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The American Journal of Clinical... Jul 2023In type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest.
OBJECTIVES
We investigated if a low-carbohydrate (LC) breakfast (∼465 kcal: 25 g protein, 8 g carbohydrates, and 37 g fat) could improve glucose control in people with T2D when compared with a low-fat control (CTL) breakfast (∼450 kcal:20 g protein, 56 g carbohydrates, and 15 g fat).
METHODS
Participants with T2D (N = 121, 53% women, mean age 64 y) completed a remote 3-month parallel-group randomized controlled trial comparing a LC with standard low-fat guideline CTL breakfast. The change in HbA1c was the prespecified primary outcome. Continuous glucose monitoring, self-reported anthropometrics, and dietary information were collected for an intention-to-treat analysis.
RESULTS
HbA1c was reduced (-0.3%; 95% CI: -0.4%, -0.1%) after 12 wks of a LC breakfast, but the between-group difference in HbA1c was of borderline statistical significance (-0.2; 95% CI: -0.4, 0.0; P = 0.06). Self-reported total daily energy (-242 kcal; 95% CI: -460, -24 kcal; P = 0.03) and carbohydrate (-73 g; 95% CI: -101, -44 g; P < 0.01) intake were lower in the LC group but the significance of this difference is unclear. Mean and maximum glucose, area under the curve, glycemic variability, standard deviation, and time above range were all significantly lower, and time in the range was significantly higher, in the LC group compared with CTL (all P < 0.05).
CONCLUSIONS
Advice and guidance to consume a LC breakfast appears to be a simple dietary strategy to reduce overall energy and carbohydrate intake and improve several continuous glucose monitoring variables when compared with a CTL breakfast in persons living with T2D. The trial was registered at clinicaltrials.gov as NCT04550468.
Topics: Humans; Female; Middle Aged; Male; Blood Glucose; Breakfast; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Dietary Carbohydrates; Blood Glucose Self-Monitoring; Glycemic Control; Diet, Fat-Restricted; Glucose
PubMed: 37257563
DOI: 10.1016/j.ajcnut.2023.04.032 -
International Journal of Epidemiology Oct 2023Food intake plays a pivotal role in regulating circadian rhythms, which modulate glucose and lipid homeostasis. However, studies investigating the association of meal...
BACKGROUND
Food intake plays a pivotal role in regulating circadian rhythms, which modulate glucose and lipid homeostasis. However, studies investigating the association of meal timing and type 2 diabetes (T2D) incidence are lacking. The objective of this study was to investigate the longitudinal associations of meal timing, number of eating occasions and night-time fasting duration with incidence of T2D.
METHODS
In total, 103 312 adults [79% women, mean age at baseline = 42.7 (SD = 14.6)] from the NutriNet-Santé cohort (2009-21) were included. Participants' meal timings and frequency were assessed using repeated 24-h dietary records and averaged from the first 2 years of follow-up (5.7 records/participant). Associations of meal timing, number of eating occasions and night-time fasting duration with incidence of T2D were assessed by using multivariable Cox proportional hazard models adjusted for known risk factors.
RESULTS
During a median follow-up of 7.3 years, 963 new cases of T2D were ascertained. Compared with participants habitually having a first meal before 8AM, those eating after 9AM had a higher incidence of T2D (HR = 1.59, 95% CI 1.30-1.94). Time of last meal was not associated with T2D incidence. Each additional eating episode was associated with a lower incidence of T2D (HR = 0.95, 95% CI 0.90-0.99). Night-time fasting duration was not associated with T2D incidence, except in participants having breakfast before 8AM and fasting for >13 h overnight (HR = 0.47, 95% CI 0.27-0.82).
CONCLUSIONS
In this large prospective study, a later first meal was associated with a higher incidence of T2D. If confirmed in other large-scale studies, an early breakfast should be considered in preventing T2D.
