Glycemic Index Meals Research Articles

7970 C3 and C4 Levels Decrease Post-prandial in Adolescents with type 1 Diabetes

Abstract Disclosure: C.P. Damilano: None. C. Yu: None. D. Zhou: None. R.P. Hoffman: None. Introduction: Cardiovascular disease will be the primary cause of future death for adolescents with type 1 diabetes (T1D) and its origins are likely to occur in this age group. Adolescents with T1D have increased systemic inflammation which is likely to play a significant role in the pathogenesis of cardiovascular disease. The complement system, in particular, components C3 and C4 are part of the innate immune system that regulates inflammation. Increased C3 and C4 levels are associated with increased cardiometabolic risk. Objective: Most studies of inflammation are done while fasting but TNFα and IL6 increase postprandially in adolescent T1D following both high and low glycemic index (GI) meals. The goal of this study was to determine whether there are similar post-prandial changes in C3 and C4 levels. Methodology: Twelve, non-obese children and adolescents, 10-18 years old, with T1D were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. After an overnight fast baseline blood samples were taken to measure plasma glucose, C3, total C4 protein, and total C4. Rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) to measure glucose and C3 and C4 levels. Visits 1 and 2 were identical except for GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Repeated measures ANOVA and Spearman’s correlation were used. Results: Glucose response was significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, p<0.001). For C3 levels, there was a significant post-prandial decrease (time effect p=0.049), but no meal effect or meal x time interaction. No specific time differences were found. C4 levels were also suppressed postprandially (p<0.001) and there was again no meal effect or meal by time interaction. Post hoc analysis found that C4 levels were lower at 60 min than at 0 min (p=0.007), 90 min (p=0.002) or 120 min (p<0.001). Conclusions: C3 and C4 levels decrease post-prandially in adolescents with T1D in contrast to increases in TNFα and IL6. Future research is clearly needed to clarify the postprandial interactions between the complement and inflammatory systems and potential pathogenic role in cardiovascular disease. Presentation: 6/3/2024

The Effect of Meal Frequency and Glycemic Index During the Night Shift on Alertness, Hunger, and Gastrointestinal Complaints in Female Health Care Workers—A Two-Armed Randomized Crossover Trial

BackgroundNutrition strategies for night-shift workers could optimize alertness and minimize hunger and reduce gastrointestinal complaints, enhancing safety and well-being. ObjectivesThis study aimed to investigate the effects of 1 or 3 small meals, with either low or high glycemic index (GI), compared with no meal, on alertness, hunger, and gastrointestinal complaints during the night shift. MethodsFifty-one female health care workers, aged 18 to 61 Y, participated in a 2-armed randomized crossover design. In 1 study arm, participants received 1 yogurt meal during the night shift, AND in the other, they received 3. Each study arm involved 3 intervention periods during night shifts, with participants consuming yogurt with low GI (1LGI or 3LGI) OR high GI (1HGI or 3HGI) carbohydrates, or no meal (0NGI). Objective alertness was assessed using a validated brief psychomotor vigilance task (PVT-B), subjective alertness with the Samn–Perelli scale, and hunger and gastrointestinal complaints through questionnaires. ResultsParticipants in the 1LGI (β: −4.6; 95% CI: 0.0, 9.3) and 3LGI (β: −3.4; 95% CI: 0.0, 6.8) conditions had fewer lapses during the PVT-B than those in the 3HGI condition. No differences were found between meal conditions for median and reciprocal reaction time or subjective alertness. All 4 conditions reported less hunger (β: from −0.6 to −1.2) compared with no meal. The 3LGI condition resulted in more rumbling intestines than the 3HGI (β: 1.1; 95% CI: 0.4, 1.7) and 0NGI (β: 0.74; 95% CI: 0.11, 1.37) conditions. ConclusionsOur study suggests that consuming 3 small low GI meals during the night shift helps maintain alertness and reduces lapses compared with 3 high GI meals. It also minimizes hunger but may cause mild gastrointestinal complaints.This trial was registered at International Clinical Trial Registry (https://trialsearch.who.int/Trial2.aspx?TrialID%3dNL-OMON25574).

