Standard Meal Research Articles

Intramyocellular lipid use is altered with exercise in males with childhood-onset obesity despite no differences in substrate oxidation.

Compared to adulthood-onset obesity (AO), those with childhood-onset obesity (CO) are at greater risk of metabolic disease. However, the differences between these two obesity phenotypes are not clear. The aim of this study is to investigate how the age of obesity onset (CO vs. AO) affects the use of intramyocellular (IMCL) and extramyocellular (EMCL) lipids in response to exercise. Males with CO (n = 5) and AO (n = 5) were recruited. At the first study visit, body composition was measured via dual-energy x-ray absorptiometry (DEXA). Energy expenditure and substrate oxidation were measured via indirect calorimetry. Participants were provided with standardized meals for 3 days prior to the exercise study visit. At the exercise study visit, IMCL and EMCL were measured via magnetic resonance spectroscopy (MRS) before and after 90-minutes of moderate intensity cycling with indirect calorimetry. Substrate oxidation at rest and during exercise was not different between groups. Post-exercise, a decrease in IMCL was observed in the AO group that was not demonstrated in the CO group. There were no changes in EMCL post-exercise in either group. This was the first study to compare the effects of exercise on IMCL and EMCL use in males with CO and AO. The decreases in IMCL of the AO group is similar with those observed in the literature in lean individuals. We made the novel observation that with moderate intensity cycling, males with CO do not appear to use IMCL as effectively as those with AO, suggesting perturbations in IMCL metabolism.

Effect of Food Intake or Coadministration With an Acid-Reducing Agent on Lenacapavir Pharmacokinetics Following Oral Administration.

Lenacapavir is a potent, long-acting HIV-1 capsid inhibitor used in combination with other antiretrovirals to treat HIV-1 infection. The pharmacokinetics of orally administered drugs may be affected by food intake or coadministration of acid-reducing agents (ARA). Two Phase 1 studies were conducted on healthy participants to evaluate the effect of food and the impact of the histamine H2-receptor antagonist famotidine in parallel cohorts. In Study 1, oral lenacapavir (300mg) was administered under fasting conditions, after a standardized high-fat meal, and after a low-fat meal (n=8/cohort). In Study 2, lenacapavir 300mg was administered alone (n=27) and 2 hours after famotidine (40mg; n=25), each under fasting conditions. For the high-fat meal versus fasted comparison, the percentage geometric least-squares mean (%GLSM) ratios for the lenacapavir area under the curve to infinity (AUCinf) and maximum concentration (Cmax) were 115.2 and 145.2, respectively. For the low-fat meal, the %GLSM ratios for lenacapavir AUCinfand Cmax were 98.6 and 115.8, respectively, versus the fasted state. In the famotidine study, the %GLSM ratio for lenacapavir AUC from time zero to the last quantifiable concentration was 137.4, and for Cmax was 100.6. Based on available clinical safety data, the exposure increases observed in these studies were not expected to be clinically relevant. Overall, these data support the dosing of oral lenacapavir without regard to food intake or coadministration with ARAs.

Use of Machine Learning to Predict Individual Postprandial Glycemic Responses to Food Among Individuals With Type 2 Diabetes in India: Protocol for a Prospective Cohort Study.

Type 2 diabetes (T2D) is a leading cause of premature morbidity and mortality globally and affects more than 100 million people in the world's most populous country, India. Nutrition is a critical and evidence-based component of effective blood glucose control and most dietary advice emphasizes carbohydrate and calorie reduction. Emerging global evidence demonstrates marked interindividual differences in postprandial glucose response (PPGR) although no such data exists in India and previous studies have primarily evaluated PPGR variation in individuals without diabetes. This prospective cohort study seeks to characterize the PPGR variability among individuals with diabetes living in India and to identify factors associated with these differences. Adults with T2D and a hemoglobin A1c of ≥7 are being enrolled from 14 sites around India. Participants wear a continuous glucose monitor, eat a series of standardized meals, and record all free-living foods, activities, and medication use for a 14-day period. The study's primary outcome is PPGR, calculated as the incremental area under the curve 2 hours after each logged meal. Data collection commenced in May 2022, and the results will be ready for publication by September 2025. Results from our study will generate data to facilitate the creation of machine learning models to predict individual PPGR responses and to facilitate the prescription of personalized diets for individuals with T2D. This study will provide the first large scale examination variability in blood glucose responses to food in India and will be among the first to estimate PPGR variability for individuals with T2D in any jurisdiction. Clinical Trials Registry-India CTRI/2022/02/040619; https://tinyurl.com/mrywf6bf. DERR1-10.2196/59308.

