Postprandial Plasma Glucose Concentrations Research Articles

Cluster analysis based on fasting and postprandial plasma glucose and insulin concentrations

Cluster analysis based on fasting and postprandial plasma glucose and insulin concentrations

Effect of micronization and meal size of corn grain on glycemic response and in vitro hindgut acidosis potential in horses

This study aimed to 1) evaluate the interaction of corn grain micronization and starch levels per meal on equine plasma glucose, and 2) determine if micronization affects the risk of hindgut acidosis. Six mature (aged 6 to 10 years), healthy, non-pregnant mares (initial body weight [BW]: 301 to 463 kg) were used in a 2×3 factorial cross-over design. The treatments included two forms of corn grain (ground and micronized flaked) at three levels of starch (1, 1.5, and 2 g/kg BW per meal). The blood was sampled before and 30, 60, 90, 120, 180, 240, and 300 min after morning feeding and the glucose concentration in the plasma was determined. Small intestine and hindgut dry matter (DM) disappearances of ground and micronized corn were also compared using in vitro techniques. Micronized flaked corn grain showed three times more in vitro enzymatic DM disappearance (p < 0.001) compared with ground corn. Residues of in vitro enzymatic digestion of micronized flaked corn fermented 38.59 % faster than ground corn during in vitro hindgut incubation. The horses that consumed micronized flaked corn had higher post-prandial plasma glucose concentrations (p < 0.001). Increasing starch levels per meal from 1–2 g/kg BW resulted in higher plasma glucose concentrations (P = 0.005). However, no interaction of processing and starch meal size was found. Overall, processing the corn grain by micronization or increasing starch level per meal increased the plasma glucose concentrations, but the magnitude of the increases did not match that expected from in vitro studies.

Obesity wars: hypothalamic sEVs a new hope.

There are currently several pharmacological therapies available for the treatment of obesity, targeting both the central nervous system (CNS) and peripheral tissues. In recent years, small extracellular vesicles (sEVs) have been shown to be involved in many pathophysiological conditions. Because of their special nanosized structure and contents, sEVs can activate receptors and trigger intracellular pathways in recipient cells. Notably, in addition to transferring molecules between cells, sEVs can also alter their phenotypic characteristics. The purpose of this review is to discuss how sEVs can be used as a CNS-targeted strategy for treating obesity. Furthermore, we will evaluate current findings, such as the sEV-mediated targeting of hypothalamic AMP-activated protein kinase (AMPK), and discuss how they can be translated into clinical application.

285-LB: LEAP2 Reduces Preprandial and Postprandial Glucose Levels and Ad Libitum Food Intake in Obese Men

The naturally occurring peptide liver-enriched antimicrobial peptide 2 (LEAP2) has gained interest as a ghrelin receptor antagonist. Recently, we reported food intake and plasma glucose-lowering effects of exogenous LEAP2 in lean healthy males. Here, we investigated the effects of LEAP2 infusion on ad libitum food intake and postprandial glucose tolerance in obese men. Twenty obese men (mean (SEM) age 44.2 (2.2) years; BMI 36.3 (0.8) kg/m2; body fat percentage 37.4 (0.9)%) were enrolled in this randomized, double-blind, placebo-controlled, crossover study comprising two experimental days. Experimental days involved a ~5-hour intravenous (iv) infusion of LEAP2 or placebo during which a liquid mixed meal test (MMT) and a subsequent ad libitum meal test were performed. Plasma glucose measures included fasted (preprandial), Cmax and Tmax values as well as area under the curve (AUC) during MMT. Ad libitum food intake was measured in kilojoule (kJ) and kJ/kg body weight. Compared to placebo, LEAP2 infusion lowered preprandial plasma glucose (mean (SEM): 5.03 (0.08) vs. 5.19 (0.06) mmol/L, P=0.0095) as well as Cmax (6.58 (0.18) vs. 6.98 mmol/L (0.18), P=0.0001) and AUC for plasma glucose during MMT (1,506 (33.4) vs. 1564 (30.4) min×mmol/L, P=0.0005), but not Tmax. Ad libitum food intake was reduced by ~13% during LEAP2 infusion compared to placebo (2,939 (266) vs. 3,378 (258) kJ, P=0.0118; 25.0 (2.4) vs. 28.4 (2.0) kJ/kg body weight, P=0.0140). We conclude that a continuous iv LEAP2 infusion reduces pre- and postprandial plasma glucose concentrations as well as ad libitum food intake in obese men. Disclosure A. Englund: None. C. A. Hagemann: Employee; Gubra ApS. L. S. Gasbjerg: Speaker's Bureau; Eli Lilly and Company, Stock/Shareholder; Antag Therapeutics. F. K. Knop: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Research Support; Novo Nordisk, Zealand Pharma A/S, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi, Lundbeck.

