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A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes.

Fernemark H, Jaredsson C, Bunjaku B, Rosenqvist U, Nystrom FH, Guldbrand H - PLoS ONE (2013)

Bottom Line: The test meals were consumed at a diabetes ward under supervision.Twenty-one participants were recruited and 19 completed the studies.The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden.

ABSTRACT

Background: In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.

Objective: To study postprandial effects of three diets, during a single day, in NIDDM.

Methods: A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision.

Results: Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).

Conclusions: The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.

Trial registration: ClinicalTrials.gov NCT01522157 NCT01522157.

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Related in: MedlinePlus

Effects of three different diets on glucose, insulin, triglycerides and glucose-dependent insulinotropic-polypeptide (GIP).Effects of a low-fat diet (open circles, regular lines), low-carbohydrate diet (open squares, dashed lines) and a Mediterranean-type diet (open triangles, dotted lines) with similar total energy intake as the low-fat and low-carbohydrate diets contained for both breakfast and lunch combined but eaten only at lunch paired with a glass of red wine (a, effects on glucose; b, effects on insulin; c, effects on serum triglyceride levels; d, effects on the incretin hormone glucose-dependent insulinotropic-polypeptide). All 19 patients with type 2 diabetes tested the three different diets for breakfast and lunch, *corresponds to Wilcoxon's signed rank paired test in comparison with the control (low-fat diet) at the same time-point (p<0.0063) for those variables that displayed differences in AUC (except GIP, see statistics section).
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pone-0079324-g002: Effects of three different diets on glucose, insulin, triglycerides and glucose-dependent insulinotropic-polypeptide (GIP).Effects of a low-fat diet (open circles, regular lines), low-carbohydrate diet (open squares, dashed lines) and a Mediterranean-type diet (open triangles, dotted lines) with similar total energy intake as the low-fat and low-carbohydrate diets contained for both breakfast and lunch combined but eaten only at lunch paired with a glass of red wine (a, effects on glucose; b, effects on insulin; c, effects on serum triglyceride levels; d, effects on the incretin hormone glucose-dependent insulinotropic-polypeptide). All 19 patients with type 2 diabetes tested the three different diets for breakfast and lunch, *corresponds to Wilcoxon's signed rank paired test in comparison with the control (low-fat diet) at the same time-point (p<0.0063) for those variables that displayed differences in AUC (except GIP, see statistics section).

Mentions: As seen in Figures 2a and 2b glucose and insulin levels increased more markedly following the low-fat meals compared with the low-carbohydrate meals. Table 3 shows the AUC for insulin, glucose, lipids and the other hormones. The corresponding figures show trends and statistical significances of the specific time-points compared with the low-fat diet as control (total cholesterol, LDL cholesterol, HDL cholesterol and leptin as Supporting Information, Figures S1–S4). The difference in AUC for triglycerides during the low-carbohydrate test day tended to be statistically significantly higher than during the low-fat test day, but the p-value (p = 0.014) did not meet the Bonferroni corrected level for statistical significance (Figure 2c and Table 3).


A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes.

Fernemark H, Jaredsson C, Bunjaku B, Rosenqvist U, Nystrom FH, Guldbrand H - PLoS ONE (2013)

Effects of three different diets on glucose, insulin, triglycerides and glucose-dependent insulinotropic-polypeptide (GIP).Effects of a low-fat diet (open circles, regular lines), low-carbohydrate diet (open squares, dashed lines) and a Mediterranean-type diet (open triangles, dotted lines) with similar total energy intake as the low-fat and low-carbohydrate diets contained for both breakfast and lunch combined but eaten only at lunch paired with a glass of red wine (a, effects on glucose; b, effects on insulin; c, effects on serum triglyceride levels; d, effects on the incretin hormone glucose-dependent insulinotropic-polypeptide). All 19 patients with type 2 diabetes tested the three different diets for breakfast and lunch, *corresponds to Wilcoxon's signed rank paired test in comparison with the control (low-fat diet) at the same time-point (p<0.0063) for those variables that displayed differences in AUC (except GIP, see statistics section).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842308&req=5

pone-0079324-g002: Effects of three different diets on glucose, insulin, triglycerides and glucose-dependent insulinotropic-polypeptide (GIP).Effects of a low-fat diet (open circles, regular lines), low-carbohydrate diet (open squares, dashed lines) and a Mediterranean-type diet (open triangles, dotted lines) with similar total energy intake as the low-fat and low-carbohydrate diets contained for both breakfast and lunch combined but eaten only at lunch paired with a glass of red wine (a, effects on glucose; b, effects on insulin; c, effects on serum triglyceride levels; d, effects on the incretin hormone glucose-dependent insulinotropic-polypeptide). All 19 patients with type 2 diabetes tested the three different diets for breakfast and lunch, *corresponds to Wilcoxon's signed rank paired test in comparison with the control (low-fat diet) at the same time-point (p<0.0063) for those variables that displayed differences in AUC (except GIP, see statistics section).
Mentions: As seen in Figures 2a and 2b glucose and insulin levels increased more markedly following the low-fat meals compared with the low-carbohydrate meals. Table 3 shows the AUC for insulin, glucose, lipids and the other hormones. The corresponding figures show trends and statistical significances of the specific time-points compared with the low-fat diet as control (total cholesterol, LDL cholesterol, HDL cholesterol and leptin as Supporting Information, Figures S1–S4). The difference in AUC for triglycerides during the low-carbohydrate test day tended to be statistically significantly higher than during the low-fat test day, but the p-value (p = 0.014) did not meet the Bonferroni corrected level for statistical significance (Figure 2c and Table 3).

Bottom Line: The test meals were consumed at a diabetes ward under supervision.Twenty-one participants were recruited and 19 completed the studies.The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden.

ABSTRACT

Background: In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.

Objective: To study postprandial effects of three diets, during a single day, in NIDDM.

Methods: A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision.

Results: Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).

Conclusions: The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.

Trial registration: ClinicalTrials.gov NCT01522157 NCT01522157.

Show MeSH
Related in: MedlinePlus