Association between glucose dips and the feeling of hunger in a dietary intervention study among students with early and late chronotype-secondary analysis of a randomized cross-over nutrition trial

Consumption of foods with high glycaemic index (GI) can cause hyperglycemia, thus increasing postprandial hunger. Since circadian rhythm differs inter-individually, we describe glucose dips after breakfast/dinner with high/medium estimated meal GI among students with early (n = 22) and late chronotype (n = 23) and examine their relation to the feeling of hunger in a secondary analysis of a randomized cross-over nutrition trial. Glucose dips reflect the difference between the lowest glucose value recorded 2–3 h postprandially and baseline, presented as percentage of average baseline level. Associations between glucose dips and the feeling of hunger were analyzed using multilevel linear models. Glucose dips were lower after medium GI meals than after high GI meals among both chronotype groups (p = 0.03). Among early chronotypes, but not among late chronotypes, glucose dip values were lower after breakfast than after dinner (−4.9 % vs. 5.5 %, p = 0.001). Hunger increased throughout the day among both chronotypes but glucose dips were not related to the feeling of hunger at the meal following breakfast. Interestingly, lower glucose dip values 2–3 h postprandially occurred particularly after medium GI meals and were seen after breakfast among early chronotypes. These glucose dips did not predict hunger at meals after breakfast.

Evaluation of glycemic response of ten local meals commonly consumed from Chad

Diabetes mellitus is a metabolic disorder characterized by the presence of chronic hyperglycaemia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids and proteins, including defects in either insulin secretion or response. The function of pancreatic cells gradually declines before the onset of clinical hyperglycemia. Its prevalence is increasing everywhere, especially in the developing countries due to the consumption of unknown glycemic index (GI) foods. Thus, the present study aimed to determine the GI of some local meals from Chad. In this purpose, ten meals were investigated and 60 non-diabetic volunteers were recruited in the present study. The proximate composition and the GI of these meals were determined. Results showed that 5 main ingredients (Hibiscus esculentus, Ipomea batata, Hibiscus sabdariffa, Corchorus oletorius and seeds of Parkia biglobosa) differentiate the meals. Soluble sugars and total carbohydrates levels showed a significant (p < 0.05) difference between meals (staples and sauces). The highest value of total carbohydrate of staples was found in Peeled dried sorghum ((BD); 31.80 %) while Cooked rice ((RZ); 19.82 %) has the lowest amount. Then, total carbohydrate content of sauces was in the range of 3.95 % (Leaves of Corchorus oletorius (MLK)) and 8.76 % (Dried okra + Fresh meat (GSV)) while, Sorrel leaves + Smoked fish ((OSP); 2.51 %) and Dried okra + Smoked fish ((GSP); 1.31 %) recorded the highest and lower values of soluble sugars, respectively. Moreover, Peeled dried maize + Dried okra + Fresh meat (MD/GSV) meal showed the highest GI (115.76 %) while the lowest value was found with Cooked rice + Sorrel leaves + Smoked fish (RZ/OZP) meal (31.08 %). The GI of Peeled dried maize + Fresh okra + Fresh meat (MD/GFV) attained a peak of 140 at 40 min while the peak of 130 was obtained with Peeled dried maize + Fresh okra + Smoked fish (MD/GFP) meal at the same time compared to glucose (160 at 40 min). Five meals (OSP/RZ; MD/GFP; MD/GFV; BD/GFP and BD/MLK) were low GI foods and were the best meals for human-being in terms of preventing diabetes mellitus. The consumption of such meals can provide a substantial contribution to the improvement of the Chadian diets.

Glycemic response to meals with a high glycemic index differs between morning and evening: a randomized cross-over controlled trial among students with early or late chronotype