Insulin Sensitivity and β-Cell Function During Early and Late Pregnancy in Women With and Without Gestational Diabetes Mellitus.

To evaluate the metabolic alterations associated with gestational diabetes mellitus (GDM) in women with overweight or obesity. We compared fasting and postprandial plasma glucose and free fatty acid (FFA) concentrations, insulin sensitivity (IS; Matsuda index), and β-cell function (i.e., β-cell responsiveness to glucose) by using a frequently sampled oral glucose tolerance test (OGTT) at 15 and 35 weeks' gestation in women with overweight or obesity who had GDM (n = 29) or did not have GDM (No-GDM; n = 164) at 35 weeks. At 15 weeks, IS and β-cell function were lower, and fasting, 1-h, and total area-under-the-curve plasma glucose concentrations during the OGTT were higher (all P < 0.05) in the GDM than in the No-GDM group. At 35 weeks compared with 15 weeks, IS decreased, β-cell function increased, and postprandial suppression of plasma FFA was blunted in both the GDM and No-GDM groups, but the decrease in IS and the increase in postprandial FFA concentration were greater and the increase in β-cell function was less (all P ≤ 0.05) in the GDM than in the No-GDM group. A receiver operating characteristic curve analysis showed that both fasting plasma glucose and 1-h OGTT glucose concentration at 15 weeks are predictors of GDM, but the predictive power was <30%. Women with overweight or obesity and GDM, compared with those without GDM, have worse IS and β-cell function early during pregnancy and a greater subsequent decline in IS and blunted increase in β-cell function. Increased fasting and 1-h OGTT plasma glucose concentration early during pregnancy are markers of increased GDM risk, albeit with weak predictive power.

Enhancing cardiometabolic health through physical activity and breakfast manipulations in children and adolescents: good for humans, good for the planet.

The human health benefits of cardiometabolic disease prevention can be accompanied by planetary co-benefits. Focusing efforts towards young people, including children and adolescents, is conducive to disease prevention. In the context of cardiometabolic disease prevention, this review paper critically summarises the available literature on the acute cardiometabolic responses to physical activity and breakfast manipulations among young people. Given the seriousness of global climate change, which will disproportionally affect our younger generations, this review paper offers new insights into the inherent interactions between child-adolescent behaviour and cardiometabolic health from an environmental sustainability perspective to aid climate change mitigation efforts, including exploring future research avenues. A growing evidence base suggests acute moderate- to high-intensity exercise bouts can attenuate postprandial plasma glucose, insulin and triacylglycerol concentrations for up to 24-48 h in young people. Whether accumulating physical activity throughout the day with short, frequent bouts promotes cardiometabolic risk marker attenuations is unclear. Breakfast consumption may enhance free-living physical activity and reduce glycaemic responses to subsequent meals for a possible additive impact. If repeated habitually, attenuations in these cardiometabolic risk factors would be conducive to disease prevention, reducing the greenhouse gas emissions associated with disease diagnosis and treatment. To progress current understanding with high public health and planetary relevance, research among samples of 'at risk' young people that span cellular-level responses to ecologically valid settings and address human and planetary health co-benefits is needed. Indeed, certain physical activity opportunities, such as active travel to school, offer important direct co-benefits to humans and planetary health.

Low-fat dairy consumption improves intestinal immune function more than high-fat dairy in a diet-induced swine model of insulin resistance.

