Article

Consuming Carbohydrates after Meat or Vegetables Lowers Postprandial Excursions of Glucose and Insulin in Nondiabetic Subjects

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  • Kanazawa University Graduate School of Medical Sciences
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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.

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... 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. ...
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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.
... Among the various interventions that involve manipulation of carbohydrate intake, the consumption of carbohydrate-rich food at the end of a meal has recently been highlighted as a cost-effective and simple method to optimise postprandial glucose excursions. Previous studies looking at food order have shown that when compared with eating carbohydrate-rich food at the beginning of a meal, eating carbohydrate-rich food at the end of a meal significantly decreases PPG excursion in people who are healthy (Nishino et al., 2018;Sun et al., 2019), have prediabetes (Shukla et al., 2019), and have diabetes (Imai et al., 2013;Kuwata et al., 2016;Shukla et al., 2017;Tricò et al., 2016). These studies were conducted among adults of Caucasian or East Asian ethnicity, limiting its generalisation to other ethnic groups at a higher risk of diabetes and cardiovascular disease. ...
... The results from this present study corroborate related study findings that using a protein first/carbohydrate last eating strategy during a meal produced a steadier PPG excursion, as compared with using a carbohydrate first/ protein last or composite eating strategy during a meal (Imai et al., 2013;Kuwata et al., 2016;Nishino et al., 2018;Shukla et al., 2017;Shukla et al., 2019;Sun et al., 2019;Tricò et al., 2016). The composite test meal reflects the typical way by which Asians eat their meals. ...
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Background Postprandial glycaemia has an impact on health but there is limited data about the effect of food order on postprandial glycaemia by body weight status. Aim To investigate the effects of food order on postprandial glucose (PPG) excursion, in Indian adults with normal (NL) and overweight/obese (OW) Body Mass Index. Methods This randomised crossover study was conducted at a Malaysian university among Indian adults without diabetes. The participants consumed isocaloric test meals at three study visits based on randomised food orders: carbohydrate first/protein last (CF); protein first/carbohydrate last (CL); and a composite meal containing carbohydrate and protein (CM). Capillary blood glucose was measured at baseline, 30, 60, 90 and 120 minutes after starting the meal. Results The CL food order had a blunting effect on PPG excursion at 30 and 60 minutes ( p < 0.01). The CL food order resulted in lower glucose peak when compared with the CF and CM food order ( p < 0.001). The CL food order resulted in lower incremental glucose peak (mmol/L) (NL: CF 3.9 ± 0.3, CM 3.0 ± 0.3, CL 2.0 ± 0.2; OW: CF 2.9 ± 0.3, CM 2.5 ± 0.3, CL 1.8 ± 0.2) and iAUC 0–120 min (mmol/Lxmin) (NL: CF 272.4 ± 26.7, CM 206.2 ± 30.3, CL 122.0 ± 14.8; OW: CF 193.2 ± 23.1, CM 160.1 ± 21.7, CL 113.6 ± 15.3) when compared with the CF food order ( p < 0.001). The effect of food order on postprandial excursion did not differ between the NL ( n = 14) and the OW ( n = 17) groups. Conclusion In participants with normal and overweight/obese BMI, consuming food in the protein first/carbohydrate last order had the biggest effect in reducing PPG excursion.
... Un incremento così spiccato della secrezione di insulina indotta dal glucosio nel soggetto diabetico rispetto al non diabetico può essere spiegato dal gradiente più elevato di aminoacidi plasmatici dopo la digestione e l'assorbimento delle proteine (54,69). In altri studi volti a valutare l'effetto insulinotropico combinato di proteine e grassi i risultati si sono rivelati eterogenei e, apparentemente, discordanti (33,41,(70)(71). ...
