Absorption characteristic of breakfast determines insulin sensitivity and carbohydrate tolerance for lunch

PROTOCOL: Breakfast consumption, anthropometry, and nutrition-related outcomes in adolescents from low- and middle-income countries: Protocol for a systematic review and meta-analysis

Objectives This is the protocol for a Campbell systematic review. The objectives are as follows: The aim of this systematic review is to examine the scientific evidence available from low- and middle-income countries on the association of breakfast consumption habits and anthropometry/adiposity- and nutrition-related outcomes in adolescents aged 10-19 years old.

A Clear Difference Emerges in Hormone Patterns Following a Standard Midday Meal in Young Women Who Regularly Eat or Skip Breakfast

BACKGROUND

Multiple hormones are involved in the regulation of food intake and glucose metabolism. Past intervention studies showed a benefit of eating breakfast on satiety, but this was possibly confounded by the disruption of habitual meal patterns.

OBJECTIVE

The objective of this study was to compare hormonal responses, including insulin, leptin, glucagon-like peptide-1, ghrelin, peptide YY (PYY3-36), and cholecystokinin (CCK), between habitual breakfast eaters (Br-Es) and habitual skippers (Br-Ss) to a standard midday meal.

METHODS

Thirty-two women [mean ± SD age: 22.6 ± 3.3 y; body mass index (in kg/m2): 21.8 ± 2.0] participated in a cross-sectional study that consisted of a 3-h test protocol that included a standard test meal served at 1230 with pre- and postmeal blood sampling. The protocol required that Br-Es eat a typical breakfast between 0700 and 1000, whereas Br-Ss had no breakfast meal and had fasted for 12 h. Blood was drawn 35 and 5 min prelunch and 5, 20, 35, 50, and 110 min postlunch.

RESULTS

Repeated-measures ANOVA revealed a group difference for PYY3-36 (P = 0.001), with the Br-E group exhibiting 50-90% higher concentrations throughout the test period. Leptin tended to be different (P = 0.08) between groups, with higher mean ± SD values for the Br-S group (27.6 ± 29.6 ng/mL) compared with the Br-E group (11.5 ± 9.8 ng/mL). Partial least squares regression analysis confirmed that these 2 hormones were important contributors to the patterns of the hormones, anthropometric, clinical, and behavioral variables that differed between groups; insulin and CCK were important as well.

CONCLUSION

We found differences between the Br-E and Br-S groups in circulating gut and adipose-derived hormones measured midday, indicating that the breakfast habit is associated with the hormonal milieu before and after a midday meal. The different patterns may be short-lived or may impact metabolism later in the day. This report is a secondary analysis of a trial registered at clinicaltrials.gov as NCT01427556.

Breakfast quality and cardiometabolic risk profiles in an upper middle-aged German population

Background/Objectives:

Little is known about relation of overall breakfast quality with cardiometabolic risk factors. Therefore, this study aimed to explore sex-specific associations between breakfast quality and cardiometabolic risk profiles in a sample of an upper middle-aged German population.

Subjects/Methods:

Cardiometabolic profiles of 339 men and 329 women were cross-sectionally assessed using an overall biomarker score (BScore), glycated hemoglobin (HbA1_c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), blood pressure, body mass index (BMI) and waist circumference (WC). Overall breakfast quality was assessed by using (i) an a-priori defined breakfast quality score (BQS) and (ii) data-driven breakfast patterns based on principal component analysis (PCA). Multiple linear regression models for association of breakfast quality with all outcomes were adjusted for all potential confounders including overall diet quality.

Results:

After adjustment for all potential confounders the BQS was inversely associated with the BScore (regression beta with 95% Confidence Interval: −0.29 (052−0.06)) and HbA1c (−0.12 (−0.21, −0.04)) in men; whereas no such associations were observed in women. Four breakfast (B) patterns were identified: B-processed-food pattern, B-cereal pattern, B-high fat pattern and B-dairy & cereal pattern. The B-processed-food pattern was positively associated with HbA1c (0.09(0.01, 0.18)), BMI (0.16 (0.06, 0.26)), and WC (0.17 (0.8, 0.26)) in men, and BMI (0.13 (0.1, 0.25)) and WC (0.11(0.01.0.22)) in women. The B-cereal pattern was inversely associated with BScore (−0.23 (−0.45, −0.01)) and BMI (-0.11 (−0.20, −0.01)) in men and WC(−0.16 (−0.27, −0.05)) in women. The B-dairy & cereal pattern was also inversely associated with BScore (−0.26 (−0.48, −0.04)) in men but not in women.