To understand the effects of consuming high-fat and low-fat dairy products on postprandial cardiometabolic risk factors and intestinal immune function, we used an established low birthweight (LBW) swine model of diet-induced insulin resistance. LBW piglets were randomized to consume one of the 3 experimental high fat diets and were fed for a total of 7weeks: (1) Control high fat (LBW-CHF), (2) CHF diet supplemented with 3 servings of high-fat dairy (LBW-HFDairy) and (3) CHF diet supplemented with 3 servings of low-fat dairy (LBW-LFDairy). As comparison groups, normal birthweight (NBW) piglets were fed a CHF (NBW-CHF) or standard pig grower diet (NBW-Chow). At 11weeks of age, all piglets underwent an established modified oral glucose and fat tolerance test. At 12weeks of age, piglets were euthanized and ex vivo cytokine production by cells isolated from mesenteric lymph node (MLN) stimulated with mitogens was assessed. Dairy consumption did not modulate postprandial plasma lipid, inflammatory markers and glucose concentrations. A lower production of IL-2 and TNF-α after pokeweed mitogen (PWM) stimulation was observed in LBW-CHF vs NBW-Chow (P < 0.05), suggesting impaired MLN T cell function. While feeding high-fat dairy had minimal effects, feeding low-fat dairy significantly improved the production of IL-2 and TNF-α after PWM stimulation (P < 0.05). Irrespective of fat content, dairy had a neutral effect on postprandial cardiometabolic risk factors. Low-fat dairy products improved intestinal T cell function to a greater extent than high-fat dairy in this swine model of obesity and insulin resistance.

The Significant Relationship between A Prostatitis and A High Level of Glycated hemoglobin in Non-Insulin dependent Diabetes Mellitus in AL-Diwaniah Province

Objectives: The aim of this study was to determine the effect of type 2 diabetes mellitus (DM) on the serum level of prostatespecific antigen. Background: Prostatitis is an inflammation of prostate gland ; several kinds chronic (nonbacterial) prostatitis and sever(chronic) bacterial prostatitis, pelvic pain syndrome. Glycated Hemoglobin A1c (HbA1c) has been widely recognized as a biomarker predictor for the severity of Diabetes Mellitus(DM). Glycated Hemoglobin (HbA1c) is a pivotal biomarker reflecting both fasting and postprandial plasma glucose concentration over the preceding 120 days. Increasing epidemiologic evidence suggests that diabetes and associated hyperglycemia and insulin resistance significantly increase the risks of BPH and LUTS. Method: A total of 175 blood samples were tested for Glycated hemoglobin with high R.B. Sugar and PSA level.(HbA1c )might have been quantified by (I Chroma 11 and ELISA). Results: One Hundred Seventy Five patients aged( 22 – 70 ± 10 years) with Type 2 DM, were studied who have signs of prostatitis inflammation ,100 under study and 75 control group. Conclusion: A significant association between poor glycemic control and high PSA level of prostatitis among diabetic patients understudy.

1425-P: Effect of Ghrelin on Glucose Tolerance after Sleeve Gastrectomy

Introduction: Ghrelin is an appetite-stimulating peptide hormone secreted from the gastric mucosa in the fasting state that decreases in response to food intake. After sleeve gastrectomy (SG) , plasma levels of ghrelin decrease dramatically, whether this may influence glucose tolerance is unknown. We therefore investigated the effects of physiological ghrelin infusions on glucose tolerance in individuals with obesity before and after SG. Methods: Nine morbidly obese individuals with normal glucose tolerance, scheduled for SG, were enrolled. Four-hour standard mixed-meal tests with concomitant patient-blinded infusions of either acyl-ghrelin (1 pmol/kg/min) or placebo (saline) were performed in randomized order before and 3 months after surgery. All values are mean ± SEM. Results: Before SG, fasting plasma glucose was unaffected by ghrelin infusion, whereas both peak (7.93 ± 0.3 mmol/L versus 6.98 ± 0.2, p&amp;lt;0.001) and total area under the curve (tAUC) of plasma glucose concentrations (1874 ± 61 mmol/L*min versus 1702 ± 42, p=0.03) increased significantly during ghrelin infusion versus placebo. After SG, fasting plasma glucose was again unaffected by ghrelin infusion, whereas peak of plasma glucose increased (8.65 ± 0.5 mmol/L versus 7.92 ± 0.3 mmol/L, p=0.04) and tAUC of plasma glucose tended to increase (1817 ± 73 mmol/L*min versus 1636 ± 44 mmol/l*min, p=0.054) during ghrelin infusions versus placebo. The increase in tAUC during ghrelin infusion versus placebo was 10% before surgery and 11% after SG (p=0.98) . Conclusion: Ghrelin infusions increased postprandial plasma glucose concentrations in obese individuals both before and following SG, suggesting a role of ghrelin in the regulation of postprandial glucose metabolism. This response appears to be maintained following SG and the low levels of ghrelin after SG may thus contribute to the improved glucose control after the operation. Disclosure N.Hedbäck: None. S.Madsbad: None. M.Dichman: None. C.Dirksen: None. K.N.Bojsen-moller: None. N.B.Jørgensen: Advisory Panel; Novo Nordisk A/S, Research Support; Boehringer Ingelheim International GmbH, Speaker's Bureau; Novo Nordisk A/S, Stock/Shareholder; Eli Lilly and Company, Novo Nordisk A/S. M.G.Hindsø: Research Support; Novo Nordisk Foundation. V.B.Kristiansen: None. J.J.Holst: Advisory Panel; Novo Nordisk, Board Member; Antag Therapeutics, Bainan Biotech. M.S.Svane: None. Funding European Research Council (Grant 695069-BYPASSWITHOUTSURGERY) Novo Nordisk Foundation