... In accordo con quanto sopra, il nostro gruppo ha dimostrato che alimenti ricchi di proteine e grassi consumati prima di un OGTT riducono del 32% l'escursione glicemica postprandiale(25). Infine, altri studi hanno mostrato che l'ingestione di carne, pesce o verdure prima di una porzione di riso ritarda di 30-60 minuti il picco glicemico postprandiale e lo riduce di quasi il 50% rispetto al medesimo pasto consumato in ordine inverso(33,71).Diabete di tipo 1La terapia del diabete di tipo 1 si basa sulla somministrazione di insulina esogena, la quale, nonostante i recenti miglioramenti farmacologici e tecnologici, è ancora gravata da aumentato rischio di ipoglicemia iatrogena. L'unico studio che ha valutato l'effetto della sequenza di assunzione dei macronutrienti nel diabete di tipo 1 è stato recentemente condotto da Faber et al.(97), i quali hanno dimostrato che proteine e grassi consumati 15 minuti prima dei carboidrati riducono di circa il 10% i livelli glicemici medi in una piccola popolazione di bambini e adolescenti affetti diabete di tipo 1. Questo studio è interessante in quanto ci permette di quantificare l'effetto dei macronutrienti sulla tolleranza glucidica indipendentemente dalle modifiche della secrezione insulinica endogena. ...
... Consistently, a mixed protein and fat preload reduced plasma glucose excursions after an OGTT by 32% in healthy young adults (18). Furthermore, the ingestion of either meat, fish, or vegetables before rice was able to decrease the postmeal glucose peak by ∼50% and to delay it by 30-60 min when compared with eating the same food in the reverse order (i.e., rice first) (31,46). ...
... The greater enhancement of glucose-induced insulin secretion in T2D may be explained by a higher gradient of plasma amino acids after protein digestion and absorption in those subjects compared with healthy individuals (72,85). Some studies with mixed preloads have reported different results (31,39,45,46), likely due to a less rigorous estimation of β cell function (i.e., insulin and Cpeptide levels were not adjusted for glucose concentrations) or to a stronger inhibition of gastric emptying by different preloads tested, which would minimize their impact on glucose-stimulated insulin secretion. ...
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Pharmacological and dietary interventions targeting postprandial glycemia have proved effective in reducing the risk for type 2 diabetes and its cardiovascular complications. Besides meal composition and size, the timing of macronutrient consumption during a meal has been recently recognized as a key regulator of postprandial glycemia. Emerging evidence suggests that premeal consumption of non-carbohydrate macronutrients (i.e., protein and fat “preloads”) can markedly reduce postprandial glycemia by delaying gastric emptying, enhancing glucose-stimulated insulin release, and decreasing insulin clearance. The same improvement in glucose tolerance is achievable by optimal timing of carbohydrate ingestion during a meal (i.e., carbohydrate-last meal patterns), which minimizes the risk of body weight gain when compared with nutrient preloads. The magnitude of the glucose-lowering effect of preload-based nutritional strategies is greater in type 2 diabetes than healthy subjects, being comparable and additive to current glucose-lowering drugs, and appears sustained over time. This dietary approach has also shown promising results in pathological conditions characterized by postprandial hyperglycemia in which available pharmacological options are limited or not cost-effective, such as type 1 diabetes, gestational diabetes, and impaired glucose tolerance. Therefore, preload-based nutritional strategies, either alone or in combination with pharmacological treatments, may offer a simple, effective, safe, and inexpensive tool for the prevention and management of postprandial hyperglycemia. Here, we survey these novel physiological insights and their therapeutic implications for patients with diabetes mellitus and altered glucose tolerance.
... 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]. ...
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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]. ...
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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.
... 27 Conversely, one clinical study reported that consuming vegetables and meat followed by carbohydrates can prevent postprandial excursions of glucose and insulin levels. 28 To prevent weight loss in patients with diabetes, a non-restrictive energy diet that incorporates ways of eating against postprandial excursions of glucose and insulin levels is necessary. In the texture-modified diet group, weight loss did not occur when patients' nutritional status was good. ...
