Consuming Carbohydrates after Meat or Vegetables Lowers Postprandial Excursions of Glucose and Insulin in Nondiabetic Subjects
Abstract
We aimed to examine the effects of variable timing of carbohydrate intake on postprandial glucose and insulin excursion in a diet with the same levels of energy and balance of three major nutrients. The study subjects included 8 healthy individuals, mean age 20.0±1.2 y (4 males and 4 females; mean age, 19.1±0.7 and 20.8±0.9 y, respectively), without a family history of diabetes. They consumed a test meal consisting of three separate plates of rice, vegetables, and meat after an overnight fast. The subjects consumed the three plates in different orders on three different days; the subsequent changes in glucose and insulin levels were measured over a 120-min period. The participants who consumed rice at the end showed a significantly lower increase in glucose and insulin levels after 30 min of consumption than that shown by participants who consumed rice first. The areas under the curves for both glucose and insulin responses over 120 min were the least when rice was consumed last, whereas they were the greatest when rice was consumed first. These findings suggested that consuming carbohydrates at the end of a meal is associated with lower postprandial excursions of glucose and insulin. In conclusion, consuming carbohydrates last following vegetables and meat protects against postprandial excursions of glucose and insulin levels.
... After screening, a total of nine reports were considered likely eligible for extraction (10)(11)(12)(18)(19)(20)(21)(22)(23). Three additional records were identified from reference lists (24)(25)(26), raising the total to 12 reports. No other records were identified by emailing a researcher (Shukla) who was a first author of multiple reports. ...
... Out of the final 11 reports included in this review, nine reported results from randomized crossover trials. The remaining two included data from studies that used a non-randomized crossover design (22,26). ...
... Not every report listed specific racial/ethnic characteristics of participants. That said, roughly half of reports either explicitly stated that participants had some type of East or Southeast Asian (Japanese, Chinese, Malaysian Indian, etc.) background (20,23,25) or implied so by referring to the study taking place in an East Asian country (19,24,26). ...
Objective
Aberrations in glucose, insulin, and other postprandial (PP) markers are common in obesity and cardiometabolic disorders. One potentially simple lifestyle/dietary modification to manage these issues is to change the order in which foods are consumed within meals. Carbohydrate exerts the largest effect on PP glucose, and there is some evidence that ingesting dietary fat or protein before carbohydrate delays gastric emptying of carbohydrate and reduces PP glucose. Additionally, certain dietary proteins may augment insulin release if ingested with carbohydrate, thereby improving blood glucose clearance. This review aimed to systematically evaluate evidence from acute experiments that modified the order in which foods were consumed in isocaloric meals.
Methods
Outcomes of interest were PP glucose and insulin (including area under the curve for both), C-peptide, gut hormones, and perceptual responses. Three databases were searched (PubMed, Cochrane CENTRAL, Web of Science) in February 2022. Additionally, reference lists of identified reports were searched, and an author of several studies was consulted to verify that relevant literature was included. The review included acute interventions that administered isocaloric meals of the same foods but with foods eaten in different orders. Studies were not excluded based on participant characteristics.
Results
Eleven reports were identified. All reports that assessed glucose and insulin showed a tendency toward lower levels, at least over parts of the PP period, by consuming carbohydrates last. GLP-1 tended to be higher in carbohydrate-last conditions, though this was only measured in a few studies. Perceptual responses (hunger, fullness, etc.) were not consistently different between conditions in two studies, but the certainty of evidence was very low.
Conclusions
Findings indicate that, at least acutely, there may be benefits to eating carbohydrate after vegetable and/or protein-rich foods. The most consistent effect (judged as moderate certainty) is that carbohydrate-last meal orders tend to lower blood glucose and insulin excursions.
... During chewing and digestion, their structure is broken, and different nutrients are absorbed. These foods require more energy to break down, and this process takes longer, with post-prandial glycemia being reduced (56)(57)(58). It should also be remembered that in this type of process, part of the fiber originally contained can be eliminated in the food, which would affect the GR. ...
... A significant decrease in AUC (mg/dl) is observed when starchy foods are consumed last, after fiber, fat, and protein. In this figure, adapted from Nishino et al. (58), AUC is represented with a circumference, being larger when the AUC is higher. for 1 and 3 days (2,032 ± 191 mg/dl, 1,881 ± 184 mg/dl, respectively) (68). ...
... In addition to meal composition and size, researchers have also looked at the impact of different foods on GR when eaten in a specific order (58). Recently, it has been seen that consuming protein, fat and fiber from vegetables before consuming starchy foods reduces postprandial blood glucose by up to 73% and circulating insulin levels by 48% (58,64,69,70), compared to consuming along with, or after eating starchy foods. ...