PurposeGlycemic response to the same meal depends on daytime and alignment of consumption with the inner clock, which has not been examined by individual chronotype yet. This study examined whether the 2-h postprandial and 24-h glycemic response to a meal with high glycemic index (GI) differ when consumed early or late in the day among students with early or late chronotype.MethodsFrom a screening of 327 students aged 18–25 years, those with early (n = 22) or late (n = 23) chronotype participated in a 7-day randomized controlled cross-over intervention study. After a 3-day observational phase, standardized meals were provided on run-in/washout (days 4 and 6) and intervention (days 5 and 7), on which participants received a high GI meal (GI = 72) in the morning (7 a.m.) or in the evening (8 p.m.). All other meals had a medium GI. Continuous glucose monitoring was used to measure 2-h postprandial and 24-h glycemic responses and their variability.ResultsAmong students with early chronotype 2-h postprandial glucose responses to the high GI meal were higher in the evening than in the morning (iAUC: 234 (± 92) vs. 195 (± 91) (mmol/L) × min, p = 0.042). Likewise, mean and lowest 2-h postprandial glucose values were higher when the high GI meal was consumed in the evening (p < 0.001; p = 0.017). 24-h glycemic responses were similar irrespective of meal time. Participants with late chronotype consuming a high GI meal in the morning or evening showed similar 2-h postprandial (iAUC: 211 (± 110) vs. 207 (± 95) (mmol/L) × min, p = 0.9) and 24-h glycemic responses at both daytimes.ConclusionsDiurnal differences in response to a high GI meal are confined to those young adults with early chronotype, whilst those with a late chronotype seem vulnerable to both very early and late high GI meals. Registered at clinicaltrials.gov (NCT04298645; 22/01/2020).

The Effect of Meal Glycemic Index and Meal Frequency on Glycemic Control and Variability in Female Nurses Working Night Shifts: A Two-Arm Randomized Cross-Over Trial

BackgroundNight shift workers are exposed to circadian disruption, which contributes to impaired glucose tolerance. Although fasting during the night shift improves glucose homeostasis, adhering to this dietary strategy may be challenging. ObjectivesThis study evaluated the effect of fasting compared with the consumption of meals with different combinations of glycemic index (GI, low or high) and frequency (1 or 3 times) during the night shift on continuous glucose monitoring metrics. MethodsA 2-arm randomized cross-over trial was conducted on female nurses working night shifts. In each of those arms, the participants were either provided with no meal (fasted), low GI, or high-GI meal during the night shift with a meal frequency according to which arm they were randomly allocated to, either 1-MEAL or 3-MEAL. Outcome variables were glycemic control and variability (GC and GV) metrics during the night shift (21:30–7:00), in the morning after the night shift (07:00–13:00), and in the 24 h period (18:00–18:00). ResultsCompared to no meal, the consumption of 1 high-GI meal increased all GV metrics not only during the night shifts but also in the morning, for instance, as observed in the coefficient of variation (β = 0.03 mmol/L; 95% CI: 0.01, 0.05), and GV percentage (β = 4.13; 95% CI: 2.07, 6.18). The consumption of 1 or 3 low GI meals did not raise GC or GV metrics except for continuous overall net glycemic action during the night shifts after consuming 3 low GI meals. When controlling for GI, night shift meal frequency did not affect any metrics in any timeframe. ConclusionsHigh meal GI but not higher meal frequency during the night shift increased GC and GV in female night shift workers. Results for 1 low-GI meal during the night shift were not different from a glucose profile after no meal.This trial was registered at trialsearch.who.int as NL8715.

Chrono-nutrition and its Association with Chronotype and Blood Glucose Control Among People with Type 2 Diabetes

Background: Recent studies have revealed conflicting results for low glycaemic index (GI) meals in the prevention and treatment of metabolic disorders. Diurnal variations in glucose homeostasis, which are frequently overlooked in epidemiological studies, may help to explain some of these discrepancies. Food is an external cue to entrain the circadian rhythm, and meal timing is a crucial factor for glucose homeostasis. The study examines the relationship between chrono-nutrition, chronotype, and blood glucose control among people with Type 2 diabetes. Materials and Methods: Chrono-nutrition questionnaire assessed eating window, breakfast skipping, evening latency, evening eating, night eating, and largest meal of patients with Type 2 diabetes. Glycaemic control was assessed using a HbA1c test, fasting blood sugar, and 2-hour post-prandial blood sugar test. Insulin resistance was assessed by fasting triglyceride glucose index (TyG). Results: There was a significant association between late dining with dysglycaemia, irrespective of GI of the meal (p&lt;0.05). Participants who had the largest meal during the active phase had better glycaemic control (p&lt;0.05). Shorter eating windows and evening latency of at least 2 hours not only aided in glycaemic control, but also gave good sleep (p&lt;0.05). Participants with the evening chronotype ate almost twice the amount of carbohydrates and fat at dinner than at breakfast. Evening chronotypes were associated with lesser servings of vegetables and fruits, and greater servings of sweets and caffeinated beverages, in comparison with morning chronotypes. Conclusions: Late diners had significantly worse blood glucose levels, irrespective of the GI of the meal. This may have public health implications, as calorie-dense meals are often consumed during late evenings, which can desynchronise the circadian rhythms. Eating meals as per the circadian rhythm could be an alternative non-pharmacological strategy to prevent diabetes and its complications.

