Postprandial Mean Research Articles

The effect of the modified fat-protein unit algorithm compared with that of carbohydrate counting on postprandial glucose in adults with type-1 diabetes when consuming meals with differing macronutrient compositions: a randomized crossover trial

BackgroundThe optimization of glucose control in type-1 diabetes is challenged by postprandial glycemic variability. This study aimed to compare the postprandial glycemic effects of carbohydrate counting and the modified fat-protein unit (FPU) algorithms following meals with different protein and fat emphases in adults with type-1 diabetes.MethodsThirty adults with type-1 diabetes aged 18 to 45 years participated in a randomized crossover trial. In a random order, participants consumed four test meals with equivalent energy and different macronutrient emphases on four separate mornings. The modified FPU algorithms and carbohydrate counting were used to determine the insulin dose for the test meals. A continuous glucose monitoring system was used to measured postprandial glycemia.ResultsCompared with carbohydrate counting, the modified FPU algorithm significantly decreased the late postprandial mean glucose levels (p = 0.026) in high protein-fat meals. The number of hypoglycemia episodes was similar between insulin dosing algorithms for the high protein-fat meals; hypoglycemic events were considerably higher for the modified FPU in the normal protein-fat meal (p = 0.042).ConclusionsThe modified FPU algorithm may improve postprandial glycemic control after consuming high protein-fat meals in adults with type-1 diabetes but may result in increased hypoglycemia risk when used with a normal protein-fat meal.

The effect of chronic nausea on gastric slow wave spatiotemporal dynamics in children

Chronic nausea in adolescents with functional gastrointestinal disorders is an increasingly reported but poorly understood symptom that negatively affects quality of life. Functional gastrointestinal disorders are known to correlate closely with slow wave rhythm disturbances. The ability to characterize gastric electrophysiologic perturbations in functional nausea patients could provide potential diagnostic and therapeutic tools for nausea patients. We used high-resolution electrogastrograms (HR-EGG) to measure gastric slow wave parameters in pediatric chronic nausea patients and healthy subjects both pre- and postprandial. We computed the dominant frequency, percentage power distribution, gastric slow wave propagation direction, and speed from HR-EGG. We observed significant differences in the dominant frequency and power distributed in normal and bradyarrhythmia frequency ranges when comparing patients and healthy subjects. Propagation patterns in healthy subjects were predominantly anterograde, while patients exhibited a variety of abnormalities including retrograde, anterograde, and disrupted patterns. There was a significant difference in the preprandial mean slow wave direction between healthy subjects (222°±22°) and patients (103°±66°; p˂0.01), although the postprandial mean direction between healthy subjects and patients was similar (p=0.73). No significant difference in slow wave propagation speed was found between patients and healthy subjects in either pre- (p=0.21) or postprandial periods (p=0.75). The spatiotemporal characterization of gastric slow wave activity using HR-EGG distinguishes symptomatic chronic nausea patients from healthy subjects. This characterization may in turn inform and direct clinical decision-making and lead to further insight into its pathophysiology.

Comparison of postprandial 90th-minute plasma glucose level with 60th- and 120th-minute levels in patients with gestational diabetes: a prospective cohort study.

The objective of the present study is to compare postprandial 90th-minute plasma glucose measurement with fasting, postprandial 60 and 120 min in gestational diabetes mellitus (GDM). One hundred and thirty-one pregnant women with GDM were hospitalized for regulation of maternal plasma glucose levels. Plasma glucose levels were daily recorded for every patient and treatment option arranged without considering the 90th-minute plasma glucose level. All patients were followed up until birth and pregnancy results were compared. At the admission, 69% of our patients were on diet and 31% were on insulin with diet therapy. The highest postprandial mean plasma glucose was seen at 90 min after breakfast (137.50 mg/dl), at 60 min after lunch (137.80 mg/dl), and 60 min after dinner (134.50 mg/dl). The cut-off level for postprandial glucose at 90th minute was determined as 130 mg/dl. The upper limit plasma glucose levels were most frequently exceeded at 90th minute for each meal. High plasma glucose levels and the need for neonatal intensive care unit were correlated (p < 0.05). The highest plasma glucose level was seen at 90 min after breakfast, 60 min after lunch, and 60 min after dinner. The upper limit plasma glucose levels were most frequently exceeded at the 90 min.

