Evening Meal Research Articles

S1575 The Use of Post-Prandial Breath Hydrogen to Monitor Antibiotic-Induced Changes in the Activity of the Gut Microbiome

Introduction: Small intestinal bacterial overgrowth (SIBO) is a common condition that is associated with a range of non-specific GI symptoms. Patients are often prescribed an empirical trial of antibiotics, however, response to treatment can vary. Due to the heterogeneous nature of symptoms experienced, post-prandial breath hydrogen (PPH2) may assist in identifying beneficial changes in the activity of the gut microbiome in those with a dysbiotic phenotype. Methods: Sixteen suspected SIBO patients measured their PPH2 using an at-home, app-connected breath analyzer (AIRE, FoodMarble). Readings were taken at 0, 30, 60, and 90 min after their morning and evening meals for 7 days pre and post-treatment. There were 14/16 patients who followed this protocol during antibiotic treatment. Six controls measured their PPH2 levels for 7 days. Gas normalization was defined as +2 SD of the mean PPH2 in controls. Results: Patients produced significantly more PPH2 (P=0.003), 27 ppm ± 22 ppm (mean ± SD) than controls (13 ppm ± 7 ppm). 5/14 patients saw a transient increase (P=0.2) of 23 ppm ± 23 ppm (mean delta ± SD) of PPH2 during treatment. Post-treatment, patients produced significantly less PPH2 (P=0.00001), 17 ppm ± 13 ppm, more closely matching that of healthy controls (Figure). Conclusion: For the first time, PPH2 was tracked before, during, and after antibiotic treatment. PPH2 was significantly greater in patients. Interestingly, for some patients, PPH2 increased during the treatment period, likely due to a dynamic rearrangement of certain microbial populations. Post-treatment, the level of PPH2 in patients was more similar to that of healthy volunteers. The collection of PPH2 data may be useful to identify those who produce elevated gas levels due to dysbiosis and to determine the normalization of their microbiome in response to antibiotics.Figure 1.: Post prandial breath hydrogen of suspected SIBO patients (n=16) before, during and after antibiotic treatment compared to healthy controls (n = 6)

Mild to Moderate Food Deprivation Increases Hepcidin and Results in Hypoferremia and Tissue Iron Sequestration in Mice

Short-term starvation and severe food deprivation (FD) reduce dietary iron absorption and restricts iron to tissues, thereby limiting the amount of iron available for erythropoiesis. These effects may be mediated by increases in the iron regulatory hormone hepcidin; however, whether mild to moderate FD has similar effects on hepcidin and iron homeostasis is not known. To determine the effects of varying magnitudes and durations of FD on hepcidin and indicators of iron status in male and female mice. Male and female C57BL/6J mice (14 wk old; n=170) were randomly assigned to consume AIN-93M diets ad libitum (AL) or varying magnitudes of FD (10%, 20%, 40%, 60%, 80%, or 100%). FD was based on the average amount of food consumed by the AL males or females, and food was split into morning and evening meals. Mice were euthanized at 48h and 1, 2, and 3 wk, and hepcidin and indicators of iron status were measured. Data were analyzed by Pearson correlation and one-way ANOVA. Liver hepcidin mRNA was positively correlated with the magnitude of FD at all time points (P<0.05). At 3 wk, liver hepcidin mRNA increased 3-fold with 10% and 20% FD compared with AL and was positively associated with serum hepcidin (R=0.627, P<0.0001). Serum iron was reduced by ∼65% (P≤0.01), and liver nonheme iron concentrations were ∼75% greater (P≤0.01) with 10% and 20% FD for 3 wk compared with AL. Liver hepcidin mRNA at 3 wk was positively correlated with liver Bmp6 (R=0.765, P<0.0001) and liver gluconeogenic enzymes (R = >0.667, P<0.05) but not markers of inflammation (P>0.05). FD increases hepcidin in male and female mice and results in hypoferremia and tissue iron sequestration. These findings suggest that increased hepcidin with FD may contribute to the disturbances in iron homeostasis with undernutrition.

Litchi consumption and missed meals continue to be associated with acute encephalopathy syndrome among children: an investigation of the 2019 outbreak in Muzaffarpur district, Bihar, India.

