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Clinical Nutrition (Edinburgh, Scotland) Nov 2020To synthesize the evidence of the effect of small doses (≤30-g/meal) of fructose and its epimers (allulose, tagatose, and sorbose) on the postprandial glucose and... (Meta-Analysis)
Meta-Analysis
AIMS
To synthesize the evidence of the effect of small doses (≤30-g/meal) of fructose and its epimers (allulose, tagatose, and sorbose) on the postprandial glucose and insulin response to carbohydrate-containing meals.
METHODS
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through to April 9, 2019. We included randomized (RCTs) and non-randomized acute, single-meal, controlled feeding trials that added ≤30-g of fructose or its epimers either prior to or with a carbohydrate-containing meal compared with the same meal alone. Outcomes included the incremental area under the curve (iAUC) for glucose and insulin, the Matsuda Insulin Sensitivity Index, and the Early Insulin Secretion Index. Data were expressed as ratio of means (RoM) with 95% CIs and pooled using the inverse variance method. The overall certainty of the evidence was evaluated using GRADE.
RESULTS
Forty trial comparisons (n = 400) were included (none for sorbose). Allulose significantly reduced the postprandial iAUC glucose response by 10% (0.90 [0.84 to 0.96], P < 0.01). Tagatose significantly reduced the postprandial iAUC insulin response by 25% (0.75 [0.62 to 0.91], P < 0.01) and showed a non-significant 3% reduction in the postprandial iAUC glucose response (0.97 [0.94 to 1.00], P = 0.07). There was no effect of fructose on any outcome. The certainty of the evidence was graded as low to moderate for fructose, moderate for allulose, and low for tagatose.
CONCLUSIONS
Small doses of allulose and tagatose, but not fructose, lead to modest improvements on postprandial glucose and insulin regulation. There is a need for long-term RCTs to confirm the sustainability of these improvements.
Topics: Adult; Blood Glucose; Carbohydrate Metabolism; Diet, Carbohydrate Loading; Female; Fructose; Hexoses; Humans; Insulin; Male; Meals; Postprandial Period; Randomized Controlled Trials as Topic; Sorbose; Young Adult
PubMed: 32220498
DOI: 10.1016/j.clnu.2020.03.002 -
Applied Physiology, Nutrition, and... Oct 2020The purpose of this systematic review was to synthesize and evaluate current literature examining the effects of exercise on postprandial fat oxidation, as well as to... (Meta-Analysis)
Meta-Analysis
The purpose of this systematic review was to synthesize and evaluate current literature examining the effects of exercise on postprandial fat oxidation, as well as to provide future direction. A quantitative review was performed using meta-analytic methods. A moderator analysis was performed to investigate potential variables that could influence the effect of exercise on postprandial fat oxidation. Fifty-six effects from 26 studies were retrieved. There was a moderate effect of exercise on postprandial fat oxidation (Cohen's = 0.58 (95% CI, 0.39 to 0.78)). Moderator analysis revealed that sex, age, weight status, training status, exercise type, exercise intensity, timing of exercise, and composition of the meal challenge significantly affected the impact of prior exercise on postprandial fat oxidation. The moderator analysis also indicated that most previous studies have investigated the impact of prior moderate-intensity endurance exercise on postprandial fat oxidation in young, healthy, lean men. Suggested priorities for future research in this area include () an examination of sex differences in and/or female-specific aspects of postprandial metabolism; () a comprehensive evaluation of exercise modalities, intensities, and durations; and () a wider variety of test meal compositions, especially those with higher fat content. A systematic review of the impact of exercise on postprandial fat oxidation was performed using meta-analytic methods. Analysis revealed a moderate effect of exercise on postprandial fat oxidation. The presented data support a need for future studies to investigate sex differences and to include comprehensive evaluations of exercise modalities, intensities, and duration.
Topics: Dietary Fats; Energy Metabolism; Exercise; Humans; Postprandial Period
PubMed: 32208104
DOI: 10.1139/apnm-2019-0917 -
The Effect of Timing of Exercise and Eating on Postprandial Response in Adults: A Systematic Review.Nutrients Jan 2020Type 2 diabetes is a major public health concern. Management of this condition has focused on behavior modification through diet and exercise interventions. A growing...