Topics: Adult; Humans; Female; Male; Diabetes Mellitus, Type 2; Feeding Behavior; Prospective Studies; Incidence; Risk Factors; Fasting
PubMed: 37328450
DOI: 10.1093/ije/dyad081 -
The Lancet. Gastroenterology &... Feb 2024Many individuals without coeliac disease or wheat allergy reduce their gluten intake because they believe that gluten causes their gastrointestinal symptoms. Symptoms... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of expectancy versus actual gluten intake on gastrointestinal and extra-intestinal symptoms in non-coeliac gluten sensitivity: a randomised, double-blind, placebo-controlled, international, multicentre study.
BACKGROUND
Many individuals without coeliac disease or wheat allergy reduce their gluten intake because they believe that gluten causes their gastrointestinal symptoms. Symptoms could be affected by negative expectancy. Therefore, we aimed to investigate the effects of expectancy versus actual gluten intake on symptoms in people with non-coeliac gluten sensitivity (NCGS).
METHODS
This randomised, double-blind, placebo-controlled, international, multicentre study was done at the University of Leeds (Leeds, UK), Maastricht University (Maastricht, the Netherlands), and Wageningen University and Research (Wageningen, the Netherlands). People aged 18-70 years with self-reported NCGS (ie, gastrointestinal symptoms within 8 h of gluten consumption) without coeliac disease and wheat allergy were recruited. Participants had to follow a gluten-free or gluten-restricted diet for at least 1 week before (and throughout) study participation and had to be asymptomatic or mildly symptomatic (overall gastrointestinal symptom score ≤30 mm on the Visual Analogue Scale [VAS]) while on the diet. Participants were randomly assigned (1:1:1:1; blocks of eight; stratified by site and gender) to one of four groups based on the expectation to consume gluten-containing (E) or gluten-free (E) oat bread for breakfast and lunch (two slices each) and actual intake of gluten-containing (G) or gluten-free (G) oat bread. Participants, investigators, and those assessing outcomes were masked to the actual gluten assignment, and participants were also masked to the expectancy part of the study. The primary outcome was overall gastrointestinal symptom score on the VAS, which was measured at and corrected for baseline (before breakfast) and hourly for 8 h, with lunch served after 4 h, and analysed per-protocol. Safety analysis included all participants incorporated in the per-protocol analysis. The study is registered at ClinicalTrials.gov, NCT05779358, and has ended.
FINDINGS
Between Oct 19, 2018, and Feb 14, 2022, 165 people were screened and 84 were randomly assigned to EG (n=21), EG (n=21), EG (n=20), or EG (n=22). One person in the EG group was excluded due to not following test day instructions, leaving 83 participants in the per-protocol analysis. Median age was 27·0 years (IQR 21·0-45·0), 71 (86%) of 83 people were women, and 12 (14%) were men. Mean overall gastrointestinal symptom score was significantly higher for EG (16·6 mm [95% CI 13·1 to 20·0]) than for EG (6·9 mm [3·5 to 10·4]; difference 9·6 mm [95% CI 3·0 to 16·2], p=0·0010) and EG (7·4 mm [4·2 to 10·7]; difference 9·1 mm [2·7 to 15·6], p=0·0016), but not for EG (11·7 mm [8·3 to 15·1]; difference 4·9 mm [-1·7 to 11·5], p=0·28). There was no difference between EG and EG (difference 4·7 mm [-1·8 to 11·3], p=0·33), EG and EG (difference 4·2 mm [-2·2 to 10·7], p=0·47), and EG and EG (difference -0·5 mm [-7·0 to 5·9], p=1·0). Adverse events were reported by two participants in the EG group (itching jaw [n=1]; feeling lightheaded and stomach rumbling [n=1]) and one participant in the EG group (vomiting).
INTERPRETATION
The combination of expectancy and actual gluten intake had the largest effect on gastrointestinal symptoms, reflecting a nocebo effect, although an additional effect of gluten cannot be ruled out. Our results necessitate further research into the possible involvement of the gut-brain interaction in NCGS.