Muzaffarpur district in Bihar State of India recorded a resurgence of acute encephalopathy syndrome (AES) cases in the summer of 2019 after no reported outbreak in 3 y. Earlier studies generated evidence that litchi consumption and missing the previous evening's meal were associated with AES. We investigated the recent outbreak to understand the risk factors associated with AES. We conducted a matched case-control study by comparing AES cases with healthy controls from case-households and the neighborhood community for risk factors like missing evening meal and litchi consumption before onset of AES. We recruited 61 cases and 239 controls. Compared with the community controls, case-patients were five times more likely to have reported eating litchi in the 7 d preceding the onset of illness (adjusted OR [AOR]=5.1; 95% CI 1.3 to 19) and skipping the previous evening's meal (AOR=5.2; 95% CI 1.4 to 20). Compared with household controls, case-patients were five times more likely to be children aged <5 y (AOR=5.3; 95% CI 1.3 to 22) and seven times more likely to have skipped the previous evening's meal (AOR=7.4; 95% CI 1.7 to 34). Skipping the previous evening's meal and litchi consumption were significantly associated with AES among children in Muzaffarpur and adjoining districts of Bihar.

NADPH and Mitochondrial Quality Control as Targets for a Circadian-Based Fasting and Exercise Therapy for the Treatment of Parkinson's Disease.

Dysfunctional mitochondrial quality control (MQC) is implicated in the pathogenesis of Parkinson’s disease (PD). The improper selection of mitochondria for mitophagy increases reactive oxygen species (ROS) levels and lowers ATP levels. The downstream effects include oxidative damage, failure to maintain proteostasis and ion gradients, and decreased NAD+ and NADPH levels, resulting in insufficient energy metabolism and neurotransmitter synthesis. A ketosis-based metabolic therapy that increases the levels of (R)-3-hydroxybutyrate (BHB) may reverse the dysfunctional MQC by partially replacing glucose as an energy source, by stimulating mitophagy, and by decreasing inflammation. Fasting can potentially raise cytoplasmic NADPH levels by increasing the mitochondrial export and cytoplasmic metabolism of ketone body-derived citrate that increases flux through isocitrate dehydrogenase 1 (IDH1). NADPH is an essential cofactor for nitric oxide synthase, and the nitric oxide synthesized can diffuse into the mitochondrial matrix and react with electron transport chain-synthesized superoxide to form peroxynitrite. Excessive superoxide and peroxynitrite production can cause the opening of the mitochondrial permeability transition pore (mPTP) to depolarize the mitochondria and activate PINK1-dependent mitophagy. Both fasting and exercise increase ketogenesis and increase the cellular NAD+/NADH ratio, both of which are beneficial for neuronal metabolism. In addition, both fasting and exercise engage the adaptive cellular stress response signaling pathways that protect neurons against the oxidative and proteotoxic stress implicated in PD. Here, we discuss how intermittent fasting from the evening meal through to the next-day lunch together with morning exercise, when circadian NAD+/NADH is most oxidized, circadian NADP+/NADPH is most reduced, and circadian mitophagy gene expression is high, may slow the progression of PD.

Towards more sustainable tourism under a carbon footprint approach: The Camino Lebaniego case study

From an economic point of view, the tourism sector is one of the most important in the world with religious tourism, such as pilgrimages, being a growth area. Tourism activities also make a significant contribution to CO2 emissions (roughly 8% of the world's carbon emissions). In this framework, the main objective of this research is to develop an integrated sustainable model by assessing the impact of pilgrimages to the Camino Lebaniego (Lebaniego Way) in the Cantabrian region, which is one of the most popular routes in northern Spain. To do this, it is necessary to quantify the environmental impacts of this activity since this is a key element in establishing appropriate and effective environmental management programmes. This study uses the Life Cycle Assessment (LCA) method, focused on the Carbon Footprint (CF) impact category, to assess the greenhouse gas (GHG) emissions of this activity considering ‘a pilgrim who completes the route in three days’ as the selected functional unit (FU). In addition, the sub-sectors of accommodation, food and beverages, and waste management are taken into account. Following this route generated a total of 13.69 kg CO2 eq./FU, of which accommodation and the services offered there contributed almost 71.47%, food was 17.08%, and waste management 11.45%. The evening meal and propane consumption were the hotspots in the hostel, accounting for almost 74% of the total impact, so alternatives were proposed to reduce the impacts associated with these. In terms of transport, it was found that for the same destination, it was better to use a car rather than a plane, because the associated CO2 emissions were lower. Finally, these aspects are discussed and improvement measures for reducing GHG emissions are proposed, involving the introduction of good practices and environmental commitments from the pilgrims themselves, as well as enterprises and local communities. Ecolabels and environmental certifications should become a key tool for sending this signal to the market as should the use of public transport to the destination, among other actions. Ultimately, religious and nature tourism seems to be on the upturn, and it is likely that pilgrimage routes could be the next post-COVID travel trend.