SAT169 Sugar Crash: A Case Of Recurrent Hypoglycemia

Abstract Disclosure: C.T. Malvar: None. P. Patel: None. H. Moran: None. D. Bleich: None. Introduction: Post-prandial hypoglycemia is a rare complication following Roux-en-Y gastric bypass surgery (RYGB). Some theories suggest that post-operative beta cell expansion and altered beta cell function may lead to increased secretion of insulin, thereby causing hypoglycemia. We report a 39-year-old female with multiple episodes of recurrent post-prandial hypoglycemia following RYGB. Case Report: A 39-year-old female with a past medical history of type 2 diabetes managed with insulin, hypertension, hyperlipidemia, and obesity underwent RYGB and developed multiple episodes of fatigue, diaphoresis, palpitations, and tremulousness a year later. The patient continued to have worsening symptoms, leading to multiple hospitalizations for hypoglycemia. During her initial presentation to the emergency department, she was found to be afebrile, tachycardic with stable blood pressure. Work up revealed a glucose of 34 mg/dl (70 - 109 mg/dl), insulin of 40.1 (2.6 - 24.9 uIU/mL), C-peptide of 3.8 (1.1 - 4.4 ng/mL), potassium of 3.2 (3.5 - 4.8 meq/l), negative sulfonylurea screen, normal renal function, and a mild leukocytosis of 12.6 (4.0 - 11.0 x 10*3/µL). CT abdomen/pelvis, chest x-ray, and urinalysis were normal and did not reveal any infection. The patient denied taking any hypoglycemic agents and reported consuming high glycemic index meals. During her hospitalization, she received a bolus of dextrose followed by a continuous dextrose drip; however, she continued to experience recurrent hypoglycemic events requiring glucagon and dextrose tablets. Subsequent morning labs showed elevated insulin levels at 34.6 (2.6 - 24.9 uIU/mL) and a normal IGF-1 level. Her 8AM cortisol level was 2.3 (6.0 - 18.4 ug/dl). Due to high suspicion of adrenal insufficiency, she was started on Hydrocortisone. Pituitary MRI was negative for any adenoma. Hydrocortisone was held and a cosyntropin stimulation test established appropriate adrenal response. Hydrocortisone and dextrose tablets were discontinued. She was educated on eating low glycemic index meals to prevent future hypoglycemic episodes. She was started on acarbose as it delays carbohydrate degradation, thereby preventing reactive hypoglycemia. Conclusion: This case highlights the importance of having a thorough differential diagnosis in patients with a history of bariatric surgery and hypoglycemic episodes including adrenal insufficiency, which in this case was ruled out. RYGB increases stimulation of islet β-cells by enteral signals and enhances GLP-1 sensitivity and insulin secretion, predisposing some individuals to hypoglycemic episodes. Patients may have remission of diabetes and no longer need medications post-operatively. Dietary modification is fundamental in the management of hypogylcemia after RYGB. Pharmacotherapy is an adjunctive treatment if symptoms persist. Presentation: Saturday, June 17, 2023

The effects of postprandial exercise and meal glycemic index on plasma glucose and glucoregulatory hormone responses after Roux-en-Y gastric bypass.

