Postprandial State Research Articles

Brown Adipose Tissue: Activation and Metabolism in Humans.

Brown adipose tissue (BAT) is a thermogenic organ contributing to non-shivering thermogenesis. BAT becomes active under cold stress via sympathetic nervous system activation. However, recent evidence has suggested that BAT may also be active at thermoneutrality and in a postprandial state. BAT has superior energy dissipation capacity compared to white adipose tissue (WAT) and muscles. Thus, it has been proposed that the recruitment and activation of additional BAT may increase the overall energy-expending capacity in humans, potentially improving current whole-body weight management strategies. Nutrition plays a central role in obesity and weight management. Thus, this review discusses human studies describing BAT hyper-metabolism after dietary interventions. Nutritional agents that can potentially recruit brown adipocytes via the process of BAT-WAT transdifferentiation are also discussed.

Intragastric Carbon Dioxide Release Prolongs the Gastric Residence Time of Postprandially Administered Caffeine.

Sparkling water is said to increase gastric motility by the release of carbon dioxide, thereby potentially affecting the pharmacokinetics of orally administered drugs. The hypothesis of the present work was that the induction of gastric motility by intragastric release of carbon dioxide from effervescent granules could promote the mixing of drugs into the chyme under postprandial conditions, resulting in a prolonged drug absorption. For this purpose, an effervescent and a non-effervescent granule formulation of caffeine as a marker for gastric emptying were developed. In a three-way crossover study with twelve healthy volunteers, the salivary caffeine pharmacokinetics, after administration of the effervescent granules with still water and the administration of the non-effervescent granules with still and sparkling water, were investigated after intake of a standard meal. While the administration of the effervescent granules with 240 mL of still water led to a significantly prolonged gastric residence of the substance compared to the administration of the non-effervescent granules with 240 mL still water, the application of the non-effervescent granules with 240 mL sparkling water did not prolong gastric residence via mixing into caloric chyme. Overall, the mixing of caffeine into the chyme following the administration of the effervescent granules did not seem to be a motility mediated process.

Antioxidant, starch-digesting enzymes inhibitory, and pasting properties of elite yellow-fleshed cassava genotypes

Biofortification of cassava roots has improved its health benefits by raising the quantity and bioavailability of bioactive compounds, particularly carotenoids. This study analyzed the bioactive constituents (carotenoids, tannins, total phenolics, and flavonoids), antioxidant, starch-digesting enzymes (α-amylase and α-glucosidase) inhibitory and pasting properties of flours of 18 elite yellow-fleshed cassava genotypes grown at the International Institute of Tropical Agriculture, Ibadan, using standard laboratory methods. Generally, the concentrations of the bioactive constituents (9-cis-β-carotene, 13-cis-β-carotene, all trans-β-carotene, total β-carotene, total carotenoids, tannins, total phenolics, and total flavonoids) of the different cassava genotypes varied. The antioxidant activity varied significantly among the different cassava genotypes, with IITA-TMS-IBA183001 having the highest reducing power (2.59 GAE mg/g) and most potent DPPH· scavenging ability (SC50: 14.56 mg/mL). However, the starch-hydrolysing enzymes (alpha-amylase and alpha-glucosidase) inhibitory and the pasting properties of the different genotypes were generally comparable. Total carotenoids content significantly correlated with the DPPH· SC50 (r = −0.495), while total phenolics content correlated with ABTS·+(r = 0.839) and DPPH· SC50 (r = −0.870). Also, tannins content significantly correlated with ABTS·+ (r = 0.553), while total flavonoids content was significantly correlated with α-amylase IC50 (r = −0.532). These findings suggest the potential of flours of the 18 elite yellow-fleshed cassava genotypes to serve as important dietary sources of antioxidants and starch-hydrolysing enzyme inhibitors, which may be beneficial in oxidative stress and postprandial hyperglycaemic conditions.