Effects of Music Therapy in the Reduction of Pre-Meal Anxiety in Patients Suffering from Anorexia Nervosa

Literature reviews appear to indicate that Music Therapy (MT) may instil a sense of empowerment and generate feelings of renewed self-confidence, distracting subjects who follow this type of intervention from negative thoughts and, generally, helping patients suffering from Anorexia Nervosa (AN) to redevelop or rediscover their identity. The purpose of the study reported in this paper is to investigate whether MT proposed before an evening meal is capable of decreasing pre-meal anxiety in adolescents suffering from AN who follow the Day-hospital Treatment Programme at the San Bortolo Hospital of Vicenza (Italy). A total of 24 patients participated voluntarily in once-weekly sessions of group-based MT conducted by a qualified music therapist over a period of six months. Before evening meals on Monday, Tuesday and Wednesday, pre-meal anxiety was measured using a self-report scale, and the MT group session occurred every Wednesday before the evening meal was consumed. MT activities were both active and receptive. It has been found that with respect to Mondays and Tuesdays, pre-meal anxiety was significantly lower on Wednesdays following participation in the MT group. MT is evidently capable of reducing pre-meal anxiety and may be adopted as a supportive element in treatment plans relating to patients with AN in a day-hospital treatment programme.

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0379 At-home Sample Collection for Identification of Alterations in HPA-axis Activity and Cortisol Area Under the Curve

Abstract Introduction Sleep problems are associated with alterations in diurnal cortisol patterns, reflective of altered hypothalamic-pituitary-axis (HPA) activity. At-home collection of dried samples for measurement of urinary free cortisol are useful for assessment of diurnal rhythms because they do not impose the stress or sleep disruption associated with inpatient studies. The purpose of this analysis was to assess urinary cortisol responses among a large real-world dataset of at-home collection kit users and the potential for utility in identifying alterations in HPA-axis activity. Methods This retrospective analysis evaluated data from 3,966 individuals who used a Sleep and Stress Test (Everlywell, Inc.) between September 2017 and July 2021. Four dried urine spot samples were collected according to habitual sleep patterns: upon waking (T1), two hours after waking (T2), prior to the evening meal (T3), and at bedtime (T4). Urinary free cortisol normalized to creatinine, indicative of HPA-axis activity was assessed (area under the curve (AUC), wake to bedtime diurnal cortisol slope (DCS), mid-morning (T2) and bedtime (T4) cortisol levels). Sample reference ranges were established from two standard deviations above and below the log-transformed mean at each time point, values were reverted to original units for reporting. Results The sample was predominantly female (n=2,832, 71%). Mean age was 42.8 (sd=12.0) years. Seventy-eight individuals had mid-morning (T2) cortisol levels that were higher than the sample reference range (7.0-170.7 ug/g Cr), and 88 individuals below. Bedtime (T4) cortisol levels were elevated in 145 individuals (reference range 1.1-25.0 ug/g Cr). Total AUC for cortisol was high in 93 and low in 81 of individuals. The slope of the diurnal cortisol response was flattened in 20.6% (n=816) of the sample. Conclusion This real-world study demonstrates that at-home dried urine sample collection can be used to characterize normal and atypical HPA-axis activity. Convenient assessment of alterations in diurnal cortisol patterns are critical in identifying and understanding the mechanisms of HPA-axis activity common in sleep disruptions/disorders. Future studies utilizing this methodology may prove useful in identifying subpopulations with altered HPA-axis activity, sleep issues, and potential relationships to cardiometabolic health. Support (If Any)