Postprandial hypoglycemia is a complication of Roux-en-Y gastric bypass (RYGB), but the effects of postprandial exercise and meal glycemic index (GI) on postprandial glucose and glucoregulatory hormone responses are unknown. Ten RYGB-operated and 10 age and weight-matched unoperated women completed four test days in random order ingesting mixed meals with high GI (HGI, GI = 93) or low GI (LGI, GI = 54), but matched on energy and macronutrient content. Ten minutes after meal completion, participants rested or cycled for 30 min at 70% of maximum oxygen uptake (V̇o2max). Blood was collected for 4 h. Postprandial exercise did not lower plasma nadir glucose in RYGB after HGI (HGI/rest 3.7 ± 0.5 vs. HGI/Ex 4.1 ± 0.4 mmol/L, P = 0.070). Replacing HGI with LGI meals raised glucose nadir in RYGB (LGI/rest 4.1 ± 0.5 mmol/L, P = 0.034) and reduced glucose excursions (Δpeak-nadir) but less so in RYGB (-14% [95% CI: -27; -1]) compared with controls (-33% [-51; -14]). Insulin responses mirrored glucose concentrations. Glucagon-like peptide 1 (GLP-1) responses were greater in RYGB versus controls, and higher with HGI versus LGI. Glucose-dependent insulinotropic polypeptide (GIP) responses were greater after HGI versus LGI in both groups. Postexercise glucagon responses were lower in RYGB than controls, and noradrenaline responses tended to be lower in RYGB, whereas adrenaline responses were similar between groups. In conclusion, moderate intensity cycling shortly after meal intake did not increase the risk of postprandial hypoglycemia after RYGB. The low GI meal increased nadir glucose and reduced glucose excursions compared with the high GI meal. RYGB participants had lower postexercise glucagon responses compared with controls.NEW & NOTEWORTHY We investigate the effect of moderate exercise after a high or a low glycemic index meal on nadir glucose and glucoregulatory hormones in gastric bypass-operated individuals and in matched unoperated controls. Cycling shortly after meal intake did not increase the risk of hypoglycemia in operated individuals. The low glycemic index meal increased glucose nadir and reduced excursions compared with the high glycemic index meal. Operated individuals had lower postexercise glucagon responses compared with controls.

1153-P: Postprandial Increase in Inflammation Is Not Affected by Glycemic Index in Children and Adolescent with Type 1 Diabetes

Patients with type 1 diabetes (T1D) have lower life expectancy than individuals without diabetes. Most of this reduction is due to cardiovascular disease, the major cause of death in patients with T1D. Post-prandial inflammation after high glycemic index (GI) meals may cause cardiovascular disease in adults. Differences in postprandial inflammatory responses between high and low GI foods have not been studied in children and adolescents with T1D. Twelve non-obese children and adolescents, 10-18 years old, with type 1 diabetes were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for their two subsequent visits was used. Baseline blood sample were taken (plasma glucose, triglyceride, IL-6, CRP, and TNF-α), rapid acting insulin was given to cover meal carbohydrate without glucose correction, and blood samples were repeated (30, 60, 90, and 120 minutes) after an overnight fast. Visits 1 and 2 were identical except for the GI of the given meal. Visits were rescheduled if the fasting glucose was greater than 200 mg/dl. Glucose response were significantly greater following high GI meal (Δglucose: high 52±12 vs low 6±5 mg/dl, mean±SE, repeated measures ANOVA, p&amp;lt;0.001), as expected. TNF-α (High 0 min: 0.86±0.08, 30 min: 1.83±0.08; Low 0 min: 0.82±0.06, 30 min 1.81±0.06 ng/ml) and IL-6 (High 0 min: 0.38±0.06, 120 min: 0.68±0.25; Low 0 min: 0.49±0.11, 120 min 0.71±0.14 ng/ml) increased following both high and low GI meals (p &amp;lt;0.001 and p=0.008, respectively), but there were no statistically significant differences between the two groups. CRP did not increase with either type of meal. Children and adolescent with T1D have post prandial inflammation, as indicated by increased TNFα and IL-6 levels. The post-prandial inflammation is not different between high and low GI meals in spite of higher glucose levels with the former. Disclosure C.P.Damilano: None. R.P.Hoffman: None. Funding Abigail Wexner Research Institute; University of Ohio

Impact of Diet on Nutrient Intake, Glycemic Index and Glycemic Load of Meals of Urban Indian Diabetic Population