Type 2 diabetes is a major public health concern. Management of this condition has focused on behavior modification through diet and exercise interventions. A growing body of evidence has focused on temporality of dietary intake and exercise and potential effects on health. This review summarizes current literature that investigates the question "how does the timing of exercise relative to eating throughout the day effect postprandial response in adults?" Databases PubMed, Scopus, Cochrane Library, CINAHL, and SPORTDiscus were searched between March-May 2019. Experimental studies conducted in healthy adults (≥18 y) and those with type 2 diabetes were included. Full texts were examined by at least two independent reviewers. Twenty studies with a total of 352 participants met the inclusion criteria. The primary finding supports that exercise performed post-meal regardless of time of day had a beneficial impact on postprandial glycemia. There was insufficient evidence regarding whether timing of exercise performed pre- vs. post-meal or vice versa in a day is related to improved postprandial glycemic response due to inherent differences between studies. Future studies focusing on the investigation of timing and occurrence of meal intake and exercise throughout the day are needed to inform whether there is, and what is, an optimal time for these behaviors regarding long-term health outcomes.
Topics: Adult; Eating; Exercise; Humans; Postprandial Period; Time Factors
PubMed: 31952250
DOI: 10.3390/nu12010221 -
Nutrition (Burbank, Los Angeles County,... Mar 2020Low glycemic index (GI) diets are recommended to reduce the risk for chronic diseases by managing postprandial elevations in blood glucose and insulin. However, to our... (Meta-Analysis)
Meta-Analysis
Low glycemic index (GI) diets are recommended to reduce the risk for chronic diseases by managing postprandial elevations in blood glucose and insulin. However, to our knowledge, a systematic review of randomized controlled trials (RCTs) to investigate this relationship and interpret its clinical relevance has yet to be performed. This review aims to assess the effect of low versus high GI breakfast meals on postprandial glycemic and insulinemic responses in adults. Two researchers independently screened 1100 articles from PubMed, CINAHL, Medline, and Cochrane databases and extracted data from 11 qualified RCTs. Meta-analyses were performed to calculate overall effect sizes of postintervention blood glucose concentration change values at different time points (60, 90, and 120 min) using a random-effects model, reporting their weighted mean differences (WMDs) and 95% confidence intervals (CIs). Low GI breakfasts significantly reduced postprandial blood glucose concentrations at all time points: 60 min (WMD: -1.32 mmol/L; 95% CIs, -1.64 to -0.99), 90 min (WMD: -0.74 mmol/L; 95% CI, -0.92 to -0.56), and 120 min (WMD: -0.44 mmol/L; 95% CI, -0.63 to -0.26). Further analyses not only indicated similar trends following the stratification of studies according to the glycemic load, but also showed a more pronounced decline in glycemic response among individuals with metabolic impairments. These results highlight the benefits of lowering breakfast meal GI to provide clinically relevant reductions in acute glucose response.
Topics: Adult; Blood Glucose; Breakfast; Female; Glycemic Index; Glycemic Load; Humans; Insulin; Male; Postprandial Period; Randomized Controlled Trials as Topic
PubMed: 31838460
DOI: 10.1016/j.nut.2019.110634 -
Chronobiology International Mar 2020Current dietary trends show that humans consume up to 40% of their energy intake during the night. Those who habitually eat during the night are observed to have an... (Meta-Analysis)
Meta-Analysis Review
Current dietary trends show that humans consume up to 40% of their energy intake during the night. Those who habitually eat during the night are observed to have an increased risk of metabolic conditions such as type-2 diabetes and cardiovascular disease. Increasing evidence suggest that a biological consequence of eating during the night is a larger postprandial glucose response, compared to meals eaten earlier in the day. However, findings from individual acute postprandial studies have been inconsistent, due to variations in protocols. Therefore, this review aimed to systematically summarize findings from acute postprandial studies and investigate whether postprandial glucose and insulin response at night differs to during the day in healthy adults. This would indicate a possible physiological mechanism linking habitual nighttime eating and increased risk of metabolic conditions. Seven electronic databases were searched in February 2018. Included studies met the following criteria: had a day-time test between 0700 - 1600h, a nighttime test between 2000 and 0400h, the test meals were identical and consumed by the same participant at both day and night time points, preceded by a 3-h fast (minimum). Primary outcome measures were postprandial glucose and insulin incremental area under the curve (iAUC) or area under the curve (AUC). Studies that reported numerical data were included in the meta-analyses, conducted using Stata statistical software (version 13.0, StataCorp, College Station, TX, USA). For eligible studies that did not report numerical data, their authors' conclusions on the effect of time of day on the primary outcome measures were summarized qualitatively. Full text of 172 articles were assessed for eligibility. Fifteen studies met the eligibility criteria, ten of which were included in the meta-analyses. Meta-analysis for glucose showed a lower postprandial glucose response in the day compared to during the night, after an identical meal (SMD = -1.66; 95% CI, -1.97 to -1.36; < .001). This was supported by the findings from included studies ineligible for meta-analysis. Meta-analysis also showed a lower postprandial insulin response in the day compared to during the night (SMD = -0.35; 95% CI, -0.63 to -0.06; = .016). However, findings from included studies ineligible for meta-analysis were inconsistent. Our results suggest poor glucose tolerance at night compared to the day. This may be a contributing factor to the increased risk of metabolic diseases observed in those who habitually eat during the night, such as shift workers.
