Acceptance and feasibility of novel staple foods among individuals with type 2 diabetes in Singapore: A mixed methods study

Hafizah Yusri¹Sean Jun Leong Ou¹Dimeng Yang¹Marcus Ting¹Salome A Rebello²Chin Meng Khoo³E Shyong Tai^2,3Mei Hui Liu^1*

• ¹Department of Food Science and Technology, Faculty of Science, National University of Singapore, Singapore, Singapore
• ²Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
• ³Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

Introduction: Novel staple foods (NVSFs) are defined as modified staple foods that provide healthier alternatives to type 2 diabetes (T2D) patients aiming to improve postprandial glycemic responses. We explored the expectations and perceptions of participants with T2D towards NVSFs alongside their feasibility using a mixed methods approach.Methods: Three distinct NVSFs were investigated: (i) bread fortified with anthocyanins for carbohydrase inhibition; (ii) white rice fortified with fibre; and (iii) microfluidic gel noodles reduced in available carbohydrates. Sixteen individuals with T2D participated in a 5-week crossover study where NVSFs or control staple foods were consumed in mixed meals for breakfast, lunch, and dinner. Participants wore continuous glucose monitoring devices during interventions to measure postprandial glycemic responses and interviews were conducted before and after interventions.Results: Qualitative analysis from interviews identified participants' prior dietary choices, prior NVSF perceptions, expectations, and impressions, trade-offs between sensory and healthfulness, price, modification methods, and other socio-economic regular consumption considerations as key factors contributing to the acceptance of NVSFs. Among the NVSFs, the anthocyanin-fortified bread and fibre-fortified rice were preferred for their palatability, but not the microfluidic noodles. However, quantitative analysis from continuous glucose monitoring revealed only the microfluidic noodle meal demonstrating a significant reduction in 2-hour iAUC value relative to its control from 160.2 ± 17.6 to 114.3 ± 12.2 mmol/L.min (mean ± SEM) p=0.046.Discussion: This highlights the challenge of attaining a balance between health and favorable sensory properties for these NVSFs, which may be attributed to their modification methods. We conclude that an alternative staple food with palatable taste and texture properties modified through the reduction of available carbohydrates may be an effective approach to enhance the acceptance and feasibility of modified staple foods for T2D management.