Background: India is heading toward becoming the global diabetic capital directly interconnected to poor lifestyle and obesity. Aims and Objectives: The aim of the study was to find an association between glycemic index (GI) and glycemic load (GL) with macronutrients and fiber in the diet of the urban Indian population. Materials and Methods: The dietary intake using food frequency questionnaire and 24–h dietary recall of 240 recruited subjects (male and female), between 25 and 60 years were taken in the study. GI and GL of all meals were calculated using values from National and the International Table of GI and GL. Results: Average mean and standard deviation of GI and GL of major meals were on the higher side. A significant correlation between GI of lunch and dinner with total available carbohydrate (CHO) and total starch intake. A positive significant correlation was observed between GI to energy intake at dinner, total available CHO, and total starch. GL of breakfast was negatively correlated to iron, zinc, insoluble, and soluble fiber intake in females. GL for lunch was positively correlated to the intake of total available CHO, total starch, insoluble, and soluble fiber. Conclusion: The present study showed high GI and GL of processed foods and refined CHO indicating that dietary habits with high GI and GL foods are an indicator to risk of diabetes and pre-diabetes among both genders.

Personalized diet intervention in Thai ageing populations

Personalized diet intervention in Thai ageing populations Professor Apichart Vanavichit a Rice Genomic Breeding Expert at the Rice Science Center looks at diet intervention and therapy for the ageing population of Thailand to prevent disease. Thailand has rapidly become an ageing society, and the average age of the Thais will be 30 years older compared to 1975. As the elderly population increases, it is anticipated that there will be more incidences of non-communicable diseases (NCDs) such as obesity (OB), diabetes (T2D), and cardiovascular disease (CVD). Notably, the prevalence of T2D has increased rapidly from 6.5% in 2015 to 10.7% in 2030 (estimated), with the most significant increase will be found among the elderly population (72%). In developing countries, NCD has become the most immense burden among the poor elderly whose life depends on their children. There are strong links between consuming high glycemic index foods, a sedentary lifestyle, and NCDs. So, developing lower glycemic index meals and changing lifestyles with diet intervention programmes are sensible solutions to slow down the prevalence of future NCDs.

Chronometabolism: The Timing of the Consumption of Meals Has a Greater Influence Than Glycemic Index (GI) on the Postprandial Metabolome.

Eating late in the day is associated with circadian desynchrony, resulting in dysregulated metabolism and increased cardiometabolic disease risk. However, the underlying mechanisms remain unclear. Using targeted metabolomics of postprandial plasma samples from a secondary analysis of a randomised 2 × 2 crossover study in 36 healthy older Chinese adults, we have compared postprandial metabolic responses between high (HI) glycemic index (GI) or low-GI (LO) meals, consumed either at breakfast (BR) or at dinner (DI). 29 out of 234 plasma metabolites exhibited significant differences (p < 0.05) in postprandial AUC between BR and DI sessions, whereas only five metabolites were significantly different between HI and LO sessions. There were no significant interactions between intake timing and meal GI. Lower glutamine: glutamate ratio, lower lysine and higher trimethyllysine (TML) levels were found during DI compared with BR, along with greater postprandial reductions (δAUC) in creatine and ornithine levels during DI, indicating a worse metabolic state during the evening DI period. Greater reductions (δAUC) in postprandial creatine and ornithine were also observed during HI compared with LO (both p < 0.05). These metabolomic changes may indicate potential molecular signatures and/or pathways linking metabolic responses with cardiometabolic disease risk between different meal intake timings and/or meals with variable GI.

Effect of Low and High Glycemic Index Meals on Hunger and Satiety

Effect of Low and High Glycemic Index Meals on Hunger and Satiety

Postprandial Metabolome Following a Low Glycaemic Index Meal-Challenge Test: A Narrative Review.