Acute Effects of Kawakawa (Piper excelsum) Intake on Postprandial Glycemic and Insulinaemic Response in a Healthy Population.

Background: Piper excelsum (kawakawa) is an endemic shrub of Aotearoa, New Zealand, of cultural and medicinal importance to Māori. Its fruits and leaves are often consumed. These tissues contain several compounds that have been shown to be biologically active and which may underpin its putative health-promoting effects. The current study investigates whether kawakawa tea can modulate postprandial glucose metabolism. Methods: We report a pilot three-arm randomized crossover study to assess the bioavailability of kawakawa tea (BOKA-T) in six male participants with each arm having an acute intervention of kawakawa tea (4 g/250 mL water; 1 g/250 mL water; water) and a follow-up two-arm randomized crossover study to assess the impact of acute kawakawa tea ingestion on postprandial glucose metabolism in healthy human volunteers (TOAST) (4 g/250 mL water; and water; n = 30 (15 male and 15 female)). Participants consumed 250 mL of kawakawa tea or water control within each study prior to consuming a high-glycemic breakfast. Pre- and postprandial plasma glucose and insulin concentrations were measured, and the Matsuda index was calculated to measure insulin sensitivity. Results: In the BOKA-T study, lower plasma glucose (p < 0.01) and insulin (p < 0.01) concentrations at 60 min were observed after consumption of a high-dose kawakawa tea in comparison to low-dose or water. In the TOAST study, only plasma insulin (p = 0.01) was lower at 60 min in the high-dose kawakawa group compared to the control group. Both studies showed a trend towards higher insulin sensitivity in the high-dose kawakawa group compared to water only. Conclusions: Consuming kawakawa tea may modulate postprandial glucose metabolism. Further investigations with a longer-term intervention study are warranted.

LEAP2 reduces postprandial glucose excursions and ad libitum food intake in healthy men

SummaryThe gastric hormone ghrelin stimulates food intake and increases plasma glucose through activation of the growth hormone secretagogue receptor (GHSR). Liver-expressed antimicrobial peptide 2 (LEAP2) has been proposed to inhibit actions of ghrelin through inverse effects on GHSR activity. Here, we investigate the effects of exogenous LEAP2 on postprandial glucose metabolism and ad libitum food intake in a randomized, double-blind, placebo-controlled, crossover trial of 20 healthy men. We report that LEAP2 infusion lowers postprandial plasma glucose and growth hormone concentrations and decreases food intake during an ad libitum meal test. In wild-type mice, plasma glucose and food intake are reduced by LEAP2 dosing, but not in GHSR-null mice, pointing to GHSR as a potential mediator of LEAP2’s glucoregulatory and appetite-suppressing effects in mice.

Riceberry rice beverage decreases postprandial glycemic response, inflammatory markers and antioxidant status induced by a high-carbohydrate and moderate-fat meal in overweight and obese men.

