premature deaths due to changes multiplied by the food’s GI and divided by 100, and it is, therefore,
in diet and lifestyle. Thus, various strategies for prevention a measure that involves the quantity and quality (GI) of dietary
and control have been developed in order to stop or delay the carbohydrate (American Diabetes Association, 2013; Danone
spread of these diseases (American Diabetes Association, 2013; Vitapole/FAO, 2001).
Salehi et al., 2012; Salgado et al., 2010).
These two concepts show that both indicators should be
Three decades ago, the concept of a dietary Glycemic Index determined when assessing how healthy or unhealthy the feeding
(GI) came under discussion as a factor that should be controlled patterns of a population are.
to prevent chronic diseases. This concept was first proposed in
The GI and GL of meals and daily consumption can be
1981 by scientists led by Dr. David Jenkins, University of Toronto,
calculated based on the GI and GL values of foods using tables
Canada (Jenkins et al., 1981).
and standardized calculation procedures available (Food and
The GI of foods is a categorization based on the effect of the Agriculture Organization & World Health Organization, 1998;
content and type of carbohydrates of a food on blood glucose Wolever et al., 2003). These tables are updated whenever new
(Brand-Miller et al., 2014; Passos, 2012). GI and GL values are established for different foods, such
as those proposed by Brand-Miller  et  al. (2014) and Sydney
An expert group convened by the Food and Agriculture
University Glycemic Index Research Service (The University
Organization/World Health Organization (Food and Agriculture
of Sydney, 2001). Among the foods listed in these tables are
Organization & World Health Organization, 1998) defined GI
fruits from different places of origin. There are several studies
as the area under the glucose response curve after ingestion
that address native or cultivated fruits grown in Europe, North
of 50g of carbohydrates of a test food expressed as a response
America, Oceania, Africa, and Asia. However, there are few
percentage to the same amount of carbohydrate from a standard
studies on fruits native to South America (Almeida et al., 2009),
food, in the same individual. The standard food is glucose or
and there are no South American fruits listed in these tables
white bread (Brand-Miller et al., 2014; Food and Agriculture
or reported in the recent literature, and they have not been
Organization & World Health Organization, 1998).
mentioned in recent publications (Brand-Miller et al., 2014).
In addition to the glycemic index, the amount of carbohydrate Brazil, a country located in South America, has a wide variety
in a food is also considered an important determinant of glucose of fruits, but many of these fruits have not yet been included in
tolerance on fasting and the postprandial glycemic response. international tables of glycemic index and glycemic load values
Thus, there is another indicator, the glycemic load (GL) of a (Almeida et al., 2009).

Received 01 Aug., 2014

Accepted 27 Dec., 2014
1
Laboratory of Nutrition and Chronic Diseases, Center for Health Sciences, State University of Ceará – UECE, Fortaleza, CE, Brazil
*Corresponding author: [email protected]

66 Food Sci. Technol, Campinas, 35(1): 66-73, Jan.-Mar. 2015

 Passos et al.

Fruits deserve special consideration when evaluating safe (Food and Agriculture Organization & World Health Organization,
food consumption because they are included in international 1998): 1) each volunteer may perform up to six glycemic
guidelines for a healthy diet, as shown in the Dietary Guidelines response measurements: 3 after consumption of the standard
for Americans (U.S. Department of Agriculture, 2010), in which food (glucose) and one measurement for each food to be tested
their daily intake is recommended consumption and they can with a maximum of three foods/person, 2); each food should
have a positive impact on the glycemic and cholesterol control and be tested by a minimum of 6 persons.
can help reduce the risk of coronary heart disease (Jenkins et al.,
According to the FAO/WHO Expert Consultation protocol
2011; Salehi et al., 2012; Balisteiro et al., 2013).
(Food and Agriculture Organization & World Health Organization,
Thus, the fruits with the most suitable composition for 1998), the quantity of the standard food and test food should ensure
consumption should be identified. In general, their recommended the availability of 50 g of glycemic carbohydrate (carbohydrates
intake is based on their concentration of vitamins, minerals, and minus fiber). Therefore, the carbohydrate and fibers of each of
fiber, whilst little attention has been given to their glycemic effect. the ten fruits were determined using the Professional DietWin
Recent publications have discussed other potential benefits of fruit 2.0 software
intake (Augustin, 2010; Ballali & Lanciai, 2012; U.S. Department The content of carbohydrates, fiber, and glycemic carbohydrates
of Agriculture, 2010; Jenkins et al., 2011; Balisteiro et al., 2013).
per 100 g of each fruit is described in Table 1.
The objective of this study is to identify the fruits that are
The total amount of Barbados cherry was 1872.7 g; therefore,
part of the usual diet of certain population groups, to determine
this fruit was excluded from this study to prevent potential
their glycemic index and glycemic load, and to assess the potential
operational infeasibility. Consequently, the final volunteer sample
health risks associated with these two indicators. was composed of 18 people.