Conclusions:

The overall breakfast quality was cross-sectionally associated with a healthier cardiometabolic profile, especially in upper-middle age men, independent of overall dietary quality. Such analyses should be supplemented by studies investigating the circadian sequence of food intake and metabolic consequences including hard disease endpoints.

Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies

Objective

Breakfast skipping has been reported to be associated with type 2 diabetes (T2D), but the results are inconsistent. No meta-analyses have applied quantitative techniques to compute summary risk estimates. The present study aimed to conduct a meta-analysis of observational studies summarizing the evidence on the association between breakfast skipping and the risk of T2D.

Design

Systematic review and meta-analysis.

Setting

Relevant studies were identified by a search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and SINOMED up to 9 August 2014. We also reviewed reference lists from retrieved articles. We included studies that reported risk estimates (including relative risks, odds ratios and hazard ratios) with 95 % confidence intervals for the association between breakfast skipping and the risk of T2D.

Subjects

Eight studies involving 106 935 participants and 7419 patients with T2D were included in the meta-analysis.

Results

A pooled adjusted relative risk for the association between exposure to breakfast skipping and T2D risk was 1·21 (95 % CI 1·12, 1·31; P=0·984; I2=0·0 %) in cohort studies and the pooled OR was 1·15 (95 % CI, 1·05, 1·24; P=0·770; I2=0·0 %) in cross-sectional studies. Visual inspection of a funnel plot and Begg’s test indicated no evidence of publication bias.

Conclusions

Breakfast skipping is associated with a significantly increased risk of T2D. Regular breakfast consumption is potentially important for the prevention of T2D.

Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

BACKGROUND

Little is known about the association between eating patterns and type 2 diabetes (T2D) risk.

OBJECTIVE

The objective of this study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and T2D risk in men.

DESIGN

Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D.

RESULTS

We documented 1944 T2D cases during follow-up. After adjustment for known risk factors for T2D, including BMI, men who skipped breakfast had 21% higher risk of T2D than did men who consumed breakfast (RR: 1.21; 95% CI: 1.07, 1.35). Compared with men who ate 3 times/d, men who ate 1-2 times/d had a higher risk of T2D (RR: 1.25; 95% CI: 1.08, 1.45). These findings persisted after stratification by BMI or diet quality. Additional snacks beyond the 3 main meals (breakfast, lunch, and dinner) were associated with increased T2D risk, but these associations were attenuated after adjustment for BMI.

CONCLUSIONS

Breakfast omission was associated with an increased risk of T2D in men even after adjustment for BMI. A direct association between snacking between meals and T2D risk was mediated by BMI.

Glycemic index predicts individual glucose responses after self-selected breakfasts in free-living, abdominally obese adults

The degree to which an individual's glycemic response to a meal is determined by the glycemic index (GI) and other components of the meal remains unclear, especially when meals are not consumed in a highly controlled research setting. To address this question, we analyzed data collected during the run-in period of a clinical trial. Free-living, nondiabetic adults (n = 57) aged 53.9 ± 9.8 y (mean ± SD) with a BMI of 33.9 ± 5.3 kg/m(2) and waist circumference of 109 ± 11 cm underwent a 75-g oral glucose tolerance test (OGTT) and, on a separate day, wore a continuous glucose-monitoring system (CGMS) for 24 h during which time they recorded all foods consumed. The protein, fat, and available carbohydrate (avCHO) content and GI of the breakfast meals were calculated from the food records and the incremental areas under the glycemic response curves (iAUC) for 2 h after breakfast (iAUC(breakfast)) were calculated from CGMS data. Values for iAUC(breakfast), avCHO, fat, fiber, and BMI were normalized by log-transformation. The ability of participant characteristics and breakfast composition to predict individual iAUC(breakfast) responses was determined using step-wise multiple linear regression. A total of 56% of the variation in iAUC(breakfast) was explained by GI (30%; P < 0.001), iAUC after the OGTT (11%; P < 0.001), avCHO (11%; P < 0.001), and waist circumference (3%; P = 0.049); the effects of fat, protein, dietary fiber, age, sex, and BMI were not significant. We concluded that, in free-living, abdominally obese adults, GI is a significant determinant of individual glycemic responses elicited by self-selected breakfast meals. In this study, GI was a more important determinant of glycemic response than carbohydrate intake.

