Small Meals Research Articles

Development of Nutrient Rich Morning Meals for Students by Concept of Tapas

A correlation between nutritional status and academic achievement has been established by many studies, but students′ eating habits often do not meet nutritional recommendations. Breakfast consumption has a positive effect on cognitively demanding tasks and results in better attention and memory. The goal of this work was to develop well-balanced, nutritionally rich morning meals for students based on the concept of tapas, a combination of several different small meals composed of different ingredients. An introductory survey about students’ morning eating habits was conducted among students of the Faculty of Tourism and Rural Development in Požega, Croatia. Forty-six full-time students (9.50% of total number of students at the faculty) participated in the survey. Sixteen types of tapas were prepared combining ingredients which students rated as desirable (cheese, prosciutto, peppers, milk spread) and undesirable (blue fish, dry fruit, cauliflower, chickpeas) in the initial survey. Tapas (one tapa = one sample) were scored by a sensory panel of 16 students, and nutritional value of the samples was assessed by web application Program Prehrane® (The Nutrition Program). All samples except two were scored as desirable by more than 60% of students, meaning that even ingredients which have been initially scored as undesirable, can be incorporated into desirable meal when properly combined. Based on the analysis of energy and nutritional value of samples, students should combine 3 to 5 different tapas to fulfill their energy needs for breakfast or 1 to 2 different tapas for a morning snack. Developed tapas can provide a perfectly balanced meal rich in different micronutrients because they include ingredients which students normally do not include in their breakfast. Especially important ingredients were blue fish rich in unsaturated acids and selenium, nuts rich in selenium and vitamin E, and red peppers rich in vitamin C and carotenoids. Tapas containing cheese and prosciutto, students’ favorite ingredients, had the highest level of sodium and fats, but not above recommended values when combined with other tapas.

7375 Severe Hypoglycemia In Graves’ Hyperthyroidism: A Rare Consequence Of Methimazole Induced Insulin Autoimmune Syndrome

Abstract Disclosure: J. Ratnasingam: None. N. Ismail: None. Y. Ng: None. T. Sarvanandan: None. N. Hee: None. Q. Lim: None. L. Lim: None. S. Paramasivam: None. P. Sthaneshwar: None. S. Vethakkan: None. Background: Islet autoimmune syndrome (IAS) is a rare disease characterized by elevated insulin autoantibodies (IAA), triggered by genetic, environmental or drug (sulfhydryl containing) factors. We describe a case of Graves’ hyperthyroidism who developed IAS with methimazole. Clinical Case: A 28-year-old Malaysian-Chinese woman presented with tremors and palpitations. She weighed 56 kg, had no palpable goiter or thyroid eye signs. The diagnosis of Graves’ disease was confirmed with ft4 66.5 (11.5-22.7)pmol/L and TSH <0.01 (0.55-4.78)mIU/L with elevated thyroid stimulating immunoglobulin of 5.4 (< 0.55)IU/L. She was treated with methimazole 20mg BID and Propranolol 20mg TID. After 5 weeks of methimazole, she experienced recurrent episodes of sweating and presented with a generalized tonic-clonic seizure with capillary blood glucose of 27mg/dL. Seizures aborted after resuscitation with dextrose. There was no history of fever, exposure to insulin or other drugs, weight gain, family history of diabetes or alcohol use. CT brain and other parameters were normal and she had no other apparent cause of seizures. During the hypoglycemic episode; with the plasma glucose of 32 mg/dL, she had disproportionately high insulin: 9309 (3-25)mIU/L relative to C-peptide: 18.6 (0.9-7.1)ng/mL, with appropriate cortisol levels of 958 nmol/L. Sulphonylurea screen and pancreatic imaging was negative. Low insulin recovery was documented following PEG precipitation suggesting the presence of anti-insulin antibody. Elevated serum IAA levels at >20 (<2.4)U/mL with positive HLA-DRB1*04:06, confirmed the diagnosis of IAS. Multiple small, low carbohydrate and frequent meals were prescribed to prevent hypoglycemia and methimazole was discontinued as she had mild hyperthyroidism at this point (ft4 20.6 pmol/L, TSH <0.01mIU/L). Three days after discontinuation of methimazole, hypoglycemia completely resolved without need for dextrose infusion or corticosteroids. She received immediate 131-iodine therapy and developed hypothyroidism within two months, requiring levothyroxine replacement. She had not reported any hypoglycemia since and repeated IAA titre significantly diminished to 3.2 U/mL two months after discontinuation of methimazole. Conclusion: Methimazole-induced IAS is a rare cause of insulin mediated hypoglycemia, caused by cleaving of the disulphide bonds of insulin by the drug, leading to a cascade of autoimmune response in susceptible individuals. This is the first reported Malaysian case of methimazole- induced IAS. To date, this condition have almost always been reported in East- Asians in whom the DRB1*0406 genotype is relatively common. Unprovoked hypoglycaemia in a patient on anti-thyroid medications should prompt clinicians to consider methimazole-induced IAS. Presentation: 6/1/2024

Chicken meal is not an appropriate reference protein for estimating protein quality of ingredients used in extruded diets intended for dogs.