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Objectives: To compare differences in weight loss in patients with Alzheimer's disease on normal, diabetic, or texture-modified diets. Methods: This prospective interventional study examined the data of patients with Alzheimer's disease who were admitted to a long-term care hospital in Japan from February to April 2013. Dietary elements and weight loss over a 3-month period were examined. Results: Of the 75 patients examined, 6 were on a normal diet, 10 were on a diabetic diet, and 59 were on a texture-modified diet. Weight loss was significantly associated with body weight, Mini Nutritional Assessment®, and diet type. In the non-malnourished patients, there was a significant difference between the three types of diets in terms of eating rate and weight loss. Conclusion: Diet type was independently associated with weight loss in patients with Alzheimer's disease. Research using larger sample sizes is necessary to eliminate the differences between these diet types.
... Accumulated evidence suggests that pre-meal consumption of protein and fat preloads can markedly reduce postprandial hyperglycemia and increase satiety via delaying GE rate and enhancing glucose-stimulated insulin release associated with increasing gut-derived hormones [7][8][9]. Meal sequence (consumption of e.g., meat, fish, or vegetables before rice) can play a role in postprandial glucose control through delaying GE rate and enhancing incretin secretion [10][11][12]. Such nutritional strategies without pharmacological treatments may be a simple, effective, and safe tool for prevention and management of postprandial hyperglycemia and overeating. ...
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Consumption of 2,4-decadienal (2,4-DD) delays gastric emptying (GE) rate in animals. Oil heating produces 2,4-DD and other aldehydes. Here we examined whether heated oil affects GE rate and food intake in humans, and whether it is mediated by 2,4-DD. In the first experiment, 10 healthy volunteers consumed 240-g pumpkin soup with 9.2 g of heated (HO) or non-heated corn oil (CO). Subsequently, 17 participants consumed pumpkin soup containing 3.1 g of either heated corn oil (HO), 1 mg 2,4-DD + non-heated corn oil (2,4-DD), or non-heated corn oil (CO). Sixty minutes following pumpkin soup, cod roe spaghetti was provided, and then energy intake was determined. To evaluate GE rate, 13C breath test (Experiment 1) and ultrasonography (Experiments 1 and 2) were used. The results from the Experiment 1 confirmed that consumption of heated corn oil reduced GE rate. Experiment 2 showed a delayed GE rate in HO and 2,4-DD trials compared with CO trial (p < 0.05). Energy intake was approximately 600–650 kJ lower in HO and 2,4-DD trials compared with CO trial (p < 0.05). These findings suggest that 2,4-DD, either formed by oil heating or added to food, contributes to suppressing GE rate and energy intake.
... For example, Shukla et al. reported that ingestion of protein and vegetables before carbohydrates leads to a 39% reduction in postprandial glycemia in individuals with impaired glucose tolerance (64). Likewise, consumption of meat or fish, or vegetables before carbohydrate has been reported to reduce the postprandial glucose peak by almost 50%, as well as delay it by 30-60min and raise the level of GLP-1 and GIP (65,66). However, as well as slowing gastric emptying, Shukla et al. demonstrated that protein and fat initially leads to higher GLP-1 levels and slower carbohydrate absorption, and also suggested that fiber from vegetables may be responsible (64,67). ...
Article
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Postprandial glycemic control is an important target for optimal type 2 diabetes management, but is often difficult to achieve. The gastrointestinal tract plays a major role in modulating postprandial glycaemia in both health and diabetes. The various strategies that have been proposed to modulate gastrointestinal function, particularly by slowing gastric emptying and/or stimulating incretin hormone GLP-1, are summarized in this review.
... In our previous study, insulin secretion was suppressed 30% by consuming vegetable salad before rice compared to the reverse regimen. 2 Additionally Nishino K et al reported that the insulin secretion was suppressed when the participants consumed the meal sequence of vegetables → meat→ rice. 26 Consequently, in this study, consuming tomato and tomato juice prior to carbohydrate insulin secretion was presumed to be suppressed compared to that of consuming water. The second limitation was that the study was conducted in Japanese healthy women, the effect of different gender, people with diabetes or impaired glucose tolerance has not been confirmed. ...