Assessment of Fasting Metabolism With Microdialysis Indicates Earlier Lipolysis in Children With VLCADD Than MCADD.

To investigate fasting metabolism in children with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) and medium-chain acyl-CoA dehydrogenase deficiency (MCADD) using microdialysis technique. Twelve patients (7 with VLCADD, 5 with MCADD, mean age 4.9 years, 10/12 diagnosed via newborn screening) were recruited for investigation in connection to clinical fasting examinations at the Karolinska University Hospital (between 2015 and 2024). Patients were subjected to a 9-h night fast after a standard late evening meal. Analysis of glucose, glycerol, lactate, and pyruvate was conducted by continuous microdialysis. Fasting hormones and acylcarnitines were analysed in blood samples at 1-h intervals in patients with VLCADD. Children with VLCADD showed signs of lipolysis after a median fasting time of 4.5 h, whereas patients with MCADD showed no significant increase in lipolysis during the fast. A shorter time to initiation of lipolysis tended to correlate with a lower residual enzyme activity in patients with VLCADD. All patients maintained euglycemia during fasting. Children with VLCADD had a shorter time to initiation of lipolysis during fasting than children with MCADD. Clinical evaluation of fasting metabolism in beta-oxidation disorders should include assessment of lipolysis as an early and important determinant.

Prediabetes risk classification algorithm via carotid bodies and K-means clustering technique

Diabetes is a disease that affects millions of people in the world and its early screening prevents serious health problems, also providing relief in the demand for healthcare services. In the search for methods to support early diagnosis, this article introduces a novel prediabetes risk classification algorithm (PRCA) for type-2 diabetes mellitus (T2DM), utilizing the chemosensitivity of carotid bodies (CB) and K-means clustering technique from the field of machine learning. Heart rate (HR) and respiratory rate (RR) data from eight volunteers with prediabetes and 25 without prediabetes were analyzed. Data were collected in basal conditions and after stimulation of the CBs by inhalation of 100% of oxygen and after ingestion of a standardized meal. During the analysis, a greater variability of groups was observed in people with prediabetes compared to the control group, particularly after inhalation of oxygen. The algorithm developed from these results showed an accuracy of 86% in classifying for prediabetes. This approach, centered on CB chemosensitivity deregulation in early disease stages, offers a nuanced detection method beyond conventional techniques. Moreover, the adaptable algorithm and clustering methodology hold promise as risk classifications for other diseases. Future endeavors aim to validate the algorithm through longitudinal studies tracking disease development among volunteers and expand the study’s scope to include a larger participant pool.

Associations Between TCF7L2, PPARγ, and KCNJ11 Genotypes and Insulin Response to an Oral Glucose Tolerance Test: A Systematic Review.

Insulin responses to standardized meals differ between individuals. This variability may in part be explained by genotype. This systematic review evaluates associations between genotype and insulin response to an oral glucose tolerance test (OGTT) in terms of insulin area under the curve (AUC). Three electronic databases (Web of Science, Embase, PubMed) were searched for studies investigating associations between insulin AUC after an OGTT and single nucleotide polymorphisms (SNPs) belonging to the transcription factor 7 like 2 (TCF7L2) gene, the peroxisome proliferator-activated receptor gamma (PPARγ) gene, or the potassium inwardly rectifying channel subfamily J member 11 (KCNJ11) gene in persons without diabetes. A total of 5199 articles were identified, of which 38 were included. Among them were family-based studies (9), twin studies (2), and studies with unrelated participants (27). Seventeen articles investigated TCF7L2 (7 SNPs), 14 investigated PPARγ (1 SNP), and 8 investigated KCNJ11 (5 SNPs). For all investigated SNPs, at least half of the reports indicated no statistically significant association with postprandial insulin AUC. No evidence was found for associations between TCF7L2, PPARγ, and KCNJ11 genotypes and insulin AUC after an OGTT. Future studies should investigate the effect of genetic risk scores on postprandial insulin.

Total Fat and Fatty Acid Content in Meals Served by Independent Takeaway Outlets Participating in the Healthier Catering Commitment Initiative in London, UK.