Topics: Adult; Blood Glucose; Circadian Rhythm; Cross-Over Studies; Glucose; Humans; Insulin; Postprandial Period; Work Schedule Tolerance
PubMed: 31782659
DOI: 10.1080/07420528.2019.1683856 -
European Journal of Clinical Nutrition Jan 2020Varying the macronutrient composition of meals alters acute postprandial responses, but the effect sizes for specific macronutrient exchanges have not been quantified by... (Meta-Analysis)
Meta-Analysis Review
Impact of isocaloric exchanges of carbohydrate for fat on postprandial glucose, insulin, triglycerides, and free fatty acid responses-a systematic review and meta-analysis.
Varying the macronutrient composition of meals alters acute postprandial responses, but the effect sizes for specific macronutrient exchanges have not been quantified by systematic reviews. Therefore the aim is to quantify the effect size of exchanging fat for carbohydrates in mixed meals on postprandial glucose (PPG), insulin (PPI), triglycerides (PPTG), and free fatty acids (PPFFA) responses by performing a systematic review and meta-analysis of randomized controlled trials. A systematic literature search was undertaken on randomized controlled trials comparing isocaloric high fat with high carbohydrate meals, with comparable protein contents and at least one postprandial glycemic- and one lipid outcome. The outcome data were extracted and expressed as mean postprandial levels over 2 h. Ten studies involving 14 comparisons met the eligibility criteria. Data were available for meta-analysis from 347 participants, consuming mixed meals containing 250-1003 kcal, and total fat contents of 33.3-75.6 percentage of energy (en%) (intervention) versus 0-31.7 en% (control). Each 10en% increase in fat, replacing carbohydrates produced a mean reduction in PPG of 0.32 mmol/l (95% CI -0.64 to -0.00, p = 0.047), a reduction in PPI of 18.2 pmol/l (95% CI -24.86 to -11.54), an increase in PPTG of 0.06 mmol/l (95% CI 0.02 to 0.09, p = 0.004), with no statistically significant effect on PPFFA. Modest exchange of carbohydrates for fats in mixed meals significantly reduces PPG and PPI and increases PPTG responses. The quantitative relationships derived here may be applied to predict responses, and to design and optimize meal macronutrient compositions in dietary intervention studies.
Topics: Blood Glucose; Cross-Over Studies; Dietary Carbohydrates; Dietary Fats; Fatty Acids, Nonesterified; Glucose; Humans; Insulin; Meals; Postprandial Period; Triglycerides
PubMed: 31767988
DOI: 10.1038/s41430-019-0534-6 -
American Journal of Therapeutics 2020Insulin therapy is the mainstay of treatment for type 1 diabetes and may be necessary in type 2 diabetes. Current insulin analogues present a more physiological profile,...
BACKGROUND
Insulin therapy is the mainstay of treatment for type 1 diabetes and may be necessary in type 2 diabetes. Current insulin analogues present a more physiological profile, are effective, and with less risk of hypoglycemia, but they are expensive. Biosimilar insulins should offer the advantages of insulin analogues at reduced costs. In addition, current rapid-acting insulin analogues are not fast enough to control excessive postprandial glucose excursions in many patients.