0350 At-home Sample Collection for Measurement of Diurnal Rhythms of Urinary Cortisol and Melatonin

Abstract Introduction Sleep- and stress-related hormones (e.g., melatonin, cortisol) can be measured from dried urine samples collected at-home and sent for laboratory testing. These measures may be used to identify patterns of circadian alignment, peak nocturnal melatonin levels as well as a cortisol awakening response. The purpose of this analysis was to describe diurnal patterns and reference ranges from a 4-timepoint serial assessment of urinary cortisol and melatonin in a large cohort of at-home self collected samples. Methods This retrospective analysis evaluated data from 3,966 individuals who used an at-home Sleep and Stress Test (Everlywell, Inc.) between September 28, 2017 and July 14, 2021. Individuals provided four urine samples according to habitual sleep patterns: upon waking (T1), two hours after waking (T2), prior to the evening meal (T3), and at bedtime (T4). Melatonin and cortisol distributions were normalized to creatinine and log transformed to approximate normal distributions to define respective reference ranges (two standard deviations above and below the log transformed mean) and reverted to original units for reporting. Results 71% (n=2,832) of users were female and mean age was 42.8 (sd=12.0) years. Mean (sd) urinary values were as follows: Cortisol: T1, 29.3 (37.9) ug/g Cr; T2, 47.2 (49.8); T3, 14.9 (36.3); T4. 8.38 (26.9). Melatonin: T1, 745 (3208) ug/g Cr; T2, 169 (1189); T3, 45 (620); T4, 155 (1701). For cortisol, only 4-5% of samples fell outside the defined reference ranges across time points. Melatonin was more variable with 23% and 15% falling outside the reference range at time points T3 and T4, respectively. A majority of individuals’ peak cortisol occurred at T2 (67.4%), and melatonin at T1 (85.2%). Conclusion This analysis demonstrates measurable physiological diurnal patterns for cortisol and melatonin using at-home self-collection for dried urine tests. This provides evidence that at-home sample collection kits using dried urine spots are a viable tool for assessing diurnal patterns of sleep and stress. Future controlled studies are needed to evaluate the utility in identifying abnormal patterns associated with shift-work or sleep disorders. Support (If Any)

A Three-Day Intervention With Granola Containing Cereal Beta-Glucan Improves Glycemic Response and Changes the Gut Microbiota in Healthy Individuals: A Crossover Study.

Intake of soluble fibers including beta-glucan, is known to improve post-prandial glycemic response. The mechanisms have been attributed to the viscous gel forming in the stomach and small intestine, giving a longer absorption time. However, recent evidence suggests a link between intake of beta-glucan and improved glycemic regulation at subsequent meals through the gut microbiota. We investigated the short-term effect of granola with different amounts of cereal beta-glucan on glycemic response and gut microbiota. After a two-week run-in period (baseline), fourteen healthy, normal weight adults completed a dose-response dietary crossover study. Different amounts of cereal beta-glucan (low: 0.8 g, medium: 3.2 g and high: 6.6 g) were provided in granola and eaten with 200 ml low-fat milk as an evening meal for three consecutive days. Blood glucose and insulin were measured fasted and after an oral glucose tolerance test (OGTT) the following day, in addition to peptide YY (PYY) and glucagon-like peptide (GLP-2), fasting short chain fatty acids (SCFA) in blood, breath H2, and gut microbiota in feces. Only the intervention with medium amounts of beta-glucan decreased blood glucose and insulin during OGTT compared to baseline. Fasting PYY increased with both medium and high beta-glucan meal compared to the low beta-glucan meal. The microbiota and SCFAs changed after all three interventions compared to baseline, where acetate and butyrate increased, while propionate was unchanged. Highest positive effect size after intake of beta-glucan was found with Haemophilus, followed by Veillonella and Sutterella. Furthermore, we found several correlations between different bacterial taxa and markers of glycemic response. In summary, intake of granola containing 3.2 g cereal beta-glucan as an evening meal for three consecutive days reduced the glycemic response after an OGTT 0-180 min and changed gut microbiota composition. Since we cannot rule out that other fiber types have contributed to the effect, more studies are needed to further explore the effect of cereal beta-glucan on glycemic regulation.Clinical Trial Registration[www.clinicaltrials.gov], identifier [NCT03293693].

