Postprandial Glucose Control With Different Hybrid Closed-Loop Systems According to Type of Meal in Adults With Type 1 Diabetes.

BACKGROUND: Hybrid Closed-Loop Systems (HCLs) may not perform optimally on postprandial glucose control. We evaluated how first-generation and advanced HCLs manage meals varying in carbohydrates, fat, and protein. METHOD: According to a cross-sectional design, seven-day food records and HCLs reports from 120 adults with type 1 diabetes (MiniMed670G: n = 40, MiniMed780G: n = 49, Control-IQ [C-IQ]: n = 31) were analyzed. Breakfasts (n = 570), lunches (n = 658), and dinners (n = 619) were divided according to the median of their carbohydrate (g)/fat (g) plus protein (g) ratio (C/FP). After breakfast (4-hour), lunch (6-hour), and dinner (6-hour), continuous glucose monitoring (CGM) metrics and early and late glucose incremental area under the curves (iAUCs) and delivered insulin doses were evaluated. The association of C/FP and HCLs with postprandial glucose and insulin patterns was analyzed by univariate analysis of variance (ANOVA) with a two-factor design. RESULTS: Postprandial glucose time-in-range 70 to 180 mg/dL was optimal after breakfast (78.3 ± 26.9%), lunch (72.7 ± 26.1%), and dinner (70.8 ± 27.3%), with no significant differences between HCLs. Independent of C/FP, late glucose-iAUC after lunch was significantly lower in C-IQ users than 670G and 780G (P < .05), with no significant differences at breakfast and dinner. Postprandial insulin pattern (Ins3-6h minus Ins0-3h) differed by type of HCLs at lunch (P = .026) and dinner (P < .001), being the early insulin dose (Ins0-3h) higher than the late dose (Ins3-6h) in 670G and 780G users with an opposite pattern in C-IQ users. CONCLUSIONS: Independent of different proportions of dietary carbohydrates, fat, and protein, postprandial glucose response was similar in users of different HCLs, although obtained through different automatic insulin delivery patterns.

Effects of a Low-Carbohydrate-High-Protein Pre-Exercise Meal in Type 1 Diabetes-a Randomized Crossover Trial.

CONTEXT: Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise. OBJECTIVE: To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump-treated type 1 diabetes. METHODS: Fourteen adults (11 women, 3 men) with insulin pump-treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise. RESULTS: Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P = .001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ-1.49 ± 1.89 vs HCLP: Δ-3.78 ± 1.95 mmol/L, P = .001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P < .001). CONCLUSION: Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise.

Size and Number of Food Boluses in the Stomach after Eating Different Meals: Magnetic Resonance Imaging Insights in Healthy Humans.

Oral processing of food results in the formation of food boluses, which are then swallowed and reach the stomach for further digestion. The number, size and surface properties of the boluses will affect their processing and emptying from the stomach. Knowledge of these parameters, however, is incomplete due to limitations of the techniques used. In this work, non-invasive magnetic resonance imaging (MRI) was used for the first time to measure boluses in the stomach a few minutes after swallowing. Three groups of nine healthy participants were fed three different meals: chicken and roasted vegetables (Meal 1), bread and jam (Meal 2) and cheese and yogurt (Meal 3), and then, their stomach content was imaged. The median number of boluses within the stomach was 282, 106 and 9 for Meal 1, Meal 2 and Meal 3 (p < 0.0001) with an average volume of 0.47 mL, 2.4 mL and 13.6 mL, respectively (p < 0.0001). The cohesiveness as well as the meal composition seem to play a key role in the resulting boluses. These new in vivo data from undisturbed organ imaging can improve knowledge of the digestion process, which will, in turn, inform in vitro and in silico modelling of digestion, thus improving their in vitro/in vivo relevance.

Impact of prolonged sitting and physical activity breaks on cognitive performance, perceivable benefits, and cardiometabolic health in overweight/obese adults: The role of meal composition.

