Thursday, 22 December 2011

Point 29

                                                                                                                                                                           Effect of meal frequency on glucose and insulin excursions over the course of a day


Background & aims

This study characterized the glucose and insulin responses to temporal alterations in meal frequency, and alterations in the macronutrient composition.


Eight subjects underwent three separate 12-h meal tests: three high carbohydrate (3CHO) meals, 6 high carbohydrate meals (6CHO), 6 high-protein meals (6HP). Blood samples were taken at 15-min intervals. Integrated area under the curve (AUC) concentrations for glucose and plasma insulin were determined (total, 4-h, and 2-h blocks) for each meal condition.


Baseline glucose and insulin values were not different between study days. Peak glucose levels were highest on the 3CHO day; however the 12 h glucose AUC was higher during the 6CHO condition (p = 0.029) than 3CHO condition, with no difference in the insulin response. The 6HP condition resulted in a decreased glucose AUC (p = 0.004) and insulin AUC (p = 0.012) compared to 6CHO.


In non-obese individuals, glucose levels remained elevated throughout the day with frequent CHO meals compared to 3CHO meals, without any differences in the insulin levels. Increasing the protein content of frequent meals attenuated both the glucose and insulin response. These findings of elevated glucose levels throughout the day warrant further research, particularly in overweight and obese individuals with and without type 2 diabetes.


Human insulinotropic response to oral ingestion of native and hydrolysed whey protein.


Human Science Research Unit, Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland.


The insulinotropic response to the ingestion of whey protein and whey protein hydrolysate, independent of carbohydrate, is not known. This study examined the effect of protein hydrolysis on the insulinotropic response to the ingestion of whey protein. Sixteen healthy males ingested a 500 mL solution containing either 45 g of whey protein (WPI) or whey protein hydrolysate (WPH). The estimated rate of gastric emptying was not altered by hydrolysis of the protein [18 (3) vs. 23 (3) min, n = 16; P = 0.15]. Maximum plasma insulin concentration (Cmax) occurred later (40 vs. 60 min) and was 28% [234 (26) vs. 299 (31) mM, P = 0.018] greater following ingestion of the WPH compared to the WPI leading to a 43% increase [7.6 (0.9) vs. 10.8 (2.6) nM, P = 0.21] in the AUC of insulin for the WPH. Of the amino acids with known insulinotropic properties only Phe demonstrated a significantly greater maximal concentration [C (max); 65 (2) vs. 72 (3) microM, n = 16; P = 0.01] and increase (+22%) in AUC following ingestion of the WPH. In conclusion, ingestion of whey protein is an effective insulin secretagogue. Hydrolysis of whey protein prior to ingestion augments the maximal insulin concentration by a mechanism that is unrelated to gastric emptying of the peptide solution.

Protein ingestion prior to strength exercise affects blood hormones and metabolism.



The effects of protein consumption before strength training session on blood hormones, energy metabolites, RER, and excess postexercise oxygen consumption (EPOC) were examined.


Ten resistance-trained young men consumed either a 25 g of whey and caseinate proteins (PROT) or a noncaloric placebo (P) in a liquid form 30 min before a heavy strength training session (STS) in a crossover design separated by at least 7 d. STS lasted 50 min and included 5 x 1 RM squats, 3 x 10 RM squats and 4 x 10 RM leg presses with 2-, 3-, and 2-min recoveries, respectively. A protein-carbohydrate supplement was consumed after STS in both trials. Venous blood samples were collected before, during, and after STS and oxygen consumption before and after STS.


Serum growth hormone (GH), testosterone, and free fatty acids (FFA) were significantly (P < or = 0.05) higher in P compared with PROT 5 min after an STS. The calculated area under curve (AUC) of the serum insulin response during an STS was significantly (P < 0.001) higher in PROT compared with P. The EPOC value from 90 to 120 min after an STS was significantly greater in the PROT condition compared with P (P = 0.01), and PROT treatment had a significantly higher RER 2 h postexercise (P = 0.04). The AUC of serum FFA during STS correlated significantly and negatively with RER 10-30 min after STS (r = -0.53, P = 0.02).


Consuming 25 g of whey and caseinate proteins 30 min before an STS significantly decreases serum GH, testosterone, and FFA levels, and increases serum insulin during an STS. Furthermore, the pre-STS protein increased EPOC and RER significantly during 2-h recovery after STS.

Food insulin index: physiologic basis for predicting insulin demand evoked by composite meals.



Diets that provoke less insulin secretion may be helpful in the prevention and management of diabetes. A physiologic basis for ranking foods according to insulin "demand" could therefore assist further research.


We assessed the utility of a food insulin index (FII) that was based on testing isoenergetic portions of single foods (1000 kJ) in predicting the insulin demand evoked by composite meals.


Healthy subjects (n = 10 or 11 for each meal) consumed 13 different isoenergetic (2000 kJ) mixed meals of varying macronutrient content. Insulin demand predicted by the FII of the component foods or by carbohydrate counting and glycemic load was compared with observed insulin responses.


Observed insulin responses (area under the curve relative to white bread: 100) varied over a 3-fold range (from 35 +/- 5 to 116 +/- 26) and were strongly correlated with insulin demand predicted by the FII of the component foods (r = 0.78, P = 0.0016). The calculated glycemic load (r = 0.68, P = 0.01) but not the carbohydrate content of the meals (r = 0.53, P = 0.064) also predicted insulin demand.


