Recent Advances in Possible Effects of Bread Types and Enrichment on Appetite during Ramadan Fasting

Document Type: Review Article


1 MD, PhD candidate, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

2 Department of Nutrition, School of Medicine, Biochemistry and Nutrition, Endoscopic & Minimally Invasive Surgery, and Cancer Research Centers, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

3 Graduate Student of Clinical Pharmacy, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran

4 PhD in Food Engineering, Post-doctoral Researcher in Nutrition, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran


Introduction: Bread is the staple food of most Muslims and can be considered to be a component with a remarkable effect on satiety and appetite during Ramadan fasting. This study aimed to present the recent advances in investigating the effect of different types of bread and enrichments on satiety and appetite. Methods: In this paper, articles focusing on the effect of various bread types (including enriched bread) on satiety and appetite, particularly during fasting were reviewed. Articles were found in databases such as ISI, PubMed and Google Scholar. Results: Different bread types with lower glycemic index are recommended for Ramadan fasting, especially for the Sahur meal, due to better satiety and sglycemic control. In addition, fermentable dietary fibers, such as arabinoxylans, β-glucan, fructans, and resistant starch, can influence appetite through fermentation in the colon by saccharolytic bacteria and gastrointestinal tract releasing hormones changes. Consumption of wholemeal bread results in the moderation of satiety and starvation. Barely, oat and rye breads demonstrate the better improvement of satiety compared to white wheat bread due to their higher fiber content, probiotic ingredients and steadier glycemia. On the other hand, use of protein-rich breads can result in delayed gastric emptying, steadier insulin levels and higher satiety. Beta-glucan enrichment shows similar significant results in terms of reducing hunger and increasing satiety by influencing the appetite and satiety and regulating hormones such as insulin, ghrelin and PYY. Fiber enrichment and probiotics (Fructo-oligosaccharides/Inulin) could also be considered in this regard. Conclusion: During Ramadan fasting, barley bread, oat bread and wholegrain wheat bread could be suggested as the preferred bread types to be incorporated into the main meals to improve satiety and decrease hunger feeling.