BACKGROUND & AIMS: Physical activity (PA) breaks may effectively attenuate the detrimental impact of prolonged sitting on acute cognitive performance, perceivable benefits (e.g. mood), vascular function, and metabolic health. To date, the impact of meal composition on the effects of sedentary behavior and/or PA breaks on health has been scarcely studied. Therefore, our aim was to investigate whether meal composition alters how sedentary behavior and PA breaks affect these acute health outcomes. METHODS: A total of 24 overweight and obese, sedentary adults completed four conditions in randomized order in a cross-over design: [a] high-protein, low-fat breakfast (HPLF) + 4hrs uninterrupted sitting (SIT), [b] HPLF + 4hrs interrupted sitting (ACT; 5-min cycling every 30 min), [c] Western breakfast (WEST; higher in fats/simple sugars, lower in protein/fiber) + SIT, [d] WEST + ACT. WEST and HPLF were isocaloric. Linear mixed models were used to examine changes in cognitive performance (Test of Attentional Performance), perceivable benefits (Likert-scales, Profile of Mood States questionnaire), vascular health (carotid artery reactivity, blood pressure), and metabolic health (post-breakfast glucose, insulin, lipids). RESULTS: Independent of meal composition, we did not observe any effect of PA breaks on cognitive performance, vascular health and post-breakfast lipid responses. PA breaks delayed post-breakfast mood and vigor decrements, as well as increases in fatigue and sleepiness (all p < 0.05), but effects were independent of meal composition (p > 0.05). WEST resulted in higher post-breakfast glucose levels compared to HPLF (p < 0.05), while PA breaks did not impact this response (p > 0.05). PA breaks reduced post-breakfast insulin (p < 0.05), which did not differ between meals (p > 0.05). CONCLUSIONS: The acute impact of PA breaks and/or prolonged sitting on cognitive performance, perceivable benefits, and vascular and metabolic health was not altered by the composition of a single meal in overweight/obese, sedentary adults. Possibly, breaking up prolonged sitting, rather than meal composition, is a more potent strategy to impact acute health outcomes, such as perceivable benefits and insulin levels.

Practical Nutrition Knowledge Mediates the Relationship Between Sociodemographic Characteristics and Diet Quality in Adults: A Cross-Sectional Analysis.

PURPOSE: To investigate the direct and indirect effects of sociodemographic/health factors on diet quality through practical nutrition knowledge (PNK) about how to compose a balanced meal. DESIGN: A cross-sectional study using data from an online survey of the 10 000 Steps cohort (data collected November-December 2016). SETTING: Australia. PARTICIPANTS: Adults (n = 8161). Response rate was 16.7%. MEASURES: Self-reported lifestyle, health, and sociodemographic characteristics, including diet quality and PNK. ANALYSIS: The PROCESS macro for SPSS was used to conduct the mediation analyses. RESULTS: Better diet quality was associated with being female, older, more highly educated, and having a lower body mass index. Mediation analysis showed that PNK significantly mediated the associations between sex (a*b = 0.54, 95% confidence interval [CI] = 0.39-0.70) and education (vocational education: a*b = 0.22, 95% CI = 0.12-0.35, university: a*b = 0.48, 95% CI = 0.35-0.64), and diet quality. Practical nutrition knowledge suppressed the association between age and diet quality (a*b = -0.03, 95% CI = -0.04 to -0.03). CONCLUSION: Variations in diet quality between sociodemographic groups were partially explained by differences in PNK, suggesting that focusing public health efforts on increasing this specific knowledge type might be promising.

LDL-Cholesterol Lowering of Plant Sterols and Stanols-Which Factors Influence Their Efficacy?

The LDL-cholesterol (LDL-C) lowering effect of plant sterols/stanols (PSS) is summarized in several meta-analyses showing a dose-response relationship with intakes of 1.5 to 3 g/day lowering LDL-C by 7.5% to 12%. This review summarizes evidence for the impact of various factors potentially influencing the LDL-C-lowering efficacy of PSS. PSS are efficacious in all food formats and in food supplements. Some factors related to food format, e.g., solid vs. liquid foods, seem to impact efficacy, while there is no difference between free PSS and esters. Compared to multiple daily intakes, once-a-day intake of PSS, especially in the morning with light breakfast, leads to a sub-optimal LDL-C lowering. However, intake frequency seems influenced by intake occasion, i.e., with or without a meal, and time of day. Meal intake is a critical factor for an optimal LDL-C lowering efficacy of PSS. While age has no impact, gender is suggested to influence the LDL-C lowering effect of PSS with greater reductions reported for men than women; but overall evidence is inconclusive and larger studies show no gender by treatment interaction. In conclusion, PSS are efficacious in all foods and food supplements; for optimal efficacy they should be consumed with a (main) meal and twice daily.