FUNDING
Government of the Netherlands Topsector Agri & Food Top Consortium for Knowledge and Innovation, AB Mauri Global Bakery Ingredients, Baking Industry Research Trust, Borgesius-Albert Heijn, CSM Innovation Centre, the International Maize and Wheat Improvement Center (CIMMYT), DSM Food Specialties, Fazer, Healthgrain Forum, the International Association for Cereal Science and Technology, the International Wheat Gluten Association, Lantmännen, Mondelez International, Nederlands Bakkerij Centrum, Nutrition & Santé, Puratos, Rademaker, Sonneveld Group, and Zeelandia HJ Doeleman.
Topics: Male; Humans; Female; Adult; Celiac Disease; Wheat Hypersensitivity; Glutens; Diet, Gluten-Free; Double-Blind Method
PubMed: 38040019
DOI: 10.1016/S2468-1253(23)00317-5 -
Advances in Clinical and Experimental... Sep 2023Proton pump inhibitors (PPIs) are currently the reference drugs for gastroesophageal reflux disease (GERD), but symptoms often recur after their withdrawal. Moreover,...
BACKGROUND
Proton pump inhibitors (PPIs) are currently the reference drugs for gastroesophageal reflux disease (GERD), but symptoms often recur after their withdrawal. Moreover, whether prokinetics or barrier drugs used alongside PPIs are more effective remains under debate.
OBJECTIVES
The aim of the study was to assess the efficacy of different therapeutic approaches to GERD treatment.
MATERIAL AND METHODS
We enrolled 211 grade A reflux esophagitis patients who consented to participate in this non-randomized, open-label trial. The study consisted of 6 sequentially administered medical treatments for GERD, lasting 2 months, with a 3-week washout period between each drug schedule: Group A: PPI (esomeprazole 40 mg/day before breakfast); Group B: mucosal protective drugs (a combination of hyaluronic acid, chondroitin sulfate and poloxamer 407, or a combination of hyaluronic acid, chondroitin sulfate and aluminum, 3 times daily after a meal); Group C: prokinetics (levosulpiride 25 mg or domperidone 10 mg, 3 times daily before a meal); Group D: barrier drug (alginate 3 times daily after a meal); Group E: PPI (esomeprazole 40 mg/day before breakfast) and mucosal protective drugs (a combination of hyaluronic acid, chondroitin sulfate and poloxamer 407, or a combination of hyaluronic acid, chondroitin sulfate and aluminum, before sleep); Group F: PPI (esomeprazole 40 mg/day before breakfast) and prokinetics (levosulpiride 25 mg or domperidone 10 mg before lunch and dinner). Symptoms were evaluated using the visual analogue scale (VAS) and global symptomatic score (GSS), as follows: heartburn: 0-3; retrosternal chest pain: 0-3; regurgitation: 0-3.
RESULTS
All but 2 treatments (groups C and D) significantly improved VAS and GSS, with group E showing the most significant GSS improvement. Group C had the highest number of dropouts due to treatment failure and reported more side effects.
CONCLUSION
Using PPIs and mucosal protective drugs resulted in significant symptom alleviation. However, the administration of prokinetics caused higher dropouts due to treatment failure.
PubMed: 37665080
DOI: 10.17219/acem/171001 -
Current Problems in Cardiology Sep 2023Evidence on common eating behaviors to support the prevention of cardiovascular disease (CVD) in Japanese people is insufficient. This retrospective cohort study aimed... (Review)
Review
Evidence on common eating behaviors to support the prevention of cardiovascular disease (CVD) in Japanese people is insufficient. This retrospective cohort study aimed to investigate the association of diet behaviors (eg, skipping breakfast, eating speed, snack after dinner, and alcohol consumption) with incident CVD in Japanese individuals. Employees of Panasonic Corporation who underwent the annual health checkups and without a history of CVD at baseline were enrolled. The main outcome was incident 3-point major adverse cardiovascular events (MACE). The secondary outcomes were incident coronary artery disease (CAD) and stroke. To assess the effect of BMI, the subgroup analysis was conducted. In total, 132,795 participants were included. Overall, 3115, 1982, and 1165 participants developed 3-point MACE, CAD, and stroke, respectively. Skipping breakfast (HR: 1.13, 95% CI: 1.03-1.23) and fast eating (HR: 1.23, 95% CI: 1.04-1.47) were associated with 3-point MACE in the participants overall. Skipping breakfast (HR: 1.23, 95% CI: 1.10-1.37) and fast eating (HR: 1.38, 95% CI: 1.12-1.71) were also associated with 3-point MACE in participants with BMI < 25 kg/m. In contrast, in participants with BMI ≥ 25 kg/m, these associations were not detectable (P value for the interaction between subgroups = 0.09 [skipping breakfast] and 0.03 [fast eating], respectively). The diet behavior is a potential risk factor of incident CVD in Japanese people, particularly in those with BMI < 25 kg/m.