  1.  Breen C, Ryan M, Gibney MJ, Corrigan M, O'Shea D. Glycemic, insulinemic, and appetite responses of patients with type 2 diabetes to commonly consumed breads. Diabetes Educ. 2013; 39(3):376-86.
  2. Isaksson H, Fredriksson H, Andersson R, Olsson J, Aman P. Effect of rye bread breakfasts on subjective hunger and satiety: a randomized controlled trial. Nutr J. 2009; 8:39.
  3. Johnson SK, Thomas SJ, Hall RS. Palatability and glucose, insulin and satiety responses of chickpea flour and extruded chickpea flour bread eaten as part of a breakfast. Eur J Clin Nutr. 2005; 59(2):169-76.
  4. Keogh J, Atkinson F, Eisenhauer B, Inamdar A, Brand-Miller J. Food intake, postprandial glucose, insulin and subjective satiety responses to three different bread-based test meals. Appetite. 2011; 57(3):707-10.
  5. Lee YP, Mori TA, Sipsas S, Barden A, Puddey IB, Burke V, et al. Lupin-enriched bread increases satiety and reduces energy intake acutely. Am J Clin Nutr. 2006; 84(5):975-80.
  6. Kristensen M, Jensen MG, Riboldi G, Petronio M, Bugel S, Toubro S, et al. Wholegrain vs. refined wheat bread and pasta. Effect on postprandial glycemia, appetite, and subsequent ad libitum energy intake in young healthy adults. Appetite. 2010; 54(1):163-9.
  7. Slavin J. Why whole grains are protective: biological mechanisms. Proc Nutr Soc. 2003; 62(1):129-34.
  8. Ritter RC. Gastrointestinal mechanisms of satiation for food. Physiol Behav. 2004; 81(2):249-73.
  9. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clin Nutr. 2010; 29(2):160-9.
  10. Nilsson AC, Ostman EM, Holst JJ, Bjorck IM. Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast. J Nutr. 2008; 138(4):732-9.
  11. Gonzalez-Anton C, Artacho R, Ruiz-Lopez MD, Gil A, Mesa MD. Modification of appetite by bread consumption: a systematic review of randomized controlled trials. Crit Rev Food Sci Nutr. 2017; 57(14):3035-50.
  12. Cinti S, Matteis RD, Pico C, Ceresi E, Obrador A, Maffeis C, et al. Secretory granules of endocrine and chief cells of human stomach mucosa contain leptin. Int J Obes Relat Metab Disord. 2000; 24(6):789-93.
  13. Zhang Y, Proenca R, Maffei M, Barone M, Leopold L, Friedman JM. Positional cloning of the mouse obese gene and its human homologue. Nature. 1994; 372(6505):425-32.
  14. Nakazato M, Murakami N, Date Y, Kojima M, Matsuo H, Kangawa K, et al. A role for ghrelin in the central regulation of feeding. Nature. 2001; 409(6817):194-8.
  15. Abizaid A, Horvath TL. Ghrelin and the central regulation of feeding and energy balance. Indian J Endocrinol Metab. 2012; 16(Suppl 3):S617-26.
  16. Radic R, Nikolic V, Karner I, Kosovic P, Kurbel S, Selthofer R, et al. Circadian rhythm of blood leptin level in obese and non-obese people. Coll Antropol. 2003; 27(2):555-61.
  17. Saad MF, Riad-Gabriel MG, Khan A, Sharma A, Michael R, Jinagouda SD, et al. Diurnal and ultradian rhythmicity of plasma leptin: effects of gender and adiposity. J Clin Endocrinol Metab. 1998; 83(2):453-9.
  18. Tschop M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature. 2000; 407(6806):
  19. Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001; 50(8):1714-9.
  20. Kolaczynski JW, Considine RV, Ohannesian J, Marco C, Opentanova I, Nyce MR, et al. Responses of leptin to short-term fasting and refeeding in humans: a link with ketogenesis but not ketones themselves. Diabetes. 1996; 45(11):1511-5.
  21. Toshinai K, Mondal MS, Nakazato M, Date Y, Murakami N, Kojima M, et al. Upregulation of Ghrelin expression in the stomach upon fasting, insulin-induced hypoglycemia, and leptin administration. Biochem Biophys Res Commun. 2001; 281(5):1220-5.
  22. Alzoghaibi MA, Pandi-Perumal SR, Sharif MM, BaHammam AS. Diurnal intermittent fasting during Ramadan: the effects on leptin and ghrelin levels. PloS One. 2014; 9(3):e92214.