Meal composition influences postprandial sensations independently of valence and gustation.

BACKGROUND: Palatability of meals with identical composition has been shown to influence postprandial sensations. Our aim was to determine to what extent meal composition influences postprandial sensations independently of palatability. METHODS: Randomized, crossover, double-blind trial comparing the postprandial responses to a low-fat vs a high-fat test meal, with the same physical and organoleptic characteristics (taste, smell, texture, color, and temperature). The test meal consisted in 150 g hummus containing either 17.7 g fat (low-fat) or 22.3 g fat (high-fat), 19.8 g toasts, 120 mL water and 50 g apple puree. In 12 non-obese healthy men, palatability, homeostatic sensations (hunger/satiety, fullness) and hedonic sensations (digestive well-being, mood) were measured on 10 cm scales before and during the 60-min postprandial period. Comparisons between meals were performed with a two-way repeated measures ANCOVA with premeal data as co-variate. KEY RESULTS: Both test meals were rated equally palatable (palatability scores 3.8 ± 0.3 low-fat, 3.3 ± 0.2 high-fat; P = .156). As compared to the high-fat meal, the low-fat meal induced more satisfaction (meal effect on well-being F(1,21) = 4.92; P = .038) and tended to improve mood (meal effect F(1,21) = 3.02; P = .064), and this was associated with a non-significant decrease in satiety (meal effect F(1,21) = 2.29; P = .145) and fullness (meal effect F(1,21) = 1.57; P = .224). CONCLUSIONS AND INFERENCES: The composition of meals with equal palatability influences postprandial satisfaction, even without significant impact on homeostatic sensations, although an effect on homeostatic sensations has not been excluded. These conditioning factors may have clinical implications in patients with impaired meal tolerance or meal-related symptoms.

Intestinal Absorption and Factors Influencing Bioavailability of Magnesium-An Update.

BACKGROUND: Information on the bioavailability of the essential mineral Mg2+ is sparse. OBJECTIVE/METHOD: Evaluation of the present knowledge on factors influencing the bioavailability and intestinal absorption of Mg2+. RESULTS: Mg2+ is absorbed via a paracellular passive and a transcellular active pathway that involves TRPM6/7 channel proteins. The bioavailability of Mg2+ varies within a broad range, depending on the dose, the food matrix, and enhancing and inhibiting factors. Dietary factors impairing Mg2+ up-take include high doses of other minerals, partly fermentable fibres (e.g., hemicellulose), non-fermentable fibres (e.g., cellulose, lignin), phytate and oxalate, whereas proteins, medium-chain-triglycerides, and low- or indigestible carbohydrates (e.g., resistant starch, oligosaccharides, inulin, mannitol and lactulose) enhance Mg2+ uptake. The Mg2+ dose is a major factor controlling the amount of Mg2+ absorbed. In principle, the relative Mg2+ uptake is higher when the mineral is in-gested in multiple low doses throughout the day compared to a single, large intake of Mg2+. The type of Mg2+ salt appears less relevant than is often thought. Some studies demonstrated a slightly higher bioavailability of organic Mg2+ salts compared to inorganic compounds under standardized conditions, whereas other studies did not. CONCLUSION: Due to the lack of standardized tests to assess Mg2+ status and intestinal absorption, it remains unclear which Mg2+ binding form produces the highest bioavailability. The Mg2+ intake dose combined with the endogenous Mg2+ status is more important. Because Mg2+ cannot be stored but only retained for current needs, a higher absorption is usually followed by a higher excretion of the mineral.

Exploratory analysis of meal composition in Australia: meat and accompanying foods.

OBJECTIVE: The study of meal patterns and overall diet in relation to health outcomes may be more important than focusing on single nutrients or food groups. The present study aimed to explore the composition of main meals and snacks in the Australian population and examine associations between meat/poultry/fish and other foods. DESIGN: The study utilised 24 h recalls. Meal composition was defined based on average intakes of food groups per meal disaggregated from all food sources. SETTING: 2011-12 National Nutrition and Physical Activity Survey. SUBJECTS: Australian people (n12153) aged 2 years or above. RESULTS: Overall, breakfast was the smallest meal of the day, typically consisting of grains, dairy products and fruit. Lunch was the second largest meal, consisting mostly of grains, non-starchy vegetables and meat/poultry/fish. The largest meal was dinner, comprising meat/poultry/fish, vegetables (starchy and non-starchy), grains and often including discretionary beverages (children) or alcohol (adults). The main food groups consumed at snacking occasions were dairy, fruit, discretionary foods and beverages (including alcohol for adults). The most frequently consumed meat types were beef and chicken at dinner and ham at lunch. Non-starchy vegetables were accompanying foods for red meat, poultry and fish/seafood consumed in varying portion sizes, but did not accompany processed meat. CONCLUSIONS: The present study considered meat, poultry and fish as the meal centre and their accompaniments of other food groups at different eating occasions. These findings expand the background evidence for health professionals developing meal-based framework/guidelines and public health messages.