Topics: Humans; Cardiovascular Diseases; Cohort Studies; Retrospective Studies; East Asian People; Feeding Behavior; Coronary Artery Disease; Stroke
PubMed: 37211300
DOI: 10.1016/j.cpcardiol.2023.101818 -
Nutrients Oct 2023Previously, it has been indicated that oat polar lipids included in a liquid meal may have the potential to beneficially modulate various cardiometabolic variables. The... (Randomized Controlled Trial)
Randomized Controlled Trial
Inclusion of Oat Polar Lipids in a Solid Breakfast Improves Glucose Tolerance, Triglyceridemia, and Gut Hormone Responses Postprandially and after a Standardized Second Meal: A Randomized Crossover Study in Healthy Subjects.
Previously, it has been indicated that oat polar lipids included in a liquid meal may have the potential to beneficially modulate various cardiometabolic variables. The purpose of this study was to evaluate the effects of oat polar lipids in a solid food matrix on acute and second meal glucose tolerance, blood lipids, and concentrations of gut-derived hormones. The oat polar lipids were consumed at breakfast and effects on the biomarkers were investigated in the postprandial period and following a standardized lunch. Twenty young, healthy subjects consumed in total four different breakfast meals in a crossover study design. The breakfasts consisted of 1. White wheat bread (WWB) with an added 7.5 g of oat polar lipids (PLL); 2. WWB with an added 15 g of oat polar lipids (PLH); 3. WWB with and added 16.6 g of rapeseed oil (RSO) as a representative of commonly consumed oils; and 4. WWB consumed alone, included as a reference. All products with added lipids contained equivalent amounts of fat (16.6 g) and available carbohydrates (50 g). Rapeseed oil was added to the oat polar lipid meals to equal 16.6 g of total fat. The standardized lunch was composed of WWB and meatballs and was served 3.5 h after the breakfast. Test variables (blood glucose, serum insulin, triglyceride (TG), free fatty acids (FFA), ghrelin, GLP-1, PYY, and GIP) were measured at fasting and repeatedly during the 5.5 h after ingestion of the breakfast. After breakfast, PLH substantially lowered postprandial glucose and insulin responses (iAUC 0-120 min) compared with RSO and WWB ( < 0.05). Furthermore, a reduced glycaemic response to lunch (210-330 min) was observed following the PLH breakfast compared to all of the other breakfasts served ( < 0.05). Oat polar lipids (PLH) significantly reduced TG and ghrelin and increased circulating gut hormones GLP-1 and PYY compared to RSO ( < 0.05). The results show that exchanging part of the dietary lipids with oat polar lipids has the potential to improve postprandial blood glucose regulation and gut hormones and thus may have a preventive effect against type 2 diabetes.
Topics: Humans; Ghrelin; Breakfast; Blood Glucose; Cross-Over Studies; Avena; Healthy Volunteers; Diabetes Mellitus, Type 2; Rapeseed Oil; Dietary Fiber; Gastrointestinal Hormones; Meals; Insulin; Glucagon-Like Peptide 1; Lipids; Postprandial Period
PubMed: 37892464
DOI: 10.3390/nu15204389 -
Public Health Nutrition Aug 2023Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS)...
OBJECTIVE
Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers.
DESIGN
Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants.
SETTING
A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions.
PARTICIPANTS
A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis.
RESULTS
The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality.
CONCLUSIONS
Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.