Therapeutic effect of ‘Qurs-i-Ziabetus Khas’ in Diabetes Mellitus – A Case Report

Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycaemia due to absolute or relative deficiency of insulin. Nearly 382 million people have been suffered from DM by 2013 AD, which may increase up to 592 million by 2035 AD. The main clinical presentations of DM are polyuria, polydipsia and polyphagia. This disease can produce many complications such as diabetic ketoacidosis, retinopathy, renal failure, peripheral neuropathy, autonomic neuropathy, arthropathy, hyperosmolar nonketotic coma, diabetic foot, myocardial ischemia, intermittent claudication etc. In Unani Medicine, diabetes mellitus is referred as Dhayābītus Shakri (DS), which has been classified under ‘Amraz-iKulyā’ (renal diseases) on the basis of clinical presentations such as polyuria and glycosuria. In this case, Qurs-i-Ziabetus Khas, a pharmacopoeial compound drug, two tablets twice in a day just before meal was given orally to a newly diagnosed case of DM for a period of two months. The clinical features such as polyuria and polydipsia, and laboratory parameters such as fasting blood glucose level, postprandial blood sugar level, HbA1c and mean plasma glucose level were assessed. His clinical features were completely subsided; and blood sugar levels, HbA1c and mean plasma glucose level were significantly decreased. Hence, the study is suggested that Qurs-i-Ziabetus Khas may be given to patients of diabetes mellitus under medical supervision for better compliance.

989-P: MEDI0382, an Oxyntomodulin-Like Peptide with Targeted GLP-1/Glucagon Receptor Activity: Safety Study in Subjects of Japanese and Chinese Descent

Background: MEDI0382 is an oxyntomodulin-like peptide with targeted GLP-1/glucagon receptor activity that is under development for type 2 diabetes mellitus. This study was conducted in subjects of Japanese and Chinese descent to facilitate expansion of its global clinical development in Japan and China. Methods: This phase 1, randomized, blinded study evaluated the safety, tolerability, pharmacokinetics, and immunogenicity of single subcutaneous (SC) doses of MEDI0382. In part A, 24 subjects of Japanese descent across 3 cohorts (8 per cohort) received single SC doses of MEDI0382 at a dose of 50 µg (cohort 1), 100 µg (cohort 2), or 150 µg (cohort 3) or placebo in a 3:1 ratio. In part B, 8 subjects of Chinese descent received a single SC dose of MEDI0382 at 100 µg or placebo in a 3:1 ratio (cohort 4). Results: In part A, the incidence of treatment-emergent adverse events (TEAEs) was highest in the 150-μg group (5 of 6 subjects). In part B, 2 of 6 subjects in the MEDI0382 group reported TEAEs. Nausea, headache, and vomiting were most common. A trend of increased pulse rate post-dose was seen in subjects of Japanese descent in the MEDI0382 100- and 150-µg groups. No clinically meaningful changes from baseline in vital signs were observed in part B. Median tmax values were 6.15-8.16 h at doses of 50-150 μg, both in subjects of Japanese and Chinese descent. In part A subjects receiving MEDI0382 100 and 150 µg, postprandial mean glucose levels remained closer to baseline levels as compared with changes seen with MEDI0382 50 µg or placebo. Discussion: The safety profile of single doses of MEDI0382 at doses of 50, 100, and 150 µg supports its further development in subjects of Japanese and Chinese descent. The pharmacokinetic data for MEDI0382 in the range of 50-150 µg also support its further clinical development in subjects of Japanese and Chinese descent. Disclosure D. Robertson: Employee; Self; AstraZeneca. Employee; Spouse/Partner; GlaxoSmithKline plc. Stock/Shareholder; Self; AstraZeneca. M. Petrone: Employee; Self; MedImmune. L. Tsai: Employee; Self; MedImmune. Other Relationship; Self; AstraZeneca. R.A. Gasser: Employee; Self; AstraZeneca, MedImmune. Funding AstraZeneca

