Correlates of Recent HIV Testing Among People Who Inject Drugs in Rural Areas: A Multi-site Cross-Sectional Study, 2018-2020.

The Rural Opioid Initiative surveyed 2693 people who inject drugs (PWID) in eight rural U.S. areas in 2018-2020 about self-reported HIV testing in the past 6 months. Correlates of interest included receipt of any drug-related services, incarceration history, and structural barriers to care (e.g., lack of insurance, proximity to syringe service programs [SSP]). Overall, 20% of participants reported receiving an HIV test within the past 6 months. Multivariable generalized estimating equations showed that attending substance use disorder (SUD) treatment (OR 2.11, 95%CI [1.58, 2.82]), having health insurance (OR 1.42, 95%CI [1.01, 2.00]) and recent incarceration (OR 1.49, 95%CI [1.08, 2.04]) were positively associated with HIV testing, while experiencing a resource barrier to healthcare (inability to pay, lack of transportation, inconvenient hours, or lack of child care) had inverse (OR 0.73, 95%CI [0.56, 0.94]) association with HIV testing. We found that the prevalence of HIV testing among rural PWID is low, indicating an unmet need for testing. While SUD treatment or incarceration may increase chances for HIV testing for rural PWID, other avenues for expanding HIV testing, such as SSP, need to be explored.

Age and Sex Interact to Determine the Effects of Commonly Consumed Dairy Products on Postmeal Glycemia, Satiety, and Later Meal Food Intake in Adults.

BACKGROUND: Dairy consumption reduces postprandial glycemia and appetite when consumed with carbohydrates. OBJECTIVES: The objective was to test the effects of frequently consumed dairy products, age, and sex on glycemia, appetite, and food intake. METHODS: In a randomized, unblinded, crossover design, 30 older [60-70 y; BMI (kg/m2): 18.5-29.9] and 28 young (20-30 y; BMI: 18.5-24.9) adults consumed 500 mL of a calorie-free control (water), skim milk and whole milk, 350 g Greek yogurt, and 60 g cheddar cheese. Food intake at an ad libitum meal was measured 120 min later. Glycemia, appetite, and gastric hormone responses were measured premeal (15-120 min), within-meal (120-140 min), and postmeal (140-170 min). Effects of treatment, age, and sex and their interactions were analyzed using ANOVA followed by Tukey's post hoc test. RESULTS: All forms of dairy, compared with water, decreased postmeal glycemia, premeal appetite, and meal intake (P < 0.0001). Premeal glucose, insulin, and glucagon-like peptide 1 increased, and ghrelin decreased, but effects of dairy differed with age and sex. Older adults had 10% higher pre- and postmeal glucose (P < 0.01). Premeal appetite suppression per 100 kcal of treatments was more after yogurt than other dairy, but overall appetite suppression was less in older adults than in young adults and in males than in females (P < 0.05). Pizza intake was reduced by 175 kcal after yogurt and cheese and by 82 kcal after milks compared to water (P < 0.001). Mealtime reduction for treatment calories averaged 62% after yogurt and cheese but was less at 33% after milks (P < 0.05). Compensation was less in older (33%) than in young (63%) adults (P < 0.03). CONCLUSIONS: Dairy products consumed in usual forms before a meal stimulate metabolic responses leading to reduced premeal appetite, later food intake, and postmeal glycemia, but their effects differ in magnitude and with the sex and age of adults.

Role of Amino Acids in Blood Glucose Changes in Young Adults Consuming Cereal with Milks Varying in Casein and Whey Concentrations and Their Ratio.