Determination of the postprandial cut-off value of triglyceride after a daily meal corresponding to fasting optimal triglyceride level in Chinese subjects

According to the 2021 consensus statement about triglyceride (TG)-rich lipoproteins and their remnants from the European Atherosclerosis Society (EAS), fasting TG level < 1.2 mmol/L is regarded as optimal, otherwise considered as non-optimal TG (NoTG). However, the postprandial cut-off value after a daily meal corresponding to a fasting TG level of 1.2 mmol/L has not been explored. Six hundred and eighteen inpatients aged 18 to 70 were recruited in this study. Among them, 219 subjects had fasting TG levels < 1.2 mmol/L (i.e., OTG group), and 399 subjects had fasting TG levels ≥ 1.2 mmol/L (i.e., NoTG group). Serum levels of blood lipids, including calculated non-high-density lipoprotein cholesterol (non-HDL-C) and remnant cholesterol (RC), were monitored at 0, 2, and 4 h after a daily Chinese breakfast according to their dietary habits. Receiver operating characteristic (ROC) curve analysis was used to determine the postprandial cut-off value corresponding to the fasting TG level of 1.2 mmol/L. Kappa statistics were performed to determine the consistency between fasting and postprandial cut-off values in determining whether TG was optimal. Univariate and multivariate logistic regression analyses were conducted to evaluate the associations between NoTG and potential confounders. Subgroup analyses were performed to explore the association between postprandial TG levels at 4h (pTG4h) and NoTG in greater detail. Postprandial levels of TG and RC significantly elevated and peaked at 4h after a daily breakfast in two groups (P < 0.05). The optimal cut-off value at 4h corresponding to fasting TG of 1.2 mmol/L was 1.56 mmol/L. According to the fasting cut-off value, the percentage of patients with NoTG was 64.6% in the fasting state while increasing obviously to 73.3-78.4% at 2 and 4h, respectively, after a daily Chinese breakfast. According to the postprandial cut-off value, the percentage of patients with NoTG at 4h after a daily Chinese breakfast was 62.6% which was close to 64.6% in the fasting state. The Kappa coefficient was 0.551, indicating a moderate consistency between the fasting and postprandial cut-off values in the diagnosis of NoTG. Moreover, the subjects with NoTG determined by the postprandial TG cut-off value had an obviously higher postprandial level of RC (1.2 vs. 0.8 mmol/L) and percentage of HRC (37.1 vs. 32.1%) than those determined by the fasting TG cut-off value. Multivariate logistic regression analyses demonstrated that except for BMI, pTG4h emerged as an independent predictor of not. Subgroup analyses revealed that the association between pTG4h and NoTG was consistent across subgroups. Taken together, we for the first time determined TG 1.56 mmol/L as the postprandial cut-off value corresponding to fasting TG 1.2 mmol/L in Chinese subjects. This could make it more convenient to determine whether TG is optimal or not in the fasting or postprandial state.

Comparative analysis between fasting and postprandial apolipoprotein B and total cholesterol/high-density lipoprotein-cholesterol ratio for atherosclerosis risk prediction in type 2 diabetes mellitus subjects of central India

Background: Type 2 diabetes mellitus (Type 2 DM), characterized by a relative insulin deficiency or insulin resistance, is associated with a cluster of metabolic abnormalities, which includes glucose intolerance, hypertension, a unique dyslipidemia, a procoagulant state, and an increase in macrovascular diseases. Aims and Objectives: The present study was conducted to correlate between fasting and postprandial apolipoprotein B and total cholesterol/high-density lipoprotein-cholesterol (TC/HDL-C) ratio for predicting the risk of atherosclerosis in T2DM subjects. Materials and Methods: Sixty clinically diagnosed cases of T2DM (age group of 35–65 years and duration of diabetes of more than 5 years) were included in the study and sixty age- and sex-matched healthy subjects were taken as the controls. In both the study groups, we measured postprandial as well as fasting lipid profile, which comprised serum TC, triglycerides (TGs), HDL-C, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B. Ratio is calculated as TC/HDL-C in both fasting and postprandial state. The statistical analysis was done using the students unpaired’-test. Results: The results of the present study showed significantly increased levels of postprandial serum TC, TGs, LDL-C, and apo B as compared to those in the fasting state (P&lt;0.05). The serum HDL-C level was significantly lower in the postprandial state as compared to that in the fasting state (P&lt;0.05). Postprandial TC/HDL-C and apo B are increased significantly as compared to fasting condition in type 2 diabetes subjects. Conclusion: The findings suggest that postprandial lipid profile, apolipoprotein B, and TC/HDL-C ratio as a cardiovascular risk factor can be utilized as simple marker utilizing simple parameters in lipid profile that significantly increased in the postprandial state.Thus, Apolipoprotein B, the marker of the number of LDL particles (for atherosclerosis) in the circulation and TC/HDL-C ratio can be routinely estimated for the atherosclerosis risk assessment in type 2 diabetes subjects in the postprandial state.