Diet plays a critical role in the management of many chronic diseases. It is well known that individuals with type 2 diabetes (T2D) need to pay close attention to foods rich in carbohydrates to better manage their blood sugar. Usually, individuals are told to increase their dietary fiber intake which is associated with better glycemic control and limit their overall carbohydrate consumption. However, there are many other cooking strategies available to reduce the glycemic response to meals rich in carbohydrates and with a high glycemic index, such as adding fats, proteins, or vinegar, modifying the cooking or preparation processes, and even the selection and storage of foods consumed. The aim of the present narrative review is to summarize some of these existing strategies applied to the cooking process and their ability to modulate glycemic response to meals in individuals with T2D.
... Eating order is a specific detail of one's eating habit and often varies from person to person. Previous studies on eating orders have focused on glycemic control in adults with diabetes (22,23). Few studies have examined the link between eating order and risk of obesity. ...
... In addition to children, eating vegetables also has many advantages for adults. A study found that eating vegetables first, then meat and/or fish, and then carbohydrates can prevent the fluctuation of postprandial blood glucose and insulin levels (23). For patients with type 2 diabetes, eating vegetables can effectively control short-and long-term blood glucose levels (30). ...
Background
Early childhood is a critical period for dietary education and development of good eating habits. However, few studies have investigated the effect of eating order in children and childhood obesity in real-world settings.Objective
To examine whether the order in which meats/fish or vegetables are consumed affects the risk of obesity in preschoolers.Methods
We conducted a population-based cross-sectional study using a self-administered online survey on the lifestyle and health behaviors of preschoolers in Taizhou, China. A total of 3,200 parents were invited to take part in the survey, and 2,049 of them completed the questionnaire. Children were classified as having a normal weight, overweight, or obesity using the definitions provided by the International Obesity Task Force, and z-scores for body mass index were calculated. We divided the children's eating order at the beginning of the meal into two groups: “vegetables before meats/fish” or “meats/fish before vegetables”. We analyzed the relationship between what was consumed first at a meal and the overweight status of each child.ResultsNo difference in body mass index was observed between the children eating meats/fish-first and the children eating vegetables-first during a meal. Children with parents who were affected by obesity were more likely to eat vegetables first. Among children of mothers with obesity, body mass index was significantly higher in the meats/fish-first group than that in the vegetable-first group (2.891 vs. 0.845, P = 0.007). In children whose mothers were affected by obesity, those that ate meats/fish first had a 12.21 times higher risk of being overweight compared with those that ate vegetables first (95% CI:1.22–121.74, P = 0.033).Conclusion
Our findings suggest eating vegetables or meats/fish at the start of a meal does not affect weight status in preschoolers.
... consume the components of the meal in the same order to avoid a meal order effect. 19,20 Water intake as allowed ad libitum. ...
Background
Glycemic markers, including postprandial glucose, insulin, and insulin resistance, are strong predictors of morbidity and mortality in individuals with and without diabetes. Stair-climbing and -descending (SCD) at a comfortable pace for 3 minutes after a sugary beverage (300 kilocalories; 100% carbohydrate) lowers insulin, with insulin sensitivity improving in 10 minutes. If similar benefits are seen following consumption of a mixed meal is unknown. We hypothesize SCD will improve these markers in a dose-response manner following a mixed meal.
Methods
In a randomized, controlled, crossover trial, young adults (N = 31) performed SCD for 0 (seated control), 1, 3, and 10 minutes after a mixed meal (650 kilocalories; 53% carbohydrates, 33% fat, and 14% protein). Differences in glucose, insulin, and insulin sensitivity (ISI) from baseline to 30 min were analyzed using a mixed-effects ANOVA.
Results
A significant fixed-effect was found for change in glucose [F(2.551,67.17) = 4.724,p = 0.007)], insulin [F(2.692,74.49) = 11.28,p < 0.001)], and ISI [F(2.127,56.00) = 5.848,p = 0.004)]. Compared to the seated control (0 minutes), changes in glucose were lower after 1 minute (−14.0 (−7.2)mg/dL,p < 0.001), 3 minutes (−18.4 (−7.0)mg/dL,p = 0.0007), and 10 minutes (−10.0 (−8.1)mg/dL,p = 0.039); changes in insulin were lower after 1 minute (−1.8 (−0.9)μIU/mL,p = 0.0011), 3 minutes (−2.8 (−0.9)μIU/mL,p < 0.001), and 10 minutes (−1.1 (−0.9)μIU/mL,p = 0.033); and changes in ISI were significantly higher after 3 minutes (2.4 (1.5),p < 0.001) and 10 minutes (1.3 (1.6),p = 0.014) but not 1 minute (1.2 (1.5),p = 0.059).
Conclusion
Postprandial glucose and insulin improved with 1 minute, and insulin resistance improved with 3 minutes, of SCD at a self-selected, comfortable pace, after consumption of a mixed meal in apparently healthy young adults.