Prior arm-crank exercise has no effect on postprandial lipaemia in nondisabled adults

A single bout of cycling or running performed in the evening can reduce postprandial lipaemia (PPL) the following morning, although this is currently unknown for upper-body exercise. The aim of this study was to determine if a bout of arm crank exercise (high-intensity interval [HIIE] or moderate-intensity continuous [MICE]), can attenuate PPL in non-injured individuals. Eleven healthy and recreationally active participants (eight males, three females; age: 27 ± 7 yr; body mass index: 23.5 ± 2.5 kg · m-2) volunteered to participate in three trials: HIIE (10 x 60 s at 80% peak power output), MICE (50% peak power output of isocaloric duration), and a no-exercise control condition. Each exercise bout was performed at 18:00, and participants consumed a standardized evening meal at 20:00. Following an overnight fast, a 5-h mixed-macronutrient tolerance test was performed at 08:00. There were no significant differences in triglyceride incremental area under the curve between HIIE (192 ± 94 mmol. L-1 per 300 min), MICE (184 ± 111 mmol. L-1 per 300 min), and the no-exercise condition (175 ± 90 mmol. L-1 per 300 min) (P=0.46). There were no significant differences in incremental area under the curve for glucose (P=0.91) or insulin (P=0.59) between conditions. Upper-body MICE and HIIE performed in the evening do not influence PPL the following morning, in normotriglyceridemic individuals. Clinical Trials Registration: NCT04277091 Novelty: • Arm crank exercise has no effect on PPL when performed the evening prior to a mixed-macronutrient meal test • Upper-body sprint interval exercise should be investigated as a potential solution to reduce PPL.

Extended Non-Fasting Period And Delayed Last Meal Are Associated With Peak Oxygen Consumption In Heart Failure With Preserved Ejection Fraction

<h3>Introduction</h3> Delayed time of eating last meal has been recently associated with favorable cardiorespiratory fitness (CRF) in patients with Heart Failure with preserved ejection fraction (HFpEF). However, whether the overall 24-hour non-fasting period is associated with CRF in these patients is unknown. The aim of this analysis was to examine associations between non-fasting period and CRF in HFpEF, and we hypothesized that a greater non-fasting period was associated with improved CRF, independent of daily caloric intake. <h3>Methods</h3> Twenty-one consecutive patients with HFpEF (left ventricular ejection fraction >50%) underwent maximal cardiopulmonary exercise testing to measure CRF, defined as peak oxygen consumption (VO₂) (ml•kg⁻¹•min⁻¹) and exercise time. A 5-pass, 24-hour dietary recall was administered to collect all timing of caloric intake. Daily non-fasting time was considered as the duration between the first and last meals. Dietary recall was analyzed with Nutrition Data Systems for Research Software to obtain total calories. The International Physical Activity Questionnaire was administered to collect self-reported physical activity. Spearman rank correlation and multiple linear regression was utilized to examine associations. Results are displayed as median (interquartile range; IQR). <h3>Results</h3> Patient characteristics are displayed in <b>Table 1</b>. On univariate analysis, daily non-fasting time was associated with peak VO₂ and exercise time (<b>Figure 1</b>). Time of last meal was also associated with peak VO₂ (r=0.571, <i>P</i>=0.007) and exercise time (r=0.528, <i>P</i>=0.014), however, time of first meal was not associated with peak VO₂ or exercise time (both <i>P</i>>0.6). On multivariate analysis, peak VO₂ remained associated with daily non-fasting time (<i>P</i>=0.041) and last meal time (<i>P</i>=0.022) when adjusted for total calories, physical activity, and age. <h3>Conclusion</h3> Extended daily non-fasting time and delayed last meal time are independently associated with more favorable CRF in patients with HFpEF. Prospective clinical trials to extend daily non-fasting window by delaying the final evening meal are warranted.

Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study

These analyses examined associations of parent dietary role modeling with diet quality among school-age children in a rural community. Past research has found protective associations between parent role modeling and children's dietary intake; however, there is a gap in understanding these associations for families in rural communities. Baseline data (2017 -2018) were drawn from the New Ulm at Home (NU-HOME) randomized controlled trial, conducted in the United States. The trial recruited 114 children (7–10 years old) and parents. Parents self-reported dietary intake [fruit and vegetable (FV), sugar-sweetened beverage (SSB), fast food (FF)] and frequency of sitting and eating with their child. Children reported parent role modeling of healthful eating (FV and salad at the evening meal; FV as snacks). Two 24-h dietary recalls assessed child diet quality indicators [Healthy Eating Index-2015 (HEI-2015) total scores, FV intake, SSB intake]. General linear models (GLM) and logistic regression analyzed associations of child diet quality (HEI score, FV intake, SSB intake) with parent dietary intake, parent sitting and eating the evening meal with their child, and child perceptions of parent role modeling healthful eating, adjusted for highest level of education in the home. Higher child HEI-2015 scores were positively associated with more frequent parent role modeling of fruit intake at meals, and inversely associated with more frequent parent role modeling of fruit as a snack; no significant associations of child FV intake with parent role modeling were observed. Higher child SSB intake was positively associated with parent FF intake. In this rural community, parents play significant roles in shaping children's dietary quality and intake, though more work needs to be done to address optimal intervention strategies to promote parent role modeling of healthful eating.