The indicator amino acid oxidation (IAAO) method has been used to determine metabolic availability (MA) of amino acids in feedstuffs for pigs, humans, and preliminarily for cats. Peas are a commonly used protein source in grain-free extruded dog diets. However, peas have a poor sulfur amino acid (AA) ratio (methionine [Met]:cysteine) with Met being the first limiting AA. Furthermore, little is known about the MA of Met in peas fed to dogs. Therefore, our objective was to compare the MA of Met in peas to chicken meal (CM), as a gold-standard reference protein. The study was done as a replicated 5 × 5 complete Latin square design. Ten neutered male mixed-breed dogs (1.5 years old; 26.0 kg ± 2.4kg body weight; BW) fed to maintain ideal BW received all dietary treatments: BAS: lamb-based diet (deboned lamb and lamb meal) providing Met at 50% of its requirement (0.27g/100g dry matter [DM]), CHK: CM and lamb-based diet, and PEA: ground dried pea and lamb-based diet both providing Met at 68% of its requirement (0.35 and 0.37g/100g DM, respectively). Two other treatments were created by blending BAS with PEA (BAP) and the BAS with CHK (BAC) to create diets with Met at 59% of requirement (0.32 and 0.31g/100g DM, respectively). This resulted in three graded levels of Met for both CM and peas to allow for a slope-ratio assay approach to quantify MA with the BAS diet as the common first point. All other AAs were provided to meet at least 120% of the AAFCO recommendations for adult dogs. The BAS diet, with supplemental DL-Met, was fed for a 2-wk wash-in period. After 2 d of diet adaptation IAAO was performed. Dogs were fed 13 small meals where meal 6 contained a priming dose (9.4mg/kg BW) of L-[1-13C]-phenylalanine (Phe; 99%) as well as a constant dose (2.4mg/kg BW) in meals 6-13. Breath samples were collected and enrichment of 13CO2 was measured using isotope-ratio mass spectrometry to calculate the rate of Phe oxidation (F13CO2 umol/kg BW/h). Oxidation was analyzed via SAS using PROC GLIMMIX with dog and period as random effects, and diet, %Met, and their interaction as fixed effects. Unexpectedly, the slope of Phe oxidation, in response to increasing Met intake, from CM was 31% of that of peas, indicating a lower MA for Met in CM as compared to peas. This finding may be due to damage of AAs during rendering. At this time, CM in extruded diets is not an acceptable reference protein to determine MA of AAs in dogs, and the MA of Met from peas cannot be confidently assessed.

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

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

Exokrinní pankreatická nedostatečnost – klinická praxe roku 2024

Summary Exocrine pancreatic insufficiency (EPI) is characterized by insufficient secretion of pancreatic digestive enzymes. According to the mechanistic theory, the lack of pancreatic enzymes in the small intestine does not ensure the digestion of food, which is mainly associated with the lack of essential fatty acids and liposoluble vitamins and, as a result, leads to the inability to ensure the nutritional and metabolic needs of the organism. In diagnostics, the standard is determination of fecal elastase. This determination is simple, the limitation is the low sensitivity to determine possible changes in pancreatic function already in the so-called initial stages of the dis ease. An alternative to fecal elastase testing is the use of breath tests using a mixture of triglycerides, radioactively labeled with carbon C13. Although the test is non-invasive, it is time-consuming and more difficult to access. The clinical symptoms of EPI are mainly those related to microbial digestion and subsequent malabsorption/maldigestion of micro- and macronutrients. In addition to the subjective feeling of bloating, borborygmy or osmotic diarrhea, low levels of liposoluble vitamins and some trace elements are frequent findings. Osteoporosis or sarcopenia belong to the picture of EPI. In EPI therapy, diet therapy and pancreatic enzyme replacement are essential approaches. The principle is to administer an adequate dose, especially of pancreatic lipase: 40,000–50,000 units with main meals, with application during meals. Smaller meals (snacks) are substituted with half the dose. The optimal galenic form is capsules with a protective cover, against the inactivation of enzymes by gastric acid, before they enter the duodenum. The galenic form is capsules containing enzymes in microparticles, 1.0–2.0 mm in size, which are released from the capsule upon entering the duodenum. This is the so-called controlled synchronization of the liberalization of the enzymes contained in the capsule. EPI is an underdiagnosed and undertreated condition in the population. The control of patients must therefore include, in addition to the evaluation of the overall clinical condition, the monitoring of changes that may manifest malabsorption. It is recommended to monitor the nutritional status at least once a year, at regular intervals. Keywords exocrine insufficiency, maldigestion, malabsorption, fecal elastase, osteoporosis, osteopenia, pancreatic replacement, microparticle capsules

Associations between child eating behaviors with eating patterns and diet quality in preschool-aged children