Out-of-home meals are characterized by poor nutritional quality, and their intake has been linked to adverse health outcomes. Therefore, national and local government initiatives have been implemented in the UK to promote healthier out-of-home meals. However, there is limited evidence of their effectiveness. This study evaluated the fat content and fatty acid profile of takeaway meals from 'standard' and from Healthier Catering Commitment (HCC)-approved takeaway outlets. Meals from 14 'standard' and 13 'HCC-awarded' takeaways (74 meals and 26 side dishes) were analyzed for total fat and fatty acid composition. No statistically significant differences in total fat, saturated, and trans fatty acids per 100 g and per portion between HCC and standard meals were observed, except for donner kebabs. Over 70% of all meals contained more than the recommended 30% of daily fat intake from a single meal. Some meals could provide more than 50% of the recommended total fat and SFAs intake. Despite businesses participating in the healthier out-of-home meal initiative, there has not been a significant improvement in the nutritional quality of the meals they offer. Further research to develop effective approaches to support independent takeaway businesses in offering meals with improved nutritional quality is warranted.

Exploring associations between the FTO rs9939609 genotype and plasma concentrations of appetite-related hormones in adults with obesity.

Associations between variants in the FTO locus and plasma concentrations of appetite related hormones are inconsistent, and might not work in a dose dependent fashion in people with obesity. Moreover, it is relevant to report meal related plasma concentrations of these hormones in persons with obesity given the growing interest in their pharmacological potential in obesity therapy. We find it clinically relevant to examine associations between the SNP rs9939609 genotypes and homeostatic appetite regulation in individuals with BMI ≥35 kg/m2. This study explored associations of the rs9939609 genotypes to plasma concentrations of acylated ghrelin, active glucagon-like peptide 1 (GLP-1), and total peptide YY (PYY), and moderating effects of fat mass (FM), in 96 adults (69% female) with BMI ≥35 kg/m2, using a cross sectional observation study designed to have 1/3 of participants each with genotypes TT, AT and AA, respectively. Participants were median (25th, 75th percentile) 42.5 (32, 50) years of age, weighed 120.9 (109.6, 142.4) kg, and had a BMI of 42.8 (39.5, 46.4) kg/m2. Acylated ghrelin, active GLP-1, and total PYY were measured in the fasted state and half-hourly for 2.5h after a standardized meal. We evaluated associations between genotype and appetite hormones in regression analysis controlling for FM and sex. Genotype did not associate with fasting or postprandial (area under curve, AUC) GLP-1 or PYY. Genotype did not associate with fasting acylated ghrelin, but in females with genotype AA, increased FM was associated with higher fasting and postprandial (AUC) acylated ghrelin concentrations relative to genotypes TT (fasting p = 0.025; AUC p = 0.004) and AT (fasting p = 0.002; AUC p < 0.001). This novel finding warrants further investigation.

Food order affects blood glucose and insulin levels in women with gestational diabetes.

Gestational diabetes mellitus (GDM) poses significant risks to both maternal and fetal health, including a heightened risk of developing type 2 diabetes (T2DM) in the future. Effective management often involves dietary changes, such as food-order, where vegetables are consumed first, followed by proteins, and then carbohydrates last. This study investigates whether food sequence improves glycemic control in women with GDM by slowing carbohydrate absorption, reducing glucose spikes, and enhancing insulin sensitivity. Twenty-five women with GDM participated in a four-week trial with three phases: baseline measurement (week 0), phase 1 (regular diet), and phase 2 (food-order) intervention. Primary outcomes were blood glucose and serum insulin levels, measured at fasting, 1-h, and 2-h postprandial intervals during each phase. In phase 1 (weeks 0-2), participants followed their usual diet. In phase 2 (weeks 2-4), the same participants followed a food-order regimen: vegetables first, then proteins, and carbohydrates last. Customized meal plans for vegetarians and non-vegetarians were provided. Participants were monitored via a mobile application (Jotform) for adherence. Follow-up blood glucose and insulin were measured before, and 60 and 120 min after, consuming a standardized meal (339 kcal, 16.4 g protein, 56.1 g carbohydrates, 3.4 g fat) in the clinic. The food-order intervention resulted in a significant reduction in postprandial blood glucose by 5.87% (p = 0.001) at 60 min and 6.06% (p = 0.001) at 120 min. Also, Serum insulin levels decreased by 8.13% (p = 0.001) at 60 min and 11.10% (p = 0.001) at 120 min, compared to the regular diet. These results suggest improved metabolic control and insulin sensitivity. Prioritizing vegetables before protein and carbohydrates improves glycemic control and insulin sensitivity in women with GDM. This simple strategy helps regulate blood glucose and may reduce the long-term risk of T2DM. It offers a practical approach to managing GDM, but further research with larger cohorts and longer interventions is needed to assess its long-term effects. https://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=81473.12293, identifier CTRI/2024/01/061220.