Exercise Timing Matters for Glycogen Metabolism and Accumulated Fat Oxidation over 24 h.

Due to increasingly diverse lifestyles, exercise timings vary between individuals: before breakfast, in the afternoon, or in the evening. The endocrine and autonomic nervous systems, which are associated with metabolic responses to exercise, show diurnal variations. Moreover, physiological responses to exercise differ depending on the timing of the exercise. The postabsorptive state is associated with greater fat oxidation during exercise compared to the postprandial state. The increase in energy expenditure persists during the post-exercise period, known as "Excess Post-exercise Oxygen Consumption". A 24 h evaluation of accumulated energy expenditure and substrate oxidation is required to discuss the role of exercise in weight control. Using a whole-room indirect calorimeter, researchers revealed that exercise performed during the postabsorptive state, but not during the postprandial state, increased accumulated fat oxidation over 24 h. The time course of the carbohydrate pool, as estimated by indirect calorimetry, suggests that glycogen depletion after postabsorptive exercise underlies an increase in accumulated fat oxidation over 24 h. Subsequent studies using 13C magnetic resonance spectroscopy confirmed that the variations in muscle and liver glycogen caused by postabsorptive or postprandial exercise were consistent with indirect calorimetry data. These findings suggest that postabsorptive exercise alone effectively increases 24 h fat oxidation.

Oseltamivir phosphate for suspension is bioequivalent to TAMIFLU in healthy volunteers: a randomized, open-label clinical study

PurposeThe study was aimed at evaluating the bioequivalence and safety of oseltamivir phosphate for suspension, provided by Shenzhen Beimei Pharmaceutical Co. Ltd. and manufactured by Hetero Labs Limited, and the reference product TAMIFLU® in healthy Chinese subjects.MethodsA single-dose, randomized, two-phase, self-crossed model was adopted. Among 80 healthy subjects, 40 subjects in the fasting group and 40 subjects in the fed group. Subjects in the fasting group were randomized into two sequences according to the proportion of 1:1, each given 75 mg/12.5 mL of Oseltamivir Phosphate for Suspension or TAMIFLU®, and cross-administered after 7 days. Postprandial group is the same as fasting group.ResultsThe Tmax of TAMIFLU® and Oseltamivir Phosphate for Suspension in the fasting group were 1.50 h and 1.25 h, which in the fed group were both 1.25 h. Geometrically adjusted mean ratios of the PK parameters of Oseltamivir Phosphate for Suspension along with TAMIFLU® under fasting and postprandial conditions were in the range of 80.00–125.00% at the 90% confidence interval (CI). The 90% CI of Cmax, AUC0-t, AUC0-∞ for fasting group and postprandial group were (92.39,106.50), (94.26,100.67), (94.32,100.89) and (93.61,105.83),(95.64,100.19),(96.06,102.66). Among the subjects on medication, a total of 18 subjects reported 27 adverse events, all of which were treatment-emergent adverse events (TEAEs), six of these TEAEs were rated as grade 2 in severity and the rest were as grade 1. The number of TEAEs in the test product and the reference product were 14,13 respectively.ConclusionTwo Oseltamivir phosphate for suspensions are safe and bioequivalent.