Effect of moderate exercise for 30 min at 30 min versus 60 min after dinner on glycemic control in patients with type 2 diabetes: a randomized, crossover, self-controlled study

To compare the effectiveness of moderate exercise for 30 min at 30 min and 60 min after dinner on glycemic control in patients with type 2 diabetes. This randomized, crossover, self-controlled pilot study was conducted in 15 inactive patients with type 2 diabetes without serious complications or use of exogenous insulin. The participants completed two randomly ordered exercise protocols (brisk walking for 30 min at 30 min or 60 min after dinner on the exercise day) spaced 1 week apart. All the exercise was performed while maintaining a heart rate reserve of 40%. The interstitial glucose level was monitored using a continuous glucose monitor (CGM) for all the participants, who maintained a standardized diet with routine medications. The 2-h postprandial mean glucose, peak glucose, and glucose area under the curve (AUC) were measured. The mean amplitude of glycemic excursions (MAGE) and other plasma glucose fluctuation parameters in 12 h after dinner, including the mean blood glucose (MBG) and the coefficient variation (CV) of glucose, were also calculated. The incidence of nocturnal hypoglycemia was recorded in all the participants. The participants had a mean age of 46±11 years with a mean BMI of 25.8±3.1 kg/m2 and a mean HbA1c of 7.7%. No significant differences were found between postprandial 30 min exercise group and postprandial 60 min exercise group in terms of 2-h postprandial mean glucose, peak glucose, glucose AUC, or in MBG, CV and MAGE during the 12-h period after dinner. No nocturnal hypoglycemia occurred in the participants after exercise at 30 or 60 min after dinner. However, significant reductions in the 2-h postprandial glucose levels were detected after exercise at 60 min after dinner as compared to exercise at 30 min. The timing (30 min vs 60 min after dinner) of moderate exercises for 30 min does not produce significant difference in the improvement of postprandial hyperglycemia in type 2 diabetic patients, and both exercise protocols are safe without a potential risk of hypoglycemia. Nevertheless, exercise at 60 min after dinner can be more effective to lower 2-h postprandial glucose, while exercise at 30 min after dinner might be safer for patients with a high risk of hypoglycemia.

Effects of Standing and Light-Intensity Walking and Cycling on 24-h Glucose.

This study aimed to compare 24-h and postprandial glucose responses to incremental intervals of standing (STAND), walking (WALK), and cycling (CYCLE) to a sit-only (SIT) condition. Nine overweight/obese (body mass index = 29 ± 3 kg·m) adults (30 ± 15 yr) participated in this randomized crossover full-factorial study, with each condition performed 1 wk apart. STAND, CYCLE, and WALK intervals increased from 10 to 30 min·h (2.5 h total) during an 8-h workday. WALK (1.0 mph) and STAND were matched for upright time, and WALK and CYCLE were matched for energy expenditure (~2 METs). Continuous interstitial glucose monitoring was performed for 24 h to include the 8-h workday (LAB), after-work evening hours (EVE), and sleep (SLEEP). Three 2-h postprandial periods were also analyzed. Linear mixed models were used to test for condition differences. Compared with SIT (5.7 ± 1.0 mmol·L), mean 24-h glucose during STAND (5.4 ± 0.9 mmol·L) and WALK (5.3 ± 0.9 mmol·L) were lower, and CYCLE (5.1 ± 1.0 mmol·L) was lower than all other conditions (all P < 0.001). During LAB and EVE, mean glucose was lower for STAND, WALK, and CYCLE compared with SIT (P < 0.001). During SLEEP, the mean glucose for CYCLE was lower than all other conditions (P < 0.001). Compared with SIT, cumulative 6-h postprandial mean glucose was 5%-12% lower (P < 0.001) during STAND, WALK, and CYCLE, and 6-h postprandial glucose integrated area under the curve was 24% lower during WALK (P < 0.05) and 44% lower during CYCLE (P < 0.001). Replacing sitting with regular intervals of standing or light-intensity activity during an 8-h workday reduces 24-h and postprandial glucose. These effects persist during evening hours, with CYCLE having the largest and most sustained effect.