Enhancing Type 1 Diabetes Immunological Risk Prediction with Continuous Glucose Monitoring and Genetic Profiling.

Background: Early identification of individuals at high risk for type 1 diabetes (T1D) is essential for timely intervention. Islet autoantibodies (AB) and continuous glucose monitoring (CGM) reveal early signs of glycemic dysregulation, while T1D genetic risk scores (GRS) further improve disease prediction. We use CGM data and T1D GRS to develop an AB classifier (1 AB vs. ≥2 AB) and predict early T1D risk. Methods: Thirty-nine AB-positive (18 with 1 and 21 with ≥2 AB) healthy relatives of T1D (mean age 22.1 ± 11.1 years, HbA1c 5.3 ± 0.3%, body mass index 24.1 ± 5.8 kg/m2) were enrolled in a National Institutes of Health's (NIH) TrialNet ancillary study. Participants wore CGMs for a week and consumed three standardized liquid mixed meals (SLMM). Post-SLMM CGM glycemic features and T1D GRS were used in a linear support vector machine (SVM) model with recursive feature elimination (RFE) for AB classification, evaluated via fivefold cross-validation using the receiver operating characteristic and precision-recall area under the curve (AUC-ROC/PR). Results: Significant differences between the AB groups were observed in the post-SLMM percent time of glucose >180 mg/dL and GRS (P = 0.020 and P = 0.001, respectively). An SVM model with two RFE-selected features (T1D GRS and incremental AUC) achieved the best performance, classifying 1 versus ≥2 AB individuals with an AUC-ROC of 0.93 (95% confidence interval [CI]: 0.83-1.00) and AUC-PR of 0.89 (95% CI: 0.71-0.99), compared with AUC-ROC of 0.80 (95% CI: 0.46-1.00) and AUC-PR of 0.82 (95% CI: 0.71-0.93) using all features. Conclusions: A machine learning approach combining a 1-week CGM home test and T1D GRS reliably assesses T1D immunological risk, enabling early intervention.

Beyond the Standard Meal: An Observational Analysis of Meals Used in Nuclear Medicine Gastric Emptying Studies.

Standardized guidelines for meals used in adult gastric emptying studies (GES) have been available since 2009; however, there is still great variability in the diets that are clinically used in these studies. The purpose of this retrospective study is to perform an observational analysis of GES meals that are used within a national radiology practice to assess for compliance. It is hypothesized that despite having well-validated standardized meal protocols, there remains great variability in its use and interpretation. This retrospective observational analysis included 11,458 GESs and their associated reports. GES meals were divided into 5 categories including solid, liquid, dual liquid and solid, alternative meals, and other. Further analysis was performed on the solid and liquid meal GESs. The total amount of studies performed with each meal was collected as well as the percentages of the results of each study categorized as normal, delayed, rapid, and limited. A total of 10,602 studies were included in the analysis, which included 9974 solid meals and 628 liquid meals. Of the solid meal type, the standard recommended meal was used most often followed by the protein variant meal. The oatmeal protocol had the least number of delayed results; however, there was otherwise a similar distribution of results for the remaining solid meal variants. The most common liquid meal utilized the nutritional drink or protein shake, and compared with the solid meal types, there were less rapid or limited results. Variability remains in clinical practice regarding the type of meal that is used in GESs as well as in the interpretation of the study. Continued reinforcement of the standardized solid meal diet and validated cutoff values for interpretation remains crucial until there is increased validation and standardization of other diets.