Childhood eating behaviors are associated with weight status and laboratory assessments of dietary intake. However, little is known about how eating behaviors relate to the eating patterns and diet quality of children from marginalized populations when assessed in their natural environments. Therefore, we examined the association of food avoidant (e.g., food fussiness and satiety responsiveness) and food approach (e.g., food responsiveness and enjoyment of food) eating behaviors with children's meal size, eating frequency, and diet quality. We analyzed data from 61 predominately low-income Hispanic/Latinx preschool-aged children. Caregivers completed the Childhood Eating Behavior Questionnaire and two 24-h dietary recalls. From the recalls, we calculated meal size, eating frequency, and modified Diet Quality Index Scores (DQIS), and evaluated associations with eating behaviors using multivariable linear models. We also explored the relationship between eating behaviors and DQIS components. Food-avoidant subscales were associated with smaller meals and satiety responsiveness were associated with decreased snack frequency. Food approach subscales were not associated with meal size or eating frequency. Both food-avoidant and food-approach behaviors were associated with components of diet quality and caloric beverages outside of meal and snacks. These findings can inform future research on the relationship between child eating behaviors and dietary intake so that we can develop more tailored and effective interventions to promote healthy eating habits for low-income, Hispanic/Latinx preschool-aged children.

Manipulation of feeding patterns in high fat diet fed rats improves microbiota composition dynamics, inflammation and gut-brain signaling

Chronic consumption of high fat (HF) diets has been shown to increase meal size and meal frequency in rodents, resulting in overeating. Reducing meal frequency and establishing periods of fasting, independently of caloric intake, may improve obesity-associated metabolic disorders. Additionally, diet-driven changes in microbiota composition have been shown to play a critical role in the development and maintenance of metabolic disorders. In this study, we used a pair-feeding paradigm to reduce meal frequency and snacking episodes while maintaining overall intake and body weight in HF fed rats. We hypothesized that manipulation of feeding patterns would improve microbiota composition and metabolic outcomes. Male Wistar rats were placed in three groups consuming either a HF, low fat diet (LF, matched for sugar), or pair-fed HF diet for 7 weeks (n = 11–12/group). Pair-fed animals received the same amount of food consumed by the HF fed group once daily before dark onset (HF-PF). Rats underwent oral glucose tolerance and gut peptide cholecystokinin sensitivity tests. Bacterial DNA was extracted from the feces collected during both dark and light cycles and sequenced via Illumina MiSeq sequencing of the 16S V4 region. Our pair-feeding paradigm reduced meal numbers, especially small meals in the inactive phase, without changing total caloric intake. This shift in feeding patterns reduced relative abundances of obesity-associated bacteria and maintained circadian fluctuations in microbial abundances. These changes were associated with improved gastrointestinal (GI) function, reduced inflammation, and improved glucose tolerance and gut to brain signaling. We concluded from these data that targeting snacking may help improve metabolic outcomes, independently of energy content of the diet and hyperphagia.

Effects of meal timing on human plasma metabolite rhythms

The term ‘chrono-nutrition’ describes the interaction between circadian timing and nutritional intake, as demonstrated by a wealth of animal and human studies(1). This relationship is bidirectional, with post-prandial response varying across the day and meal timing acting as a synchronising signal for some circadian rhythms. In humans, we have demonstrated that meal timing is a strong synchroniser of plasma glucose rhythms(2). Our recent data also suggest that interstitial glucose concentration can anticipate large meals(3). However, little is known about the effects of meal timing on other metabolic pathways. The existence of circadian rhythms in human plasma metabolites(4-6) provides a clear opportunity to address this timely issue. Here, in a controlled laboratory protocol, we tested the hypothesis that the anticipation of large meals is observed in human plasma metabolites.Twenty-four male participants undertook an 8-day laboratory study, with strict sleep-wake schedules, light-dark schedules, and food intake. For 6 days, participants consumed either hourly small meals throughout the waking period or two large daily meals (7.5 and 14.5 h after wake-up). Isocaloric meals were calculated using the Mifflin St Jeor formula, and contained 55% carbohydrate, 15% protein, 30% fat(2). All participants then undertook a 37-h constant routine. Samples were collected across a 30-h period in the middle of the constant routine. Plasma was collected every 30 minutes for targeted UPLC-MS/MS metabolomics analysis (Absolute p180 Biocrates kit), and saliva was collected hourly for assessment of melatonin onset, a marker of circadian timing. Data were statistically evaluated by cosinor analysis, unpaired t-test, and repeated measures ANOVA.There was no difference (p >0.05) in melatonin onset between the two groups. Rhythms, as indicated by significant (p < 0.05) cosinor fit, were detected in 64 plasma metabolites (out of 141 detected) in both groups. These metabolites included glucose, triglyceride, cholesterol, plus multiple amino acids, acylcarnitines, phospholipids and sphingolipids. Consistent with previous work, there was a large (c. 7-hour) difference in the phase of plasma glucose between groups, with no significant difference in the phase of plasma triglyceride. Some other metabolites (e.g. histidine and proline) exhibited phase changes like that of glucose, but the phase was mostly unchanged. Glucose, alanine, arginine, citrulline, glutamine, methionine, phenylalanine, met-SO, 3 acylcarnitines and 13 phospholipids exhibited a significant interaction (FDR <0.05 meal-size x time, n=25). Totalcholesterol, asparagine, glutamate, glycine, isoleucine, leucine, ornithine, proline, serine, threonine, tryptophan, tyrosine, kynurenine, SDMA, sarcosine, t4-OH-Pro, taurine, 6 acylcarnitines, 25 phospholipids and SMC18:1 exhibited a significant effect of meal-size and time. A further 8 metabolites had a significant effect of time only. Sixteen metabolites had no significant differences in neither meal size nor time. Our data therefore reveal novel effects of meal timing on multiple metabolite rhythms and average daily concentrations.

