Mechanisms through which a small protein and lipid preload improves glucose tolerance

Tricò, Domenico; Baldi, Simona; Tulipani, Alberto; Frascerra, Silvia; Macedo, M. Paula; Mari, Andrea; Ferrannini, Ele; Natali, Andrea

doi:10.1007/s00125-015-3710-9

Cited by 45 publications

(47 citation statements)

References 49 publications

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“…Alternative preloads could be evaluated; Tricò et al (32) recently reported that a preload of protein (egg) and fat (cheese) reduced the glycemic response to oral glucose substantially, but the effect on the secretion of incretin hormones was rather modest, despite higher caloric value of the preload compared with our whey preload. We studied only male patients with relatively good glycemic control on metformin in order to minimize heterogeneity in this "proof of concept" study.…”

Section: Discussionmentioning

confidence: 99%

A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes

Little

Bound

et al. 2016

Diabetes Care

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OBJECTIVENutrient "preloads" given before meals can attenuate postprandial glycemic excursions, at least partly by slowing gastric emptying and stimulating secretion of the incretins (i.e., glucagon-like peptide-1 [GLP-1] and glucose-dependent insulinotropic polypeptide [GIP]). This study was designed to evaluate whether a protein preload could improve the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin to increase incretin concentrations, slow gastric emptying, and lower postprandial glycemia in type 2 diabetes. RESEARCH DESIGN AND METHODSTwenty-two patients with type 2 diabetes treated with metformin were studied on four occasions, receiving either 50 mg vildagliptin (VILD) or placebo (PLBO) on both the evening before and the morning of each study day. The latter dose was followed after 60 min by a preload drink containing either 25 g whey protein (WHEY) or control flavoring (CTRL), and after another 30 min by a 13 C-octanoate-labeled mashed potato meal. Plasma glucose and hormones, and gastric emptying, were evaluated. RESULTSCompared with PLBO/CTRL, PLBO/WHEY reduced postprandial peak glycemia, increased plasma insulin, glucagon, and incretin hormones (total and intact), and slowed gastric emptying, whereas VILD/CTRL reduced both the peak and area under the curve for glucose, increased plasma intact incretins, and slowed gastric emptying but suppressed plasma glucagon and total incretins (P < 0.05 each). Compared with both PLBO/WHEY and VILD/CTRL, VILD/WHEY was associated with higher plasma intact GLP-1 and GIP, slower gastric emptying, and lower postprandial glycemia (P < 0.05 each). CONCLUSIONSIn metformin-treated type 2 diabetes, a protein preload has the capacity to enhance the efficacy of vildagliptin to slow gastric emptying, increase plasma intact incretins, and reduce postprandial glycemia.The "incretin" hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are major determinants of postprandial glycemia (1). The latter is an important target in patients with type 2 diabetes, particularly those with modestly elevated HbA 1c (2). In health, both incretins stimulate insulin secretion in a glucose-dependent manner (1). However, the effect of GIP is substantially diminished in type 2 diabetes (3), whereas GLP-1

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Section: Discussionmentioning

confidence: 99%

A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes

Little

Bound

et al. 2016

Diabetes Care

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“…In a study published in Diabetologia, Tricò et al (51) showed that the administration of a meal composed of 50 g of Parmigiano Reggiano, a boiled egg, and 300 mL of water, 30 minutes prior the ingestion of a strong glucose load, has a hypoglycaemic eff ect in comparison with a control group that did not receive this meal. The authors observed that proteins co-ingested with carbohydrates exert a hypoglycaemic eff ect on both normal subjects and subjects with diabetes, through the enhancement of insulin secretion and a minor delay in gastric emptying.…”

Section: Parmigiano Reggiano Protein and Glucose Tolerancementioning

confidence: 99%

Cheese as Functional Food: The Example of Parmigiano Reggiano and Grana Padano

Summer

Formaggioni

Franceschi

et al. 2017

Food Technol. Biotechnol.