BACKGROUND: Increasing the total protein content and reducing the casein to whey ratio in milks consumed with breakfast cereal reduce postprandial blood glucose (BG). OBJECTIVES: We aimed to explore associations between plasma amino acids (AAs), BG, and glucoregulatory hormones. METHODS: In this repeated-measures design, 12 healthy adults consumed cereal (58 g) and milks (250 mL) with 3.1 wt% or high 9.3 wt% protein concentrations and with casein to whey ratios of either 80:20 or 40:60. Blood was collected at 0, 30, 60, 120, 140, 170, and 200 min for measurement of the primary outcome, BG, and for the exploratory outcomes such as plasma AA, gastric emptying, insulin (INS), and glucoregulatory hormones. Measures were made prior to and after an ad libitum lunch at 120 min. Exploratory correlations were conducted to determine associations between outcomes. RESULTS: Pre-lunch plasma AA groups [total (TAA), essential (EAA), BCAA, and nonessential (NEAA)] were higher after 9.3 wt% than 3.1 wt% milks by 12.7%, 21.4%, 20.9%, and 7.6%, respectively (P ≤ 0.05), while post-lunch AA groups were higher by 10.9%, 19.8%, 18.8%, and 6.0%, respectively (P ≤ 0.05). Except for NEAA, pre-lunch AAs were higher after 40:60 than 80:20 ratio milks by 4.5%, 8.3%, and 9.3% (P ≤ 0.05). When pooled by all treatments, pre-lunch AA groups associated negatively with BG (r/ρ ≥ -0.45, P ≤ 0.05), but post-lunch only TAA and NEAA correlated (r ≥ -0.37, P < 0.05). Pre-lunch BG was inversely associated with Leu, Ile, Lys, Met, Thr, Cys-Cys, Asn, and Gln (r/ρ ≥ -0.46, P ≤ 0.05), but post-lunch, only with Thr, Ala, and Gly (r ≥ -0.50, P ≤ 0.05). Pre-lunch associations between AA groups and INS were not found. CONCLUSIONS: Protein concentration and the ratio of casein to whey in milks consumed at breakfast with cereal affect plasma AA concentrations and their associations with decreased BG. The decrease in BG could be explained by INS-independent mechanisms. This trial was registered at www.clinicaltrials.gov as NCT02471092.

Metabolic response to oral glucose tolerance test performed in neutral and warm environmental temperature.

Objective: Hot environments are associated with impaired glucose metabolism at rest in healthy humans. The purpose of this study was to explore the contribution of key glucoregulatory hormones and biomarkers to this altered glucose tolerance. Methods: The effects of ambient temperature on glucose tolerance and its determinants were assessed with a 3-hr oral glucose tolerance test (OGTT) administered to 19 healthy young men and women at 22 °C and 31 °C. Results: The glucose response amplitude was greater in warm environment (AUC 904 ± 151 vs. 721 ± 89 mmol/l·180 min at 31 °C and 22 °C, respectively, p < .001). There was no significant effect of environmental temperature on insulin, growth hormone or pancreatic polypeptide concentrations (all p > .17). The cortisol response to the glucose load was reduced 30, 60, 90 and 120 minutes postload at 31 °C compared with 22 °C (p = .001). The interleukin-6 concentration was also lower in the session at 31 °C (p = .043). Conclusion: We conclude that the effects of environmental temperature on the glucoregulatory hormones and biomarkers reported in this study do not explain the exaggerated increase in blood glucose after a glucose load taken in a warm environmental temperature. Precis statement: This work demonstrates in healthy men and women that the ingestion of glucose elicits an exaggerated increase in blood glucose when the environmental temperature is warm.

Increased milk protein content and whey-to-casein ratio in milk served with breakfast cereal reduce postprandial glycemia in healthy adults: An examination of mechanisms of action.