Effects of Dietary Factors on Gastroesophageal Reflux Disease (GERD) Among the Student and Faculty of Public and Private Medical Universities of Karachi, Pakistan

Aim: Gastroesophageal reflux disease (GERD) results from gastric contents moving into the esophagus, causing distressing symptoms and complications. Its prevalence has surged in the past two decades, notably in Asian countries. While nutritional management is common in clinical practice, definitive recommendations remain unclear. Few studies have explored the link between food and GERD. Methods: We conducted a descriptive cross-sectional study involving 359 eligible subjects out of 405 participants. We employed purposive sampling, targeting medical students, teachers, and staff aged 18 to 60 from four universities. Data were analyzed using SPSS version 26.0 with a confidence interval of 95% and a significance threshold of p < 0.05. Results: Among participants, 56.5% were female, with an average age of 24.55. Notably, 70.4% tested positive for GERD. Trigger foods included oily (24.2%) and spicy (45.4%) items, while 24.2% reported no specific triggers. Conclusion: This study underscores the significance of dietary modifications in managing GERD symptoms. Tailoring diets to individual symptoms and adjusting meal size, timing, and composition offer more benefits than elimination diets, particularly focusing on smaller meals and avoiding late-night eating habits. Keywords: Gastroesophageal reflux disease (GERD), reflux, esophageal disease, diet, nutrition, food intake, heartburn, fast-food.

Meal effects on gastric bioelectrical activity utilizing body surface gastric mapping in healthy subjects.

Gastric sensorimotor disorders are prevalent. While gastric emptying measurements are commonly used, they may not fully capture the underlying pathophysiology. Body surface gastric mapping (BSGM) recently emerged to assess gastric sensorimotor dysfunction. This study assessed varying meal size on BSGM responses to inform test use in a wider variety of contexts. Data from multiple healthy cohorts receiving BSGM were pooled, using four different test meals. A standard BSGM protocol was employed: 30-min fasting, 4-h post-prandial, using Gastric Alimetry® (Alimetry, New Zealand). Meals comprised: (i) nutrient drink + oatmeal bar (482 kcal; 'standard meal'); (ii) oatmeal bar alone; egg and toast meal, and pancake (all ~250 kcal). Gastric Alimetry metrics included BMI-adjusted Amplitude, Principal Gastric Frequency, Gastric Alimetry Rhythm Index (GA-RI) and Fed:Fasted Amplitude Ratio (ff-AR). 238 participants (59.2% female) were included. All meals significantly increased amplitude and frequency during the first postprandial hour (p < 0.05). There were no differences in postprandial frequency across meals (p > 0.05). The amplitude and GA-RI of the standard meal (n = 110) were significantly higher than the energy bar alone (n = 45) and egg meal (n = 65) (all p < 0.05). All BSGM metrics were comparable across the three smaller meals (p > 0.05). A higher symptom burden was found in the oatmeal bar group versus the standard meal and pancake meal (p = 0.01, 0.003, respectively). The consumption of lower calorie meals elicited different postprandial responses, when compared to the standard Gastric Alimetry meal. These data will guide interpretations of BSGM when applied with lower calorie meals.