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SummaryItalian hard cooked types of cheese, like Parmigiano Reggiano and Grana Padano, are characterised by positive nutritional qualities. In fact, they contain substances that have particular biological activities, and therefore they can be fully considered, according to the defi nition given by the European Unit, as 'functional' foods. This short review concisely describes these components and the benefi cial eff ects related to their activities. The description of the biologically active components has been organised in the following paragraphs: protein and peptides, fat and lipids, carbohydrates and prebiotics, probiotic bacteria, vitamins, mineral salts, and components of dairy products active in disease prevention. In particular, several known bioactive peptides were found in Parmigiano Reggiano cheese samples: for example, phosphopeptides, which are known for their mineral-binding capacity and vehiculation activity, peptides with immunomodulatory activity, and angiotensin-converting enzyme-inhibitory peptides with anti-hypertensive eff ects. Among lipids, the role of conjugated linoleic acid and other fatt y acids present in these cheese types was taken into consideration. The presence of oligosaccharides with prebiotic properties and probiotic bacteria was also described. Finally, particular emphasis was given to highly available calcium and its impact on bone health.

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“…Lipid and protein ingested before carbohydrate, as a ‘preload', have been shown to acutely improve glucose tolerance, mainly by delaying gastric emptying and by enhancing insulin secretion. 1 , 2 , 3 , 4 , 5 , 6 Indeed, we recently reported that a small mixed non-glucidic preload markedly improved glucose tolerance by delaying glucose absorption, enhancing beta cell function and reducing insulin clearance in patients with type 2 diabetes. 1 , 2 Whether these acute effects persist over time is unclear.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 Indeed, we recently reported that a small mixed non-glucidic preload markedly improved glucose tolerance by delaying glucose absorption, enhancing beta cell function and reducing insulin clearance in patients with type 2 diabetes. 1 , 2 Whether these acute effects persist over time is unclear. 7 , 8 Furthermore, adding a nutrient preload to each meal to improve postprandial glucose control could be unfeasible and/or increase the total daily caloric intake.…”

Section: Introductionmentioning

confidence: 99%

Manipulating the sequence of food ingestion improves glycemic control in type 2 diabetic patients under free-living conditions

et al. 2016

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Lipid and protein ingested before carbohydrate reduce postprandial hyperglycemia. We tested feasibility, safety and clinical efficacy of manipulating the sequence of nutrient ingestion in patients with type 2 diabetes (T2D). After a 4-week run-in, 17 T2D patients were randomized to either a control diet (CD) or to an experimental diet (ED) allowing the consumption of high-carbohydrate foods only after high-protein and high-fat foods at each main meal (lunch+dinner). Both diets were accurately followed and neutral on arterial blood pressure, plasma lipids and indices of hepatic and kidney function. After 8 weeks, in spite of a similar reduction of body weight (ED −1.9 95% confidence interval (−3.4/−0.4)kg, P<0.03; CD −2.0 (−3.6/−0.5)kg, P<0.02) and waist circumference (ED −2.9 (−4.3/−1.5)cm, P<0.002; CD −3.3 (−5.9/−0.7)cm, P<0.02), the ED only was associated with significant reductions of HbA1c (−0.3 (−0.50/−0.02)%, P<0.04), fasting plasma glucose (−1.0 (−1.8/−0.3)mmol l−1, P<0.01), postprandial glucose excursions (lunch −1.8 (−3.2/−0.4)mmol l−1, P<0.01; dinner: −1.0 (−1.9/−0.1)mmol l−1, P<0.04) and other indices of glucose variability (s.d.: −0.5 (−0.7/−0.2)mmol l−1, P<0.02; Coefficient of variation: −6.6 (−10.4/−2.7)%, P<0.02). When compared with the CD, the ED was associated with lower post-lunch glucose excursions (P<0.02) and lower glucose coefficients of variation (P<0.05). Manipulating the sequence of nutrient ingestion might reveal a rapid, feasible, economic and safe strategy for optimizing glucose control in T2D.

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Mechanisms through which a small protein and lipid preload improves glucose tolerance

Abstract: ClinicalTrials.gov NCT02342834 FUNDING: This work was supported by grants from the University of Pisa (Fondi di Ateneo) and by FCT grant (PIC/IC/82956/2007).

Cited by 45 publications

References 49 publications

A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes

A Protein Preload Enhances the Glucose-Lowering Efficacy of Vildagliptin in Type 2 Diabetes

Cheese as Functional Food: The Example of Parmigiano Reggiano and Grana Padano

Manipulating the sequence of food ingestion improves glycemic control in type 2 diabetic patients under free-living conditions

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