Packed red blood cell transfusion (PRBC) attenuates intestinal blood flow responses to feedings in pre-term neonates with normalization at 24 hours

Objective: To determine whether packed red blood cell (PRBC) transfusion affects post-prandial superior mesenteric artery blood flow velocities (SMA BFVs) in very-low birth weight (VLBW) neonates and if so, at what time point after transfusion restoration of previous SMA BFV patterns occurs.Design/Methods: VLBW pre-term neonates, older than 14 days and tolerating bolus enteral feedings administered every 3 h were enrolled in this prospective observational study. Pulsed Doppler ultrasound was used to measure pre- and post-prandial (at 45 min) time-averaged mean, peak and end diastolic velocities (TAMV, PSV, EDV) immediately before and after 15 ml/kg of PRBC transfusion was given over 3 h; patent ductus arteriosus (PDA) status was also evaluated. Subsequent pre- and post-prandial SMA BFVs were recorded 24 and 48 h after the transfusion.Results: Pre- and post-prandial measurements were obtained for 21 out of 25 enrolled infants. Post-prandial SMA BFVs were attenuated during the feedings immediately after transfusion; at 24 and 48 h after transfusion, changes in post-prandial SMA BFVs were similar to those measured prior to transfusion; the presence of the PDA did not affect results.Conclusions: PRBC transfusion blunted SMA BFV responses to feedings immediately after the transfusion with normalization observed 24 h post-transfusion.

Reproducibility of subjective appetite ratings and ad libitum test meal energy intake in overweight and obese males

Background: To determine whether changes in appetite and energy intake (EI) can be detected and play a role in the effectiveness of interventions, it is necessary to identify their variability under normal conditions. We assessed the reproducibility of subjective appetite ratings and ad libitum test meal EI after a standardised pre-load in overweight and obese males. Methods: Fifteen overweight and obese males (BMI 30.3 ± 4.9 kg/m2, aged 34.9 ± 10.6 years) completed two identical test days, 7 days apart. Participants were provided with a standardised fixed breakfast (1676 kJ) and 5 h later an ad libitum pasta lunch. An electronic appetite rating system was used to assess subjective ratings before and after the fixed breakfast, and periodically during the postprandial period. EI was assessed at the ad libitum lunch meal. Sample size estimates for paired design studies were calculated. Results: Appetite ratings demonstrated a consistent oscillating pattern between test days, and were more reproducible for mean postprandial than fasting ratings. The correlation between ad libitum EI on the two test days was r = 0.78 (P < 0.01). Using a paired design and a power of 0.8, a minimum of 12 participants would be needed to detect a 10 mm change in 5 h postprandial mean ratings and 17 to detect a 500 kJ difference in ad libitum EI. Conclusion: Intra-individual variability of appetite and ad libitum test meal EI in overweight and obese males is comparable to previous reports in normal weight adults. Sample size requirements for studies vary depending on the parameter of interest and sensitivity needed.

Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes

Objective: To evaluate the effects of patent ductus arteriosus (PDA) on postprandial superior mesenteric artery blood flow velocities (SMA BFV)s and feeding tolerance in extremely low birth weight (ELBW) neonates.Methods: Appropriate for gestational age, ELBW preterm neonates, tolerating bolus enteral feedings were eligible to participate in this prospective observational study. Pulsed Doppler was used to measure preprandial and postprandial (at 30 and 60 min) time-averaged mean velocity (TAMV), peak systolic velocity (PSV) and end diastolic velocity (EDV) once during the day of life 5–7; at the same time, PDA size was estimated using the PDA: left pulmonary artery (LPA) ratio.Results: A total of 38 infants were studied, 16 in small, 13 in moderate and 9 in large PDA groups. The postprandial SMA BFVs were lower in the large PDA group, although not reaching statistical significance. Importantly, infants in the large PDA group reached full enteral intake later (p = 0.02) and had higher incidence of death secondary of necrotizing enterocolitis (NEC; p = 0.04).Conclusions: ELBW preterm neonates with large PDA may have attenuated intestinal blood flow responses to feedings. There was also an association with higher rates of necrotizing enterocolitis and feeding intolerance in the large PDA group.

Clinical application of electrogastrography in patients with stomach cancer who undergo distal gastrectomy.

PurposeElectrogastrography is a method of measuring action potentials of the stomach. The purpose of this study was to investigate early postoperative changes in the electrogastrography and determine the correlation between electrogastrography and quality of life of patients with stomach cancer who underwent distal gastrectomy.Materials and MethodsThis study analyzed 20 patients with stomach cancer who underwent electrogastrography and quality of life was measured 1, 12, and 24 weeks after the operation. Quality of life-C30 version 3.0 and quality of life-STO22, were used.ResultsFasting and postprandial mean dominant frequency at 1 week after the operation was 2.7 and 2.7 cycles per minute, and 2.8 and 2.7 cycles per minute at 12 weeks, 2.6 and 2.8 cycles per minute at 24 weeks. Fasting and postprandial mean dominant power at 1 week was 36.5 and 36.4 dB, 36.3 and 40.1 dB at 12 weeks and 40.9 and 42.3 dB at 24 weeks. The percentage of tachygastria was increased whereas the percentage of bradygradia was decreased during the postoperative periods (P<0.05). Global health, physical, emotional and social functioning scales were improved, but role and cognitive functioning were not changed. Pain, insomnia, diarrhea and financial difficulties were significantly improved according to the postoperative periods (P<0.05). The correlation between the STO22 and electrogastrography parameters was not significant (P>0.05).ConclusionsThese may suggest that electrogastrography is a simple and noninvasive method and may be applicated for evaluating motility and autonomic functions of the remnant stomach.

Blood Pressure Decreases More after High-Carbohydrate Meals Than after High-Protein Meals in Overweight Adults with Elevated Blood Pressure, but There Is No Difference after 4 Weeks of Consuming a Carbohydrate-Rich or Protein-Rich Diet

The replacement of dietary carbohydrates with proteins can lower blood pressure (BP), but the mechanisms remain unclear. This randomized, double-blind, parallel-group study aimed to compare 12-h postprandial sympathetic and hemodynamic responses after high-protein (HP) meals and high-carbohydrate (HC) meals. Fifty-two men and women with untreated elevated BP were tested on d 1 and after 4 wk of supplementation [3 × 20 g protein (HP) or maltodextrin (HC) per day]. No between-group differences were found in postprandial plasma norepinephrine on d 1 and at wk 4. On d 1, postprandial mean arterial pressure (MAP) decreased more in the HC group than in the HP group (P = 0.002). This difference was not present at 4 wk, because the postprandial decline in MAP tended to become larger in the HP group after 4 wk of supplementation (P = 0.07). On both test days, postprandial total peripheral resistance tended to decrease more in the HC group (P < 0.08). After 4 wk of supplementation, cardiac output tended to increase more in the HC group (P = 0.08). In conclusion, ingestion of an HP diet induced a smaller decrease in BP on d 1 than did ingestion of an HC diet. This difference disappeared after 4 wk due to a more pronounced decrease in BP in the HP group after 4 wk than on d 1. These findings cannot explain the BP-lowering effect ascribed to dietary proteins.