The Identifying the dynamic metabolome of the individual in response to a particular stimulus using a metabolomic approach is an emerging research area. Measuring the postprandial metabolite response utilising a meal-challenge test (MCT) provides information beyond the fasting state, which is especially important since human beings spend most of their time in the postprandial state. This is pertinent as an excessive rise in postprandial glycaemia is common in individuals with type 2 diabetes mellitus (T2DM), which puts them at a high risk of developing cardiovascular disease (CVD). While a low glycaemic index (GI) meal improves postprandial glycaemia and insulin levels in MCT studies among individuals with T2DM, its effect on metabolite changes in the postprandial state is unclear. This review summarises the perturbation in postprandial metabolites following a low GI meal in comparison to that following a usual or high GI meal and maps the metabolites in their metabolic pathways. We undertook a literature review using electronic databases, with the Medical Subject Headings (MeSH) terms, to retrieve relevant studies based on specific criteria. A total of seven related studies were documented. For the majority of metabolites studied, it was identified that metabolic regulation following an MCT extends beyond the glucose pathway. Altered metabolic pathways after the consumption of a low GI meal include: i) essential amino acid metabolism by altering the levels of plasma phenylalanine, tyrosine, lysine, leucine, isoleucine and valine; ii) glycolysis and tricarboxylic acid (TCA) metabolism by altering citrate and alanine, and iii) gut microbiota metabolism by altering betaine and acetate. The altered metabolites regulated the pancreatic insulin secretion and related to other dietary factors beyond GI modifications. These metabolomics data need to be interpreted cautiously because the metabolic changes analysed might not be due to the beneficial effects of a low GI meal. Validation of the putative metabolomic biomarkers following a dietary intervention MCT is suggested because researchers need to fully understand the kinetics and metabolism of individuals metabolite before reaching a solid conclusion. Further research characterising the metabotype based on habitual dietary patterns is warranted.

Super Bolus: a remedy for a high glycemic index meal in children with type 1 diabetes on insulin pump therapy?\u2014study protocol for a randomized controlled trial

BackgroundPostprandial hyperglycemia (PPH) is a common clinical problem among patients with type 1 diabetes (T1D), which is related to high glycemic index (h-GI) meals. The main problem is linked to high, sharp glycemic spikes following hypoglycemia after h-GI meal consumption. There is a lack of effective and satisfactory solutions for insulin dose adjustment to cover an h-GI meal. The goal of this research was to determine whether a Super Bolus is an effective strategy to prevent PPH and late hypoglycemia after an h-GI meal compared to a Normal Bolus.MethodsA total of 72 children aged 10–18 years with T1D for at least 1 year and treated with continuous subcutaneous insulin infusion for more than 3 months will be enrolled in a double-blind, randomized, crossover clinical trial. The participants will eat a h-GI breakfast for the two following days and receive a prandial insulin bolus in the form of a Super Bolus 1 day and a Normal Bolus the next day. The glucose level 90 min after the administration of the prandial bolus will be the primary outcome measure. The secondary endpoints will refer to the glucose levels at 30, 60, 120, 150, and 180 min postprandially, the area under the blood glucose curve within 180 min postprandially, peak glucose level and the time to peak glucose level, glycemic rise, the mean amplitude of glycemic excursions, and the number of hypoglycemia episodes.DiscussionThere are still few known clinical studies on this type of bolus. A Super Bolus is defined as a 50% increase in prandial insulin dose compared to the dose calculated based on the individualized patient’s insulin-carbohydrate ratio and a simultaneous suspension of basal insulin for 2 h. Our patients reported the best experience with such a combination. A comprehensive and effective solution to this frequent clinical difficulty of PPH after an h-GI meal has not yet been found. The problem is known and important, and the presented solution is innovative and easy to apply in everyday life.Trial registrationClinicalTrials.gov NCT04019821

Effect of Extra Virgin Olive Oil and Butter on Endothelial Function in Type 1 Diabetes.

Post-prandial hyperglycemia can be relevant in developing early manifestations of atherosclerosis. EVOO (Extra Virgin Olive Oil), rich in saturated fatty acids and commonly used in the Mediterranean diet, seems to control post-prandial hyperglycemia better than butter. Subjects with type 1 diabetes are at higher risk of developing cardiovascular disease and show endothelial dysfunction, an early manifestation of atherosclerosis in the first years of the disease. Our study aims to evaluate whether EVOO and butter influence endothelial function in subjects with type 1 diabetes when added to a single high glycemic index (HGI) meal. In this exploratory cross-over study, 10 subjects with type 1 diabetes and 6 healthy subjects were scheduled to receive two types of HGI meals: one enriched with EVOO and one with butter. Before and after each test meal at different time points, all subjects underwent the evaluation of endothelial function by flow-mediated dilation technique, glucose and lipids measurements, and gastric emptying assessment by ultrasound. Flow-mediated dilation significantly increased after EVOO-enriched meal compared with butter in subjects with type 1 diabetes (two-way-repeated measurements ANOVA, p = 0.007). In patients with type 1 diabetes, the add-on of EVOO to HGI meal improves vascular function compared to butter, which has detrimental effects.