Effect of meal composition on postprandial glucagon-like peptide-1, insulin, glucagon, C-peptide, and glucose responses in overweight/obese subjects.

BACKGROUND: Glucagon-like peptide-1 (GLP-1), an incretin hormone, is released in response to food intake. It is unclear how meals high in protein (HP) and monounsaturated fat (HMF) affect GLP-1 response. PURPOSE: To examine the effect of a HP versus a HMF meal on GLP-1 response. METHODS: Twenty-four overweight/obese participants consumed two meals (HP: 31.9 % energy from protein; HMF: 35.2 % fat and 20.7 % monounsaturated fat) in a random order. Both meals contained the same energy and carbohydrate content. GLP-1, insulin, glucagon, C-peptide, and glucose were assessed from blood drawn in the fasting and postprandial states. The effect of meal condition on hormone and glucose responses and appetite ratings were assessed by repeated measures analysis. RESULTS: Statistically significant (p < 0.01) time by meal condition effect was observed on active GLP-1, total GLP-1, insulin, C-peptide, and glucagon, but not glucose (p = 0.83). Area under the curve was significantly higher during the HP versus the HMF meal conditions for active GLP-1 (23.7 %; p = 0.0007), total GLP-1 (12.2 %; p < 0.0001), insulin (54.4 %; p < 0.0001), C-peptide (14.8 %; p < 0.0001), and glucagon (40.7 %; p < 0.0001). Blood glucose was not different between the HP versus HMF conditions (-4.8 %; p = 0.11). Insulin sensitivity was higher during the HMF versus HP conditions (Matsuda index mean difference: 16.3 %; p = 0.007). Appetite ratings were not different by meal condition. CONCLUSIONS: GLP-1 and insulin responses were higher during the HP condition. However, no difference was found in blood glucose between conditions, and insulin sensitivity was higher during the HMF condition, indicating that a HMF meal may be optimal at regulating blood glucose in overweight/obese individuals without type 2 diabetes.

Postprandial insulin action relies on meal composition and hepatic parasympathetics: dependency on glucose and amino acids: Meal, parasympathetics & insulin action.

Insulin sensitivity (IS) increases following a meal. Meal composition affects postprandial glucose disposal but still remains unclear which nutrients and mechanisms are involved. We hypothesized that gut-absorbed glucose and amino acids stimulate hepatic parasympathetic nerves, potentiating insulin action. Male Sprague-Dawley rats were 24 h fasted and anesthetized. Two series of experiments were performed. (A) IS was assessed before and after liquid test meal administration (10 ml.kg(-1), intraenteric): glucose + amino acids + lipids (GAL, n=6); glucose (n=5); amino acids (n=5); lipids (n=3); glucose + amino acids (GA, n=9); amino acids + lipids (n=3); and glucose + lipids (n=4). (B) Separately, fasted animals were submitted to hepatic parasympathetic denervation (DEN); IS was assessed before and after GAL (n=4) or GA administration (n=4). (A) Both GAL and GA induced significant insulin sensitization. GAL increased IS from 97.9±6.2 mg glucose/kg bw (fasting) to 225.4±18.3 mg glucose/kg bw (P<0.001; 143.6±26.0% potentiation of IS); GA increased IS from 109.0±6.6 to 240.4±18.0 mg glucose/kg bw (P<0.001; 123.1±13.4% potentiation). None of the other meals potentiated IS. (B) GAL and GA did not induce a significant insulin sensitization in DEN animal. To achieve maximal insulin sensitization following a meal, it is required that gut-absorbed glucose and amino acids trigger a vagal reflex that involves hepatic parasympathetic nerves.

What is healthy food? Objective nutrient profile scores and subjective lay evaluations in comparison.