Clinical application of electrogastrography (EGG) in stomach cancer patients with distal gastrectomy.

59 Background: Electrogastrography (EGG) is a method of measuring action potentials of the stomach. The purposes of this study were to investigate postoperative changes in the EGG and then evaluated gastric motility and to determine the correlation between EGG and quality of life (QOL) of stomach cancer patients with distal gastrectomy. Methods: This study analyzed 20 cases of stomach cancer patients between May 2010 and Dec. 2010. All patients were measured EGG and QOL at 1, 12, and 24 weeks after the operation. The EORTC quality of life questionnaire QOL-C30 version 3.0 and QOL-STO22 were used in this study to assess QOL of gastric cancer patients. Results: Fasting and postprandial mean dominant frequency at 1 week after the operation were 2.7 and 2.6 cycles per minute (cpm), and 2.9 and 2.7 cpm at 12 weeks. Fasting and postprandial dominant power at 1 week were 36.5 and 36.4 dB, and 36.3 and 40.1 dB at 12 weeks. After postoperative week 12, the mean percentage of normal rhythm in both recordings was not changed, whereas the mean percentage of bradygastria was decreased and tachygastria was increased. Regarding QOL, global health, physical, emotional and social status were improved, but pain, insomnia, diarrhea, and financial status was worsened at 12 weeks. On the STO22, the correlation between the QOL and EGG parameters was not significant (p&gt;0.05). Conclusions: These suggest that EGG is a simple and noninvasive method and may be applicated for evaluating motility and autonomic functions of the remnant stomach after distal gastrectomy.

Postprandial microvascular function deteriorates in parallel with gradual worsening of insulin sensitivity and glucose tolerance in men with the metabolic syndrome or type 2 diabetes

Hyperinsulinaemia-induced whole-body glucose uptake during a euglycaemic-hyperinsulinaemic clamp is partly mediated by increased capillary density. We hypothesised that physiological insulinaemia in response to a mixed meal may also enhance microvascular function, and that this may be impaired in insulin-resistant individuals and patients with type 2 diabetes. Twelve men with uncomplicated type 2 diabetes, 13 with metabolic syndrome and 12 age-matched healthy normoglycaemic controls, mean age 57 ± 6 years, underwent skin capillary video microscopy before and 60 and 120 min following a standardised mixed meal to measure baseline capillary density (BCD) and capillary density during post-occlusive peak reactive hyperaemia (PRH), also termed capillary recruitment. Oral glucose insulin sensitivity (Matsuda index) and postprandial hyperglycaemia (2 h AUC(glucose)) were calculated. Fasting BCD was similar among groups, but fasting PRH was lowest in diabetes (p < 0.05). Postprandially, both BCD and PRH increased in all groups (p < 0.001); however, the meal-related increase in BCD was significantly lower in diabetes and metabolic syndrome vs controls (both p < 0.05). At all time points, postprandial PRH was lower in both diabetes and metabolic syndrome vs controls (both p < 0.05). In pooled analysis, postprandial mean PRH correlated with Matsuda index (r = 0.386, p = 0.018) and inversely with 2 h AUC(glucose) (r = -0.336, p = 0.042). Gradual deterioration in meal-related capillary recruitment was paralleled by decreasing insulin sensitivity and postprandial hyperglycaemia, as assessed in healthy normoglycaemic men, men with the metabolic syndrome and those with type 2 diabetes. These findings suggest that in both impaired glucose tolerance and in overt diabetes microvascular dysfunction might contribute to postprandial dysglycaemia. ClinicalTrials.gov NCT00721552.