Decreased Need for Correction Boluses with Universal Utilisation of Dual-Wave Boluses in Children with Type 1 Diabetes.

Insulin pumps offer standard (SB), square and dual-wave boluses (DWB). Few recommendations exist on how to use these dosing options. Several studies suggest that the DWB is more effective for high-fat or high-carbohydrate meals. Our objective was to test whether time in range (TIR) improves in children with type 1 diabetes (T1D) using the universal utilization of the dual-wave boluses for all evening meals regardless of the composition of the meal. This was a 28-day long prospective randomized open-label single-center crossover study. Twenty-eight children with T1DM using a Medtronic 640G pump and continuous glucose monitoring system were randomly assigned to receive either DWB or SB for all meals starting from 6:00 p.m. based solely on the food carbohydrate count. DWB was set for 50/50% with the second part extended over 2 h. After two weeks patients switched into the alternative treatment arm. TIR (3.9–10 mmol/L), time below range (TBR) (<3.9 mmol/L) and time above range (TAR) (>10 mmol/L) and sensor glucose values were measured and compared between the groups. Twenty-four children aged 7–14 years completed the study according to the study protocol. There were no statistically significant differences in mean TIR (60.9% vs. 58.8%; p = 0.3), TBR (1.6% vs. 1.7%; p = 0.7) or TAR (37.5 vs. 39%; p = 0.5) between DWB and SB groups, respectively. Subjects in the SB treatment arm administered significantly less correction boluses between 6 p.m. and 6 a.m. compared to those in the DWB group (1.2 ± 0.8 vs. 1.7 ± 0.8, respectively; p < 0.01). DWB for evening meals in which insulin is calculated solely on the food carbohydrate content did not improve TIR compared to standard bolus in children with T1D. However, DWB enabled to use significantly less correction boluses to achieve euglycemia by the morning compared to the SB.

Midpoint of energy intake, non-fasting time and cardiorespiratory fitness in heart failure with preserved ejection fraction and obesity

BackgroundDelayed time of evening meal is associated with favorable cardiorespiratory fitness (CRF) in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. It is unknown, however, if increasing daily non-fasting time or delaying the midpoint of energy intake may also be associated with CRF. ObjectiveOur aim was to examine whether a longer non-fasting time, delayed midpoint of energy intake, or both, are associated with greater CRF in patients with HFpEF and obesity. MethodsWe measured peak oxygen consumption (VO2), a measure of CRF, in 32 patients with HFpEF and obesity with cardiopulmonary exercise testing, and dietary intake using a five-pass 24-h dietary recall. Participants were divided into groups by having lesser (<11.6) or greater (≥11.6) periods of non-fasting time than the median and similarly, with earlier (<2:15 PM) or later (≥2:15 PM) than median midpoint of energy intake. ResultsMedian non-fasting time was 11.6 [10.6‐12.9] hours and midpoint of energy intake was 2:15 [1:04–3:00] PM. There were no differences in CRF between those with a shorter (<11.6) or longer (≥11.6) non-fasting time. Participants with a delayed midpoint of energy intake (≥2:15 PM) had greater peak VO2 and exercise time. Midpoint of energy intake (r = 0.444, P = 0.011) and time of last meal (r = 0.550, P = 0.001) displayed a positive association with peak VO2, but not non-fasting time nor time of first meal. ConclusionsDelaying the midpoint of energy intake by postponing last meal is associated with better peak VO2 and exercise time in patients with HFpEF and obesity.

Optimize meal timing to minimize diabesity

This perspective article addressed a rising question if optimizing meal timing can help minimize obesity and diabetes (diabesity) via optimizing glucose and insulin circadian metabolism. Meal properties including timing, sequence, and frequency are of metabolic importance in ruminants and humans. The modern man consumes fast foods at wrong times of the 24-h circadian period. Suboptimal meal timing and inadequate physical activity can impair normal biological rhythmicity of glucose and insulin metabolism, which may lead to diabetes. Type 2 diabetes mellitus (T2D) and obesity could, thus, largely be a consequence of suboptimal meal timing and lifestyle. Avoiding sugar- and carbohydrate-rich evening and nocturnal meals should help improve glucose and insulin metabolism. Optimal meal timing is a growing practice that should be incorporated into healthy nutritional programs to help avert obesity and T2D in today’s stressful life. Subsequently, nutrient-dense evening and night meals must be avoided to reduce diabesity risk.