Aging Is Associated With Impaired Postprandial Response of Skeletal Muscle Protein Synthesis to High-Intensity Muscle Contraction in Mice.

The purpose of this study was to investigate whether aging alters the effect of nutritional status on contraction-induced muscle protein metabolism. In an overnight fasted or fed states, the right gastrocnemius muscle of young (3 months) and aged (24 months) male C57BL/6J mice was isometrically contracted via percutaneous electrical stimulation. The left gastrocnemius muscle served as a control. In the fasted state, there were no differences in basal or contraction-induced muscle protein synthesis between young and old mice. However, in the fed state, basal muscle protein synthesis was greater in young mice, and contraction increased muscle protein synthesis only in young mice. In the fed state, although phosphorylation of 4E-BP1 was similarly increased by contraction in both ages, the increase in phosphorylation of p70S6K was greater in young mice. Our results indicate that aging impairs the ability to integrate signals from muscle contraction and nutrition, leading to aging-induced anabolic resistance to muscle contraction in the postprandial state.

Association between Fasting and Postprandial Levels of Liver Enzymes with Metabolic Syndrome and Suspected Prediabetes in Prepubertal Children.

Elevated liver enzyme activity may be associated with metabolic syndrome (MetS); however, it is not included in the MetS definition for children. Postprandial changes in the levels of biochemistry tests are related to manifestations of metabolic abnormalities. We assessed the association between fasting and postprandial liver enzymes levels with MetS and elevated hemoglobin A1c (HbA1c) in children aged 9-11. The study included 51 girls and 48 boys, all presumably healthy. In all participants' anthropometric indices, fasting glucose, insulin, lipid profile and HbA1c were measured. Enzymes, including alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT), were assayed in fasting and postprandial states. Individuals were divided into subgroups: with (MetS(+): n = 26); without MetS (MetS(-): n = 73); with HbA1c levels ≤ 5.3% (n = 39); and ≥5.7% (n = 11). Elevated fasting GGT levels were found in 23% of MetS(+) children and rarely in MetS(-) children; increased postprandial GGT was noted in 35% of MetS(+) individuals. Postprandial GGT changes tend to predict MetS (OR = 1.16; p = 0.092). Increased fasting ALT was found rarely in MetS(+) children, but did not occur in MetS(-) children. HbA1c ≥ 5.7% occurred rarely and neither fasting ALT nor GGT were related to elevated HbA1c. However, postprandial change of ALT was a good positive predictor of increased HbA1c (OR = 1.33; p = 0.021). Postprandial GGT performs better as an indicator of metabolic syndrome occurrence, and instead postprandial ALT may predict prediabetes in prepubertal children.

Protein-based nutritional strategies to manage the development of diabetes: evidence and challenges in human studies.

Type 2 diabetes mellitus (T2DM) is one of the most prevalent diseases in modern society, governed by both genetic and environmental factors, such as nutritional habits. This metabolic disorder is characterized by insulin resistance, which is related to high blood glucose levels, implying negative health effects in humans, hindering the healthy ageing of people. The relationship between food and health is clear, and the ingestion of specific nutrients modulates some physiological processes, potentially implying biologically relevant changes, which can translate into a health benefit. This review aims to summarize human studies published in which the purpose was to investigate the effect of protein ingestion (in native state or as hydrolysates) on human metabolism. Overall, several studies showed how protein ingestion might induce a decrease of glucose concentration in the postprandial state (area under the curve), although it is highly dependent on the source and the dose. Other studies showed no biological effects upon protein consumption, mostly with fish-derived products. In addition, the major challenges and perspectives in this research field are highlighted, suggesting the future directions, towards which scientists should focus on. The dietary intake of proteins has been proven to likely exert a beneficial effect on diabetes-related parameters, which can have a biological relevance in the prevention and pre-treatment of diabetes. However, the number of well-designed human studies carried out to date to demonstrate the effects of specific proteins or protein hydrolysates in vivo is still scarce.

