Substituting brown rice for white rice on diabetes risk factors in India: a randomised controlled trial

India has the second largest number of people with type 2 diabetes (T2D) globally. Epidemiological evidence indicates that consumption of white rice is positively associated with T2D risk, while intake of brown rice is inversely associated. Thus, we explored the effect of substituting brown rice for white rice on T2D risk factors among adults in urban South India. A total of 166 overweight (BMI >= 23 kg/m(2)) adults aged 25-65 years were enrolled in a randomised cross-over trial in Chennai, India. Interventions were a parboiled brown rice or white rice regimen providing two ad libitum meals/d, 6 d/week for 3 months with a 2-week washout period. Primary outcomes were blood glucose, insulin, glycosylated Hb (HbA1c), insulin resistance (homeostasis model assessment of insulin resistance) and lipids. High-sensitivity C-reactive protein (hs-CRP) was a secondary outcome. We did not observe significant between-group differences for primary outcomes among all participants. However, a significant reduction in HbA1c was observed in the brown rice group among participants with the metabolic syndrome (-0.18 (SE 0.08) %) relative to those without the metabolic syndrome (0.05 (SE 0.05) %) (P-for-heterogeneity = 0.02). Improvements in HbA1c, total and LDL-cholesterol were observed in the brown rice group among participants with a BMI >= 25 kg/m(2) compared with those with a BMI < 25 kg/m(2) (P-for-heterogeneity < 0.05). We observed a smaller increase in hs-CRP in the brown (0.03 (SD 2.12) mg/l) compared with white rice group (0.63 (SD 2.35) mg/l) (P=0.04). In conclusion, substituting brown rice for white rice showed a potential benefit on HbA1c among participants with the metabolic syndrome and an elevated BMI. A small benefit on inflammation was also observed.