First meal size influences postprandial glycaemic control during prolonged sitting

  • Parr EB & al.
  • Nutrients
  • 6 Jun 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • A low energy first meal may be desirable for postprandial glucose and insulin regulation in adults with prediabetes during periods of prolonged sitting, particularly in the hours leading to lunch.
  • However, high energy first meal produced exaggerated plasma insulin and glucose responses until lunch, although 24-hour glycaemic control was not impaired.

Why this matters

  • No study has evaluated the effect of energy intake on daily glucose and insulin levels and the effect of meal size during prolonged periods of sittings in adults with diabetes.

Study design

  • Participants with diabetes completed 2 trial conditions in a randomised order separated by >10 days (n=13; mean±SD age, 60±6 years; BMI, 33±4 kg/m2; 2-hour oral glucose tolerance test: 8.9±1.1 mmol/L).
  • 3 meals were incorporated with different energy distribution: high-energy breakfast (HE-BF: breakfast, 50%; lunch, 30%; dinner, 20% energy intake) and low-energy breakfast (LE-BF: 20%/30%/50% energy intake).
  • Blood was collected hourly and 30 minutes post each meal.
  • Funding: Novo Nordisk Foundation Challenge Grant.

Key results

  • Mean plasma glucose concentration (+0.5 mmol/L; P=.014) and total plasma glucose area under the curve (AUC; +5.7 mmol/L/h; P=.019) was greater in the HE-BF group compared with LE-BF group.
  • In the HE-BF condition, postprandial glycaemic response, measured by incremental AUC (iAUC) was 44%±59% greater vs LE-BF (+2.9 mmol/h/L; P=.03).
  • However, in the LE-BF condition, a 55%±36% greater iAUC in the 4-hour post-lunch meal period was observed (+4.8 mmol/h/L; P=.02).
  • In the HE-BF, insulin was higher until 2-hour post-lunch (P<.03 and was elevated above baseline from hour post-meal for the entire day vs le-bf condition.>
  • Total insulin AUC was higher in the HE-BF vs LE-BF condition (P<.01>
  • 24-hour continuous glucose monitor showed no difference in mean glucose and total AUC between 2 trial conditions.


  • Lack of venous sampling after 1800 hours.