Effects of a 4-week pecan-enriched diet on cognitive function in healthy older adults

BACKGROUND: Pecans are rich in nutrients known to benefit cognition. OBJECTIVE: To examine the effect of daily pecan consumption on cognitive function in older adults. METHODS: In this randomized controlled trial, 42 adults (50–75y) either consumed 68 g of pecans/day for 4-weeks (pecan; n = 21) or avoided all nuts (control; n = 21). At pre- (V1) and post-intervention (V2) visits, cognitive function was assessed using a fluid composite score and four subtests from the NIH Toolbox-Cognitive Battery (NIHTB-CB) (Flanker Test, Digital Change Card Sort Test (DCCS), Picture Sequence Memory Test (PSMT), NIHTB Auditory Verbal Learning Test (RAVLT)) at fasting, 30- and 210-min after a high-saturated fat meal void of pecans. RESULTS: From V1 to V2, fasting and postprandial cognitive performance did not differ between groups. There were improvements in both groups for fasting fluid composite score (p &lt; 0.001) and performance on RAVLT, PSMT, DCCS, and Flanker tests from V1 to V2 (p &lt; 0.001 for all), with no differences between groups. Additionally, postprandial performance on RAVLT, PSMT, and Flanker tests improved at V2 (p &lt; 0.01 for each), with no differences between groups. CONCLUSIONS: A short-term pecan-enriched diet did not provide additional cognitive benefits in healthy older adults in the fasted or postprandial state.

Human fasting modulates macrophage function and upregulates multiple bioactive metabolites that extend lifespan in Caenorhabditis elegans: a pilot clinical study

BackgroundPeriodic prolonged fasting (PF) extends lifespan in model organisms and ameliorates multiple disease states both clinically and experimentally owing, in part, to its ability to modulate the immune system. However, the relationship between metabolic factors, immunity, and longevity during PF remains poorly characterized especially in humans. ObjectiveThis study aimed to observe the effects of PF in human subjects on the clinical and experimental markers of metabolic and immune health and uncover underlying plasma-borne factors that may be responsible for these effects. MethodsIn this rigorously controlled pilot study (ClinicalTrial.gov identifier, NCT03487679), 20 young males and females participated in a 3-d study protocol including assessments of 4 distinct metabolic states: 1) overnight fasted baseline state, 2) 2-h postprandial fed state, 3) 36-h fasted state, and 4) final 2-h postprandial re-fed state 12 h after the 36-h fasting period. Clinical and experimental markers of immune and metabolic health were assessed for each state along with comprehensive metabolomic profiling of participant plasma. Bioactive metabolites identified to be upregulated in circulation after 36 h of fasting were then assessed for their ability to mimic the effects of fasting in isolated human macrophage as well as the ability to extend lifespan in Caenorhabditis elegans. ResultsWe showed that PF robustly altered the plasma metabolome and conferred beneficial immunomodulatory effects on human macrophages. We also identified 4 bioactive metabolites that were upregulated during PF (spermidine, 1-methylnicotinamide, palmitoylethanolamide, and oleoylethanolamide) that could replicate these immunomodulatory effects. Furthermore, we found that these metabolites and their combination significantly extended the median lifespan of C. elegans by as much as 96%. ConclusionsThe results of this study reveal multiple functionalities and immunological pathways affected by PF in humans, identify candidates for the development of fasting mimetic compounds, and uncover targets for investigation in longevity research.

Interorgan Metabolism of Ganglioside Is Altered in Type 2 Diabetes.