  23. Natalucci G, Riedl S, Gleiss A, Zidek T, Frisch H. Spontaneous 24-h ghrelin secretion pattern in fasting subjects: maintenance of a meal-related pattern. Eur J Endocrinol. 2005; 152(6):845-50.
  24. Nedvidkova J, Krykorkova I, Bartak V, Papezova H, Gold PW, Alesci S, et al. Loss of meal-induced decrease in plasma ghrelin levels in patients with anorexia nervosa. J Clin Endocrinol Metab. 2003; 88(4):1678-82.
  25. Whybrow S, Stephen JR, Stubbs RJ. The evaluation of an electronic visual analogue scale system for appetite and mood. Eur J Clin Nutr. 2005; 60(4):558-60.
  26. Flint A, Raben A, Blundell JE, Astrup A. Reproducibility, power and validity of visual analogue scales in assessment of appetite sensations in single test meal studies. Int J Obes Relat Metab Disord. 2000; 24(1):38-48.
  27. Bahammam A. Does Ramadan fasting affect sleep? Int J Clin Pract. 2006; 60(12):1631-7.
  28. Roky R, Chapotot F, Hakkou F, Benchekroun MT, Buguet A. Sleep during Ramadan intermittent fasting. J Sleep Res. 2001; 10(4):319-27.
  29. McNeil J, Mamlouk MM, Duval K, Schwartz A, Nardo Junior N, Doucet E. Alterations in metabolic profile occur in normal-weight and obese men during the Ramadan fast despite no changes in anthropometry. J Obes. 2014; 2014:482547.
  30. Finch GM, Day JE, Razak H, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998; 31(2):159-70.
  31. Roberts SB. Glycemic index and satiety. Nutr Clin Care. 2003; 6(1):20-6.
  32. Bornet FR, Jardy-Gennetier AE, Jacquet N, Stowell J. Glycaemic response to foods: impact on satiety and long-term weight regulation. Appetite. 2007; 49(3):535-53.
  33. Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB. High glycemic index foods, overeating, and obesity. Pediatrics. 1999; 103(3):E26.
  34. Roberts SB. High-glycemic index foods, hunger, and obesity: is there a connection? Nutr Rev. 2000; 58(6):163-9.
  35. Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan: Update 2010. Diabetes Care. 2010; 33(8):1895-902.
  36. Bravis V, Hui E, Salih S, Mehar S, Hassanein M, Devendra D. Ramadan education and awareness in diabetes (READ) programme for muslims with type 2 diabetes who fast during Ramadan. Diabet Med. 2010; 27(3):327-31.
  37. Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al. Diabetes and Ramadan: practical guidelines. Diabetes Res Clin Pract. 2017; 126:303-16.
  38. Png W, Bhaskaran K, Sinclair AJ, Aziz AR. Effects of ingesting low glycemic index carbohydrate food for the sahur meal on subjective, metabolic and physiological responses, and endurance performance in Ramadan fasted men. Int J Food Sci Nutr. 2014; 65(5):629-36.
  39. Samra RA, Anderson GH. Insoluble cereal fiber reduces appetite and short-term food intake and glycemic response to food consumed 75 min later by healthy men. Am J Clin Nutr. 2007; 86(4):972-9.
  40. Smith CE, Tucker KL. Health benefits of cereal fibre: a review of clinical trials. Nutr Res Rev. 2011; 24(1):118-31.
  41. Frolich W, Aman P, Tetens I. Whole grain foods and health - a Scandinavian perspective. Food Nutr Res. 2013; 57:1-7.
  42. Isaksson H, Rakha A, Andersson R, Fredriksson H, Olsson J, Aman P. Rye kernel breakfast increases satiety in the afternoon - an effect of food structure. Nutr J. 2011; 10:31.
  43. Duncan SH, Louis P, Thomson JM, Flint HJ. The role of pH in determining the species composition of the human colonic microbiota. Environ Microbiol. 2009; 11(8):2112-22.
  44. Liljeberg Elmstahl H. Resistant starch content in a selection of starchy foods on the Swedish market. Eur J Clin Nutr. 2002; 56(6):500-5.
  45. Ibrugger S, Vigsnaes LK, Blennow A, Skuflic D, Raben A, Lauritzen L, et al. Second meal effect on appetite and fermentation of wholegrain rye foods. Appetite. 2014; 80:248-56.
  46. Isaksson H, Sundberg B, Åman P, Fredriksson H, Olsson J. Whole grain rye porridge breakfast improves satiety compared to refined wheat bread breakfast. Food Nutr Res. 2008; 52:1-7.