Topics: Humans; Female; Breakfast; Feeding Behavior; Body Mass Index; Cross-Sectional Studies; Eating
PubMed: 37078522
DOI: 10.1017/S1368980023000794 -
Journal of Atherosclerosis and... Sep 2023Little is known regarding the association between breakfast type and cardiovascular mortality. We examined the associations between breakfast type and risks of mortality...
AIM
Little is known regarding the association between breakfast type and cardiovascular mortality. We examined the associations between breakfast type and risks of mortality from stroke, coronary heart disease (CHD), and total cardiovascular disease (CVD).
METHODS
A total of 85,319 males and females aged 40 to 79 years who were free from CVD and cancers at baseline were involved in this study. The participants were divided into five groups according to their self-reported breakfast types: Japanese breakfast, Western breakfast, mixed Japanese-Western breakfast, other breakfast, and skipping breakfast groups. All hazard ratios (HRs) were estimated using Cox proportional hazards regression models after adjusting for the potential confounding factors.
RESULTS
During the median 19-year follow-up, we identified CVD deaths of 5,870 subjects. Compared to the Japanese breakfast, the multivariable HRs (95% CIs) of total CVD were 0.64 (0.52-0.79) for mixed Japanese-Western breakfast, 0.90 (0.77-1.04) for Western breakfast, 1.24 (0.95-1.61) for other breakfast, and 1.31 (1.00-1.71) for skipping breakfast. The corresponding HRs (95% CIs) of total stroke were 0.67 (0.49-0.91), 0.83 (0.66-1.05), 1.15 (0.76-1.74), and 1.25 (0.82-1.92), and those of CHD were 0.73 (0.48-1.12), 1.08 (0.81-1.44), 1.09 (0.60-1.98), and 1.77 (1.11-2.83).
CONCLUSION
Compared to Japanese breakfast, mixed Japanese-Western breakfast may have a protective role in cardiovascular mortality whereas skipping breakfast may harm cardiovascular health.
Topics: Male; Female; Humans; Cohort Studies; Japan; Breakfast; Prospective Studies; Stroke; Cardiovascular Diseases; Coronary Disease; Proportional Hazards Models; Risk Factors
PubMed: 36543187
DOI: 10.5551/jat.63564 -
International Urology and Nephrology Dec 2023There are few reports on the relationship between skipping breakfast and chronic kidney disease (CKD). We examined the skipping breakfast-CKD relationship and the...
BACKGROUND/OBJECTIVES
There are few reports on the relationship between skipping breakfast and chronic kidney disease (CKD). We examined the skipping breakfast-CKD relationship and the mediation effects of metabolic diseases (obesity, hypertension, and diabetes) on this relationship.
SUBJECTS/METHODS
We analyzed the data of 21,138 participants aged ≥ 40 years from the Korea National Health and Nutrition Examination Survey 2013-2018. Skipping breakfast was defined as rarely eating breakfast over the past year. CKD was defined as decreased kidney function expressed by an estimated glomerular filtration rate of < 60 mL/min/1.73 m. We used a complex sample logistic regression model to examine the relationship between skipping breakfast and CKD. We used Baron and Kenny's approach to examine whether metabolic diseases work as a mediator within the skipping breakfast-CKD relationships.
RESULTS
About 7.6% of participants skipped breakfast, and 5.5% had CKD. After adjusting for confounders, participants who skipped breakfast were at higher odds of having CKD (odds ratio 1.61; 95% confidence interval 1.07-2.42; p value 0.021) compared to those who did not skip breakfast. With full adjustments for confounders, skipping breakfast was not significantly associated with any metabolic diseases, while CKD was significantly associated with diabetes and hypertension.
CONCLUSION
We found that middle-aged or older people who skipped breakfast had a significantly higher odds of having CKD compared to those who did not skip breakfast. However, metabolic diseases did not mediate the relationship between skipping breakfast and CKD.
Topics: Middle Aged; Humans; Aged; Breakfast; Feeding Behavior; Nutrition Surveys; Diabetes Mellitus; Metabolic Diseases; Hypertension; Renal Insufficiency, Chronic
PubMed: 37093440
DOI: 10.1007/s11255-023-03590-5