Article
Background and objectives: Our aim was to evaluate the effect of consuming tomato juice before carbohydrate on postprandial glucose concentrations in healthy women. Methods and study design: In this randomized controlled cross-over study, 25 healthy women (age 21.6±3.8 years, HbA1c 5.3±0.2 %, mean±SD) consumed either 200 g of tomato juice, tomato, or water (control) at 30 min before consuming 200 g of boiled white rice at 9:00 and consumed identical lunch at 13:00 for 3 days. The blood glucose concentrations were measured by selfmonitoring blood glucose at 0, 30, 45, 60, 90, 150, and 210 min pre- and post-breakfast, and at 0, 30, 60, 120, 150, and 180 min pre- and post-lunch. The concentration of postprandial glucose, incremental glucose peak (IGP), and incremental area under the curve for glucose after the test meals were compared among 3 days. Results: Incremental blood glucose concentrations at 60 min (2.32±0.16 vs 2.97±0.19 mmol/L, p<0.05, mean±SEM), 90 min (2.36±0.23 vs 3.23±0.24 mmol/L, p<0.01), and IGP (2.77±0.19 vs 3.68±0.22 mmol/L, p<0.001) in consuming tomato juice 30 min before carbohydrate were all significantly lower than those of water, while IGP of consuming tomato was tended to be lower than that of water (2.82±0.19 mmolL, p=0.023). No significant difference was observed in glycaemic parameters after consuming lunch among 3 days. Conclusions: Consuming tomato juice half hour before carbohydrate ameliorates the postprandial blood glucose concentrations, although total amounts of energy and carbohydrate of tomato juice are higher than those of water.
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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.
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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.
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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.
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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.
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The effect of increasing the intake of dietary fiber on glycemic control in patients with type 2 diabetes mellitus is controversial. In a randomized, crossover study, we assigned 13 patients with type 2 diabetes mellitus to follow two diets, each for six weeks: a diet containing moderate amounts of fiber (total, 24 g; 8 g of soluble fiber and 16 g of insoluble fiber), as recommended by the American Diabetes Association (ADA), and a high-fiber diet (total, 50 g; 25 g of soluble fiber and 25 g of insoluble fiber), containing foods not fortified with fiber (unfortified foods). Both diets, prepared in a research kitchen, had the same macronutrient and energy content. We compared the effects of the two diets on glycemic control and plasma lipid concentrations. Compliance with the diets was excellent. During the sixth week, the high-fiber diet, as compared with the the sixth week of the ADA diet, mean daily preprandial plasma glucose concentrations were 13 mg per deciliter [0.7 mmol per liter] lower (95 percent confidence interval, 1 to 24 mg per deciliter [0.1 to 1.3 mmol per liter]; P=0.04) and mean median difference, daily urinary glucose excretion 1.3 g (0.23; 95 percent confidence interval, 0.03 to 1.83 g; P= 0.008). The high-fiber diet also lowered the area under the curve for 24-hour plasma glucose and insulin concentrations, which were measured every two hours, by 10 percent (P=0.02) and 12 percent (P=0.05), respectively. The high-fiber diet reduced plasma total cholesterol concentrations by 6.7 percent (P=0.02), triglyceride concentrations by 10.2 percent (P=0.02), and very-low-density lipoprotein cholesterol concentrations by 12.5 percent (P=0.01). A high intake of dietary fiber, particularly of the soluble type, above the level recommended by the ADA, improves glycemic control, decreases hyperinsulinemia, and lowers plasma lipid concentrations in patients with type 2 diabetes.
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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.
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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 …
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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.
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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.