GM3 is implicated in cell signaling, inflammation and insulin resistance. The intestinal mucosa metabolizes ganglioside and provides gangliosides for uptake by peripheral tissues. Gangliosides downregulate acute and chronic inflammatory signals. It is likely that transport of intestinal derived gangliosides to other tissues impact the same signals characteristic of inflammatory change in other chronic conditions such as Type 2 Diabetes (T2DM). The postprandial ceramide composition of GM3 and other gangliosides in plasma and chylomicrons has not been examined in T2DM. The present study assessed if diet or T2DM alters ganglioside components in plasma and chylomicrons secreted from the intestinal mucosa after a meal. GD1, GD3, and GM3 content of chylomicrons and plasma was determined by LC/triple quad MS in non-diabetic (control) and T2DM individuals in the fasting and postprandial state after 2 days of consuming a low or high fat diet in a randomized blinded crossover design. Diet fat level did not alter baseline plasma or chylomicron ganglioside levels. Four hours after the test meal, plasma monounsaturated GD3 was 75% higher, plasma saturated GD3 was 140% higher and plasma polyunsaturated GM3 30% lower in diabetic subjects compared to control subjects. At 4 h, chylomicron GD1 was 50% lower in T2DM compared to controls. The proportion of d34:1 in GD3 was more abundant and d36:1 in GD1 less abundant in T2DM compared to control subjects at 4 h. The present study indicates that T2DM alters ceramide composition of ganglioside available for uptake by peripheral tissues.

Magnetic Resonance Imaging and Spectroscopy Methods to Study Hepatic Glucose Metabolism and Their Applications in the Healthy and Diabetic Liver.

The liver plays an important role in whole-body glucose homeostasis by taking up glucose from and releasing glucose into the blood circulation. In the postprandial state, excess glucose in the blood circulation is stored in hepatocytes as glycogen. In the postabsorptive state, the liver produces glucose by breaking down glycogen and from noncarbohydrate precursors such as lactate. In metabolic diseases such as diabetes, these processes are dysregulated, resulting in abnormal blood glucose levels. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are noninvasive techniques that give unique insight into different aspects of glucose metabolism, such as glycogenesis, glycogenolysis, and gluconeogenesis, in the liver in vivo. Using these techniques, liver glucose metabolism has been studied in regard to a variety of interventions, such as fasting, meal intake, and exercise. Moreover, deviations from normal hepatic glucose metabolism have been investigated in both patients with type 1 and 2 diabetes, as well as the effects of antidiabetic medications. This review provides an overview of current MR techniques to measure hepatic glucose metabolism and the insights obtained by the application of these techniques in the healthy and diabetic liver.

Amyloid‐β plus cholesterol treatment impairs the ability of microglia to efflux excess cholesterol

AbstractBackgroundMicroglia, specialized phagocytic cells of the brain, play a critical role in the clearance of amyloid beta (Aβ), which is involved in the pathogenesis of Alzheimer’s disease. The ability of microglia to remove Aβ is influenced by their cellular cholesterol clearance capacity. It is not known to what extent Aβ impairs microglial cholesterol efflux capacity, especially in the context of excess cholesterol.MethodHMC3 microglia were treated with Aβ‐oligomer (AβO, 2µM), cholesterol loading (20µg), or AβO + cholesterol in combination, and with or without cholesterol acceptor, high‐density lipoprotein (HDL), at 0.1 mg/mL. Pooled HDL from 18 individuals in a 2‐hour postprandial state and a 36‐hour fasted state were compared. The cellular content of unesterified and esterified cholesterol was measured.ResultsThe addition of cholesterol, AβO, and cholesterol+AβO increased cellular cholesterol content, which was attenuated by the addition of HDL. Importantly, cells treated with cholesterol plus AβO had the highest overall cholesterol content (27.80+/‐2.85µM), and both fasted (20.67+/‐3.04µM, p≥0.05) and postprandial HDL (21.95+/‐3.84µM, p&lt;0.05) were not able to reduce the cellular cholesterol content as well as in the untreated (fasted: 16.17+/‐2.28µM, p&lt;0.05; postprandial: 18.55+/‐2.01µM, p&gt;0.05), cholesterol only (fasted: 17.72+/‐2.17µM, p&lt;0.05; postprandial: 18.14+/‐3.19µM, p&lt;0.05), or AβO only condition (fasted: 16.80+/‐1.40µM, p&lt;0.05; postprandial: 18.42+/‐2.05µM, p&gt;0.05). Fasted HDL more efficiently removed cellular cholesterol in the untreated and in AβO+cholesterol treated cells. Intriguingly, cellular esterified cholesterol content was significantly lowered with fasted HDL but not postprandial HDL in both AβO alone (fasted: 5.73+/‐2.27 µM, p&lt;0.05; postprandial: 10.32+/‐2.70µM, p&gt;0.05) and AβO + cholesterol (fasted: 2.87+/‐2.13µM, p&lt;0.05; postprandial: 9.03+/‐1.74µM, p&gt;0.05).ConclusionThese findings suggest that microglia exposed to a double‐hit of AβO and excess cholesterol experience an impaired ability to efflux excess cholesterol. Additionally, HDL from fasted individuals displayed an enhanced capacity to efflux cholesterol, especially in microglia dually encumbered by AβO + cholesterol. Further studies are needed to examine the impact of this diminished cholesterol efflux capacity and cholesterol accumulation on the phagocytic capacity of microglia.

