The effect of meal frequency in a reduced-energy regimen on the gastrointestinal and appetite hormones in patients with type 2 diabetes: A randomised crossover study

Abstract

BackgroundAppetite and gastrointestinal hormones (GIHs) participate in energy homeostasis, feeding behavior and regulation of body weight. We demonstrated previously the superior effect of a hypocaloric diet regimen with lower meal frequency (B2) on body weight, hepatic fat content, insulin sensitivity and feelings of hunger compared to the same diet divided into six smaller meals a day (A6). Studies with isoenergetic diet regimens indicate that lower meal frequency should also have an effect on fasting and postprandial responses of GIHs. The aim of this secondary analysis was to explore the effect of two hypocaloric diet regimens on fasting levels of appetite and GIHs and on their postprandial responses after a standard meal. It was hypothesized that lower meal frequency in a reduced-energy regimen leading to greater body weight reduction and reduced hunger would be associated with decreased plasma concentrations of GIHs: gastric inhibitory peptide (GIP), glucagon-like peptide-1(GLP-1), peptide YY(PYY), pancreatic polypeptide (PP) and leptin and increased plasma concentration of ghrelin. The postprandial response of satiety hormones (GLP-1, PYY and PP) and postprandial suppression of ghrelin will be improved.MethodsIn a randomized crossover study, 54 patients suffering from type 2 diabetes (T2D) underwent both regimens. The concentrations of GLP-1, GIP, PP, PYY, amylin, leptin and ghrelin were determined using multiplex immunoanalyses.ResultsFasting leptin and GIP decreased in response to both regimens with no difference between the treatments (p = 0.37 and p = 0.83, respectively). Fasting ghrelin decreased in A6 and increased in B2 (with difference between regimens p = 0.023). Fasting PP increased in B2with no significant difference between regimens (p = 0.17). Neither GLP-1 nor PYY did change in either regimen. The decrease in body weight correlated negatively with changes in fasting ghrelin (r = -0.4, p<0.043) and the postprandial reduction of ghrelin correlated positively with its fasting level (r = 0.9, p<0.001). The postprandial responses of GIHs and appetite hormones were similar after both diet regimens.ConclusionsBoth hypocaloric diet regimens reduced fasting leptin and GIP and postprandial response of GIP comparably. The postprandial responses of GIHs and appetite hormones were similar after both diet regimens. Eating only breakfast and lunch increased fasting plasma ghrelin more than the same caloric restriction split into six meals. The changes in fasting ghrelin correlated negatively with the decrease in body weight. These results suggest that for type 2 diabetic patients on a hypocaloric diet, eating larger breakfast and lunch may be more efficient than six smaller meals during the day.

New roles for prokineticin 2 in feeding behavior, insulin resistance and type 2 diabetes: Studies in mice and humans

“…This is a characteristic of neuropeptides that reduce food intake, their expression is often lowered in states of negative energy balance [33]. This is also in agreement with behavioral studies previously demonstrating that fasting increases while feeding decreases the olfactory system responsiveness in rodents [36]. Furthermore, we showed that Prok2 underexpression in the MOB following Prok2 shRNA injection increased food intake with no significant repercussion on body weight.…”

Evaluation of insulin resistance improvement after laparoscopic sleeve gastrectomy or gastric bypass surgery with HOMA-IR

“…The foregut effect meant avoiding food contact with the proximal jejunum reducing the gastrointestinal secretion of anti-incretin. A hindgut effect meant that the food, which is not completely digested quickly enters the distal intestine, and stimulates the distal intestine to secrete increnin, including glucagon like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP) and peptide tyrosine-tyrosine (PYY) (20)(21)(22). This study showed that LSG could also cause a similar postoperative effect for the early response of insulin resistance as that with LGB.…”

The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting

“…An increase in the number of snacks can also increase the amount of dietary protein [54]. Data suggest that whilst there is no correlation between number of snacks and hunger [54], or at least not a positive one [55,56], there is a greater fullness-related response with higher protein intake [41,55]. Thus, when discussing meal frequency, it is essential to also consider, from an ecological perspective, that changing meal frequency could also change the percentage of energy from particular macronutrients during the day.…”