2 Materials and methods The fruit portions were weighed on a Nutri subtype
Plenna® digital balance that offers a weighing capacity of 2000g
The present study was conducted at Nutrindo – Laboratory and 1g graduation.
of Nutrition and Chronic Diseases, of the State University of
Ceará (UECE). It was approved by the Ethics Committee of All procedures for measuring the glycemic response
Ceará State University – FR 3079667 – (Appendix A), and the followed the FAO/WHO Expert Consultation Protocol (Food
individuals who agreed to participate in the study were required and Agriculture Organization & World Health Organization,
to sign a consent form. 1998). The area under the curve was calculated as the incremental
area under the response curve of glucose. This can be calculated
geometrically by applying the trapezoidal rule. It should be
2.1 Identification of fruits with unknown GI
noted that when a blood glucose value falls below the base line,
The laboratory researchers conducted an initial search of the area between this point and the fasting level is not included
research databases for articles published over the past 10 years by in the calculation; thus, only the areas above the fasting level
at the. These databases contain information on the usual intake of are included.
different population groups: children, adolescents, adults, elderly,
After calculation, the glycemic index was categorized as low,
healthy pregnant women, adults with psychiatric disorders, and
medium, or high based on the classification of Brand-Miller et al.
adults and seniors with chronic diseases, totaling 1,830 people. (2003), where low GI ≤ 55, moderate GI 56-69, and high GI ≥ 70.
Data on fruit intake were collected using questionnaires applied The fruits with low-GI were considered healthy.
to these specific groups of people, of which 148 different items
were identified. The glucose load was also calculated as the fruit’s carbohydrate
content (g) multiplied by the food’s GI and divided by 100, as
The GI and the GL of the fruits were taken from international
tables (Brand-Miller et al., 2014; Brand-Miller et al., 2013). It was
found that 10 of the fruits found in the aforementioned database Table 1. Content of carbohydrates and fiber in 100g of the fruits used
were not included in any of these tables, namely Barbados cherry in this study.
(Malpighia emarginata), coconut water (for the purpose of this
study, coconut water was classified as a fruit) (Cocos nucifera), Fruit Carbohydrate (g) Fiber (g)
custard apple (Annona squamosa), hog plum (Spondias lutea), Barbados cherry 5.00 2.33
cashew (Anacardium occidentale), guava (Psidium guajava), Coconut water * 5.30 0.10
soursop (Annona muricata), passion fruit (Passiflora sp), sapodilla Custard Apple 12.06 2.89
(Manilkara zapota), and tamarind (Tamarindus indica). Hog plum 13.80 1.00
Cashew 11.60 1.5
2.2 Determination of the GI and GL of the fruits identified Guava 17.30 5.30
Soursop 14.90 1.10
The sample was initially composed of 21 volunteers, students Passion fruit 21.20 0.70
of the university where the present study was conducted, who Sapodilla 25.90 9.90
received a description of the research procedures in visits to Tamarind 71.80 3.00
their classroom. This number was defined according to two * Source: Brazilian Table of Food Composition (Universidade Estadual de Campinas,
recommendations of the joint FAO/WHO Expert Consultation 2006).