Recent clinical studies support the beneficial role of riceberry rice and its food products in controlling the glycemic response in healthy subjects. The aim of the current work was to determine the effects of riceberry rice beverage (RRB) on postprandial glycemic, insulin and triglyceride responses, inflammatory biomarkers, and antioxidant status as well as appetite sensation following a high-carbohydrate and moderate-fat (HCMF) meal in overweight/obese subjects. Thirteen participants, overweight and obese men (age = 24.46 ± 0.90 years and BMI = 25.92 ± 0.69 kg m-2), completed a randomized, crossover intervention study. They consumed an HCMF meal with or without RRB (2 g of riceberry rice extract powder/400 ml). Blood samples and appetite sensation were measured at the fasting state and up to 6 h after meal consumption. The ingestion of the HCMF meal accompanied by RRB had a lower incremental area under the curve (iAUC) for postprandial plasma glucose, insulin, malondialdehyde (MDA) and serum triglyceride concentrations when compared to the control. A significant increase in the ferric reducing ability of plasma (FRAP), Trolox equivalent antioxidant capacity (TEAC), and thiol level, all measures of antioxidant capacity, was also observed in the participants who consumed the HCMF meal accompanied by RRB. The postprandial level of pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) significantly increased at 3 h and 6 h after the HCMF meal intake when compared to the fasting state. Interestingly, these values were significantly decreased upon consumption of RRB. However, there were no statistically significant differences in the rating scores of hunger, fullness, desire to eat, and satiety among the tested meals. In conclusion, RRB intake prevented HCMF meal-induced postprandial glycemic, lipemic, and pro-inflammatory responses and improved plasma antioxidant capacity in overweight and obese participants.

Role of Fluid Milk in Attenuating Postprandial Hyperglycemia and Hypertriglyceridemia.

Postprandial plasma glucose and triglyceride concentrations are predictive of relative cardiovascular disease (CVD) risk, and the pathogenesis of both insulin resistance and atherosclerosis has been attributed to acute states of hyperglycemia and hypertriglyceridemia. Postprandial lipemia and hyperglycemia suppress vascular reactivity and induce endothelial dysfunction. Epidemiological studies suggest that chronically-high consumption of milk and milk products is associated with a reduced risk of type 2 diabetes, metabolic syndrome, and CVD. The addition of dairy products to meals high in carbohydrates and fat may lessen these risks through reductions in postprandial glucose and triglyceride responses. Purported mechanisms include dairy proteins and bioactive compounds, which may explain the inverse relationship between dairy consumption and cardiometabolic diseases. The current review evaluates the available literature describing the relationships between metabolic dysfunction, postprandial metabolism, and vascular dysfunction and discusses the potential role of milk and dairy products in attenuating these impairments.

Effects of high and low glycemic isoenergetic breakfast on glucose homeostasis and substrate oxidation during high intensity intermittent exercise

Summary Objective The purpose of the present study was to investigate the effect of high glycemic (HGI) and low glycemic (LGI) isoenergetic breakfast on glucose homeostasis and substrate oxidation during high intensity intermittent exercise (HIIE). Methods On two occasions, 7 days apart, eight healthy and practiced men with age (23.4 ± 0.9 years) maximal oxygen uptake (53.7 ± 1.0 mL/kg/min) participated in this trial. At each stage, 60 minutes after consumption isoenergetic breakfast, completed HIIE. Blood samples collected in 6 stages for measuring plasma glucose, insulin and glucagon. Results The results showed that in the postprandial period, plasma glucose and insulin concentrations in HGI were higher than LGI (P  Conclusion HGI causes hyperglycemia and hyperinsulinemia in the postprandial period, and higher levels of insulin before exercise can lead to a sudden drop in blood glucose over the course of the exercise, but LGI, due to lower insulinemia, helps to maintain better blood glucose and Glucose homeostasis during HIIE. LGI also increases fat oxidation, which can save carbohydrates.

The intestinal microbiome is a co-determinant of the postprandial plasma glucose response.