EFFECT OF AGE ON THE DYNAMICS OF ACYLATED GHRELIN IN FASTING CONDITIONS AND IN RESPONSE TO A MEAL

EFFECT OF AGE ON THE DYNAMICS OF ACYLATED GHRELIN IN FASTING CONDITIONS AND IN RESPONSE TO A MEAL

Nasal continuous positive airway pressure affects pre- and postprandial intestinal blood flow velocity in preterm infants

To measure the effect of nasal continuous positive airway pressure (CPAP) on intestinal blood flow velocity responses to enteral feedings and left ventricular output (LVO). Eighteen infants completed the study (birth weight 1793+/-350 g, gestational age 32.1+/-1.1 weeks). On the day infants were weaned from CPAP to room air, pre- and postprandial (0, 30, 60 and 90 min after feeding) mean velocity (MV), peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured for one feeding given when receiving CPAP ('on CPAP'), and for one feeding given after CPAP had been discontinued ('off CPAP'). Preprandial LVO was measured before and after CPAP discontinuation. MV and PSV were significantly lower when infants were on CPAP (P<0.05). Maximum postprandial MV, PSV and EDV occurred at 30 min when on CPAP and at 60 min when off CPAP. Preprandial LVO was similar when infants were on and off CPAP. CPAP administration affects pre- and postprandial intestinal blood flow velocity, which may impact tolerance to enteral feedings.

Comparison of Low-Fat Meal and High-Fat Meal on Postprandial Lipemic Response in Non-Obese Men according to the −1131T>C Polymorphism of the Apolipoprotein A5 (APOA5) Gene (Randomized Cross-Over Design)

Objective: The purpose of this study was to compare low-fat (LF) meal and high-fat (HF) meal on the postprandial lipemic responses according to the −1131T>C polymorphism of the APOA5 gene in a population usually consuming a LF diet and having a high frequency of the variant allele at the APOA5 −1131T>C SNP.Methods: This study was conducted using a cross-over design and 49 non-obese healthy men (42.8 ± 0.7 yrs, 23.9 ± 0.25 kg/m2) participated in the meal tolerance test. They were randomly assigned to consume one of two types of experimental enteral formulae (LF vs HF) with a seven-day interval. Blood samples were collected at 0, 2, 3, 4 and 6h after ingestion and analyzed for total and chylomicron TG, glucose, insulin and free fatty acid.Results: No differences were found in anthropometic parameter, calorie and macronutrient intakes and total energy expenditure between TT (n = 23) and TC + CC (n = 26) men. Fasting total TG were higher in TC + CC men than TT men, but fasting chylomicron TG were not significantly different between TT men and C carriers, TT subjects had no significant differences in postprandial responses of total TG and chylomicron TG and postprandial mean changes of chylomicron TG between LF and HF meal. On the other hand, C carriers had delayed peak time of total TG compared to TT subject and higher postprandial response and mean changes of chylomicron TG at HF meal compared to LF meal.Conclusion: The capacity to clear chylomicron-TG or hydrolyze TG might become a rate-limiting factor on HF diet in TC + CC men resulting in higher postprandial triglyceridemia. Therefore, HF diet for C carriers of the APOA5 gene may be one of important CVD risk factors.

Effects of Pramlintide on Postprandial Glucose Excursions and Measures of Oxidative Stress in Patients With Type 1 Diabetes

Oxidative stress has been shown to be increased in the postprandial period in patients with diabetes and has been implicated in the pathogenesis of micro- and macrovascular complications. The aim of this post hoc analysis was to assess the effects of pramlintide, an amylin analog shown to reduce postprandial glucose excursions in patients with diabetes, on markers of oxidative stress in the postprandial period. In a randomized, single-blind, placebo-controlled, crossover study, 18 evaluable subjects with type 1 diabetes underwent two standardized breakfast meal tests and received pramlintide or placebo in addition to their preprandial insulin. The plasma concentrations of glucose and markers of oxidative stress (nitrotyrosine, oxidized LDL [ox-LDL], and total radical-trapping antioxidant parameter [TRAP]) were measured at baseline and during the 4-h postprandial period. Compared with placebo, pramlintide treatment significantly reduced postprandial excursions of glucose, nitrotyrosine, and ox-LDL and prevented a decline in TRAP (P < 0.03 for all comparisons). Correlation analyses adjusted for treatment revealed a significant association between postprandial mean incremental area under the curve from 0 to 4 h (AUC(0-4 h)) for glucose and postprandial mean incremental AUC(0-4 h) for each measure of oxidative stress (r = 0.75, 0.54, and -0.63 for nitrotyrosine, ox-LDL, and TRAP, respectively; P < 0.001 for all correlations). These findings indicate that the postprandial glucose-lowering effect of pramlintide in type 1 diabetes is associated with a significant reduction in postprandial oxidative stress.