Protocol
Trial registration: ClinicalTrials.gov Identifier: NCT04232475.
... [8,9] Recent studies have reported that vegetables consumption before carbohydrate can decrease the postprandial glucose levels among diabetic patients in USA and Japan. [10][11][12] Growing evidence also indicates that the consumption of vegetables before carbohydrate decreases post prandial glucose and insulin levels and up-regulates GLP-1 secretion in healthy people, [13] pre diabetes patients [14] and T2DM patients. [10] Therefore, these findings become a strategic and promising method for diet modification in T2DM patients. ...
Background:
Type 2 Diabetes Mellitus (T2DM) is the prominent public health issue. Pharmacotherapy and diet modification should be integrated into T2DM management.
Aims:
To investigate the effects of vegetables consumption before carbohydrates on blood glucose and GLP-1 levels in T2DM patients.
Methods:
A non-randomized quasi experimental study was conducted to recruit T2DM patients who attended at the Gatot Soebroto Central Army Hospital, Jakarta, Indonesia from April to May 2016. The Lemeshow's formula was used to determine sample size. A total of 12 non-diabetic and 24 diabetic patients were participated in our study. Glucose levels were measured using a routine hexokinase method while serum GLP-1 levels were determined using the ELISA. The student t-test was used to compare two groups with parametric data. The significant difference was at P < 0.05.
Results:
Our data showed that T2DM patients who consumed vegetables before carbohydrates, had relatively stable glucose levels at 0, 60 and 120 mins (164.25 ± 86.89 vs 183.5 ± 55.96 vs 167.83 ± 65.53, P = 0.163) and stay lowered within the normal range compared to T2DM patients who consumed vegetables after carbohydrates (165.08 ± 67.89 vs 241.92 ± 68.03 vs 204.92 ± 81.76, P = 0.022). Additionally, GLP-1 levels remained stable after 60 and 120 min at day 1 (P = 0.816) and day 3 (P = 0.955).
Conclusions:
Vegetables consumption before carbohydrate is a promising and simple method of diabetes diet for maintaining blood glucose and GLP-1 levels and preventing from vascular complication.
... It was comprised of 1 cup of fortified breakfast cereal (Cheerios, General Mills), 1 cup of 2% cow's milk (Trader Joe's), 1 slice of 100% whole wheat bread (Western Hearth), 2 tablespoons of peanut butter (Jif), 1 tablespoon of blackberry jam (Smucker's), and 100 g of a fresh ripe banana (Chiquita) for a total of 650 kilocalories (53% carbohydrate, 33% fat, and 14% protein). The order of consumption of these food items was kept consistent within subjects to minimize the meal order effect [26,27]. ...
Backgrounds and aims
Single, short stair climbing and descending (SCD) bouts of low to moderate intensity effectively lower postprandial blood glucose but previous reports have found conflicting results on interactions by sex during exercise. We hypothesize SCD at a self-selected intensity will be equally effective at lowering postprandial blood glucose in males and females. Methods and Results: Thirty subjects (age: 23.8 (3.0) y) performed 0, 1, 3, and 10 minutes of SCD following consumption of a mixed meal. SCD was performed at a self-selected comfortable pace and all bouts ended at minute 28. Postprandial blood glucose was measured every 15 min for 1 hour and analyzed as glucose over time, area under the curve (AUC), and incremental AUC (iAUC) using mixed design ANOVAs with repeated measures. Although there was no interaction between sex and condition or time (p = .129-.541) for glucose over time, AUC, or iAUC, there was a main effect for sex for glucose over time (p = .004) and AUC (p = .006), but not iAUC (p = .125). Females had higher blood glucose throughout each trial (22% (13–31%), p = .004) but both males' and females’ postprandial blood glucose was lowered following 10 min of SCD relative to the seated control condition. Conclusions: Males and females benefited equally from single, short SCD bouts of low to moderate intensity despite females having higher blood glucose at all timepoints. Previous findings of sex differences in the attenuating effect of exercise on postprandial blood glucose are likely due to the use of absolute workloads leading to varying relative intensities.
... This practice is reported to improve the HbA1c value in diabetic patients [3][4]. The same effect is confirmed by eating both vegetables and meat, fish, etc [5][6]. ...