Circulating and hepatic levels of growth differentiation factor 15 in patients with metabolic dysfunction‐associated steatotic liver disease

AbstractAimIncreased growth differentiation factor 15 (GDF15) may reflect impaired metabolic health and an inflammatory state in metabolic dysfunction‐associated steatotic liver disease (MASLD). We investigated the role of GDF15 in histologically verified MASLD in a meal test (discovery) cohort (n = 20) and a prospective (validation) cohort with 2 years of follow‐up (n = 276).MethodsParticipants were evaluated clinically and histologically in both cohorts. Fibrosis severity was classified as no/mild (F0/F1) or significant (F2–4). Plasma GDF15 was measured by enzyme‐linked immunosorbent assays and the SOMAScan platform. Hepatic GDF15 mRNA expression was analyzed by RNA in situ hybridization and bulk RNA‐sequencing. In addition, we used data from public single‐nucleus RNA‐sequencing datasets.ResultsIn both cohorts, plasma GDF15 was increased in MASLD compared with healthy controls (p &lt; 0.0001) with the highest levels in patients with significant fibrosis (area under the curve 0.83; 95% confidence interval [CI], 0.76–0.91). The GDF15 levels were unaffected by a standardized meal and there was no difference in peripheral or hepatic venous concentrations. After 2 years, the increase in GDF15 levels was reduced in patients treated with glucagon‐like peptide receptor agonists (GLP‐1‐RA) compared to patients receiving lifestyle advice (−28%; 95% CI, −44 to −8; p = 0.01). Plasma GDF15 was associated with circulating insulin‐like growth factor 1 and related proteins. Hepatic GDF15 mRNA was mainly expressed in hepatocytes and in cholangiocytes in fibrotic areas and was increased in MASLD (p = 0.02) with the highest expression in the group with steatohepatitis (p = 0.009).ConclusionsIncreased hepatic and circulating GDF15 are found in MASLD. Treatment with GLP‐1‐RA may reduce GDF15, possibly reflecting beneficial metabolic and inflammatory effects.

Stronger association between morning serum cortisol level and diurnal time in range in type 2 diabetes?

BackgroundThe hypothalamic-pituitary-adrenal axis is thought to play a vital role in glucose homeostasis and diabetes. This study investigated the association between morning serum cortisol and time in range (TIR), including daytime TIR, in type 2 diabetes (T2DM).Methods310 patients with T2DM had serum cortisol measured at 8 a.m. All participants underwent continuous glucose monitoring (CGM) for three consecutive days, then TIR and glycemic variability (GV) parameters were evaluated. Using 100 g standard steamed bread meal test, blood glucose, C peptide and insulin at different points were collected to assess insulin sensitivity and islet function.ResultsPatients with higher serum cortisol exhibited lower TIR and TITR (P < 0.001). Spearman correlation analysis showed that the negative correlation between cortisol and daytime TIR (r=-0.231, P < 0.001) was stronger than that of overnight TIR (r=-0.134, P = 0.028). Similarly, there existed a negative correlation between cortisol and pancreatic function indicators such as HOMA-β, insulinogenic index (IGI), area under the curve of C-peptide within half an hour (AUCCp0.5 h) and three hours (AUCCp3h) (r=-0.248, -0.176, -0.140, -0.185, respectively, P < 0.05). In contrast, cortisol was positively associated with TAR (r = 0.217, P < 0.001) and GV parameters including MBG, MAGE, LAGE, HBGI, MODD, ADDR (P of MAGE and MODD > 0.05). Multiple stepwise regression revealed that cortisol was an independent contributor of TIR, TITR and diurnal TIR, with diurnal TIR of stronger relevance.ConclusionsMorning serum cortisol is negatively correlated with TIR, especially diurnal TIR and positively associated with GV parameters. Inappropriate cortisol secretion may have an adverse influence on glucose homeostasis in T2DM.

Effect of Dietary Cold-Pressed Hempseed Cake Supplemented with Tomato Waste on Laying Hen Performance and Egg Yolk Lipid Profile and Antioxidant Status Before and After Storage.