PSIV-A-8 Effects of meal frequency on heart rate in horses

Abstract In humans, meal size has been shown to affect heart function with meal ingestion being associated with an increase in heart rate (HR) and cardiac output lasting significantly longer when larger meals are consumed. In horses, HR spikes at the sight of feed due to anticipation, but no studies have specifically evaluated the effect of meal frequency or size on HR. Heart rate has also been used as a measure both positive and negative stress. Domesticated horses are often meal fed, with small frequent meals requiring more labor than large infrequent meals. Fewer larger meals may have negative welfare implications for a grazing species. As part of a larger project investigating the effects of meal frequency on the behavior and metabolism of horses, the objective of this study was to evaluate equine HR in response to feeding frequencies commonly practiced in the field [once (1x), twice (2x), or thrice (3x) per day]. Feeding times were at 0800 (1x, 2x, and 3x), 1300 (3x), and 1800 (2x and 3x) h. The 12 adult clinically healthy horses [average ± SD; 14 ± 6 yr and 572 ± 32 kg body weight (BW)] were separated into two equal groups before completing a 14-d acclimation period to the diet during which they were fed 2x. The diet was provided at 2% BW on a dry matter (DM) basis (1.55% BW grass hay in a slow feed hay net plus 0.45% BW complementary fortified feed). During the study the same diet was fed but the meal frequency, and therefore meal size, differed between the treatments. The order of treatments, lasting 1 wk each, was decided at random for each group. On d 6 of each treatment HR was measured using individual H10 Polar HR monitors, which recorded every second from 0700 to 1900 h yielding 1,514,799 data points. During this time the aisleways housing the stalled horses were blocked off to minimize exposure to human presence other than at feeding time(s). After removing outliers, the mode was calculated for HR of each horse, which was considered to be the resting HR for that horse and ranged from 31 to 46 beats/min. The percentage of data above, below, or at the mode was calculated for each horse over the 12 h period and evaluated using Chi Square tests for statistical significance. The proportion of HR values above, below, or at the mode differed between treatments (P = 0.02). When fed 1x, 69 ± 14% of the HR readings were above the mode on average, as compared with 42 ± 18% and 44 ± 18% for 2x and 3x, respectively. These results suggest that the increase in HR was more than anticipatory and that there may be sustained stress when horses are fed at fewer frequency, such as once daily.

Sensory and physical-chemical analyzes of a gluten-free salt snack: development of a product based on oat flour enriched with chickpeas and carrots

Snacks are practical, quick-to-eat foods that are often included in snacks and small meals and have a major influence on the general population's diet. However, they are not recognized as healthy foods due to their low nutritional properties, excess fat, high calorie content and because they exclude people with celiac disease. This highlights the need to develop projects aimed at producing snacks with superior sensory and palatable characteristics. To meet this demand, a product was developed with the addition of chickpeas, carrots and oat flour, replacing the wheat flour commonly used in existing formulations. This was developed by making a vegetable paste and molding a dough compatible with the typical shapes of these foods. The results of the water activity, humidity and pH analyses showed levels very close to those of snacks sold on supermarket shelves, but the concentration of protein in the product was a major highlight (over 20%), demonstrating that a tasty, convenient product with a long shelf life can have high nutritional values. In the sensory analysis, the product stood out in terms of crunchiness, with the sum of the concepts “I loved it” and “I liked it” being 89.8%, and taste with 87.7%.

Quality of Life and Its Association With Time in Range Among People With Type 2 Diabetes Mellitus Following Different Dietary Interventions: A Crossover Clinical Trial.

Background Quality of Life (QoL) is an essential consideration in healthcare. Numerous studies have examined QoL in India; however, data on QoL following different dietary interventions are lacking. Similarly, the use of technology such as continuous glucose monitoring (CGM) for diabetes care has independently demonstrated improvements in glycemic control; however, its association with QoL remains limited. Purpose The purpose was to study the role of different dietary interventions on QoL and its association with Time in Range (TIR), Time Above Range (TAR), and Time Below Range (TBR) among the Type 2 Diabetes Mellitus (T2DM) population. Methodology A crossover interventional clinical trial (CTRI/2022/07/044356) was conducted among participants with T2DM of less than 5 years' duration, aged between 25 and 55 years, with an HbA1c level of less than 8%, and who were on Metformin only. Their QoL was assessed after following two diet patterns: the Continuous Calorie Restricted Diet (CCRD) - calorie reduction with small frequent meals, and Time Restricted Intermittent Fasting (TRIF) - calorie reduction with only two meals a day, using the Modified QoL (MDQOL-17) questionnaire. The association between post-dietary interventions QoL and TIR was studied using a 14-day CGM device. Results The overall QoL of 51 participants at the end of the dietary interventions was significantly better compared to their QoL before any dietary intervention (85.6±19.0% and 63.1±13.0%, respectively, p = 0.000). Decreased TIR correlated with increased role limitations due to physical functioning (p = 0.002) and decreased energy levels (p = 0.00). As TBR increased, role limitation due to emotional well-being increased, and energy levels decreased significantly (p = 0.01). As TAR increased, energy levels decreased (p = 0.01). A simple linear regression model was statistically significant for role limitations due to physical functioning (p = 0.003) and energy fatigue (p = 0.000), suggesting that higher TIR is associated with higher scores in these domains. Conclusion Dietary interventions that improve the TIR and reduce the TAR and TBR can enhance the QoL of individuals with T2DM.

IJCM_360A: Do Body Image Concerns Affect Our Adolescent girls? A Cross-sectional Study among female undergraduate medical students in Guntur medical college.