Food Sci. Technol, Campinas, 35(1): 66-73, Jan.-Mar. 2015 67

 Tropical fruits: glycemic index and load

proposed by Burani (2006). The Brazilian dietary guidelines, Wolever  et  al. (2003) found variations in the glycemic
which defines one portion of a fruit as the amount that contains responses of the same food between the areas of the gliycemic
70 calories (Brasil, 2006), were used to calculate the portion curves after glucose ingestion (standard food) in different
of fruits to be used. Different studies available in the literature individuals and in the same individuals. These variations were
were reviewed to define the portion of each fruit (Brasil, 2006; also observed in the present study. In the glucose tests, some
Instituto Brasileiro de Geografia e Estatística, 2011; Pacheco, subjects showed greater increase in the level of blood glucose
2006). The GL of each fruit was categorized as low (values ​​less after intake of certain fruits. In other subjects, the glucose level
than or equal to 10), moderate (values between11-19), or high, reached peaks greater than 200 mg/dL within first 45 minutes
(values greater than or equal to 20), (Burani, 2006). after ingestion of the glucose solution, representing an increase
of more than 100% compared with their fasting blood glucose
Table 2 shows the nine fruits that were evaluated and the level. The same increase was not observed in the same subjects
respective portion used to calculate the GI and GL. in the other tests conducted with the glucose solution.
The graphs (Figures 1-9) show that some fruits have a high
3 Results initial peak of glucose level (15 min), followed by a gradual
Graphs 1-9 show the average blood glucose levels obtained reduction in blood glucose. This was observed for the coconut
with the measurement of diluted glucose (3 measurements) and water (Figure 1), custard apple (Figure 2), cashew (Figure 4),
the measurement of the fruit tested. soursop (Figure 6), and sapodilla (Figure 8). However, as for
the cashew, the initial peak was higher than that of the other
4 Discussion fruits and even higher than that obtained with the glucose level
curves. With regard to custard apple, the normalization of blood
The methodological aspects of GI in terms of its determination glucose values was a little slower than that of cashew.
have been widely discussed. The wide variability between GI
values ​​reported by different laboratories can be food-related The early glucose level peak observed in these fruits can be
(digestibility and starch structure, among others) or it can be considered a promising result in terms of their recommended
caused due to methods such as the procedures used to collect intake for patients who have a metabolic syndrome or those
blood samples and measure blood glucose, or it can be associated who are obese and have diabetes, for example. This is due to the
with demographic characteristics and ethnic origin of the subjects fact that blood glucose level glucose levels can vary widely in
(Wolever et al., 2003). diabetic patients, and those who are obese have a strong tendency
to develop insulin resistance due to hormone activity, such as
Wolever (2004) compared different protocols to determine the leptin. This hormone can begin a chain reaction in the fasting
glycemic index, and they suggested the use of the recommendations glucose levels or significant insulin sensitivity reduction (Mahan &
of the FAO/WHO Expert Consultation protocol (Food and Escott-Stump, 2010). Accordingly, the ingestion of large amounts
Agriculture Organization & World Health Organization, 1998), of the fruits tested could induce a major imbalance, especially
which was adopted in the present study. This protocol is a those with higher early peak, such as cashew fruit. This fruit,
recommended standard to determine capillary blood glucose which is seasonal and is available almost year round, can be a
levels, and each food was evaluated in six subjects to improve risk to patients with the diseases mentioned above or even cause
the reliability of the method (Wolever et al., 2003). these diseases in people who have genetic susceptibility to them.
With regard to custard apple, in addition to its early initial
peak, the fact that glucose level normalization is slow makes
Table 2. Portions of selected fruits containing 50g glycemic carbohydrate this fruit a bad choice for patients with high fasting glucose
used to calculate the glycemic index (GI) and portion (g/mL) used to level. The consumption of the custard apple, besides rapidly
calculate the glycemic load (GL).
raising glucose levels, makes glucose level normalization more
Portion used to Portion used (g/mL) to difficult. This is especially true for individuals with reduced
Fruit
determine GI calculate the GL glucose metabolism.
Coconut Water 961.5 200.0 b
Analyzing the glycemic responses of the hog plum (Figure 3),
Custard Apple 545.3 75.0
guava (Figure 5), passion fruit (Figure 7), and tamarind (Figure 9),
Hogs Plum 390.6 70.0 b
it was observed that the glucose levels are not very high and
Cashew 495.0 147.0
remain constant over time, showing that these fruits have low
Guava 416.7 95.0
effect on blood glucose levels. Tamarind has the initial peak
Soursop 362.3 75.0 c
later, at 30 minutes. Thus, these fruits can be the best option
Passion fruit 243.9 94.0
for patients with unregulated glucose levels since they did not
Sapodilla 312.5 70.0 b
have high or early peaks and the blood glucose level remained
Tamarind 72.7 35.0 b
stable without major peaks or variations contributing to low
a
Recommended amount according to the Food Guide for the Brazilian population (2006),
b
recommended amount according to Pacheco (2006), with standard caloric equivalent effect on blood glucose levels.
to that in the Food Guide for the Brazilian population (2006), crecommended amount
according to the Consumer Expenditure Survey (Instituto Brasileiro de Geografia e The amount of fruit required was a negative factor in this
Estatística, 2011). study. Although the subjects were allowed to select the fruit