Background: It has been confirmed that the daily consumption of seaweed such as Wakame (Undaria pinnatifida) and Kombu (Saccharina japonica) has an inhibitory effect on the rise in postprandial blood glucose levels. Similar effects can also be expected for Mekabu, which is Wakame sporophylls and contains large quantities of water-soluble dietary fiber. In this study, we examined the effects of preprandial intake of Mekabu on postprandial blood glucose levels and blood glucose regulation-related hormones in healthy young women.Methods: The subjects were ten healthy young adult women. Mekabu was eaten, followed by rice only. Blood was sampled five times: while fasting (0 min), and 15, 30, 90, and 120 minutes after eating. Measurements were taken of blood glucose level and blood glucose regulation-related hormones.Result: Eating Mekabu before rice resulted in a significant reduction of Δglucose and Δinsulin at 30 minutes after ingestion (p = 0.034, p = 0.049, respectively). The concentration of glucagon-like peptide-1 (GLP-1) in plasma was higher 30 minutes after eating (p = 0.044), 60 minutes (p = 0.0.31), and 120 minutes (p = 0.019) when Mekabu was eaten preprandially.Conclusions: In the present study, GLP-1 secretion was sustained by eating Mekabu, which is Wakame sporophylls, before rice. Our results suggest that ingesting Mekabu, which contains large amounts of viscous alginic acid, prior to a meal not only suppresses postprandial blood glucose level, but supports the extended secretion of GLP-1, providing a sustainable incretin effect.
Chegando ao seu quarto ano desde sua primeira versão, a Diretriz da SBD atinge a incrível marca de 4,9 milhões de acessos. A constante busca da excelência científica já se tornou o lema desta Diretriz, que vai se tornando referência nacional para orientar o tratamento do diabetes. Um trabalho incessante e criterioso, que só tem sido possível graças ao portfólio de mentes brilhantes e abnegadas que compõem a SBD em seus comitês e departamentos. A velocidade com que a ciência evolui em torno do Diabetes nos obriga a produzir atualizações quase que em fluxo contínuo, de forma que, entre os UPDATES anuais, frequentes inserções de novas recomendações têm sido necessárias sob forma de revisão. O formato digital tem cumprido sua função em tornar ágil a chegada da informação atualizada ao profissional. No seu UPDATE 2024 a Diretriz lança 9 novos capítulos, atingindo um total de 45. Os principais destaques desta edição são: o manejo da hiperglicemia hospitalar no paciente não-crítico; o manejo da doença hepática gordurosa metabólica, em sintonia com a nova diretriz da SBEM; o novo UPDATE do manejo da doença renal do diabetes, agora bem mais abrangente e já incluindo o estudo FLOW, com um reposicionamento da semaglutida e da finerenona; uma importante atualização no capítulo de diagnóstico do diabetes, agora incluindo o papel da glicemia intermediária com o TTGO de 1h, que passa a ser recomendada em pessoas com pré-diabetes. Além disso uma revisão do manejo da hiperglicemia no DM2, com novidades em pacientes com doença cardiovascular isquêmica e insuficiência cardíaca. Todos os grandes trials, pertinentes ao manejo do diabetes e publicados até junho de 2024 foram incluídos neste UPDATE. Importante enfatizar que, quando novos grandes estudos vierem a surgir, novas atualizações pontuais serão realizadas, nos próximos meses, mesmo antes do lançamento do UPDATE anual. Uma nova interface gráfica com um novo design permite maior fluidez na navegação no site. Figuras e tabelas passaram por melhorias substanciais para atingir uma excelente qualidade gráfica. Uma nova seção de perspectivas no diabetes foi incluída, onde serão abordadas, periodicamente, novidades em tecnologia no diabetes. A SBD cumpre assim sua missão de informar, com qualidade, ao maior número possível de profissionais de saúde que impactam na vida das pessoas com diabetes. Esta evolução é fruto de um grupo de pessoas que está comprometido com a excelência no tratamento do diabetes no Brasil. Saudações a todos. Marcello Bertoluci – Editor-chefe da edição 2024.
Ingestion of foods containing dietary fiber and main dishes containing protein moderates glucose absorption into the body from the intake of staple foods. In recent years, the “eating order diet,” which slows the rise in blood glucose levels by changing the order in which meals are eaten, has been attracting attention. In this study, we used a flash glucose monitoring device, FreeStyle Libre, to examine the effects of food combinations and eating order on suppressing increases in interstitial fluid glucose levels and their individual differences.
Seventeen healthy young women consented to this study, had FreeStyle Libre worn on their upper arms, and interstitial fluid glucose levels were monitored at 15-minute intervals for 3 hours after breakfast intake. The meal consisted of 150 g of white rice, 150 g of cabbage (2.7 g of dietary fiber), 10 g of oat bran (2.5 g of dietary fiber), and 80 g of grilled salted salmon. To compare interstitial fluid glucose level increases, the areas under the glucose level increase curves (iAUC0-2 and iAUC0-3) for 2 hours and 3 hours after meals were used.