Background: People’s thoughts and feelings about their own bodies are related to their body image. Adolescents want to gain or lose weight in order to achieve the ideal physique in today’s culture due to the developing notion of ideal body image. Because there are currently few studies on body image, this research aims to fill in the gaps in our understanding of the still-developing field of body image perception. Objectives: 1. To find out the proportion of girls dissatisfied about body image. 2. To find the association of various factors with body image dissatisfaction and to ascertain the weight control behaviours adopted by adolescent medical under graduate students. Methodology: A cross-sectional study was done among 300 medical undergraduate college girls in Guntur medical college. A semi-structured questionnaire was used to collect data on various factors associated with body image dissatisfaction. Body mass index (BMI) of the participants was calculated. Results: Body image dissatisfaction was there among 65.3% of the girls. It was found that factors such as higher BMI, sociocultural pressure to be thin and depression were all significantly associated with body image dissatisfaction. The most commonly followed weight control behaviours were eating small meals and skipping meals. Improving the appearance and body shape were the main reasons for weight control behaviour. Conclusion: This study establishes the fact that body image dissatisfaction is no longer a western concept and affects Indian adolescent girls to a great extent. Hence, effective interventions have to be planned to increase awareness on ideal body weight and protect our young generation from pressures of negative body image.

Decreased Body Mass Index (BMI) in COVID-19 Patients with Anosmia Symptoms

Introduction: COVID-19 is a respiratory infection caused by the SARS-CoV-19 virus and impacts the appearance of anosmia symptoms. Anosmia impacts reducing appetite, so it impacts fulfilling the nutritional needs of COVID-19 patients. This study aims to determine the effect of anosmia on the nutritional status of COVID-19 patients.&#x0D; Methods: This study is an observational study with a retrospective cohort design. The samples of this study were 48 health record data of COVID-19 patients who experienced anosmia in Karangploso View Housing, Malang Regency, from July to December 2021, selected according to the inclusion and exclusion criteria. The independent variable in this study is the incidence of anosmia felt by residents. The dependent variable is residents' Body Mass Index (BMI) before and after recovering from COVID-19 infection. This study was conducted from July 15 to August 11, 2023. Research data analysis using the SPSS version 22 program using the paired T-test and Wilcoxon test with α = 5%.&#x0D; Results: The paired T-test results on the weight variable showed a significant difference in the patient's weight between before and after COVID-19 illness with symptoms of anosmia (p-value = 0.000). The results of the Wilcoxon Test on the BMI variable showed a significant difference in the nutritional status (BMI) of respondents between before and after COVID-19 illness with symptoms of anosmia (p-value = 0.000).&#x0D; Conclusion: The condition of anosmia alters a person's food preferences, resulting in the perception of certain foods as less pleasant, bland, and unappealing. This condition results in loss of appetite, inadequate nutrient intake, and potential malnutrition. Self-efforts to prevent malnutrition due to anosmia in COVID-19 patients: using aromatic herbs and spices, eating small and frequent meals, modifying food texture and color seasoning, and consulting a dietician to develop a balanced and nutrient-rich meal plan.

P-25 Unusual cause for spontaneous hypoglycemia: Hirata's Disease in Iraqi patient

Abstract Introduction Hirata's Disease, is a rare condition characterized by episodes of spontaneous hypoglycemia associated with hyperinsulinemia with positive insulin autoantibodies. Hypoglycemia is common in patients with diabetes mellitus especially those who are taking insulin therapy or insulin secretogogues oral medications but spontaneous hypoglycemia is rare and there is no clear figures about those patients in Iraq. We receive a lot of persons claim to have hypoglycemia but most of them fail to fulfill the Whipple triad. Although endogenous hyperinsulinemic hypoglycemia especially insulinoma is very rare condition, it is still concern for endocrinologist in patients presented with presumed hypoglycemia. Clinical Case A 43 year old female presented with frequent fainting attacks over several weeks. She has no past medical history a part of localized areas of vertigo for which she received no systematic treatment. Initial medical evaluation was unremarkable but with documented hypoglycemia below 40 mg/dl. She has normal heart, brain, kidney, liver, thyroid and adrenal function. She has multiple emergency admissions treatment with glucose infusion. She gains more weight as she eats more to avoid hypoglycemia. Her specific lab during the attack shows high serum insulin level (141.10 mIU/ml) with high C-peptide 18.55 ng/ml Work up for insulinoma shows normal MRI abdomen, normal endoscopic ultrasound and negative PET Gallium 68 scan. There are no previous reports of Insulin autoimmune syndrome in Iraq. The insulin autoantibodies in this patient were very high (more than 300.00 U/ml) which highly suggestive of this syndrome after excluding other factors that may cause elevation of these autoantibodies. Patient condition persist for about eight months and was advised for small multiple meals and diazoxide was not used much because it is not available in Iraq widely. Her condition resolved spontaneously after one year with dietary modifications. Conclusion Hirata syndrome is very rare but important cause of spontaneous hypoglycemia that should not be ignored. Up to our knowledge this is the first documented case in Iraq.

