Abstract
This is an observational study of interstitial glucose (IG) concentrations, IG variability and dietary intake under free-living conditions in 46 females with obesity but without diabetes. We used continuous glucose monitoring, open-ended food recording and step monitoring during regular dietary intake followed by a low-energy diet (LED). Thirty-nine participants completed both study periods. The mean BMI at baseline was 43.6 ± 6.2 kg/m2. Three weeks of LED resulted in a mean weight loss of 5.2% with a significant reduction in diurnal IG concentration but with greater glycemic variability observed during LED. The mean 24 h IG concentration decreased from 5.8 ± 0.5 mmol/L during the regular diet period to 5.4 ± 0.5 mmol/L (p < 0.001) during LED, while the mean amplitude of glycemic excursion increased from 1.5 ± 0.7 to 1.7 ± 0.7 mmol/L (p = 0.031). The positive incremental area under the curve at breakfast was significantly larger for LED compared to regular diet. The daily fiber intake and the glycemic index of breakfast meals were significantly associated with the glycemic variability during regular dietary intake. In conclusion, the 24 h mean IG concentration was lower but with more pronounced glycemic variability during LED compared to a regular diet.
Highlights
Obesity is a growing health problem worldwide and the prevalence of obesity has more than doubled since 1980 [1]
Low-energy diet (LED) regimens, such as diet replacement formulas or hypocaloric diets, which are frequently used for weight loss, are used immediately before bariatric surgery to reduce the risk of surgical complications [6]
After a median period of three weeks of the four week LED regimen, the mean weight loss was 6.4 ± 2.6 kg, which corresponded to 5.2% total body weight loss and a body mass index (BMI) of 41.4 ± 5.7 kg/m2 (p < 0.001)
Summary
Obesity is a growing health problem worldwide and the prevalence of obesity has more than doubled since 1980 [1]. For patients with a body mass index (BMI) of 35 kg/m2 or above, bariatric surgery has become frequently used worldwide in the struggle against obesity-related complications such as type 2 diabetes and cardiovascular diseases [2,3]. Low-energy diet (LED) regimens, such as diet replacement formulas or hypocaloric diets, which are frequently used for weight loss, are used immediately before bariatric surgery to reduce the risk of surgical complications [6]. Previous studies have demonstrated that LED resulted in lowered body weight and decreased liver volume, and in lowered fasting and postprandial glucose concentrations and improved insulin sensitivity [7,8,9,10,11]. The glycemic response of a mixed meal is influenced by the fat and protein content, the amount and type of carbohydrates have been suggested as the major contributors to the postprandial glycemic response [14]
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