In the control test of consuming only white rice, the iAUC0-2 of 17 participants showed significant individual differences ranging from 6.81 to 1.69 mM・h. The participants were divided into two groups; the top nine were in the H-group, and the remaining eight were in the L-group. When compared under three experimental conditions: ingesting cabbage followed by white rice, white rice and grilled salted salmon, and cabbage followed by white rice and grilled salted salmon, cabbage and grilled salted salmon suppressed the increase in interstitial fluid glucose levels, respectively, and both cabbage and grilled salted salmon intake had an additive effect in the H-group. However, no suppressive effect was observed in the L-group under all three conditions. A similar difference between the H- and L-groups was observed when cabbage was replaced with oat bran.
We conclude that the effect of prior intake of foods containing dietary fiber or main dishes containing protein in slowing the rise in interstitial fluid glucose levels is practical for people whose interstitial fluid glucose levels are prone to rise after consuming white rice; however, the effect is negligible for people whose interstitial fluid glucose levels are not prone to rise.
【緒言】FreeStyleリ ブレを用いて、食材の組み合わせや食べる順番が及ぼす間質液グルコース値上昇の抑制の効果およびその 個人差を検討した。
【方法】 本試験に同意した若年女性健常者17名を対象にFreeStyleリブレを上腕部に装着させ、朝食の摂 取より３時間にわたり15分間隔で間質液のグルコース値をモニターした。食事は、白飯150 g、キャベツ 150 g (食物繊維として2.7 g) 、えん麦ふすま10 g(食物繊維として2.5 g) 、焼き塩鮭80 gを用いた。間質 液グルコース値上昇の比較は、食後２時間および３時間のグルコース値上昇曲線下面積(iAUC 0-2 および iAUC 0-3)を用いた。
【結果】 白飯のみ摂取の対照試験では、17名のiAUC 0-2 は、6.81 ～ 1.69 mM・hと大きな個人差が見られ た。上位９名をH-グループ、 残り８名をL-グループとし、 キャベツ摂取後に白飯摂取、 白飯と焼き塩鮭摂取、 キャベツ摂取後に白飯と焼き塩鮭摂取の３実験条件で比較すると、H-グループでは、キャベツや焼き塩鮭 による間質液グルコース値上昇の抑制効果ならびにキャベツと焼き塩鮭の相加効果の傾向が見られた。し かし、L-グループでは３条件すべてで抑制効果は見られなかった。キャベツをえん麦ふすまに替えた場合 も同様にH-グループとL-グループの差が見られた。
【考察】 食物繊維を含む食品の事前摂取やたんぱく質を含む主菜摂取による間質液グルコース値上昇を緩 やかにする効果は、白飯摂取後に間質液グルコース値の上昇しやすい人には効果があるが、元々上昇しに くい人には効果が小さいことが示唆された。
Background and Aims
Almost all of the energy in noodle dishes is derived from carbohydrates, particularly starch. Recently, we invented a pasta with reduced starch content to about 50% and increased dietary fiber content, designated low-starch high-fiber pasta (LSHFP). In this study, we investigated the ingestion of LSHFP on the postprandial glucose response as a breakfast meal.
Methods and Result
This was a randomized, single-blinded, crossover study. The postprandial glucose area under the curve for 4 hours (4h-gluAUC), as the primary outcome, and the extent of postprandial glucose elevation (maxΔBG) were evaluated using a continuous glucose monitoring system in healthy volunteers and patients with type 2 diabetes (T2DM) after intake of LSHFP, standard pasta (SP), and rice. The amount of total carbohydrate was matched between LSHFP and SP. Ten individuals with T2DM and 10 individuals who did not have T2DM and were otherwise healthy were enrolled in this crossover study. The 4h-gluAUC for LSHFP (137.6±42.2 mg/dL・h) was significantly smaller than the 4h-gluAUC for rice (201.7±38.7 mg/dL・h) (p=0.001) and SP (178.5±59.2 mg/dL・h) (p=0.020). The maxΔBG for rice (118.6±24.2 mg/dL) was significantly higher than those for SP (87.5±19.9 mg/dL) (p<0.001) and LSHFP (72.7±26.2 mg/dL) (p=0.001), while the maxΔBG for LSHFP (p=0.047) was significantly lower than that for SP, in T2DM patients as well as in healthy participants.
Conclusions
This study demonstrated that LSHFP can reduce postprandial glucose elevation compared with SP in both healthy participants and patients with T2DM.