Elevated postprandial plasma glucose is a risk factor for development of type 2 diabetes and cardiovascular disease. We hypothesized that the inter-individual postprandial plasma glucose response varies partly depending on the intestinal microbiome composition and function. We analyzed data from Danish adults (n = 106), who were self-reported healthy and attended the baseline visit of two previously reported randomized controlled cross-over trials within the Gut, Grain and Greens project. Plasma glucose concentrations at five time points were measured before and during three hours after a standardized breakfast. Based on these data, we devised machine learning algorithms integrating bio-clinical, as well as shotgun-sequencing-derived taxa and functional potentials of the intestinal microbiome to predict individual postprandial glucose excursions. In this post hoc study, we found microbial and clinical features, which predicted up to 48% of the inter-individual variance of postprandial plasma glucose responses (Pearson correlation coefficient of measured vs. predicted values, R = 0.69, 95% CI: 0.45 to 0.84, p<0.001). The features were age, fasting serum triglycerides, systolic blood pressure, BMI, fasting total serum cholesterol, abundance of Bifidobacterium genus, richness of metagenomics species and abundance of a metagenomic species annotated to Clostridiales at order level. A model based only on microbial features predicted up to 14% of the variance in postprandial plasma glucose excursions (R = 0.37, 95% CI: 0.02 to 0.64, p = 0.04). Adding fasting glycaemic measures to the model including microbial and bio-clinical features increased the predictive power to R = 0.78 (95% CI: 0.59 to 0.89, p<0.001), explaining more than 60% of the inter-individual variance of postprandial plasma glucose concentrations. The outcome of the study points to a potential role of the taxa and functional potentials of the intestinal microbiome. If validated in larger studies our findings may be included in future algorithms attempting to develop personalized nutrition, especially for prediction of individual blood glucose excursions in dys-glycaemic individuals.

Maternal Glycemia During Pregnancy and Child Carotid Intima Media Thickness, Pulse Wave Velocity, and Augmentation Index.

In women without diabetes, little is known about the consequences of hyperglycemia during pregnancy for the offspring's cardiovascular structure and function. To investigate the association of maternal glycemia during pregnancy with cardiovascular risk markers in their children in GUSTO, a Singaporean birth cohort study. Around 26 weeks' gestation, a 75 g oral glucose tolerance test was performed and fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPPG) concentrations were measured. Gestational diabetes mellitus (GDM) was defined using WHO 1999 diagnostic criteria. At 6 years of age, we measured the child's carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity (cfPWV), aortic augmentation index (AIx), and blood pressure (BP). Association of maternal glycemia during pregnancy with cardiovascular risk markers in their children were analyzed using multiple linear and logistic regressions. Analysis were performed on 479 mother-child dyads. Higher maternal FPG was associated with higher cIMT and, in males, with a higher cfPWV in the offspring (adjusted β [CI 95%], cIMT: 0.08 per 10mm increase [0.02; 0.15], cfPWV: 0.36 m/s [0.01; 0.70]). Higher 2-hour PPPG was associated with higher cfPWV and AIx. Gestational diabetes mellitus was associated with higher AIx. No association was found between maternal glycemia and their offspring blood pressure. among mothers without pre-existing diabetes, higher glycemia during pregnancy was associated with mild structural and functional vascular changes in their children at 6 years of age across a continuum. These results support the necessity to monitor maternal glycemia during pregnancy even in the absence of pre-existing diabetes or diagnosed GDM.

Hepatic de novo lipogenesis is suppressed and fat oxidation is increased by omega-3 fatty acids at the expense of glucose metabolism

ObjectiveIncreased hepatic de novo lipogenesis (DNL) is suggested to be an underlying cause in the development of nonalcoholic fatty liver disease and/or insulin resistance. It is suggested that omega-3 fatty...

Effects of a novel combination of orlistat and acarbose on tolerability, appetite, and glucose metabolism in persons with obesity.