Does postprandial lipemia interfere with blood gas analysis and assessment of acid-base status in dogs?

To evaluate the interference of postprandial lipemia on blood gas parameters and to assess the acid-base status by the quantitative approach of the strong ion model blood samples of 15 healthy dogs were collected during fasting (0 h) and at one (1 h), three (3 h) and five (5 h) hours after the induction of lipemia with a hypercaloric diet. Total cholesterol (TC) and triglyceride (TG) levels were used to assess lipemia and these were correlated with the parameters evaluated accordingly. Anion gap decreased at 5 h without correlation with TC and TG, whereas other parameters measured by the blood gasometer did not change. In the evaluation of the acid base state, the apparent strong ion difference (SIDa) and the strong ion gap (SIG) showed a decrease at 5 h without correlation with lipemia. Lipid levels correlated with the effective strong ion difference (SIDe), the concentration of total non-volatile weak acids (Atot), albumin, phosphate, and magnesium. The SIDe increased at 1 h and at 3 h; the Atot at 1 h, 3 h, and 5 h; albumin increased at 1 h and 3 h; phosphate increased at 1 h, 3 h and 5 h; and magnesium decreased at 5 h. Though postprandial lipemia does not interfere with blood gas analysis, it can cause errors in the variables used to assess the acid-base status, which are dependent on biochemical analytes. Therefore, caution is required when interpreting electrolyte disturbances that result from the postprandial state.

Non-invasive vagus nerve stimulation in a hungry state decreases heart rate variability

Vagus nerve signals from the gut to brain carry information about nutrients and drive food reward. Such signals are disrupted by consuming large amounts of high-calorie foods, necessitating greater food intake to elicit a similar neural response. Non‐invasive vagus nerve stimulation (nVNS) via a branch innervating the ear is a candidate treatment for obesity in humans. There is disagreement on the optimal location of nVNS in the ear for experimental and clinical studies. There are also no studies comparing nVNS in hungry and post-prandial states. We aimed to compare ear position(s) for nVNS and explore the effects of nVNS during hungry and post-prandial states on proxies for autonomic outflow (heart-rate variability) and efferent metabolism (gastric wave frequency and resting energy expenditure).In a within-subject design, 14 participants (10 women, on average 29.4 +/- 6.7 years old) received nVNS in four different locations (cymba conchae, tragus, earlobe, or tragus AND cymba conchae) on separate days. In each session, participants were asked to consume a palatable chocolate flavored milk. With electrography on the abdomen and indirect calorimetry in a canopy, we measured electro-cardiogram, electro-gastrogram and resting energy expenditure for 15 min before and at least 35 min after consumption of the palatable drink. We also collected ratings of the palatable drink and internal and other states.Pre-drink consumption (in a hungry state) we observed no differences in the effect of location of acute nVNS on resting energy expenditure and gastric wave measures. However, nVNS in cymba conchae decreases heart-rate variability (relative to sham) and ratings of how much participants want to consume the drink (relative to tragus AND cymba conchae and a trend relative to sham). After drink consumption and with continued nVNS, gastric wave frequency is unchanged, and resting energy expenditure increases regardless of stimulation location. Heart-rate variability decreases in all locations, except cymba conchae. We also observe a trend for an increase in gastric wave amplitude in late post-drink consumption time-points in cymba conchae. We observe no support for the combined stimulation of tragus AND cymba conchae being more effective than either of the individual locations.These results suggest that nVNS in the cymba conchae in a hungry state has a similar acute effect on vagal tone as food consumption: to decrease heart rate variability. This effect then negates the usual postprandial effects of a decrease in heart rate variability as seen in the other nVNS locations. These preliminary observations suggest that nVNS in cymba conchae may act primarily on vagal afferent autonomic (and only modestly on metabolic output) in a similar way as food consumption does.