Lipid and protein ingested before carbohydrate reduce postprandial hyperglycemia. We tested feasibility, safety and clinical efficacy of manipulating the sequence of nutrient ingestion in patients with type 2 diabetes (T2D). After a 4-week run-in, 17 T2D patients were randomized to either a control diet (CD) or to an experimental diet (ED) allowing the consumption of high-carbohydrate foods only after high-protein and high-fat foods at each main meal (lunch+dinner). Both diets were accurately followed and neutral on arterial blood pressure, plasma lipids and indices of hepatic and kidney function. After 8 weeks, in spite of a similar reduction of body weight (ED -1.9 95% confidence interval (-3.4/-0.4)kg, P<0.03; CD -2.0 (-3.6/-0.5)kg, P<0.02) and waist circumference (ED -2.9 (-4.3/-1.5)cm, P<0.002; CD -3.3 (-5.9/-0.7)cm, P<0.02), the ED only was associated with significant reductions of HbA1c (-0.3 (-0.50/-0.02)%, P<0.04), fasting plasma glucose (-1.0 (-1.8/-0.3)mmol l(-1), P<0.01), postprandial glucose excursions (lunch -1.8 (-3.2/-0.4)mmol l(-1), P<0.01; dinner: -1.0 (-1.9/-0.1)mmol l(-1), P<0.04) and other indices of glucose variability (s.d.: -0.5 (-0.7/-0.2)mmol l(-1), P<0.02; Coefficient of variation: -6.6 (-10.4/-2.7)%, P<0.02). When compared with the CD, the ED was associated with lower post-lunch glucose excursions (P<0.02) and lower glucose coefficients of variation (P<0.05). Manipulating the sequence of nutrient ingestion might reveal a rapid, feasible, economic and safe strategy for optimizing glucose control in T2D.
Aims/hypothesis
Investigation of dietary therapy for diabetes has focused on meal size and composition; examination of the effects of meal sequence on postprandial glucose management is limited. The effects of fish or meat before rice on postprandial glucose excursion, gastric emptying and incretin secretions were investigated.
Methods
The experiment was a single centre, randomised controlled crossover, exploratory trial conducted in an outpatient ward of a private hospital in Osaka, Japan. Patients with type 2 diabetes (n = 12) and healthy volunteers (n = 10), with age 30–75 years, HbA1c 9.0% (75 mmol/mol) or less, and BMI 35 kg/m2 or less, were randomised evenly to two groups by use of stratified randomisation, and subjected to meal sequence tests on three separate mornings; days 1 and 2, rice before fish (RF) or fish before rice (FR) in a crossover fashion; and day 3, meat before rice (MR). Pre- and postprandial levels of glucose, insulin, C-peptide and glucagon as well as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide were evaluated. Gastric emptying rate was determined by 13C-acetate breath test involving measurement of 13CO2 in breath samples collected before and after ingestion of rice steamed with 13C-labelled sodium acetate. Participants, people doing measurements or examinations, and people assessing the outcomes were not blinded to group assignment.
Results
FR and MR in comparison with RF ameliorated postprandial glucose excursion (AUC−15–240 min-glucose: type 2 diabetes, FR 2,326.6 ± 114.7 mmol/l × min, MR 2,257.0 ± 82.3 mmol/l × min, RF 2,475.6 ± 87.2 mmol/l × min [p < 0.05 for FR vs RF and MR vs RF]; healthy, FR 1,419.8 ± 72.3 mmol/l × min, MR 1,389.7 ± 69.4 mmol/l × min, RF 1,483.9 ± 72.8 mmol/l × min) and glucose variability (SD−15–240 min-glucose: type 2 diabetes, FR 1.94 ± 0.22 mmol/l, MR 1.68 ± 0.18 mmol/l, RF 2.77 ± 0.24 mmol/l [p < 0.05 for FR vs RF and MR vs RF]; healthy, FR 0.95 ± 0.21 mmol/l, MR 0.83 ± 0.16 mmol/l, RF 1.18 ± 0.27 mmol/l). FR and MR also enhanced GLP-1 secretion, MR more strongly than FR or RF (AUC−15–240 min-GLP-1: type 2 diabetes, FR 7,123.4 ± 376.3 pmol/l × min, MR 7,743.6 ± 801.4 pmol/l × min, RF 6,189.9 ± 581.3 pmol/l × min [p < 0.05 for FR vs RF and MR vs RF]; healthy, FR 3,977.3 ± 324.6 pmol/l × min, MR 4,897.7 ± 330.7 pmol/l × min, RF 3,747.5 ± 572.6 pmol/l × min [p < 0.05 for MR vs RF and MR vs FR]). FR and MR delayed gastric emptying (Time50%: type 2 diabetes, FR 83.2 ± 7.2 min, MR 82.3 ± 6.4 min, RF 29.8 ± 3.9 min [p < 0.05 for FR vs RF and MR vs RF]; healthy, FR 66.3 ± 5.5 min, MR 74.4 ± 7.6 min, RF 32.4 ± 4.5 min [p < 0.05 for FR vs RF and MR vs RF]), which is associated with amelioration of postprandial glucose excursion (AUC−15–120 min-glucose: type 2 diabetes, r = −0.746, p < 0.05; healthy, r = −0.433, p < 0.05) and glucose variability (SD−15–240 min-glucose: type 2 diabetes, r = −0.578, p < 0.05; healthy, r = −0.526, p < 0.05), as well as with increasing GLP-1 (AUC−15–120 min-GLP-1: type 2 diabetes, r = 0.437, p < 0.05; healthy, r = 0.300, p = 0.107) and glucagon (AUC−15–120 min-glucagon: type 2 diabetes, r = 0.399, p < 0.05; healthy, r = 0.471, p < 0.05). The measured outcomes were comparable between the two randomised groups.