This study describes the effects on glycemic response and the underlying mechanisms of action of increasing the protein concentration and decreasing the casein-to-whey ratio in milk when consumed with a high glycemic breakfast cereal. Twelve healthy men and women, aged 18 to 30 yr and with a body mass index of 20 to 24.9 kg/m2, consumed (in random order) milk beverages (250 mL) containing either 3.1 or 9.3% protein and casein-to-whey ratios of either 80:20 or 40:60. We measured postprandial appetite, glucose, regulatory hormones, and stomach emptying rate over 200 min, as well as food intake at an ad libitum meal at 120 min. Although pre-meal appetite was suppressed to a greater extent with milk beverages that had high (9.3%) compared with regular (3.1%) protein content, food intake was similar among all 4 treatments. Pre-meal mean blood glucose was lower with beverages that had high rather than regular milk protein content, with the lowest glucose peaks after the high milk protein treatment with the 40:60 casein-to-whey ratio. Pre-meal insulin and C-peptide levels were not affected by milk protein content or casein-to-whey ratio, but pre-meal glucagon-like peptide 1 was higher after the treatment containing high milk protein and the 40:60 casein-to-whey ratio, and pre-meal cholecystokinin was higher after the treatments containing high milk protein content. Plasma paracetamol response was also lower after the treatments containing high compared with regular milk protein content. When consumed with carbohydrate, milk beverages with high protein content and (to a lesser extent) a decreased casein-to-whey ratio lowered postprandial glycemia through insulin-independent mechanisms, primarily associated with delayed stomach emptying.

Recent advances in dietary proteins and lipid metabolism.

PURPOSE OF REVIEW: There is growing interest in defining the dietary approaches for the management of lipid disorders. This review focuses on dietary proteins. RECENT FINDINGS: Increasing protein intake was coupled with improved lipid profiles in humans and animals. However, most studies increased the protein content by reducing that of fat or carbohydrate or both, making unclear the role of protein alone. Mechanisms of action differ with the sources of proteins, because of amino acid composition and bioactive peptides encrypted in their sequences. Soy protein was investigated the most, and many studies show that its consumption reduces blood cholesterol. The role of other constituents including isoflavones is debated. Short-term studies are consistent in showing lipid-lowering properties of whey proteins, attributed to their relative high content in branched chain amino acids. A limited number of studies, the majority being on animals, have shown hypocholesterolemic activities of fish proteins. SUMMARY: Dietary proteins regulate lipid metabolism in a manner dependent on their quantity and composition. There is a general consensus that proteins slow lipid absorption and synthesis, and promote lipid excretion. The benefits of dietary proteins remain to be confirmed in individuals with lipid abnormalities, for formulation of optimal dietary alternatives for the management of lipid disturbances.

Barriers to Healthcare and Social Service Utilization Among Rural Older Adults Who Use Drugs.

The objective of this study was to understand barriers to healthcare and social service utilization among older adults residing in rural areas who use drugs. A cross-sectional survey of persons who use opioids or inject drugs in rural counties with high overdose rates across ten states was conducted. For this analysis, participants were restricted to only the 375 individuals aged 50 and older. They were asked about barriers to utilizing healthcare and social services. Multivariate analyses were conducted. The most common barriers were a lack of transportation and a fear of stigma. The average number of barriers was 2.53. Those who were either uninsured or homeless endorsed 37% more barriers. For every five-year increase in age, the number of barriers reduced by 15%. Efforts to reduce these barriers may include expanding eligibility for transportation and housing services and leveraging trusted community members to broker linkages to providers to overcome stigma.

Caloric beverages consumed freely at meal-time add calories to an ad libitum meal.

The objective was to compare the effects of ad libitum consumption of commonly consumed meal-time beverages on energy and fluid intakes and post-meal average subjective appetite and blood glucose in healthy adults. In a randomized controlled design, 29 males and females consumed to satiation an ad libitum pizza meal with one of five beverages in unlimited amount including water (0 kcal), 1% milk (44 kcal/100 ml), regular cola (44 kcal/100 ml), orange juice (44 kcal/100 ml) and diet cola (0 kcal). Food and fluid intakes were measured at the meal. Average subjective appetite and blood glucose were measured before and for 2h after the meal. Although energy intake from pizza was similar among all beverage treatments, the amount of fluid consumed (g) varied among the beverages with intake of orange juice higher than regular and diet cola, but not different from water or milk. Meal-time ingestion of caloric beverages, milk, orange juice and regular cola, led to higher total meal-time energy intakes compared to either water or diet cola. Post-meal blood glucose area under the curve (AUC) was lower after milk than after meals with water, orange juice and regular cola and post-meal average subjective appetite AUC was lower after milk than after meals with water. Meal intakes of nutrients including protein, calcium, phosphorus, zinc, vitamins B12, A and D were higher at the meal with milk compared to the other beverages. Thus, caloric beverages consumed ad libitum during a meal add to total meal-time energy intake, but 1% milk favors a lower post-meal blood glucose and average subjective appetite score and adds to nutrient intake.