AREAS OF UNCERTAINTY
Biosimilar insulins demonstrated that are safe and effective, but interchangeability and automatic substitution remain an issue. Ultrafast-acting insulins should reduce postprandial hyperglycemia and improve flexibility in insulin dosing.
DATA SOURCES
This systematic review was conducted following widely recommended methods. We searched for each topic in Medline, Embase, the Cochrane Library, and SCISEARCH for relevant citations for the appropriate period.
THERAPEUTIC ADVANCES
LY2963016 and MK-1293 are biosimilar insulins of insulin glargine, and SAR342434 is a biosimilar of insulin lispro. The abbreviated developed program demonstrated comparable efficacy and safety and supports their use for treatment of people with diabetes but no interchangeability. Faster-acting insulin aspart is a new formulation of insulin aspart with accelerated subcutaneous absorption. Faster aspart demonstrated noninferiority in reducing HbA1c as compared to insulin aspart with superiority in controlling postprandial hyperglycemia without increasing hypoglycemia, and flexible insulin dosing.
CONCLUSIONS
Biosimilar insulins have comparable PK-PD profiles and equivalent efficacy and safety to original insulins at a lower price, making them available for more people with diabetes. Faster aspart is the first ultrafast-acting insulin. New upcoming clinical trials and more clinical experience with faster aspart will show the real potential of this new insulin.
Topics: Biosimilar Pharmaceuticals; Blood Glucose; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Hyperglycemia; Hypoglycemic Agents; Insulin Glargine; Insulin Lispro; Randomized Controlled Trials as Topic
PubMed: 31764128
DOI: 10.1097/MJT.0000000000001079 -
Sports Medicine (Auckland, N.Z.) Feb 2020Physical activity (PA) breaks in sitting time might attenuate metabolic markers relevant to the prevention of type 2 diabetes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Physical activity (PA) breaks in sitting time might attenuate metabolic markers relevant to the prevention of type 2 diabetes.
OBJECTIVES
The primary aim of this paper was to systematically review and meta-analyse trials that compared the effects of breaking up prolonged sitting with bouts of PA throughout the day (INT) versus continuous sitting (SIT) on glucose, insulin and triacylglycerol (TAG) measures. A second aim was to compare the effects of INT versus continuous exercise (EX) on glucose, insulin and TAG measures.
METHODS
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Eligibility criteria consisted of trials comparing INT vs. SIT or INT vs. one bout of EX before or after sitting, in participants aged 18 or above, who were classified as either metabolically healthy or impaired, but not with other major health conditions such as chronic obstructive pulmonary disease or peripheral arterial disease.
RESULTS
A total of 42 studies were included in the overall review, whereas a total of 37 studies were included in the meta-analysis. There was a standardised mean difference (SMD) of - 0.54 (95% CI - 0.70, - 0.37, p = 0.00001) in favour of INT compared to SIT for glucose. With respect to insulin, there was an SMD of - 0.56 (95% CI - 0.74, - 0.38, p = 0.00001) in favour of INT. For TAG, there was an SMD of - 0.26 (95% CI - 0.44, - 0.09, p = 0.002) in favour of INT. Body mass index (BMI) was associated with glucose responses (β = - 0.05, 95% CI - 0.09, - 0.01, p = 0.01), and insulin (β = - 0.05, 95% CI - 0.10, - 0.006, p = 0.03), but not TAG (β = 0.02, 95% CI - 0.02, 0.06, p = 0.37). When energy expenditure was matched, there was an SMD of - 0.26 (95% CI - 0.50, - 0.02, p = 0.03) in favour of INT for glucose, but no statistically significant SMDs for insulin, i.e. 0.35 (95% CI - 0.37, 1.07, p = 0.35), or TAG i.e. 0.08 (95% CI - 0.22, 0.37, p = 0.62). It is worth noting that there was possible publication bias for TAG outcomes when PA breaks were compared with sitting.