SummaryObjectiveThere is an unmet medical need for a safe and effective weight loss product with minimal systemic side‐effects. In this study, the effect of a novel modified‐release fixed‐dose combination of orlistat and acarbose (MR‐OA) was compared with conventional orlistat (CO) regarding tolerability, appetite and glucose metabolism.MethodsSixty‐seven men with obesity, aged 24 to 60 years with body mass indexes (BMIs) 33 to 40 kg m−2 or BMIs 30 to 32 kg m−2 and waist circumference above 102 cm were included. They were randomized to either three different doses of the test formulation MR‐OA (60 mg orlistat/20 mg acarbose, 90/30 and 120/40) or CO (Xenical, 120 mg orlistat) for a 2‐week study of daily treatment. The participants spent days 1 and 14 at the clinical research centre where they received standardized meals, had blood sampling and filled in questionnaires regarding tolerability and appetite after meals. In days 2 to 13, the participants were at home and continued to fill in the questionnaires daily.ResultsIn the MR‐OA groups, reports of liquid and oily stools as well as faecal incontinence were fewer, whereas reports of gastric distension and flatulence were higher, compared with the CO group. More participants reported decreased hunger in the 90/30 and 120/40 MR‐OA, and postprandial plasma glucose concentration was reduced in all MR‐OA groups compared with CO.ConclusionsThis study shows that by using a modified‐release dosage form, orlistat and acarbose can be combined without compromising tolerability. Furthermore, MR‐OA shows promising effects regarding reduction of appetite and reduces postprandial glucose. Tolerability is coupled to compliance and thereby efficacy of a treatment; therefore, this novel combination MR‐OA could be an effective approach for weight loss treatment. A follow‐up study in a more diverse population and for a longer duration with weight loss as primary outcome variable is planned.

Effect of replacing lactose with fat in milk replacer on abomasal emptying and glucose–insulin kinetics in male dairy calves

ABSTRACT Objective Altering energy supply and the relative proportions of energy source in the first weeks of life of dairy calves may influence glycemic and insulinemic responses. The objective of this study was to assess the metabolic responses to high-lactose or high-fat milk replacer. Materials and Methods Forty male calves were fed 7 L of milk replacer per day in 2 meals given 10 h apart, considered either high lactose (44% lactose, HL) or high fat (37% lactose, HF), from the first week of life to 30 d of age. Postprandial blood plasma glucose, insulin, and acetaminophen (an abomasal emptying marker) concentrations were measured up to 420 min and used to fit a mathematical model of abomasal emptying and glucose–insulin dynamics. Additionally, an i.v. glucose tolerance test was used to assess glucose tolerance and insulin sensitivity. Results and Discussion Insulin sensitivity remained unchanged; however, glucose maximal concentration and change from baseline tended to be greater for HL in response to an i.v. glucose challenge. Postprandial glucose was elevated at 30 min for HL and HF at 60 and 90 min. Model parameterization showed no difference in abomasal emptying; however, intestinal glucose absorption tended to be faster with HL. Potentiation of insulin action was greater with HL, and pancreatic responsiveness tended to be greater with HF. Implications and Applications These results suggest HL increased early-phase postprandial glucose appearance, which may influence insulin action. In this study, modifying milk replacer composition to more closely resemble cow’s milk did not negatively affect glucose metabolism.

A role for exogenous GLP-1 in the management of postprandial hypoglycaemia after Roux-en-Y gastric bypass?

Roux-en-Y gastric bypass (RYGB) is one of the most common and successful bariatric surgeries. However, more than half of RYGB-operated individuals may suffer from post-bariatric hypoglycaemia (PBH) characterised by traditional hypoglycaemic symptoms occurring 1 to 4 hours after meal intake. The mechanisms underlying PBH most likely relate to accelerated delivery of nutrients to the small intestine resulting in unretarded nutrient absorption, large elevations in postprandial plasma glucose concentrations (constituting a potent insulin secretory stimulus), and grossly elevated postprandial plasma levels of the insulinotropic gut-derived hormone glucagon-like peptide 1 (GLP-1) potentiating glucose-stimulated insulin secretion. Based on previous findings that circulating GLP-1 concentrations increased by ~100% during insulin-induced hypoglycaemia before but not after RYGB, Almby et al. explored whether exogenous GLP-1 may protect against PBH. They performed hyperinsulinaemic hypoglycaemic clamps with concomitant infusion of the GLP-1 analogue exenatide and saline, respectively, in individuals who had undergone RYGB surgery. Infusion with exenatide during hypoglycaemia had no plasma glucose-raising effects, did not increase the counterregulatory glucagon response, and did not affect symptom scores. In the present commentary, potentially important implications derived from the study by Almby et al. published in the August issue of EJE, are discussed in the light of previous observations on GLP-1 receptor agonist treatment in PBH. While the findings by Almby et al. do not provide a solution for patients with PBH, they contribute to the knowledge base needed to address the growing problem of PBH.