Conclusions/interpretation
Meal sequence can play a role in postprandial glucose control through both delayed gastric emptying and enhanced incretin secretion. Our findings provide clues for medical nutrition therapy to better prevent and manage type 2 diabetes.
Aims/IntroductionThis cohort study assessed the risk among Japanese men for developing type 2 diabetes, based on the percentage of energy intake from carbohydrates and degree of obesity.Participants and Methods
The participants were 2,006 male factory employees, and the macronutrient intake of each patient was measured using a self-administered diet history questionnaire. The incidence of diabetes was determined in annual blood examinations over a 10-year period.ResultsDuring the study, 232 participants developed diabetes. The crude incidence rates (/1,000 person-years) for different levels of carbohydrate intake as a percentage of calories consumed (<50.0%, 50.0–57.4%, 57.5–65.0%, >65.0% of energy intake) were 16.5, 14.4, 12.7, and 17.6. Overall, carbohydrate intake was not associated with the risk of diabetes. However, there was significant interaction between carbohydrate intake and degree of obesity on the incidence of diabetes (p for interaction = 0.024). Higher carbohydrate intake was associated with elevated risk for diabetes among participants with a body mass index ≥25.0 kg/m2 (p for trend = 0.034). For obese subjects, the multivariate-adjusted hazard ratio for those with carbohydrate intakes >65% energy was 2.01 (95% confidence interval, 1.08–3.71), which was significantly higher than that of subjects with carbohydrate intakes 50.0–57.4% energy.Conclusions
Higher carbohydrate intake was associated with higher risk of diabetes in obese subjects, but not in non-obese subjects. Obese subjects with carbohydrate intakes >65% energy should reduce their intakes to levels within the desirable carbohydrate energy proportion for Japanese (50-65% energy) to prevent development of type 2 diabetes.This article is protected by copyright. All rights reserved.
Large fluctuations in blood glucose are reported to promote the micro- and macrovascular complications associated with Type 2 diabetes. Postprandial plasma glucose and glycaemic spikes are more strongly associated with atherosclerosis than fasting plasma glucose or HbA(1c) level [1]. Therefore, safe and effective interventions, including diet, are needed to reduce glycaemic variability and minimize hypoglycaemic events. The continuous glucose monitoring system is capable of detecting hypoglycaemia and hyperglycaemia that may be undetectable by self monitoring blood glucose and HbA(1c) [2]. In particular, the mean amplitude of glycaemic excursions is a significant determinant of overall metabolic control, as well as increased risk of diabetes complications. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Postprandial hyperglycemia is associated with increased risk for macrovascular disease. We studied the effects of eating "vegetables before carbohydrates" on postprandial plasma glucose in outpatients with type 2 diabetes mellitus (T2DM). We conducted a randomized crossover study in 15 subjects with T2DM patients controlled by diet and having the following profiles age 61.7 ± 11.6 yrs, male/female ratio: 7/8, BMI 24.7 ± 4.3. HbA1c 6.0 ± 0.6%, years of DM duration 5.3 ± 8.8 yrs: mean ± SD. Subjects ate test meals consisting of white rice and vegetable salad, eating either "carbohydrates before vegetables" or vice versa for 4 weeks. Plasma glucose and serum insulin were evaluated at 0,30,60, and 120 min after each meaL Postprandial plasma glucose in those following the "vegetables before carbohydrates" regimen was reduced at 30 and 60 min compared to the reverse regimen at 217 ± 40 vs 172 ± 31 mg/d/ (P < 0.01) and 208 ± 56 vs 187 ± 41 mg/d/ (P = 0.074). Postprandial serum insulin decreased significantly at 30 and 60 min in the "vegetables before rice" regimen at 32.9 ± 20.8 vs 22.3 ± 14.6 μU/ml (P<0.01), 35.4 ± 21.6 vs 24.9 ± 13.4μ U/ml (P< 0.05). These results suggest that eating vegetables before carbohydrates may be beneficial in preventing subjects with postprandial hyperglycemia and T2DM.