Energy and macronutrient content of familiar beverages interact with pre-meal intervals to determine later food intake, appetite and glycemic response in young adults.

The objective was to compare the effects of pre-meal consumption of familiar beverages on appetite, food intake, and glycemic response in healthy young adults. Two short-term experiments compared the effect of consumption at 30 (experiment 1) or 120 min (experiment 2) before a pizza meal of isovolumetric amounts (500 mL) of water (0 kcal), soy beverage (200 kcal), 2% milk (260 kcal), 1% chocolate milk (340 kcal), orange juice (229 kcal) and cow's milk-based infant formula (368 kcal) on food intake and subjective appetite and blood glucose before and after a meal. Pre-meal ingestion of chocolate milk and infant formula reduced food intake compared to water at 30 min, however, beverage type did not affect food intake at 2h. Pre-meal blood glucose was higher after chocolate milk than other caloric beverages from 0 to 30 min (experiment 1), and after chocolate milk and orange juice from 0 to 120 min (experiment 2). Only milk reduced post-meal blood glucose in both experiments, suggesting that its effects were independent of meal-time energy intake. Combined pre- and post-meal blood glucose was lower after milk compared to chocolate milk and orange juice, but did not differ from other beverages. Thus, beverage calorie content and inter-meal intervals are primary determinants of food intake in the short-term, but macronutrient composition, especially protein content and composition, may play the greater role in glycemic control.

Gluten-Free Product Recalls and Their Impact on Consumer Trust.

The range of gluten-free food products available to consumers is steadily expanding. In recent years, recalls of food products have highlighted the importance of accurate labeling of food products for the presence of wheat, other gluten-containing cereals, or gluten itself as refined ingredient. The purpose of this study was to gain more insights into recent food recalls related to undeclared gluten/wheat contamination and consumer experiences with these recalls. Recalls of products triggered by gluten contamination are relatively scarce and are not often triggered by a consumer complaint. The impact of these recalls on consumer trust was evaluated through an online survey that was distributed among supporters of Celiac Canada (CCA) and covered (i) strategies to adhere to a gluten-free diet, (ii) experiences with gluten-free recalls and their impact on consumer trust, and (iii) demographic information. Consumer concern regarding gluten-free product recalls is significant, but the concern regarding recalls is not heightened after experiencing a recall. Companies pursuing transparency in the process, identification of the source of contamination, and mitigation strategies going forward are likely to retain consumer trust in their product and brand. Based on the survey results, further efforts focusing on consumer education regarding interpreting nutrient labels, identifying sources of information on product recalls, and understanding procedures to follow upon suspected gluten contamination of a gluten-free product are recommended.

Determinants of supplementation among Canadian university students: a theory of planned behavior perspective.

OBJECTIVE: The purpose of this study was to identify the psychosocial determinants of (1) intention to use dietary supplements (DS) and (2) the behavior of engaging in supplementation by testing the fit of the Theory of Planned Behavior (TPB). METHODS: A total of 778 students at a Canadian university in Ontario completed a cross-sectional survey assessing participants' attitude, injunctive norm, descriptive norm, perceived behavioral control and intention toward DS use. Data were analyzed using independent sample t-tests and linear and logistic regressions. RESULTS: Attitude, injunctive norm and perceived behavioral control were significant predictors of intention to use DS. Attitude, injunctive norm and intention were significant predictors of engaging in supplementation. The model explained 75.5% of the variance and correctly classified 89.6% of cases. The odds of using DS doubled with every one-unit increase in intention. CONCLUSIONS: This study confirms the utility of the TPB in predicting university students' supplementation habits.

Dietary Supplements: A Gateway to Doping?

