Abstract
We compared the impact of a high versus low energy intake first meal on glucose and insulin responses during prolonged sitting in individuals with prediabetes. Thirteen adults with overweight/obesity and prediabetes (mean ± SD age: 60 ± 6 years, BMI: 33 ± 4 kg/m2; 2 h OGTT: 8.9 ± 1.1 mmol/L) completed two randomised trials: 10 h uninterrupted sitting, incorporating three meals with matching macronutrient compositions but different energy distributions: High-Energy Breakfast (HE-BF; breakfast: 50%, lunch: 30%, dinner: 20% energy intake), Low-Energy Breakfast (LE-BF: 20%/30%/50% energy intake). Venous blood was sampled from 08:00–18:00 h for determination of plasma glucose and insulin concentrations, with 24 h continuous glucose monitoring (CGM). Total glucose area under the curve (AUC; +5.7 mmol/L/h, p = 0.019) and mean plasma glucose concentrations (+0.5 mmol/L, p = 0.014) were greater after HE-BF compared to LE-BF. In the HE-BF condition, compared to LE-BF, there was a greater incremental area under the curve (iAUC) for plasma glucose post-breakfast (+44 ± 59%, p = 0.007), but lower iAUC post-lunch (−55 ± 36%, p < 0.001). Total insulin AUC was greater (+480 mIU/mL/h, p < 0.01) after HE-BF compared to LE-BF. Twenty-four-hour (24 h) CGM revealed no differences in mean glucose and total AUC between conditions. Compared to a low-energy first meal, a high-energy first meal elicited exaggerated plasma insulin and glucose responses until lunch but had little effect on 24 h glycaemia. During periods of prolonged sitting, adults with prediabetes may have more beneficial postprandial insulin responses to a low-energy first meal.
Highlights
The continued rise in the prevalence of obesity and the rate of diagnosis of individuals with type 2 diabetes (T2D) imposes a substantial burden on healthcare systems
Both observational and experimental studies demonstrate that prolonged sitting is detrimental to postprandial glucose levels [7], where the greatest exaggeration in hyperglycaemia with prolonged sitting occurs in the period after the first meal [8,9]
Twelve participants were classified as having IGT, with one participant classified as having IFG, with n = 8 taking medication (for hypertension (n = 4), hypercholesterolemia (n = 3), 3
Summary
The continued rise in the prevalence of obesity and the rate of diagnosis of individuals with type 2 diabetes (T2D) imposes a substantial burden on healthcare systems. Understanding the extent to which behavioural factors, such as meal size and prolonged periods of inactivity, influence the postprandial state is essential for future management of adults with prediabetes. Sedentary behaviour is associated with increased risk of T2D even after accounting for habitual physical activity levels [5,6]. Both observational and experimental studies demonstrate that prolonged sitting is detrimental to postprandial glucose levels [7], where the greatest exaggeration in hyperglycaemia with prolonged sitting occurs in the period after the first meal [8,9]. Optimising the daily distribution of energy may be a practical strategy for modifying postprandial hyperglycaemic responses to meals
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