The relative insulin demand evoked by mixed meals is best predicted by a physiologic index based on actual insulin responses to isoenergetic portions of single foods. In the context of composite meals of similar energy value, but varying macronutrient content, carbohydrate counting was of limited value.

Point 24, 25

Hormonal responses to a fast-food meal compared with nutritionally comparable meals of different composition.



Fast food is consumed in large quantities each day. Whether there are differences in the acute metabolic response to these meals as compared to 'healthy' meals with similar composition is unknown.


Six overweight men were given a standard breakfast at 8:00 a.m. on each of 3 occasions, followed by 1 of 3 lunches at noon. The 3 lunches included: (1) a fast-food meal consisting of a burger, French fries and root beer sweetened with high fructose corn syrup; (2) an organic beef meal prepared with organic foods and a root beer containing sucrose, and (3) a turkey meal consisting of a turkey sandwich and granola made with organic foods and an organic orange juice. Glucose, insulin, free fatty acids, ghrelin, leptin, triglycerides, LDL-cholesterol and HDL-cholesterol were measured at 30-min intervals over 6 h. Salivary cortisol was measured after lunch.


Total fat, protein and energy content were similar in the 3 meals, but the fatty acid content differed. The fast-food meal had more myristic (C14:0), palmitic (C16:0), stearic (C18:0) and trans fatty acids (C18:1) than the other 2 meals. The pattern of nutrient and hormonal response was similar for a given subject to each of the 3 meals. The only statistically significant acute difference observed was a decrease in the AUC of LDL cholesterol after the organic beef meal relative to that for the other two meals. Other metabolic responses were not different.

Metabolic and behavioral effects of a high-sucrose diet during weight loss.


In response to evidence linking obesity and high amounts of dietary fat, the food industry has developed numerous reduced-fat and nonfat food items. These items frequently derive a relatively large percentage of their energy from sugars and the effect of these sugars on weight regulation is not well known. We studied the comparative effects of high- and low-sucrose, low-fat, hypoenergetic diets on a variety of metabolic and behavioral indexes in a 6-wk weight-loss program. Both diets contained approximately 4606 kJ energy/d with 11% of energy as fat, 19% as protein, and 71% as carbohydrate. The high-sucrose diet contained 43% of the total daily energy intake as sucrose; the low-sucrose diet contained 4% of the total daily energy intake as sucrose. Twenty women aged 40.6 +/- 8.2 y (mean +/- SD) with a body mass index (in kg/m2) of 35.93 +/- 4.8 consumed the high-sucrose diet; 22 women aged 40.3 +/- 7.3 y with a body mass index of 34.93 +/- 4.4 consumed the low-sucrose diet. Mixed-design analysis of variance showed a main effect of time (P < 0.01), with both diet groups showing decreases in weight, blood pressure, resting energy expenditure, percentage body fat, free triiodothyronine (FT3), urinary norepinephrine, and plasma lipids. Small but significant interactions were found between group and time in total cholesterol (P = 0.009) and low-density lipoprotein (LDL) (P = 0.01). Both groups showed decreases in depression, hunger, and negative mood, and increases in vigilance and positive mood with time (P < 0.01). Results showed that a high sucrose content in a hypoenergetic, low-fat diet did not adversely affect weight loss, metabolism, plasma lipids, or emotional affect.

The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial.


One of the proposed causes of obesity and metabolic syndrome is the excessive intake of products containing added sugars, in particular, fructose. Although the ability of excessive intake of fructose to induce metabolic syndrome is mounting, to date, no study has addressed whether a diet specifically lowering fructose but not total carbohydrates can reduce features of metabolic syndrome. A total of 131 patients were randomized to compare the short-term effects of 2 energy-restricted diets-a low-fructose diet vs a moderate natural fructose diet-on weight loss and metabolic syndrome parameters. Patients were randomized to receive 1500, 1800, or 2000 cal diets according to sex, age, and height. Because natural fructose might be differently absorbed compared with fructose from added sugars, we randomized obese subjects to either a low-fructose diet (<20 g/d) or a moderate-fructose diet with natural fruit supplements (50-70 g/d) and compared the effects of both diets on the primary outcome of weight loss in a 6-week follow-up period. Blood pressure, lipid profile, serum glucose, insulin resistance, uric acid, soluble intercellular adhesion molecule-1, and quality of life scores were included as secondary outcomes. One hundred two (78%) of the 131 participants were women, mean age was 38.8 ± 8.8 years, and the mean body mass index was 32.4 ± 4.5 kg/m(2). Each intervention diet was associated with significant weight loss compared with baseline. Weight loss was higher in the moderate natural fructose group (4.19 ± 0.30 kg) than the low-fructose group (2.83 ± 0.29 kg) (P = .0016). Compared with baseline, each intervention diet was associated with significant improvement in secondary outcomes. Reduction of energy and added fructose intake may represent an important therapeutic target to reduce the frequency of obesity and diabetes. For weight loss achievement, an energy-restricted moderate natural fructose diet was superior to a low-fructose diet.

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