68 Food Sci. Technol, Campinas, 35(1): 66-73, Jan.-Mar. 2015

 Passos et al.

Figure 1. Average glucose levels based on the intake of coconut water Figure 4. Average glucose levels based on the intake of cashew by
by healthy subjects (n = 6). healthy subjects (n = 6).

Figure 2. Average glucose levels based on the intake of custard apple Figure 5. Average glucose levels based on the intake of guava by healthy
by healthy subjects (n = 6). subjects (n = 6).

Figure 3. Average glucose levels based on the intake of hog plum by Figure 6. Average glucose levels based on the intake of soursop by
healthy subjects (n = 6). healthy subjects (n = 6).

Food Sci. Technol, Campinas, 35(1): 66-73, Jan.-Mar. 2015 69

 Tropical fruits: glycemic index and load

of their choice for the test, the amount of fruit was very high,
especially in the case of the custard apple and coconut water.
The glycemic carbohydrate content required in the protocol
used (Food and Agriculture Organization & World Health
Organization, 1998) is 50g, also reported in most studies as shown
in recent investigations such as those of Augustin (2010), Bell
(2011), Brand-Miller et al. (2009b), Kinnear (2010), Lan‑Pidhainy
& Wolever (2011) and Uchiki et al. (2012). In order to minimize
this problem, the use of 25 g of carbohydrate glucose has been
proposed (Brand-Miller et al., 2009a), but this practice is still
under debate.
Low and moderate glycemic indexes were found in the
fruits tested (Table 3). However, the glycemic load for portions
considered healthy (Brasil, 2006; Instituto Brasileiro de Geografia
e Estatística, 2011; Pacheco, 2006) was considered as low for all
fruits. Despite frequent consumption in Brazil, some fruits are
Figure 7. Average glucose levels based on the intake of passion fruit
considered seasonal, as they are available in greater quantity at
by healthy subjects (n = 6).
specific times of the year. According to the “Brazilian Regional
Food” (Brasil, 2002), many of the fruits investigated are found
throughout the year, such as coconut (from which coconut water
is extracted) and passion fruit. Aside from cashew, the others are
also available most of the year, but they can be easily found in
certain periods of the year: hog plum is most commonly found
from December to June, soursop between January and March
and guava from April to June and November to January. Only
cashew is found almost exclusively from July to December.
The literature has highlighted the effect of fibers on the
glycemic response, especially soluble fibers (Hettiaratchi et al.,
2011; Menezes et al., 2009; Mira et al., 2009). Among the fruits
mentioned, the fiber isolated from passion fruit has been identified
as having hypoglycemic effects (Salgado et al., 2010, Zeraik et al.,
2010), which was also observed in the present study, where the
GI of this fruit was one of the lowest among those evaluated.
In addition to soluble fibers, studies available in the literature
have discussed other components that can affect glycemic
Figure 8. Average glucose levels based on the intake of sapodilla by
responses, for example, acidity, which causes delayed gastric
healthy subjects (n = 6).
emptying, resulting in a slower rate of digestion with subsequent
reduction of the glycemic response (Brand-Miller et al., 2014).
It is therefore likely that the acidity present in many of the
fruits evaluated contributed to the findings of the present study
(Brand‑Miller et al., 2003; Novotni et al., 2011; Brand‑Miller et al.,
2014).
Despite the detailed discussions about the glycemic peaks
above, the glycemic index of the fruits evaluated suggest beneficial
health effects since most of them had low GI (77.8%), two had
moderate GI (coconut water and custard apple), and none of
them had high GI. GL was low for all fruits. Regarding the
recommendations that both GI and GL should be low, (Salehi et al.,
2012; Egan et al., 2011), dietary restriction of coconut water and
custard apple intake is advised. However, with regard to cashew
(Figure 4), although its GI and GL are low, the initial glycemic
peak triggered can be harmful, especially for people who have
high fasting glucose level, such as obese patients who have
metabolic syndrome and diabetic patients (Brand-Miller et al.,
Figure 9. Average glucose levels based on the intake of tamarind by 2009a). Gibson et al. (2011) also found variations in the glucose
healthy subjects (n = 6). level peaks of foods belonging to the same food group.