A ten-week study was conducted to investigate the effects of the dietary inclusion of HSC as a source of PUFAs together with a natural source of antioxidants such as DT or DTP on the performance of laying hens and egg quality, as well as the lipid profile, antioxidant content and oxidative stability of egg yolk before and after storage. A total of 96 laying hens (aged between 28 and 37 weeks) were divided into three groups of 32 birds each (eight replicate cages, four birds per cage) and were assigned randomly the following dietary treatments: a standard corn-soybean meal diet (C), a diet containing 20% hempseed cake and 4% dried whole tomato (HT) and a diet containing 20% hempseed cake and 4% dried tomato pomace (HTP). The incorporation of HSC and tomato waste (DT and DTP) into the diet of hens caused increases in feed intake (p < 0.05) and yolk color score without changing egg production, egg weight or feed conversion ratio (FCR). The HT and HTP diets ensured a lower content (p < 0.05) of cholesterol in the egg yolk but a higher content (p < 0.001) of n-3 FAs, especially of ALA (α-linolenic acid, 18:3n-3), EPA (eicosapentaenoic acid, 20:5n-3) and DHA (docosahexaenoic acid, 22:6n-3), which allowed for an increase in the hypo-/hypercholesterolemic FA ratio and a reduction in the n-6/n-3 FA ratio and TI (thrombogenicity index) value compared to those of C eggs. In addition, the inclusion of DT or DTP in the diet of laying hens increased the antioxidant content in the yolk, which led to an increase in the oxidative stability of the yolk lipids, evidenced by a decrease in the concentrations of MDA (malondialdehyde) in fresh eggs and those stored for 30 days at 4 °C. DTP exerted the most desirable effects because the egg yolk had the most intense color, the highest contents of n-3 FAs and natural antioxidants and the best oxidative stability of yolk lipids before and after egg storage. It was concluded that the simultaneous enrichment of the diet of laying hens with n-3 FAs and natural antioxidants (carotenoids, tocopherols and phenols), in addition to improving the color of the yolk, leads to eggs with a higher content of n-3 FAs and antioxidants, improved antioxidant activity and better PUFA stability during egg storage.

Secretin infusion decreases food intake in healthy men-a randomized, placebo-controlled, double-blind, crossover study.

The hormone secretin, best known for regulating pH in the duodenum, has anorectic properties in mice proposedly mediated via secretin-induced brown adipose tissue (BAT) activation. We investigated the effects of exogenous secretin on ad libitum food intake, BAT activity, and postprandial physiology in healthy male volunteers. In a randomized, placebo-controlled, double-blind, crossover study, 25 healthy men underwent two 5-h i.v. infusions of secretin (1 pmol/kg/min) and placebo (saline), respectively, with an interposed 2-month wash-out period. After 30 min of infusion, a standardized liquid-mixed meal was ingested, and after 5 h, food intake and meal duration were assessed during an ad libitum meal test. Brown adipose tissue activity was assessed regularly by thermal imaging-measured supraclavicular skin temperature. Compared with placebo, secretin significantly decreased ad libitum food intake by 173 ± 88 kcal (95% CI, 0.76-0.99, P = .039) but did not alter ad libitum meal duration. Secretin acutely decreased BAT activity but increased it postprandially compared with placebo. Acetaminophen-assessed gastric emptying was not affected by exogenous secretin, but secretin increased gallbladder volume, bile acid synthesis, and circulating levels of lipase, amylase, and triglycerides, while decreasing plasma Na+. Compared with placebo, secretin infusion was associated with 24.0 ± 10.8% (95% CI, 0.3-1, P = .025) more adverse events (headache, nausea, diarrhea, and vomiting). In healthy men, secretin infusion decreased ad libitum food intake concomitantly with a postprandial increase in BAT activity as assessed by thermal imaging-measured supraclavicular skin temperature. Clinicaltrials.gov, NCT04613700.

Effects of Tegoprazan, Potassium-Competitive Acid Blocker, on the Gastric Emptying and Postprandial Symptoms in Healthy Humans.

Proton pump inhibitors are potent gastric acid inhibitors. However, they may worsen symptoms such as postprandial fullness and early satiation by reducing gastric emptying (GE). This study aims to evaluate the effects of tegoprazan, a new potassium-competitive acid blocker, on GE and dyspeptic symptoms. A randomized, double-blind, placebo-controlled design was adopted for this study. Participants underwent GE tests and responded to a questionnaire regarding gastrointestinal symptoms before and after administration of tegoprazan 50mg. GE was assessed using scintigraphy over 4h with a standardized solid meal. Thirty participants were recruited (19 men, mean age 28.2 ± 7.3years). After medication, no significant differences were observed in gastric half emptying time (T1/2) and gastric retention at 4h (GE 4h) between the tegoprazan and the control group (114.2 ± 48.9min vs. 93.7 ± 34.7min, P = 0.20; 10.1 ± 12.0% vs. 4.3 ± 5.4%, P = 0.11, respectively). Furthermore, there were no statistically significant differences detected in the changes within each group between two groups (T1/2, 9.9 ± 52.7min vs. -4.7 ± 30.5min, P = 0.36; GE 4h, 5.2 ± 13.9% vs. -1.3 ± 6.5%, P = 0.12). The changes in dyspeptic symptom scores after tegoprazan administration did not significantly differ from those in the control group with no correlation between symptoms and GE parameters. In healthy adults, the administration of tegoprazan did not show a significant impact on GE and dyspeptic symptoms, especially postprandial fullness or early satiation.

