The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet.

Shapira Shapira

doi:10.3390/nu11102373

Abstract

With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.

Highlights

As people in the modern world are increasingly in a postprandial state [1], acute effects of meals are garnering expanding interest and concern beyond the morning fast state
Scientific literature describing the acute effects of foods, their components, interactions between them, and the meal course order on key metabolic axes—postprandial satiety, glycaemic and oxidative responses and associated immune outcomes—exemplifying their direct health effects and those potentially exerted through inflammatory response, was reviewed
As satiety is first elicited by the gut distension response to portion size/volume/weight rather than to caloric/energy intake [63], the low energy density (ED, kcal/100 g) principle becomes a key factor in satiety-related intake control and obesity prevention [26] (Figure 1)

Summary

Introduction

As people in the modern world are increasingly in a postprandial state [1], acute effects of meals are garnering expanding interest and concern beyond the morning fast state. Postprandial studies show that common meals may have significant negative effects, including promotion of chronic inflammation, especially in people at high risk [2]. These effects would occur several times daily and last for several hours [3], covering a major part of the day, potentially up to 18 h [1]. Inflammatory markers in the systemic circulation may transiently increase as a reaction to the acute ingestion of nutrients and immune challenges This postprandial inflammation, which is a normal metabolic response, has become an important risk factor for human health, since people in industrialised countries are almost constantly in a postprandial state, with corresponding inflammation trajectory [4,5].

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