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TGR5 is a G protein-coupled receptor expressed in brown adipose tissue and muscle, where its activation by bile acids triggers an increase in energy expenditure and attenuates diet-induced obesity. Using a combination of pharmacological and genetic gain- and loss-of-function studies in vivo, we show here that TGR5 signaling induces intestinal glucagon-like peptide-1 (GLP-1) release, leading to improved liver and pancreatic function and enhanced glucose tolerance in obese mice. In addition, we show that the induction of GLP-1 release in enteroendocrine cells by 6alpha-ethyl-23(S)-methyl-cholic acid (EMCA, INT-777), a specific TGR5 agonist, is linked to an increase of the intracellular ATP/ADP ratio and a subsequent rise in intracellular calcium mobilization. Altogether, these data show that the TGR5 signaling pathway is critical in regulating intestinal GLP-1 secretion in vivo, and suggest that pharmacological targeting of TGR5 may constitute a promising incretin-based strategy for the treatment of diabesity and associated metabolic disorders.
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Incretin-based therapies address the progressive nature of type 2 diabetes mellitus, not only by addressing glucose control but also with weight-neutral (i.e., dipeptidyl peptidase-4 inhibitors sitagliptin and vildagliptin) and weight-reducing effects (i.e., glucagonlike peptide-1 [GLP-1] receptor agonists exenatide and liraglutide). Preclinical data suggest that incretin-based therapies may also preserve beta-cell function, holding promise of a truly disease-modifying therapy. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of these agents in routine clinical practice. We propose a systematic approach to treatment, addressing (1) patient selection, (2) optimal treatment combinations, and (3) timing and guidance for both initiation and intensification of therapy. The GLP-1 receptor agonists, for example, could be particularly beneficial in patients whose weight significantly increases cardiovascular risk. Early use of these agents may be effective in preventing diabetes in those at risk, or in halting or retarding disease progression in patients with frank diabetes. Additional clinical investigation will be required to test such hypotheses. Given the ever-increasing incidence of diabetes worldwide, the link between obesity and the development of type 2 diabetes, and the need for more effective, weight-focused, convenient and sustainable treatments, the data from such studies will be invaluable to further clarify the role of the incretins in the management of patients with type 2 diabetes.
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Cholesterol metabolism was studied in 34 50-y-old men at home on high and low mixed-fiber diets. The high-fiber diet increased fiber intake (26.2 vs 11.6 g/d) and decreased slightly but significantly total energy, carbohydrate, and protein intakes and serum total, low-density-lipoprotein, and high-density-lipoprotein cholesterol values with no effect on dietary cholesterol and fat composition or body weight. Biliary molar lipid percentages were unaffected but deoxycholic acid was increased and chenodeoxycholic acid was decreased by the high-fiber diet. The high-fiber diet changed cholesterol absorption and fecal output of neutral and total sterols nonsignificantly but increased fecal bile acids by 13% (p less than 0.05) and reduced bacterial conversion of fecal sterols to secondary products. The decreased serum cholesterol concentration was probably caused by enhanced fecal output of cholesterol as bile acids resulting in enhanced cholesterol synthesis as indicated by an increased serum concentration of a cholesterol precursor, lathosterol.
Article
We studied the effect of increasing the frequency of meals on serum lipid concentrations and carbohydrate tolerance in normal subjects. Seven men were assigned in random order to two metabolically identical diets. One diet consisted of 17 snacks per day (the nibbling diet), and the other of three meals per day (the three-meal diet); each diet was followed for two weeks. As compared with the three-meal diet, the nibbling diet reduced fasting serum concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B by a mean (+/- SE) of 8.5 +/- 2.5 percent (P less than 0.02), 13.5 +/- 3.4 percent (P less than 0.01), and 15.1 +/- 5.7 percent (P less than 0.05), respectively. Although the mean blood glucose level and serum concentrations of free fatty acids, 3-hydroxybutyrate, and triglyceride were similar during both diets, during the nibbling diet the mean serum insulin level decreased by 27.9 +/- 6.3 percent (P less than 0.01) and the mean 24-hour urinary C-peptide output decreased by 20.2 +/- 5.6 percent (P less than 0.02). In addition, the mean 24-hour urinary cortisol excretion was lower by 17.3 +/- 5.9 percent (P less than 0.05) at the end of the nibbling diet than at the end of the three-meal diet. The blood glucose, serum insulin, and C-peptide responses to a standardized breakfast and the results of an intravenous glucose-tolerance test conducted at the end of each diet were similar. We conclude that in addition to the amount and type of food eaten, the frequency of meals may be an important determinant of fasting serum lipid levels, possibly in relation to changes in insulin secretion.