Effect of pre- and postpartum supplementation of a pure glycerol product to dairy cows on feeding behavior, lying behavior, and reticulorumen pH

The objective of this study was to quantify the effects of supplementing a low level of dry glycerol product pre- and postpartum on the feeding behavior, lying behavior, and reticulorumen pH of dairy cows. Multiparous Holstein dairy cows (n = 60) were enrolled in a 2 × 2 factorial design study. Twenty-one days before expected parturition, cows individually received a dry cow diet with (1) 250 g/d glycerol supplementation (GLY; 66% pure glycerol, United States Pharmacopeia grade), or (2) no supplementation (CON). Following parturition, cows were individually assigned to either (1) 250 g/d glycerol product (GLY; 66% pure glycerol), or (2) no supplementation (CON) to their partial mixed ration (PMR) for the first 21 d in milk (DIM). All cows were milked by an automated milking system and offered a target of 5.4 kg/d pellet (23% of target total dry matter intake [DMI]). For both treatment periods, cows were individually assigned to automated feed bins to measure PMR feeding behavior. Rumination time and lying behavior were monitored with electronic sensors for the whole study (-21 to 21 DIM). Reticulorumen pH boluses were administered to a subset of cows (n = 40) where pH was recorded every 10 min from 21 d prepartum to 21 d postpartum. Prepartum, cows fed GLY had fewer, larger meals and spent 20.2% more time feeding than CON while consuming feed at a similar rate. Cows on the CON diet prepartum spent more time lying down in more frequent bouts in the 21 d before calving. Following parturition, cows that received GLY prepartum continued to devote more time to eating, while tending to spend less time ruminating per kilogram of DMI. Cows receiving CON postpartum had larger meals with longer intervals between meals. In the first 21 DIM, cows receiving CON prepartum tended to have shorter, but significantly more frequent, lying bouts than cows fed GLY prepartum. Glycerol supplementation pre- and postpartum resulted in less time spent lying down following parturition. Minimal differences between treatments were observed for pre- and postpartum sorting behavior or reticulorumen pH. Overall, supplementation of glycerol pre- and postpartum altered cow time budgets, with cows spending more time eating pre- and postpartum, less time lying pre- and postpartum, and having fewer, larger meals prepartum when receiving glycerol prepartum, and with cows having slower feeding rates and smaller meals following parturition with postpartum glycerol supplementation.

THU390 Case Report On Hirata Syndrome: A Rare Cause Of Hypoglycemia

Abstract Disclosure: M. Pranala: None. V. Kuttiyil Oommen: None. V. Sanker: None. S. Vallabhaneni: None. K. Ajith: None. A. Thomas: None. Introduction: Hirata's disease, also known as insulin autoimmune syndrome (IAS), is a rare cause of hypoglycemia that is characterized by episodes of spontaneous hypoglycemia and insulin autoantibodies in patients who have not received exogenous insulin. IAS has been associated with rheumatoid arthritis and Graves' disease in 96% of Japanese IAS patients, and it has also been associated with other autoimmune disorders like Graves' disease. Case History: We report a case of 73-year-old male presented with the complaints of episodes of profuse sweating, palpitation and numbness over his head. Patient was initially treated symptomatically and since the symptoms were not resolving further evaluation was done. Two hourly GRBS, c- peptide, insulin levels and serum cortisol of our patient was monitored. Patient had extremely high serum insulin levels. Serum insulin antibodies level was also high (&amp;gt;300 U/ml). CT abdomen ruled out pancreatic pathology. It has been speculated that hypoglycemia occurring in IAS is due to dissociation of insulin from its antibodies in the post absorptive state. Our patient was diagnosed with IAS based on the criteria of Hirata. The age at onset, sex, and duration of hypoglycemic attacks, outcome or treatment, medication taken prior to the onset of IAS and background disease were all taken into consideration. In our patient, hypoglycemia occurred spontaneously in the post-absorptive state 4–6 hours after meal rather than after a 72-hour fast test. Extremely high levels of insulin (&amp;gt;200 µIU/mL) and Serum insulin antibodies found to be &amp;gt;30 U/ml were constructive in the diagnosis of IAS. The patient improved on dietary management alone consisting of frequent small meals. Conclusion: In order to facilitate early recognition and prevent unnecessary investigations, this could be the most significant syndrome in the differential diagnosis of endogenous hyper-insulinemic hypoglycemia (EHH). In such patients with a high index of suspicion, insulin autoantibodies should be examined. IAA prevents insulin to bind its receptor in the postprandial phase, possibly resulting in mild hyperglycemia; thereafter, insulin is released from the complexes irrespective of blood glucose concentrations, thus inducing hypoglycemia Presentation: Thursday, June 15, 2023

THU276 The Use of Continuous Glucose Monitors for Management of Postbariatric Hypoglycemia

