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Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State.

ABSTRACT: Context:According to the carbohydrate-insulin model of obesity, an elevated insulin-to-glucagon ratio in response to a high-carbohydrate diet directs metabolic fuels toward storage, resulting in lower circulating energy. Objective:To determine differences in total circulating energy post-meal related to dietary carbohydrate. Design:Ancillary study within the Framingham State Food Study. Setting:University community. Participants:29 adults (aged 20 to 65 years) with overweight or obesity (body mass index ?25 kg/m2). Intervention:After achieving 10% to 14% weight loss on a run-in diet, participants were randomized to weight-loss-maintenance test diets varying in carbohydrate content (high-carbohydrate, 60% of total energy, n = 11; moderate-carbohydrate, 40%, n = 8; low-carbohydrate, 20%, n = 10) and controlled for protein (20%). During 24-hour metabolic ward admissions between 10 and 15 weeks on the test diets, metabolic fuels and hormones were measured. Main Outcome Measure:Energy availability (EA) based on energy content of blood glucose, beta-hydroxybutyrate, and free fatty acids, in the late postprandial period (180 to 300 minutes). Insulin at 30 minutes into the test meal (Meal Insulin-30) was measured as an effect modifier. Results:Insulin-to-glucagon ratio was 7-fold higher in participants on the high- vs low-carbohydrate diet (2.5 and 0.36, respectively). Late postprandial EA was 0.58 kcal/L lower on the high- vs low-carbohydrate diet (P < 0.0001), primarily related to suppression of free fatty acids. Early postprandial EA (30 to 180 minutes) declined fastest in the high-carbohydrate group, and Meal Insulin-30 modified this diet effect. Conclusions:During weight-loss maintenance on a high-carbohydrate diet, late postprandial EA is reduced, consistent with the carbohydrate-insulin model.

SUBMITTER: Shimy KJ

PROVIDER: S-EPMC7326475 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State.

Shimy Kim J KJ Feldman Henry A HA Klein Gloria L GL Bielak Lisa L Ebbeling Cara B CB Ludwig David S DS

Journal of the Endocrine Society 20200526 7

<h4>Context</h4>According to the carbohydrate-insulin model of obesity, an elevated insulin-to-glucagon ratio in response to a high-carbohydrate diet directs metabolic fuels toward storage, resulting in lower circulating energy.<h4>Objective</h4>To determine differences in total circulating energy post-meal related to dietary carbohydrate.<h4>Design</h4>Ancillary study within the Framingham State Food Study.<h4>Setting</h4>University community.<h4>Participants</h4>29 adults (aged 20 to 65 years) ...[more]

PMID: 32666008

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Project description:BACKGROUND:Postprandial non-esterified fatty acid (NEFA) and triglyceride (TG) responses are increased in subjects with type 2 diabetes mellitus (T2DM) and may impair insulin action and increase risk of cardiovascular disease and death. Dietary carbohydrate reduction has been suggested as non-pharmacological therapy for T2DM, but the acute effects on NEFA and TG during subsequent meals remain to be investigated. METHODS:Postprandial NEFA and TG responses were assessed in subjects with T2DM by comparing a carbohydrate-reduced high-protein (CRHP) diet with a conventional diabetes (CD) diet in an open-label, randomized, cross-over study. Each diet was consumed on two consecutive days, separated by a wash-out period. The iso-caloric CRHP/CD diets contained 31/54 E% from carbohydrate, 29/16 E% energy from protein and 40/30 E% from fat, respectively. Sixteen subjects with well-controlled T2DM (median HbA1c 47?mmol/mol, (37-67?mmol/mol) and BMI 30?±?4.4?kg/m2) participated in the study. NEFA and TG were evaluated following breakfast and lunch. RESULTS:NEFA net area under curve (AUC) was increased by 97?±?38??mol/Lx270 min (p?=?0.024) after breakfast but reduced by 141?±?33??mol/Lx180 min (p?<?0.001) after lunch on the CRHP compared with CD diet. Likewise, TG net AUC was increased by 80?±?28??mol/Lx270 min (p?=?0.012) after breakfast but reduced by 320?±?60??mol/Lx180 min (p?<?0.001) after lunch on the CRHP compared with CD diet. CONCLUSIONS:In well-controlled T2DM a modest reduction of dietary carbohydrate with a corresponding increase in protein and fat acutely reduced postprandial serum NEFA suppression and increased serum TG responses after a breakfast meal but had the opposite effect after a lunch meal. The mechanism behind this second-meal phenomenon of CRHP diet on important risk factors for aggravating T2DM and cardiovascular disease awaits further investigation. TRIAL REGISTRATION:The study was registered at clinicaltrials.gov ID: NCT02472951. https://clinicaltrials.gov/ct2/show/NCT02472951 . Registered June 16, 2015.

Project description:BackgroundThe major circulating metabolic fuels regulate hunger, and each is affected by dietary composition. An integrated measure of postprandial energy availability from circulating metabolic fuels may help inform dietary recommendations for weight maintenance after weight loss.AimWe examined the effect of low-fat (LF, 60% of energy from carbohydrate, 20% fat, 20% protein), low-glycemic index (LGI, 40%-40%-20%), and very low-carbohydrate (VLC, 10%-60%-30%) diets on total postprandial metabolic fuel energy availability (EA) during weight loss maintenance.MethodsEight obese young adults were fed a standard hypocaloric diet to produce 10-15% weight loss. They were then provided isocaloric LF, LGI, and VLC diets in a randomized crossover design, each for a 4-week period of weight loss maintenance. At the end of each dietary period, a test meal representing the respective diet was provided, and blood samples were obtained every 30 minutes for 5 hours. The primary outcome was EA, defined as the combined energy density (circulating level × relative energy content) of glucose, free fatty acids, and β-hydroxybutyrate. Secondary outcomes were individual metabolic fuels, metabolic rate, insulin, glucagon, cortisol, epinephrine, and hunger ratings. Respiratory quotient was a process measure. Data were analyzed by repeated-measures analysis of variance, with outcomes compared in the early (30 to 150 min) and late (180 to 300 min) postprandial periods.ResultsEA did not differ between the test meals during the early postprandial period (p = 0.99). However, EA in the late postprandial period was significantly lower after the LF test meal than the LGI (p<0.0001) and VLC (p<0.0001) test meals. Metabolic rate also differed in the late postprandial period (p = 0.0074), with higher values on the VLC than LF (p = 0.0064) and LGI (p = 0.0066) diets.ConclusionThese findings suggest that an LF diet may adversely affect postprandial EA and risk for weight regain during weight loss maintenance.

Dataset Information

Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State.

Publications

Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State.

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