Effect of orlistat on postprandial lipemia, NMR lipoprotein subclass profiles and particle size

Evidence suggests that metabolic phenomena during postprandial lipemia may be important in the pathogenesis of atherosclerosis. Both lipid concentrations and lipoprotein subclass patterns may be important cardiovascular risk modifiers. The pancreatic lipase inhibitor orlistat reduces fat absorption by 30% and is used for the treatment of overweight and obesity. We evaluated the effect of orlistat on postprandial lipemia and lipoprotein particle distribution after moderate-and high-fat meals in healthy volunteers. In this double-blind, randomized, cross-over study, 10 healthy young men received orlistat 120 mg plus a high-fat meal (HFO), orlistat plus a moderate-fat meal (MFO) or placebo plus a high-fat meal (HFP). Plasma triacylglycerol, glucose, insulin, and free fatty acids were measured at baseline (fasting) and postprandially for 8 h. Lipoprotein subclass profile was assessed by nuclear magnetic resonance spectroscopy. The 8 h postprandial mean triacylglycerol area under the curve (AUC) was significantly lower with MFO and HFO (0.79 versus 1.33 mmol/l h) versus HFP (4.33 mmol/l h; p = 0.02). Mean change in large VLDL subclass concentration during the 4–8 h and mean VLDL size after 8 h was significantly lower with HFO and MFO versus HFP ( p < 0.001). Small HDL particle concentration decreased significantly with HFP versus MFO or HFO ( p < 0.001). There was no significant difference in postprandial concentrations of glucose, insulin or free fatty acids on the different regimens. The lowering of postprandial triacylglycerol AUC, shorter postprandial lipemia, lower concentration of large triacylglycerol-rich particles and decrease of VLDL particle size supports the hypothesis of a less atherogenic postprandial lipoprotein profile following orlistat ingestion.

Glucose levels observed in daily clinical practice induce endothelial dysfunction in the rabbit macro- and microcirculation.

We investigated whether different concentrations of elevated glucose - corresponding to levels observed in patients with type 2 diabetes under routine care (post-prandial mean and maximum values) and those used for diagnosing diabetes - induce impairment of vascular reactivity of the macro- and microcirculation in non-diabetic rabbits. Aortic rings and isolated perfused kidneys from normal rabbits were acutely exposed (3 h) to normal (5.5 mm) or high (7-25 mM) D-glucose concentrations. Vascular reactivity was evaluated with endothelium-dependent [acetylcholine (ACh) and bradykinin (BK)] and independent [sodium nitroprusside (SNP)] vasodilating agents. Endothelium-dependent relaxation of the thoracic aorta induced by ACh or BK was significantly attenuated after a 3-h exposure to high D-glucose (15-25 mM) but not after corresponding increased osmolarity with mannitol solutions. Relaxation induced by SNP (endothelium-independent) was not affected by high D-glucose concentrations. Moreover, endothelium-dependent but not independent vasodilation of the isolated rabbit kidney was also impaired after 3-h perfusion with high D-glucose (11.1-25 mM). Perfusion with mannitol solutions (15-25 mM) partially blunted endothelium-dependent renal vasodilation. It is concluded that acute hyperglycemia corresponding to post-prandial levels in patients with type 2 diabetes induces endothelial dysfunction of conduit vessels as well as of the renal circulation of non-diabetic rabbits.