Abstract Disclosure: S. Jani: None. S. Bao: None. Postprandial hypoglycemia is a known complication of bariatric surgery. Mixed meal tolerance test performed in these patients often revealed hypoglycemia 1-3 hours after meals. Recent clinical studies using continuous glucose monitors (CGM) have shown the incidence of postbariatric hypoglycemia is much higher than previously identified. In addition to diet modification and medication treatment, CGM has become a more popular and useful tool in managing severe cases. We present a case of using CGM to manage postbariatric hypoglycemia. A 47 year old female with prior history of class 3 obesity treated with sleeve gastrectomy presented with hypoglycemia 2.5 years after her bariatric surgery. She complained of headache, anxiety, dizziness, and fatigue during a routine clinic visit, two hours after consuming a carbohydrate rich meal with simple sugars. Blood glucose was obtained and revealed severe hypoglycemia (glucose 38 mg/dL). This prompted an urgent referral to endocrinology. Review of glucose trends revealed multiple instances of postprandial hypoglycemia. Further labs suggested a low likelihood for insulinoma with no fasting hypoglycemia and HA1C normal at 5.3%. Postprandial hyperinsulinemic hypoglycemia was suspected clinically. Dietary modification with multiple small meals consisting of high protein, fiber and complex carbohydrates was recommended. Additionally, she was started on Libre 2 CGM for monitoring and prevention of severe hypoglycemia. Review of her CGM data during follow up visit demonstrated very low incidence of hypoglycemia and absence of severe hypoglycemia. Over time with continued use of her CGM and low incidence of hypoglycemia, she did not require medical therapy. Postprandial hypoglycemia after bariatric surgery can be severe and lead to disabling neuroglycopenic symptoms. With increased utilization of bariatric surgery, these postoperative complications will likely become more prevalent. In a Swedish nationwide study, the prevalence of postbariatric hypoglycemia was close to 0.2% in a cohort of 5040 patients. However, a more recent prospective study with a two-year observation of 333 patients after bariatric surgery using 2-hour glucose tolerance test revealed much higher prevalence of severe postprandial hypoglycemia (25.6%). Hypoglycemia was highest after gastric bypass surgery (32.6%), followed by sleeve gastrectomy (22.6%). Currently, there is no official guideline on utilization of CGM in management of hypoglycemia in nondiabetic patients. This case highlights the role of CGM in managing postbariatric hypoglycemia. CGM provides continuous glucose data, trends and alerts that can be a critical tool for patients to monitor, anticipate and prevent hypoglycemic events. Additionally, the real time data provided by CGM’s can help clinicians identify high risk patients who may benefit from the addition of medications to treat hypoglycemia. Presentation: Thursday, June 15, 2023

SAT163 Title: Adult-onset Hyperinsulinemic Hypoglycemia Due To An Activating Mutation In Glucokinase

Abstract Disclosure: S. Vaid: None. R. Ghosh: None. H. Elenius: None. C. Cochran: None. R. Chang: None. N. Nilubol: None. R. Muniyappa: None. Introduction: Glucokinase (GK), the key β-cell glucose sensor, determines the threshold for glucose-stimulated insulin secretion. Activating mutations of GK are infrequent causes (prevalence of 1.2%) of congenital hyperinsulinemic hypoglycemia (HH). Adult-onset of severe hypoglycemia due to GK-HH is extremely rare. Clinical Case: A 26-year-old well-nourished female (BMI, 27 kg/m2) with a recent history of dizziness, tremulousness, fatigue, sweating, and hunger, associated with weight gain presented for further workup. Hypoglycemia was noted, and Whipple's triad was confirmed. She had no family history of endocrine disease or hypoglycemia. Supervised fasting promptly produced symptomatic hypoglycemia with hyperinsulinemia. Laboratory studies revealed a low glucose level at 44 mg/dL; a plasma insulin level at 93 μIU/mL (&amp;lt;3 μIU/ml); a C-peptide level at 8.1 ng/mL (&amp;lt;0.6 ng/mL); pro-insulin at 266 pmol/L (&amp;lt;5 pmol/L); and beta-hydroxybutyrate &amp;lt;2.7 mmol/L. IGF2/IGF-1 ratio was 3.1 (&amp;lt;10) and renal and liver function was normal. Interestingly, a mixed meal also provoked significant hypoglycemia within an hour of consumption of a meal. Urine for sulfonylurea screen was negative, and so were anti-insulin antibodies. Imaging of the pancreas with computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound revealed a 1.2x0.8cm nodule on the superior margin of the body of the pancreas. 68Ga-DOTATATE​​ PET/CT (targeting somatostatin receptors) showed mild uptake coinciding with the nodule on the CT scan. Arteriography with calcium stimulation and venous sampling (ASVS) was non-localizing. The patient subsequently underwent laparoscopic exploration with intraoperative ultrasound (IOUS) of the pancreas followed by the enucleation of the pancreatic nodule. Histopathology of the nodule revealed a normal pancreatic tissue with no evidence of a neuroendocrine tumor. Change to multiple small meals, addition of cornstarch to diet, continuous blood glucose monitoring (CGM), diazoxide (70 mg oral, three times a day), and monthly octreotide LAR (30 mg) has allowed the patient to avoid hypoglycemia. Genetic testing by analysis of the genes known to cause hypoglycemia revealed a heterozygous GCK variant [c.1367C&amp;gt;T (p.Ala456Val), which was predicted to be a pathological mutation. This mutation is known to increase affinity for glucose, which leads to exaggerated insulin secretion. Conclusion: Our study highlights that in adults with non-insulinoma pancreatogenous hypoglycemia, genetic causes of HH should be considered in the differential diagnosis. Presentation: Saturday, June 17, 2023