Postprandial hyperglycemia is an important therapeutic target for optimizing glycemic control and for mitigating the proatherogenic vascular environment characteristic of type 2 diabetes. Existing evidence indicates that the quantity and type of carbohydrate consumed influence blood glucose levels and that the total amount of carbohydrate consumed is the primary predictor of glycemic response (1). Previous studies have shown that premeal ingestion of whey protein, as well as altering the macronutrient composition of a meal, reduces postmeal glucose levels (2–4). There are limited data, however, regarding the effect of food order on postprandial glycemia in patients with type 2 diabetes (5). In this pilot study, we sought to examine the effect of food order, using a typical Western meal, incorporating vegetables, protein, and carbohydrate, on postprandial glucose and insulin excursions in overweight/obese adults with type 2 diabetes.
A total of 11 subjects (6 female, 5 male) with metformin-treated type 2 diabetes were studied …
Background:
New diagnostic criteria for diabetes based on fasting blood glucose (FBG) level were approved by the American Diabetes Association. The impact of using FBG only has not been evaluated thoroughly. The fasting and the 2-hour glucose (2h-BG) criteria were compared with regard to the prediction of mortality.
Methods:
Existing baseline data on glucose level at fasting and 2 hours after a 75-g oral glucose tolerance test from 10 prospective European cohort studies including 15 388 men and 7126 women aged 30 to 89 years, with a median follow-up of 8.8 years, were analyzed. Hazards ratios for death from all causes, cardiovascular disease, coronary heart disease, and stroke were estimated.
Results:
Multivariate Cox regression analyses showed that the inclusion of FBG did not add significant information on the prediction of 2h-BG alone (P>.10 for various causes), whereas the addition of 2h-BG to FBG criteria significantly improved the prediction (P<.001 for all causes and P<.005 for cardiovascular disease). In a model including FBG and 2h-BG simultaneously, hazards ratios (95% confidence intervals) in subjects with diabetes on 2h-BG were 1.73 (1.45-2.06) for all causes, 1.40 (1.02-1.92) for cardiovascular disease, 1.56 (1.03-2.36) for coronary heart disease, and 1.29 (0.66-2.54) for stroke mortality, compared with the normal 2h-BG group. Compared with the normal FBG group, the corresponding hazards ratios in subjects with diabetes on FBG were 1.21 (1.01-1.44), 1.20 (0.88-1.64), 1.09 (0.71-1.67), and 1.64 (0.88-3.07), respectively. The largest number of excess deaths was observed in subjects who had impaired glucose tolerance but normal FBG levels.
Conclusion:
The 2h-BG is a better predictor of deaths from all causes and cardiovascular disease than is FBG.
This cohort study investigated the association between dietary glycemic index (GI), glycemic load (GL), and the incidence of type 2 diabetes mellitus in middle-aged Japanese men, and the effect of insulin resistance and pancreatic B-cell function on the association. Participants were 1995 male employees of a metal products factory in Japan. Dietary GI and GL were assessed using a self-administered diet history questionnaire. The incidence of diabetes was detected in annual medical examinations over a 6-year period. The association between GI, GL, and the incidence of diabetes was evaluated using Cox proportional hazards models. During the study, 133 participants developed diabetes. Age- and body mass index-adjusted hazard ratios across the GI quintiles were 1.00 (reference), 1.62, 1.50, 1.68, and 1.80; and those of GL were 1.00 (reference), 1.07, 1.48, 0.95, and 0.98. The hazard ratio for the highest GI quintile was significantly greater than that for the lowest quintile. The influence of GI was more pronounced in the lowest insulin resistance subgroups. GI and pancreatic B-cell function were independently associated with the incidence of type 2 diabetes mellitus; participants with low B-cell function and the highest tertile of GI had the highest risk of diabetes. Dietary GI is associated with the incidence of diabetes in middle-aged Japanese men. GI and B-cell function were independently associated with incidence of diabetes.
This study aimed to determine whether educating diabetic patients to 'eat vegetables before carbohydrate' was as effective on long-term glycemic control as a traditional exchange-based meal plan. To test this hypothesis, we carried out a randomized, controlled trial in patients with type 2 diabetes that compared changes in HbA1c as the primary outcome. A total of 101 patients were stratified according to sex, age, BMI, duration of diabetes, and HbA1c, and then randomized to receive instructions to eat either vegetables before carbohydrate (VBC, n=69) or an exchange-based meal plan (EXB, n=32). The impact of the two plans on glycemic control was compared over 24 months of follow-up. Significant improvements in HbA1c over 24 months were observed in both groups (VBC, 8.3 to 6.8% vs EXB, 8.2 to 7.3%). HbA1c levels were significantly lower in the VBC group than in the EXB group after 6, 9, 12 and 24 months of the study. Both groups exhibited similar improvements in dietary practices with respect to intake of carbohydrate, fats and sweets, while the VBC group had a significant increase in consumption of green vegetables and a significant decrease in fruit consumption. A simple meal plan of 'eating vegetables before carbohydrate' achieved better glycemic control than an exchange-based meal plan in Japanese patients with type 2 diabetes over a 24-month period.