Dietary supplements are widely used among athletes, but many may be unaware of the potential for unintentional doping, especially considering that supplements can often be contaminated with prohibited substances. The reason behind the widespread use of dietary supplements among athletes is often cited as being for the purposes of enhancing health or performance. However, many athletes turn to unreliable sources of information, and often lack knowledge of dietary supplement regulations. The aim of this narrative review is to explore the current research surrounding the psychological constructs (such as norms, attitudes, and beliefs) related to dietary supplement use among athletes that may lead to inadvertent doping. This review also covers possible programme structures that may be effective at preventing inadvertent doping.

Prevalence of Dietary Supplement Use among Athletes Worldwide: A Scoping Review.

Athletes represent a major part of dietary supplement users. This scoping review aims to explore the prevalence of dietary supplement use among athletes worldwide, most commonly used supplements, sources of information on dietary supplements and their reasons for use of these supplements. PubMed, CINAHL, MEDLINE, and PsycInfo were searched for original research articles. Studies were included if they involved athletes, identified the prevalence of dietary supplement use, and were published after 2017. A total of 26 articles were reviewed. Prevalence of dietary supplement use varied among articles, but sex-based differences related to the types of used dietary supplements existed. Generally, the findings were consistent in terms of reasons for use and sources of information. Unfortunately, the lack of homogeneity regarding the definition of dietary supplements, definition of use, reporting timeframes, and data collection methods complicates the attempt to compare the findings among studies.

Rural and urban differences in undersupply of buprenorphine provider availability in the United States, 2018.

BACKGROUND: Medications to treat opioid use disorder (OUD) including buprenorphine products are evidence-based and cost-effective tools for combating the opioid crisis. However, limited availability to buprenorphine is pervasive in the United States (US) and may serve to exacerbate the deadly epidemic. Although prior research points to rural counties as especially needy of strategies that improve buprenorphine availability, it is important to investigate the availability of waivered providers according to treatment need as defined by the county-level rate of opioid-overdose deaths (OOD). This study examined differences in buprenorphine provider availability relative to treatment need among rural and urban counties in the US. METHODS: Buprenorphine provider availability relative to need in each county was defined as the number of waivered providers divided by the rate of OODs (i.e., number of OODs/100,000 population), according to 2018 data. Counties with ratios in the bottom tertile of their state were classified as buprenorphine undersupplied. We estimated logit models to statistically test the association of rurality and state main effects and their interaction terms (independent variables) and the county classified as buprenorphine undersupplied (dependent variable). RESULTS: A total of 38 states and 2595 counties had sufficient non-suppressed data to remain in the analysis. A larger percent of urban counties (36.43%) than rural counties (32.01%) were classified as buprenorphine undersupplied (p = 0.001). The likelihood of a rural county being undersupplied varied considerably by state (Chi Square = 82.88, p = 0.000). All states with significant (p < 0.05 or p < 0.10) interaction terms showed lower likelihood of buprenorphine undersupply in rural counties. CONCLUSIONS: The rural-urban distribution in undersupply of waivered buprenorphine providers relative to need varied markedly by state. Strategies for improving access to buprenorphine-waivered providers should be state-centric and informed by county-specific indicators of need.

Dietary approaches to managing nonalcoholic fatty liver disease.

ABSTRACT: Nonalcoholic fatty liver disease (NAFLD), a multisystem, prevalent liver disease, can be managed with lifestyle interventions, including diet, given the lack of well-established pharmacologic therapies. This review explores the different dietary approaches that have been found effective in the management of NAFLD, offering a unique resource to healthcare professionals.

Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review.

The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents.

Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study.

BACKGROUND: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. OBJECTIVE: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). METHODS: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC's COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. RESULTS: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed. CONCLUSIONS: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis.

Dietary Supplementation Practices among Varsity Athletes at a Canadian University.