Breakfast frequency and quality may affect glycemia and appetite in adults and children

Observational studies of breakfast frequency in children and adults suggest an inverse (protective) association between the frequency of eating breakfast and the risk for obesity and chronic diseases such as type 2 diabetes. More prospective studies with stronger designs are needed, as are experimental studies on this topic. In addition, above and beyond breakfast frequency, the roles of dietary quality and composition need to be studied in the context of eating or skipping breakfast. Experimental studies are also necessary to rigorously test causality and biological mechanisms. Therefore, we conducted 2 pilot experimental studies to examine some of the effects of breakfast skipping and breakfast composition on blood glucose and appetite in children and adults. Our results suggest that breakfast frequency and quality may be related in causal ways to appetite controls and blood sugar control, supporting the hypothesis that the breakfast meal and its quality may have important causal implications for the risk of obesity and type 2 diabetes.

Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens)

OBJECTIVE

Breakfast-eating frequency declines through adolescence and has been inversely associated with body weight in cross-sectional studies, with few prospective studies on this topic. This study was conducted to examine the association between breakfast frequency and 5-year body weight change in 2216 adolescents.

PATIENTS AND METHODS

Project EAT (Eating Among Teens) was a 5-year longitudinal study of eating patterns and weight concerns among adolescents. Surveys were completed in 1998-1999 (time 1) and 2003-2004 (time 2). Multivariable linear regression was used to examine the association between breakfast frequency and change in BMI, with adjustment for age, socioeconomic status, race, physical activity, time 1 BMI and breakfast category, and time 1 dietary and weight-related variables.

RESULTS

At time 1, frequency of breakfast was directly associated with intake of carbohydrate and fiber, socioeconomic status, white race, and physical activity and inversely associated with smoking and alcohol consumption and dieting and weight-control behaviors. In cross-sectional analyses at times 1 and 2, inverse associations between breakfast frequency and BMI remained largely independent of all of the confounding and dietary factors. Weight-related factors (concerns, behaviors, and pressures) explained little of the breakfast-BMI association. In prospective analyses, frequency of breakfast was inversely associated with BMI in a dose-response manner. Further adjustment for confounding and dietary factors did not seem to explain the association, but adjustment for weight-related variables seemed to partly explain this finding.

CONCLUSIONS

Although experimental studies are needed to verify whether the association between breakfast and body weight is of a causal nature, our findings support the importance of promoting regular breakfast consumption among adolescents. Future studies should further examine the role of breakfast habits among youth who are particularly concerned about their weight.

Diurnal metabolic profiles after 14 d of an ad libitum high-starch, high-sucrose, or high-fat diet in normal-weight never-obese and postobese women

BACKGROUND

The influence of the amount and type of carbohydrates in the diet on risk factors for obesity, diabetes, and cardiovascular disease remains unclear.

OBJECTIVE

We investigated the effects of 2 low-fat diets (high-sucrose and high-starch) and a high-fat diet on glycemia, lipidemia, and hormonal responses in never-obese and postobese women.

DESIGN

Eighteen normal-weight women (8 postobese and 10 never-obese) consumed 3 ad libitum diets (high-fat, high-starch, and high-sucrose) for 14 d each. On day 15, we measured fasting and postprandial glucose, lactate, insulin, triacylglycerol, nonesterified fatty acids (NEFA), glycerol, glucagon, glucose-dependent insulinotropic polypeptide, and glucagon-like peptide 1.

RESULTS

The high-sucrose diet induced significantly lower total areas under the curve (AUCs) for glucose and NEFA and a significantly higher lactate AUC than did the high-fat and high-starch diets; there were no significant differences in the insulin AUCs. The triacylglycerol AUC was greater with the high-fat and high-sucrose diets than with the high-starch diet. Gastrointestinal hormone concentrations differed between diets, but not between the 2 subject groups. Comparisons between subject groups for all diets combined showed lower relative insulin resistance and lower AUCs for glucose, insulin, and triacylglycerol in the postobese group.

CONCLUSIONS

High-starch and high-sucrose diets had no adverse effects on postprandial glycemia, insulinemia, or lipidemia compared with a high-fat diet. A sucrose-rich diet may improve glucose metabolism, but may have an adverse effect on lipidemia, compared with a starch-rich diet. Postobese women seemed to be more insulin-sensitive and more efficient at storing triacylglycerol than were never-obese women, regardless of dietary composition.