CONCLUSION
The use of PA breaks during sitting moderately attenuated post-prandial glucose, insulin, and TAG, with greater glycaemic attenuation in people with higher BMI. There was a statistically significant small advantage for PA breaks over continuous exercise for attenuating glucose measures when exercise protocols were energy matched, but no statistically significant differences for insulin and TAG. PROSPERO Registration: CRD42017080982.
PROSPERO REGISTRATION
CRD42017080982.
Topics: Blood Glucose; Diabetes Mellitus, Type 2; Exercise; Humans; Insulin; Postprandial Period; Sedentary Behavior; Sitting Position; Triglycerides
PubMed: 31552570
DOI: 10.1007/s40279-019-01183-w -
Postgraduate Medicine Nov 2019: Compared with traditional outpatient follow up, short message service (SMS) provides more convenience for diabetes self-management. However, the feasibility,... (Meta-Analysis)
Meta-Analysis
: Compared with traditional outpatient follow up, short message service (SMS) provides more convenience for diabetes self-management. However, the feasibility, effectiveness, and satisfaction of SMS intervention remain unclear.: A systematic retrieval of databases, including PubMed, EMBASE, and Cochrane Library, was used to evaluate the effect of SMS on the diabetes glycemic control. Complete quantitative reports on the changes of glycosylated hemoglobin (HbA) before and after intervention were collected. The study type was limited to randomized controlled trials (RCTs).: 13 RCTs were identified as eligible for this subject. Overall result revealed a statistical decline of HbA by -0.62% (95% CI -0.82 to -0.41). The longest intervention duration was 12 months with the noteworthy improvement of HbA by -1.63% (-2.27 to -0.99). Compared with control groups, five trials quantitatively demonstrated a significant decline in fasting plasma glucose (FPG) by -0.45 (95% CI -0.7 to -0.19) and -1.05 (95% CI -1.35 to -0.75) in 2-h postprandial blood glucose (2hPBG).: This meta-analysis demonstrated that text message intervention indeed leads to a decline in HbA and improvement of blood glucose control. No convincing evidence was found on quality of life improvement, satisfaction, body mass index (BMI), blood lipid levels, the frequency of hypoglycemia, self-monitoring of blood glucose or complications reduction.
Topics: Blood Glucose; Blood Glucose Self-Monitoring; Body Mass Index; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Hypoglycemia; Lipids; Patient Satisfaction; Postprandial Period; Quality of Life; Randomized Controlled Trials as Topic; Self-Management; Text Messaging
PubMed: 31524035
DOI: 10.1080/00325481.2019.1668723 -
Diabetic Medicine : a Journal of the... Dec 2019Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribute to...
AIM
Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribute to postprandial glycaemic excursions with recommendations to consider protein when calculating mealtime insulin doses. The aim of this review is to identify and synthesize evidence about the glycaemic impact of dietary protein and insulin requirements for individuals with Type 1 diabetes.
METHODS
A systematic literature search of relevant biomedical databases was performed to identify research on the glycaemic impact of dietary protein when consumed alone, and in combination with other macronutrients in individuals with Type 1 diabetes.
RESULTS
The review included 14 published studies dated from 1992 to 2018, and included studies that researched the impact of protein alone (n = 2) and protein in a mixed meal (n = 12). When protein was consumed alone a glycaemic effect was not seen until ≥ 75 g. In a carbohydrate-containing meal ≥ 12.5 g of protein impacted the postprandial glucose. Inclusion of fat in a high-protein meal enhanced the glycaemic response and further increased insulin requirements. The timing of the glycaemic effect from dietary protein ranged from 90 to 240 min. Studies indicate that the postprandial glycaemic response and insulin requirements for protein are different when protein is consumed alone or with carbohydrate and/or fat.
CONCLUSIONS
This systematic review provides evidence that dietary protein contributes to postprandial glycaemic excursions and insulin requirements. These insights have important implications for the education of people with Type 1 diabetes and highlights the need for more effective insulin dosing strategies for mixed macronutrient meals.
Topics: Adolescent; Adult; Blood Glucose; Child; Diabetes Mellitus, Type 1; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Female; Humans; Hyperglycemia; Insulin; MEDLINE; Male; Meals; Postprandial Period; Time Factors
PubMed: 31454430
DOI: 10.1111/dme.14119