The effect of a breakfast’s glycaemic index and type of hydration on metabolism and cycling performance: a crossover, randomized, controlled clinical trial.

The purpose of this study was to compare the effect of the glycaemic index of breakfast on metabolic parameters and performance of cyclists with different types of hydration (water or isotonic beverage). Twelve male recreational cyclists participated in four experimental trials where they consumed either a high glycaemic index (HGI) or low glycaemic index (LGI) meal, 30 min before exercise on a cycle ergometer. Exercise was performed at 70% maximal oxygen uptake for 90 min followed by a 6 km performance. During each trial, 3 mL.kg-1 body mass of either water or isotonic beverage was provided. The postprandial glycaemic response and areas under the blood glucose curve 30 min after ingestion were higher after the consumption of the HGI meals than that after the consumption of the LGI meals. The glycaemic response and carbohydrate oxidation during the trials with isotonic beverage consumption were higher than that in trials with water consumption during exercise (p&lt;0.05). There was no significant difference on exercise performance among all trials (p=0.409). This study demonstrated that, despite significant metabolic changes, neither LGI nor HGI meals consumed for breakfast, 30 min before exercise on a cycle ergometer, affect subsequent cycling performance.

Consumption of decaffeinated coffee with milk and sugar added before a high-glycemic-index meal lowers postprandial glucose surge when compared with consuming it after the meal

This study aimed to compare the effect of consuming decaffeinated coffee at different times around a high glycemic index (GI) meal on postprandial glycemic responses. Ten healthy adults completed this randomized, crossover trial. In each session, overnight-fasted participants consumed the test drink, which was a cup of decaffeinated coffee with low-fat milk and white sugar added, at different timepoints before or after a high GI meal. Postprandial levels of glucose, insulin, and nitrotyrosine at individual timepoints, as well as the area-under-curves (AUC), were compared among the treatments using mixed-effect linear model. Results showed that consuming the test drink 30 and 60 min before the high GI meal (glucose AUC ± SE: 862.6 ± 24.8 and 861.4 ± 24.8 mmol * 120 min/L, respectively) led to significantly reduced glycemic responses when compared with consuming it after the meal (952.7 ± 24.8 mmol * 120 min/L, p < 0.05 compared with either treatment). Drinking the test drink at least 30 min before the meal also led to smaller insulinemic responses, while nitrotyrosine levels were not significantly different between different consumption times. These showed that consuming decaffeinated coffee with milk and sugar added at least 30 min before a meal could benefit postprandial glycemic control.

The association of meal glycemic index/load with quantitative and qualitative indicators of sleep: a systematic review.

We sought to systematically review the association between meal glycemic index or glycemic load and sleep indicators. PubMed, Scopus, Web of Science, and Embase were searched up to March 2021. Both observational and clinical trials studies, with both male and female participants of all ages, were included. A total of 10 studies were included in this review; six with clinical trial and four with cross-sectional design. Among the six clinical trial, three studies indicated a significant effect of high glycemic index on sleep (two in young male athletes [N.=8 and N.=9] and one in adults [N.=8]), while three others failed to detect any significant effect (young males [N.=12], children [N.=8], toddlers [N.=56]). Among the cross-sectional studies, high glycemic index meals were associated with improved sleep duration or quality in two studies (594 toddlers and 1848 adults), however, contrastingly, were also associated with sleep disturbances (108 students and 53,069 postmenopausal women). High glycemic index meals likely improve sleep onset latency in young males. For other indicators of sleep quality and other population groups, the results are equivocal. Most of the available studies were conducted in special population groups and were inadequately designed; whilst clinical trials were of short duration and small sample sizes. Therefore, further well-designed clinical trials are required before further definitive conclusions can be made.