BACKGROUND: Given the risks of inadvertent doping associated with dietary supplement (DS) use, it is critical to explore the extent of dependence of varsity athletes on DS to improve performance and support recovery. The purpose of this study was to gain insight into dietary supplementation practices among varsity athletes in a university setting in Ontario, Canada. METHODS: An online DS use questionnaire was completed by 302 varsity athletes (30.5% male, 69.5% female; 20.5 ± 1.8-year old) who were competing in intermittent, power and endurance-based sports at the University of Guelph. The data from supplement users were analyzed using a Chi-square analysis to investigate type of DS consumption, frequency of use and reasons for use. RESULTS: Overall, 58.3% of athletes reported having used at least one type of DS in the past six months. Gender and age had significant associations with prevalence of DS use, with male athletes and athletes over 20-year old being more likely to be DS users. The most frequently reported reasons for consuming DS were to maintain good health, increase energy, promote recovery, correct or prevent micronutrient deficiencies and supply convenient forms of energy and/or macronutrients. Although, most athletes were using reliable sources of information, health care professionals, 58.6% still mentioned wanting to become more knowledgeable about DS. CONCLUSIONS: Findings from this study may guide the development of educational materials needed to address knowledge gaps on DS among varsity athletes.

Postprandial ghrelin and PYY responses of male subjects on low carbohydrate meals to varied balancing proportions of proteins and fats.

PURPOSE: This study was conducted to investigate whether a higher proportion of protein or fat is more favorable for optimal ghrelin and peptide YY (PYY) release in subjects consuming low carbohydrate meals. METHODS: Eight normal weight men received, on three separate occasions, high protein low fat (HPLF) (40% protein, 25% fat), low protein high fat (LPHF) (10% protein, 55% fat) or medium protein medium fat (MPMF) (25% protein, 40% fat) meals, with equal low carbohydrates content in all three meals (35% of energy). Postprandial blood samples were collected before and 15, 30, 60, 120, 180 and 240 min following the ingestion of each meal. Plasma acylated ghrelin and PYY(3-36) as well as serum insulin, glucose and triglycerides were measured. RESULTS: Comparing meals and considering each time point separately, a trend for a statistically significant difference in acylated ghrelin was observed between HPLF and LPHF meals and a statistically significant change of PYY from baseline was noted between HPLF and LPHF meals as compared to the MPMF meal at certain time points. When data were pooled together, a statistically significant difference in acylated ghrelin change from baseline was observed between HPLF and LPHF meals, while both HPLF and LPHF meals resulted in a significantly higher PYY(3-36) release in comparison to MPMF meal. AUC data analysis for PYY(3-36) revealed significantly higher values following HPLF in comparison to MPMF meal. Correlation analysis revealed a significant negative correlation between acylated ghrelin and insulin only with the HPLF meal. Postprandial glucose and triglyceride levels were not significantly different between the three meals. CONCLUSIONS: In subjects consuming low carbohydrate meals, higher concentrations of proteins to fat seem to have more favorable effects on postprandial appetite hormones.

Metabolic and appetite hormone responses of hyperinsulinemic normoglycemic males to meals with varied macronutrient compositions.

AIMS: The aim of this study was to investigate the appetite hormones and metabolic responses of hyperinsulinemic subjects to high-protein (HP) meals as compared to high-carbohydrate (HC) and high-fat (HF) meals. DESIGN: Fifteen hyperinsulinemic normoglycemic men received, on 3 separate occasions, HP, HC, or HF meals in a randomized crossover design. Blood samples were collected before and after the ingestion of each meal. Postprandially, acylated ghrelin, PYY(3-36), insulin, glucose, and triglycerides were measured. RESULTS: While the HC meal induced an acutely greater postprandial ghrelin decrease below baseline, the HP meal maintained this decline significantly more than the HF meal at 240 min. Postprandial PYY(3-36) responses did not significantly vary with time and meal composition. Postprandial insulin and glucose peaks were significantly lower following the HP and HF meals in comparison to the HC meal, whereas triglyceride responses were significantly higher following the HF meal. Significant correlations, negative between acylated ghrelin and insulin and positive between PYY(3-36) and insulin, were observed. CONCLUSIONS: In hyperinsulinemic normoglycemic men, HP meals ensure a longer-lasting suppression of circulating ghrelin levels and result in more favorable metabolic responses, characterized by a lower surge of postprandial insulin and glucose and a reduced postprandial triglyceride response, as compared to both HC and HF meals.