To date, it is unclear how consumers evaluate the healthiness of individual foods and meals and how consumers' perceptions are related to expert opinions. This knowledge is essential for efficient communication of nutrition information with the goal of promoting healthy eating. This study used the fake food buffet method to investigate health perceptions of selected meals and of 54 individual foods and beverages. Lay consumers' subjective healthiness evaluations of meals and foods were compared to objective nutrient profile scores, which were previously shown to correlate highly with expert opinions. The results show that nutrition profile scores and lay evaluations were highly correlated, which indicates that lay people used similar criteria as experts to evaluate the healthiness of foods. However, lay consumers tended to neglect the amount of saturated fat, protein and sodium for their judgments. Also, it was found that while lay consumers were quite able to evaluate single food products, they had difficulties in evaluating entire meals. Future interventions should focus particularly on educating the consumer about the negative effects of diets high in salt and saturated fat and they should improve the consumer's abilities to evaluate entire meals.

The web-buffet--development and validation of an online tool to measure food choice.

OBJECTIVE: To date, no data exist on the agreement of food choice measured using an online tool with subsequent actual consumption. This needs to be shown before food choice, measured by means of an online tool, is used as a dependent variable to examine intake in the general population. DESIGN: A 'web-buffet' was developed to assess food choice. SETTING: Choice was measured as planned meal composition from photographic material; respondents chose preferred foods and proportions for a main meal (out of a possible 144 combinations) online and the validity was assessed by comparison of a meal composed from a web-buffet with actual food intake 24-48 h later. Furthermore, correlations of food preferences, energy needs and health interest with meals chosen from the web-buffet were analysed. SUBJECTS: Students: n 106 (Study I), n 32 (Study II). RESULTS: Meals chosen from the web-buffet (mean = 2998 kJ, SD = 471 kJ) agreed with actual consumption (rs = 0.63, P < 0.001) but were on average 367 kJ (10.5%) lower in energy than consumed meals (mean = 3480 kJ, SD = 755 kJ). Preferences were highly associated with chosen amounts and health interest was negatively correlated with the energy selected (rs = -0.40, P<0.001). CONCLUSIONS: Meal composition choice in the web-buffet agrees sufficiently well with actual intake to measure food choice as a dependent variable in online surveys. However, we found an average underestimation of subsequent consumption. High correlations of preferences with chosen amounts and an inverse association of health interest with total energy further indicate the validity of the tool. Applications in behavioural nutrition research are discussed.

The interaction between nutrition and the brain and its consequences for body weight gain and metabolism; studies in rodents and men.

Aberrant feeding behavior can lead to obesity and obesity-related medical consequences, such as insulin resistance and diabetes. Although alterations in glucose metabolism (i.e. insulin resistance), in the presence of excessive fat tissue are often explained by the consequences of dysfunctional adipose tissue, evidence is emerging that also altered brain functions might be an important determinant of insulin resistance. In this review, we provide an overview of how feeding behavior and obesity interact with brain circuitry and how these interactions affect glucose metabolism. Because brain circuitries involved in food intake have been shown to partly control glucose metabolism as well, targeting these circuitries in obese subjects might not only affect food intake and body weight but also glucose metabolism.

The influence of plate size on meal composition. Literature review and experiment.

Environmental factors, such as the size of containers, can influence our energy intake. Even though different sized food containers are often recommended to control portion sizes, the evidence to support this is contradictory. In the present study, we conducted a literature review and a controlled laboratory experiment to investigate whether plate size influences the composition of a meal and the total meal energy. The results of the review suggest that distraction factors, the type of container, the food-serving mode (self-service or being served) and the type of food offered all influenced the results observed in the various published studies. For the experiment in this study, eighty-three participants were individually invited to serve themselves a lunch from a buffet containing 55 replica food items. Either a standard size plate (27 cm) or a large plate (32 cm) was provided to the participants. The results of the experiment suggest that the plate size had no significant effect on the total energy of the meal (F(1,81) =0.782, P> .05). However, participants using a large plate served themselves significantly more vegetables (F(1,81) =4.786, P< .05), particularly vegetables generally eaten as side dishes (F(1,81) =6.804, P< .05). Therefore, reducing the plate size does not seem to be an appropriate intervention to reduce the total energy intake in order to promote weight loss. Rather, using a large plate might be a simple and inexpensive strategy to increase vegetable consumption.