ODP553 Hypoglycemia after sleeve gastrectomy: a rare case of an insulinoma

Abstract Background The obesity pandemic has become a great topic of interest due its implications for quality of life, comorbidities, increasing mortality and the economic impact on health services worldwide(1). Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders, achieving weight loss due to its restrictive and humoral effects (2). Its prevalence has increased from 5 to 37% since 2008 (3). One common complication after bariatric surgery (BS) is the postprandial hyperinsulinemic hypoglycemic state (4). While rare, insulinomas can cause it, where symptoms are more common during the fasting state; thus, evaluation of insulin secretion is needed to exclude dumping syndrome or nesidioblastosis. Until now, this is the first report of insulinoma after LSG. Clinical Case We here present 43-year-old women who was referred to the Obesity Clinic two years after LSG was performed. She had symptoms of hypoglycemia predominantly in the fasting state with a documented glycemic level of less than 30 mg/dl, compatible with Whipple's Triad. Initially, we suspected dumping syndrome but after documentation of a second low fasting plasma glucose, we decided to perform a 72-hour fasting test, which tested positive. Computed tomography and endoscopic ultrasound were performed, identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas. The diagnosis was compatible with insulinoma. A laparoscopic enucleation of insulinoma was performed, and after that, the hypoglycemic symptoms and blood sugar levels improved, remaining asymptomatic until now. The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4% of the neoplastic cells. Conclusion This is the first case of insulinoma after sleeve gastrectomy, the suggested physiopathology is due to a combination of increased plasma concentrations of incretins, mainly glucagon-like peptide 1 (GLP-1), and an accelerated release of nutrients in the proximal duodenum (5). Although this is a very rare case condition, clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.

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.

Remnant cholesterol and atherosclerotic cardiovascular disease: Metabolism, mechanism, evidence, and treatment.

This review aimed to summarize the evidence of elevated remnant cholesterol and the risks of atherosclerotic cardiovascular disease (ASCVD) and to search for further guidance in clinical therapy. The lipids-lowering treatments such as statins and ezetimibe targeted on low-density lipoprotein cholesterol (LDL-C) have always been the first-line therapy for ASCVD. However, even after statins or new lipid-lowering drugs lowered LDL-C to recommended concentrations, and with other risk factors well-controlled, such as high blood pressure, the risks of developing ASCVD remained. Remnant cholesterol (RC) referred to the cholesterol contained in all remnant lipoprotein particles, which was the cholesterol in the hydrolyzed very-low-density lipoprotein and intermediate-density lipoprotein in the fasting state, and the cholesterol in the chylomicron remnants in the postprandial state. Evidence from in vitro and animal pathogenic mechanisms studies, epidemiology, and genetic studies all indicated that RC played an important role in predicting the incidence of ASCVD. As a new indicator to reflect atherosclerosis, especially when LDL-C has been controlled to a recommended level, RC was considered as a priority treatment target for people at high risk of ASCVD. The use of statins, fibrates, APOC3 inhibitors, PCSK9 inhibitors, and omega-3 fatty acids to reduce RC levels in the plasma may provide long-term benefits. However, the standardized detection of RC was still controversial, and more studies on appropriate treatments of elevated RC are urgently needed. These positive trials may benefit more patients at high ASCVD risks worldwide in the future.