The impact of distraction, masticatory performance and sex on food intake of school children from public and private schools: a randomized trial

Recent research highlights the influence of distraction on caloric intake in adults. This study investigated the impact of smartphone use and reading comic book on food intake of schoolchildren aged 10 to 12 years. One hundred and twenty students from public and private schools participated in experimental meal sessions. Individual parameters such as sex, age, body mass index (BMI), and eating preferences were assessed during the first session. In subsequent appointments, participants consumed standardized meals without distraction, while using a smartphone, or reading comic books in a random order. Child Three-Factor Eating Questionnaire (CTFEQr-21) was administered to assess eating behavior, and total caloric intake (kcal), total amount (g) and medium/high-energy-dense amount (g) were measured in each session. No significant difference was observed in food intake among the three experimental meals (without distractor, using smartphone and reading comic book). Masticatory performance, number of chewing cycles, and time until swallow were similar between sexes and school types (p>0.05). Regression models showed that meal duration was dependent on school type, number of teeth, time until swallow and absence of distractor, while total caloric intake was dependent on school type (public), sex (male), time until swallow, and number of cycles. Besides, total amount ingested, and medium/high-energy-dense amount were dependent on school type (public), sex (male), age, size of the particles and time until swallowing, uncontrolled eating and body mass index (p<0.05). In conclusion, the primary factors affecting food/caloric ingestion were sex, school type, and masticatory parameters, while the absence of distractor had an influence on meal duration.

Hemodynamic effects of carvedilol plus simvastatin in cirrhosis with severe portal hypertension and suboptimal response to β-blockers: A double-blind, placebo-controlled, randomized trial.

Carvedilol is a nonselective β-blocker (NSBB) with anti-α1-adrenergic activity, more effective than traditional NSBBs in reducing portal pressure hepatic venous pressure gradient (HVPG). However, 35%-45% of patients still have insufficient HVPG decrease. Statins ameliorate endothelial dysfunction, reduce hepatic vascular resistance, and have pleiotropic effects. We investigated whether the addition of simvastatin improves the efficacy of carvedilol on HVPG in cirrhosis with severe portal hypertension and suboptimal response to traditional NSBBs. Patients with cirrhosis and high-risk varices referred for primary prophylaxis were consecutively included. HVPG was measured at baseline and again after i.v. propranolol. Suboptimal responders (HVPG decrease <20%) were treated with carvedilol and were randomized to double-blind administration of placebo or simvastatin. Chronic HVPG response was assessed after 4-6 weeks, repeating HVPG measurements after a standard liquid meal to estimate endothelial dysfunction. Plasma samples were obtained before each study to investigate inflammatory parameters. Of 184 eligible patients, 82 were randomized to carvedilol + simvastatin (N = 41) or carvedilol + placebo (N = 41). Baseline characteristics were similar. HVPG significantly decreased with both, carvedilol + simvastatin (18.6 ± 4 to 15.7 ± 4mmHg, p < 0.001) and carvedilol + placebo (18.9 ± 3 to 16.9 ± 3mmHg, p < 0.001). The decrease was greater with carvedilol + simvastatin (2.97 ± 2.5 vs. 2.05 ± 1.6mmHg, p = 0.031). An HVPG decrease ≥20% occurred in 37% versus 15% of patients, respectively (OR: 3.37, 95% CI = 1.15-9.85; p = 0.021). With test meal, HVPG increased in both groups ( p < 0.01), although carvedilol + simvastatin attenuated such increment (12 ± 8% vs. 23 ± 16%, p < 0.001). Cytokine levels (Interleukine-6, monocyte-chemoattractant protein-1, and malondialdehyde) decreased significantly more with carvedilol + simvastatin ( p < 0.01). The incidence of adverse events was similar. In patients with severe portal hypertension (all with high-risk varices) and suboptimal hemodynamic response to traditional NSBBs, combined therapy with carvedilol plus simvastatin significantly enhances the portal pressure reduction achieved with carvedilol monotherapy, improves endothelial dysfunction, and reduces proinflammatory cytokines.