Article
To evaluate the suitability for glycaemic index (GI) calculations of using blood sampling schedules and methods of calculating area under the curve (AUC) different from those recommended, the GI values of five foods were determined by recommended methods (capillary blood glucose measured seven times over 2.0 h) in forty-seven normal subjects and different calculations performed on the same data set. The AUC was calculated in four ways: incremental AUC (iAUC; recommended method), iAUC above the minimum blood glucose value (AUCmin), net AUC (netAUC) and iAUC including area only before the glycaemic response curve cuts the baseline (AUCcut). In addition, iAUC was calculated using four different sets of less than seven blood samples. GI values were derived using each AUC calculation. The mean GI values of the foods varied significantly according to the method of calculating GI. The standard deviation of GI values calculating using iAUC (20.4), was lower than six of the seven other methods, and significantly less (P<0.05) than that using netAUC (24.0). To be a valid index of food glycaemic response independent of subject characteristics, GI values in subjects should not be related to their AUC after oral glucose. However, calculating GI using AUCmin or less than seven blood samples resulted in significant (P<0.05) relationships between GI and mean AUC. It is concluded that, in subjects without diabetes, the recommended blood sampling schedule and method of AUC calculation yields more valid and/or more precise GI values than the seven other methods tested here. The only method whose results agreed reasonably well with the recommended method (ie. within +/-5 %) was AUCcut.
Crossover study of the effect of “eating vegetables before carbohydrate” on reducing postprandial glucose and insulin in Japanese subjects with type 2 diabetes mellitus
  • S Imai
  • M Matsuda
  • S Fujiawa
  • S Miyatani
  • G Hasegawa
  • M Fukui
  • M Morigami
  • N Ozasa
  • S Kajiyama
Study of basic performance and standard value of Lumipulse prestin insulin measuring reagent using Lumipulse Prest II
  • M Karasawa
  • M Turue
  • K Takenami
  • M Kikuti
  • H Wakabayashi
Karasawa M, Turue M, Takenami K, Kikuti M, Wakabayashi H. 2006. Study of basic performance and standard value of Lumipulse prestin insulin measuring reagent using Lumipulse Prest II. J Clin Lab Inst Reag 29(5): 479-484 (in Japanese).
Dietary carbohydrate intake, presence of obesity and the incident risk of type 2 diabetes in Japanese men
  • M Sakurai
  • K Nakamura
  • K Miura
  • T Takamura
  • K Yoshita
  • S Nagasawa
  • Y Morikawa
  • M Ishizaki
  • T Kido
  • Y Naruse
  • K Nagawa
  • Y Nakashima
  • K Nogawa
  • S Sasaki
  • H Nakagawa
Sakurai M, Nakamura K, Miura K, Takamura T, Yoshita K, Nagasawa S, Morikawa Y, Ishizaki M, Kido T, Naruse Y, Nagawa K, Nakashima Y, Nogawa K, Sasaki S, Nakagawa H. 2016. Dietary carbohydrate intake, presence of obesity and the incident risk of type 2 diabetes in Japanese men. J Diabetes Investig 7: 343-351.
Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria
The DECODE Study Group on behalf of the EDEG. 2001. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 161: 397-405.
Japan Society of Clinical Chemistry Reagent Task Committee
Japan Society of Clinical Chemistry Reagent Task Committee. 1991. Recommendation method for serum glucose measurement. Clinical Chemistry 20(4): 247-254 (in Japanese).