Reduced postprandial blood glucose levels in recently diagnosed non-insulin-dependent diabetics secondary to pharmacologically induced delayed gastric emptying

In a previous study we demonstrated that patients with recently diagnosed non-insulin-dependent diabetes mellitus (NIDDM) had significantly increased gastric emptying rates of glucose solutions compared with those of nondiabetic sex- and age-matched controls. This finding of rapid gastric emptying contrasts with the delayed gastric emptying often exhibited as a late manifestation of diabetes mellitus that is attributed to autonomic neuropathy. The purpose of this study was to determine, in seven of the patients previously studied, whether (1) an intravenous infusion of cholecystokinin-8 (CCK-8) would delay the gastric emptying of a liquid glucose meal and, if so, (2) whether the delay in gastric emptying would result in reduced postprandial blood glucose concentrations due to prolongation of the absorption of the glucose in the liquid meal. Each patient underwent two separate gastric emptying studies, one during a saline infusion and one during a CCK-8 infusion. Blood samples were obtained at 15-min intervals for measurement of glucose, insulin, CCK-8, and gastric inhibitory polypeptide (GIP) concentrations. The average gastric half-emptying time was 41 min with the saline infusion and 94 min with the CCK-8 infusion (P = 0.0042). The average glucose concentration over the 2-hr period following glucose ingestion was 17.1 mmol/liter with the saline infusion and 14.0 mmol/liter with the CCK-8 infusion (P = 0.0073). The average glucose excursion value over the 2-hr period was reduced from 5.6 mmol/liter to 3.7 mmol/liter with the CCK-8 infusion (P = 0.0550).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of muesli or cornflakes at breakfast on carbohydrate metabolism in type 2 diabetic patients

Fourteen overweight insulin-treated type 2 diabetic patients ate a breakfast, consisting of either muesli (slow release starch: SRS) or cornflakes (fast release starch: FRS), in either case with milk (46 g carbohydrate), during two consecutive randomized crossover periods of two weeks. The rest of the diet remained unchanged. At the end of each period the patients underwent a glucose tolerance test after an overnight fast without their usual evening insulin injection. Both mean plasma glucose responses curves were identical after the two dietary periods, but plasma insulin was significantly lower at zero (-17%, P less than 0.05) and 2 h (-21%, P less than 0.05) at the end of the muesli (SRS) period as compared to the cornflakes (FRS) period. The mean day-long plasma glucose level (four measurements) at the end of the muesli period was 21% (P = 0.023) lower than after the cornflakes period. These results show that switching, at breakfast only, from standard cereals to slow release starch cereals improves the carbohydrate metabolism of diabetic patients. In addition, the fact that diabetic patients could reduce their insulin requirement (P less than 0.05) with concomitant reduction of their daily blood glucose level implies that sensitivity to insulin was improved by slow release starct foods consumed at breakfast.

Influence of non-carbohydrate foods on glucose and insulin responses to carbohydrates of different glycaemic index in type 2 diabetic patients

In order to study the influence of non-carbohydrate foods on responses to carbohydrates during mixed meals, 30 Type 2 (non-insulin-dependent) diabetic patients followed a standardized diet for 5 consecutive days. On days 2, 3, 4, and 5, four different lunches were eaten in a randomized order. Lunches consisted of rice or glucose (50 g carbohydrate) eaten either alone, or as part of a mixed meal (32 g protein, 20 g fat). Glucose and insulin levels prior to the lunches did not differ significantly. Glucose and insulin responses differed (p less than 0.001), responses to rice being lower than responses to glucose, and responses to the meal plus rice lower than responses to the meal plus glucose. The ratios of glucose responses to rice and glucose (glycaemic index) were similar (alone, 47 +/- 4%; meal, 47 +/- 4%; NS). The ratios of the insulin responses did not differ (78 +/- 8 vs 96 +/- 7%; NS). The blood glucose responses to mixed meals were lower than responses to the carbohydrates eaten alone, the ratios being similar (rice, 52 +/- 3%; glucose, 58 +/- 5%; NS). Serum insulin responses were however higher, and the ratios differed (172 +/- 13 vs 138 +/- 14%; p = 0.05). These results suggest that the glycaemic index of isolated carbohydrate foods can predict the relative response to mixed meals in the same individuals with Type 2 diabetes. They also support the insulin secretagogue effect of non-carbohydrate foods, which may vary according to the source of carbohydrate in the meal.