The detection of infectious endocarditis may be enhanced by a repeat FDG-PET while maintaining patients on a ketogenic diet

BackgroundThis study aims to determine whether the suppression of myocardial FDG uptake and detection of infectious endocarditis (IE) may be enhanced when FDG-PET is repeated on the next day while maintaining patients on a ketogenic diet in the interim. MethodsSeventeen patients with definite IE underwent FDG-PET investigations both after a conventional metabolic preparation (> 12-hour fast after a low-carbohydrate evening meal) and a subsequent 12-hour extension of the low-carbohydrate diet followed by an additional > 12-hour fast. ResultsPlasma biomarkers showed increased ketogenic metabolism between the two FDG-PET scans. A myocardial FDG uptake persisted on the 1st PET in 9 patients (53%) for whom myocardial FDG uptake decreased significantly on the 2nd PET (SUVmax: 6.05 ± 3.25 vs 4.32 ± 3.47, P = 0.021), resulting in an enhancement in the diagnostic confidence of IE in 6 cases. These enhancements were not documented in the 8 patients exhibiting a total suppression of myocardial FDG uptake on the 1st PET. ConclusionsBetter suppression of myocardial uptake and enhanced detection of IE may be achieved when an FDG-PET, showing an incomplete suppression of the myocardial FDG uptake, is repeated as soon as the next day, while maintaining patients on a ketogenic diet in the interim.

Love in the Time of Coronavirus: A Pandemic Pilgrimage

I have admired Angela Alaimo O'Donnell and her poems from the moment I first encountered them twenty years ago. A poet of vast imaginative range, she has the will, wit, and bravura to reinvent herself and her oeuvre to accommodate whatever muse hovers over her.This luminous new volume quietly astonishes. It contemplates, in a series of inventive hybrid sonnets, spanning a period from March 22, 2020, to March 22, 2021, the first year of lockdown under the rule and cloud of COVID. Her title pays homage to Gabriel Garcia Marquez's Love in the Time of Cholera, a novel that champions love as the ultimate balm to misery and dissolution.Pilgrimage, in O'Donnell's economy, is the operative word. Here, as in all of her work, we see the world through the lens of the seeker, the questing pilgrim, discovering with wonder the minute-by-minute offices and rituals of drawing breath on this earth. “These poems map a private pilgrimage to nowhere,” she writes in the preface, “—from the chair to the couch, from the couch to the chair.” But beyond these “private” visions under sequestered circumstances, there emerges a global awareness; the poems “map a public pilgrimage . . . from dire disaster to the hope for healing.”In a work well structured, choreographed really, its individual sonnets are the varied rooms, at once familiar and foreign, the suddenly compartmentalized life by and in which the speaker is both confined and liberated, rooms into which readers traipse along with the speaker, conscious that O'Donnell is writing herself (and us) out of that diminished, threatening, yet numinously amplified, world. The poems are prayers, a litany of praise, of hope, of gratitude. Even as the world draws up, it opens; and, though its subject is often grave, Love in the Time of Coronavirus is not doleful. It is also rife with whimsy and a wry, endearingly self-effacing humor. In “Lockdown Metamorphosis,” the speaker likens herself to a caterpillar building time in its chrysalis, “pure goo,” only to emerge “a butterfly with an attitude.”Each poem is crafted with pristine care (there's even an acrostic sonnet), and the collection is embedded with O'Donnell's characteristic allusions to faith and social and restorative justice. In the near-apocalyptic realm of COVID, these poems hold fast to home in all its sacramental valence: tranquility, surrender, the recognition of the simple gifts that had been there all along: “flowers on all the tabletops, / lilacs and lilies, larkspur and rose.” One of the finest sonnets, “Our Emmaus,” invokes Transubstantiation in the throes of an evening meal: Better to sit here. Just me and you.To set on our table olives and wine,to savor the taste of sweet grapes and brine,to raise our glasses and toast the poor dead,to mend the world and break our bread.The family meal, it goes without saying, is the single strongest representation of divine immanentism in the world of the southern Italians.The sonic heft and thrum of these splendid poems—the transformative love that beats so passionately in a seemingly shrunken world—ring like Sanctus bells long after the volume concludes.