Acute inflammatory and metabolic effect of high fructose intake in normal-weight women: A randomized, double-masked, crossover trial

We aimed to evaluate the acute effect of a fructose-rich single meal on metabolic and inflammatory biomarkers RESEARCH METHODS AND PROCEDURES: This single-center, double-masked, randomized crossover trial recruited females aged 20 to 47 with a normal body mass index and was conducted at Hospital das Clínicas (Belo Horizonte, MG, Brazil). Participants received a standardized meal with either sucrose, glucose, or a fructose overload. Blood samples were collected after overnight fasting (baseline) and at 30, 60, 120, and 240 minutes postprandial. Serum levels of glucose, triglycerides (primary outcome), total cholesterol, alanine aminotransferase, aspartate aminotransferase, adiponectin, leptin, resistin, interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor, eotaxin, and total blood leukocytes were measured. This trial was completed with 25 enrolled participants, and three dropped out. The per-protocol analysis included 22 participants. As expected, postprandial glycemia increased 30 minutes after consuming meals rich in sucrose (P = 0.045) or glucose (P < 0.001). Triglyceride and leucocyte concentrations increased only at 240 minutes after consuming a high-fructose meal (P < 0.05). Regardless of the type of carbohydrate overload, leptin concentrations decreased postprandially compared to baseline at all time points (P < 0.05). Four participants reported adverse events after consuming the standardized meal with glucose or fructose, including nausea and malaise. Our findings indicate that a fructose-rich single meal leads to a more significant increase in triglyceride and leukocyte concentrations compared to glucose and sucrose in healthy women. These findings support concerns regarding the potential inflammatory and metabolic dysfunction associated with frequent consumption of high-fructose meals.

Suppression of the postprandial hyperglycemia in patients with type 2 diabetes by a raw medicinal herb powder is weakened when consumed in ordinary hard gelatin capsules: A randomized crossover clinical trial.

Contradictory claims about the efficacy of several medicinal plants to promote glycemic control in patients with type 2 diabetes mellitus (T2DM) have been explained by divergences in the administration form and by extrapolation of data obtained from healthy individuals. It is not known whether the antidiabetic effects of traditional herbal medicines are influenced by gelatin capsules. This randomized crossover trial aimed to evaluate the acute effect of a single dose of raw cinnamon consumed orally either dissolved in water as a beverage or as ordinary hard gelatin capsules on postprandial hyperglycemia (>140 mg/dL; >7.8 mmol/L) in T2DM patients elicited by a nutritionally-balanced meal providing 50 g of complex carbohydrates. Fasting T2DM patients (n = 19) randomly ingested a standardized meal in five experimental sessions, one alone (Control) and the other after prior intake of 3 or 6 g of crude cinnamon in the form of hard gelatin capsules or powder dissolved in water. Blood glucose was measured at fasting and at 0.25, 0.5, 0.75, 1, 1.5 and 2 hours postprandially. After each breakfast, its palatability scores for visual appeal, smell and pleasantness of taste were assessed, as well as the taste intensity sweetness, saltiness, bitterness, sourness and creaminess. The intake of raw cinnamon dissolved in water, independently of the dose, decreased the meal-induced large glucose spike (peak-rise of +87 mg/dL and Δ1-hour glycemia of +79 mg/dL) and the hyperglycemic blood glucose peak. When cinnamon was taken as capsules, these anti-hyperglycemic effects were lost or significantly diminished. Raw cinnamon intake did not change time-to-peak or the 2-h post-meal glycaemia, but flattened the glycemic curve (lower iAUC) without changing the shape that is typical of T2DM patients. This cinnamon's antihyperglycemic action confirms its acarbose-like property to inhibit the activities of the carbohydrate-digesting enzymes α-amylases/α-glucosidases, which is in accordance with its exceptionally high content of raw insoluble fiber. The efficacy of using raw cinnamon as a diabetes treatment strategy seems to require its intake at a specific time before/concomitantly the main hyperglycemic daily meals. Trial registration: Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-98tx28b.