70 Food Sci. Technol, Campinas, 35(1): 66-73, Jan.-Mar. 2015

 Passos et al.

Table 3. Glycemic Index (GI) and glycemic load (GL) of the fruits diseases such as diabetes mellitus. In Brazil, empirically, it
evaluated and their classification. has been observed in health services that there is an excessive
FRUIT GI CLASSIFICATION* GL** CLASSIFICATION *** intake of certain fruits during periods of greater availability,
Coconut with subsequent reports of altered glucose levels in certain
67±18.9 Moderate 7±2.0 Low populations during these periods. It is important that seasonal
Water
Custard consumption be investigated and quantified in order to be sure
59±21.1 Moderate 4±1.5 Low
Apple of the real impact of such consumption on health.
Hogs
Plum
24±17.8 Low 2±1.6 Low It cannot be omitted that the dietary analysis that uses GI
Cashew 45±12.2 Low 7±1.8 Low and GL is still controversial as to the indications and importance.
Guava 12±11.3 Low 1±1.3 Low Some systematic reviews and revisions (Esfahani et al., 2009;
Soursop 32±19.1 Low 3±1.8 Low Gnagnarella et al., 2008; Mente et al., 2009) demonstrate the value
Passion of using these indicators, but others do not show this relevance
16±11.5 Low 3±2.2 Low (Dong & Qin, 2011; Esfahani et al., 2011; Mulholland et al., 2008,
fruit
Sapodilla 37±27.9 Low 4±3.1 Low 2009). There is still a long way to go for researchers regarding
Tamarind 23±13.9 Low 6±3.3 Low this issue to ensure that GI and GL are quantified and addressed
* According to Brand-Miller  et  al. (2003). ** Recommended amount according to in studies on consumption and dietary prescription aimed at
the Food Guide for the Brazilian population (2006), Pacheco (2006), with standard
promoting health and preventing diseases.
caloric equivalent to that in the Food Guide for the Brazilian population (2006) and the
Consumer Expenditure Survey (Instituto Brasileiro de Geografia e Estatística, 2011).
***According to Burani (2006). 5 Conclusions
Most of the Brazilian fruits evaluated have low-glycemic index
and low glycemic load and can be consumed safely following
According to Brand-Miller et al. (2009b), the glycemic curve the dietary guidelines for quantity and variety. More effective
should not be evaluated only in terms of calculation of the area control of coconut water, cashew and custard apple intake is
under the curve (which leads to the determination of GI). The recommended, specifically for patients with chronic diseases
reason is that it is likely that the carbohydrates in some foods and poor glycemic control.
cause a sharp peak in the glycemic curve. However, these peaks
can quickly disappear so that a value lower than the reference
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