Meal Timing and Macronutrient Composition Modulate Human Metabolism and Reward-Related Drive to Eat.

The ‘time-of-day’ modifies the metabolic response to meals, but less data exist on the diurnal variations in the hedonic drive to eat. In the present paper, we evaluate the effects of meal timing and macronutrient composition on metabolic responses and the homeostatic vs. hedonic regulation of appetite. In study 1, 84 young, healthy adults completed an online computer-based task assessing the homeostatic and hedonic drive to eat in the morning and evening. In study 2, 24 healthy, young men received 2 identical (850 kcal each) meals in the morning (8:45 h) and evening (18:00 h), of 2 experimental conditions: (i) regular carbohydrate (CH) meals (regular-CH), and (ii) high carbohydrate (high-CH) meals, containing 50 and 80% of energy from CHs, respectively. Serial blood samples were obtained, and the postprandial feelings of hunger, satiety, wanting and liking were assessed. Study 1 revealed a higher hedonic drive to eat in the evening compared to the morning. Study 2 confirmed this diurnal pattern of hedonic appetite regulation and, moreover, showed increased glucose and insulin responses to the evening meal. Postprandial ghrelin and leptin as well as feelings of hunger and satiety were not different between the mealtimes nor between the macronutrient conditions. In line with this, the homeostatic drive to eat was neither affected by the mealtime nor macronutrient composition. Increased the hedonic drive to eat in the evening may represent a vulnerability to palatable food and, thus, energy overconsumption. Together with lower evening glucose tolerance, these findings reflect an adverse metabolic constellation at the end of the day, especially after the ingestion of CH-rich foods.

Postprandial Glucose Excursions in Asian Versus Non-Asian Patients with Type 2 Diabetes: A Post Hoc Analysis of Baseline Data from Phase 3 Randomised Controlled Trials of IDegAsp.

IntroductionIncreased postprandial glucose (PPG) is associated with high glycated haemoglobin levels and is an independent risk factor for cardiovascular diseases. The aim of this study was to compare PPG increments in Asian versus non-Asian adults with type 2 diabetes (T2D), who were insulin-naïve or insulin-experienced, from the phase 3 insulin degludec/insulin aspart (IDegAsp) clinical trials.MethodsThis was a post hoc analysis of data from 13 phase 3, randomised, parallel-group, open-label IDegAsp trials in patients with T2D. The pooled baseline clinical data were analysed for insulin-naïve and insulin-experienced groups; and each group was split into subgroups of Asian and non-Asian patients, respectively, and analysed accordingly. Baseline self-monitored blood glucose (SMBG) values at breakfast, lunch and the evening meal (before and 90 min after each meal) were used to assess PPG increments. The estimated differences in baseline SMBG increment between the Asian and non-Asian subgroups were analysed.ResultsClinical data from 4750 participants (insulin-naïve, n = 1495; insulin-experienced, n = 3255) were evaluated. In the insulin-naïve group, the postprandial SMBG increment was significantly greater in the Asian versus the non-Asian subgroup at breakfast (estimated difference 28.67 mg/dL, 95% confidence interval [CI] 18.35, 38.99; p < 0.0001), lunch (17.34 mg/dL, 95% CI 6.47, 28.21; p = 0.0018) and the evening meal (16.19 mg/dL, 95% CI 5.04, 27.34; p = 0.0045). In the insulin-experienced group, the postprandial SMBG increment was significantly greater in the Asian versus non-Asian subgroup at breakfast (estimated difference 13.81 mg/dL, 95% CI 9.19, 18.44; p < 0.0001) and lunch (29.18 mg/dL, 95% CI 24.22, 34.14; p < 0.0001), but not significantly different at the evening meal.ConclusionIn this post hoc analysis, baseline PPG increments were significantly greater in Asian participants with T2D than in their non-Asian counterparts at all mealtimes, with the exception of the evening meal in insulin-experienced participants. Asian adults with T2D may benefit from the use of regimens that control PPG excursions.Clinical Trial NumbersNCT02762578, NCT01814137, NCT01513590, NCT01009580, NCT01713530, NCT02648217, NCT01045447, NCT01365507, NCT01045707, NCT01272193, NCT01059812, NCT01680341, NCT02906917.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01196-7.