  47. Hlebowicz J, Lindstedt S, Bjorgell O, Hoglund P, Almer LO, Darwiche G. The botanical integrity of wheat products influences the gastric distention and satiety in healthy subjects. Nutr J. 2008; 7:12.
  48. Najjar AM, Parsons PM, Duncan AM, Robinson LE, Yada RY, Graham TE. The acute impact of ingestion of breads of varying composition on blood glucose, insulin and incretins following first and second meals. Br J Nutr. 2009; 101(3):391-8.
  49. Granfeldt Y, Liljeberg H, Drews A, Newman R, Bjorck I. Glucose and insulin responses to barley products: influence of food structure and amylose-amylopectin ratio. Am J Clin Nutr. 1994; 59(5):1075-82.
  50. Johansson EV, Nilsson AC, Ostman EM, Bjorck IM. Effects of indigestible carbohydrates in barley on glucose metabolism, appetite and voluntary food intake over 16 h in healthy adults. Nutr J. 2013; 12:46.
  51. Nilsson AC, Johansson-Boll EV, Bjorck IM. Increased gut hormones and insulin sensitivity index following a 3-d intervention with a barley kernel-based product: a randomised cross-over study in healthy middle-aged subjects. Br J Nutr. 2015; 114(6):899-907.
  52. Berti C, Riso P, Brusamolino A, Porrini M. Effect on appetite control of minor cereal and pseudocereal products. Br J Nutr. 2005; 94(5):850-8.
  53. Mälkki Y, Virtanen E. Gastrointestinal effects of oat bran and oat gum: a review. LWT-Food Sci Technol. 2001; 34(6):337-47.
  54. Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002; 76(1):5-56.
  55. Thorne MJ, Thompson LU, Jenkins DJ. Factors affecting starch digestibility and the glycemic response with special reference to legumes. Am J Clin Nutr. 1983; 38(3):481-8.
  56. Gonzalez-Anton C, Lopez-Millan B, Rico MC, Sanchez-Rodriguez E, Ruiz-Lopez MD, Gil A, et al. An enriched, cereal-based bread affects appetite ratings and glycemic, insulinemic, and gastroin-testinal hormone responses in healthy adults in a randomized, controlled trial. J Nutr. 2015; 145(2):231-8.
  57. Vitaglione P, Lumaga RB, Stanzione A, Scalfi L, Fogliano V. beta-Glucan-enriched bread reduces energy intake and modifies plasma ghrelin and peptide YY concentrations in the short term. Appetite. 2009; 53(3):338-44.
  58. Morris C, Morris GA. The effect of inulin and fructo-oligosaccharide supplementation on the textural, rheological and sensory properties of bread and their role in weight management: a review. Food Chem. 2012; 133(2):237-48.
  59. Gerstein DE, Woodward-Lopez G, Evans AE, Kelsey K, Drewnowski A. Clarifying concepts about macronutrients' effects on satiation and satiety. J Am Diet Assoc. 2004; 104(7):1151-3.
  60. Holt SH, Miller JB. Particle size, satiety and the glycaemic response. Eur J Clin Nutr. 1994; 48(7):496-502.
  61. Behall KM, Scholfield DJ, Hallfrisch J. The effect of particle size of whole-grain flour on plasma glucose, insulin, glucagon and thyroid-stimulating hormone in humans. J Am Coll Nutr. 1999; 18(6):591-7.
  62. Holt SH, Brand-Miller JC, Stitt PA. The effects of equal-energy portions of different breads on blood glucose levels, feelings of fullness and subsequent food intake. J Am Diet Assoc. 2001; 101(7):767-73.
  63. Holt S, Brand J, Soveny C, Hansky J. Relationship of satiety to postprandial glycaemic, insulin and cholecystokinin responses. Appetite. 1992; 18(2):129-41.
  64. Hall AC, Fairclough AC, Mahadevan K, Paxman JR. Ascophyllum nodosum enriched bread reduces subsequent energy intake with no effect on post-prandial glucose and cholesterol in healthy, overweight males. A pilot study. Appetite. 2012; 58(1):379-86.
  65. Coe S, Ryan L. White bread enriched with polyphenol extracts shows no effect on glycemic response or satiety, yet may increase postprandial insulin economy in healthy participants. Nutr Res. 2016; 36(2):193-200.