Table 2.
Effect of First meal of the Day on Glycemia in healthy individuals and subjects at high risk for developing or with type 2 diabetes.
| Study | Health Status Age (Years) BMI (kg/m2) |
Duration & Design of Dietary Intervention | Sample Size | Description of Groups | Dietary Intervention | Selected Clinical Outcomes |
|---|---|---|---|---|---|---|
| Effect of first meal of the day on glycemia. | ||||||
| ||||||
| Morris, et al., 2015 [263] | Healthy 28 ± 9 25.4 ± 2.6 |
2 weeks Within-participant cross-over |
14 | Circadian alignment Circadian misalignment (12 h shift) |
Alignment protocol had B at 8:00 AM Misalignment protocol had “B” at 8:00 PM Isocaloric diets of 15–20% PRO, 45–50% CHO, 30–35% FAT |
+8% and +14% ppd AUCGlu and ppd AUCIns at Dinner time +3% ISR at Dinner time +12% and −27% ppd AUCGlu and ppd AUCIns in biological evening +8% ISR in biological evening −21% Fasting Ins in biological evening +14% and +9% late phase Ins/ISR and 24 h Ins at circadian misalignment |
| Betts, et al., 2014 [280] | Healthy lean 36 ± 11 22.4 ± 2.2 |
6 weeks Randomized controlled trial |
33 | B group Fasting group |
B: ≥700 kcal before 11:00, Fasting group: extend o/n fast until 12:00, ad libitum intake for the rest of the day |
Glu (mg/dL) +1.3 (fast) vs +1.1 (B) Ins (μIU/mL) +0.32 (fast) vs +0.35 (B) HOMA-IR +0.10 (fast) vs +0.10 (B) C-ISI Matsuda index +0.38 (fast) vs −0.97 (B) Index of adipose insulin sensitivity (%) +3.3 (fast) vs +9.9 (B) Peak Glu until 12:00 + 1.1 mmol/L in B vs fasting Mean morning Glu +0.3 mmol/L in B vs fasting Greater Glu variability in fasting group |
| Chowdhury, et al., 2016 [283] | Obese 44 ± 10 33.7 ± 4.9 |
6 weeks Randomized controlled trial |
23 | B group Fasting group |
B: ≥700 kcal before 11:00, Fasting group: extend o/n fast until 12:00, ad libitum intake for the rest of day |
Fasting Glu (mg/dL) +1.7 (fast) vs +1.4 (B) Fasting Ins (μIU/mL) −0.62 (fast) vs +0.39 (B) HOMA-IR −0.13 (fast) vs +0.18 (B) C-ISI Matsuda index −0.05 (fast) vs +0.05 (B) Ins AUC Glu, mg·120 min/dL +171 (fast) vs −231 (B) |
| Jakubowicz, et al., 2017 [285] | Healthy: 44.3 ± 2.9 23.1 ± 0.4 T2D: 66.8 ± 1.9 30.7 ± 1.1 |
2 test days Randomized open-label crossover-within-subject clinical trial |
32 | YesB NoB |
Each test meal: 572 ± 8 kcal 32% PRO 49% CHO 19.4% FAT |
+15–18% AUCGlu after lunch w/o B −25% AUCIns after L for T2DM grp w/o B −35% AUCiGLP-1 after L on NoB |
| Nas, et al., 2017 [286] | Healthy adults 24.6 ± 3.3 23.7 ± 4.6 |
3 test days Randomized crossover nutritional intervention |
17 | Control (C) (3 meals) BSD (B skipping) DSD (D skipping) |
Isocaloric diets 55% CHO, 30% FAT, 15% PRO BSD-washout-C-DSD or DSD-washout-C-BSD |
HOMA-IR 1.96 ± 0.82 (C), 2.07 ± 0.91 (BSD), 1.96 ± 1.05 (DSD) GlycemiatAUC (mg/dLx24 h): 2360 ± 111 (C), 2425 ± 131 (BSD), 2374 ± 165 (DSD) MAGE 3.90 ± 1.32 (C), 3.65 ± 1.52 (BSD), 3.28 ± 1.75 (DSD) C-peptide (μg/day) 74 ± 38 (C), 86 ± 40 (BSD), 75 ± 42 (DSD) iAUCIns (μU/mLx 2 h) after L: 211 ± 74 (BSD) 144 ± 74 (DSD) iAUCGlu (mg/dLx 2 h) after L: 114 ± 41 (BSD), 62 ± 40 (DSD) HOMA-IR pp after L: 59 ± 44 (BSD), 27 ± 23 (DSD) |
| Kobayashi, et al., 2014 [287] | Healthy 25.3 ± 1.2 BW 74.5 ± 4.3 kg (noB), 73.9 ± 4.2 kg (B) |
2 test days Randomized crossover |
8 | B (3 meals) noB (2 meals) |
PRO 364 ± 16 kcal CHO 1310 ± 77 kcal FAT 462 ± 33 kcal Individually adjusted meals of 2190 ± 124 kcal/day B at 8:00 h, L at 12:00 h, D at 19:00 |
+9 mg/dL Blood Glu after L in noB vs B group (p < 0.05) +10 mg/dL sleep Blood Glu in noB vs B group (p < 0.05) AUCGlu after L 409 ± 99 mg/dL min in B group vs 811 ± 101 mg/dL min in noB group AUCGlu after D 1049 ± 144 mg/dL min in B group vs 1196 ± 204 mg/dL min in noB group |
| Jakubowicz, et al., 2015 [301] | T2DM 56.9 ± 1.0 28.2 ± 0.6 |
2 test days Randomized, open-label, crossover- within-subject clinical trial |
22 | YesB (B, L, D) NoB (L, D) |
Each test meal: 701 ± 8 kcal; 26% PRO, 54% CHO, 20% FAT, 7% fiber B at 8:00 h, L at 13:30 h, D at 19:00 h |
NoB vs YesB after B: Glu (mg/dL·min) −43%, Ins (μIU/mL·min) −72.1%, Glucagon (pg/mL·min) −20.6% C-peptide (ng/mL·min) −63.3%, iGLP−1 (pmol/L·min) −60.5% NoB vs YesB after L: Glu (mg/dL·min) +39.8%, Ins (μIU/mL·min) −24.7%, Glucagon (pg/mL·min) +9.7% C-peptide (ng/mL·min) −13.6%, iGLP−1 (pmol/L·min) −21.5% NoB vs YesB after D: Glu (mg/dL·min) +24.9%, Ins (μIU/mL·min) −10.8%, Glucagon (pg/mL·min) +8.5% C-peptide (ng/mL·min) −14.5%, iGLP-1 (pmol/L·min) −14.5% |
| ||||||
| Kang, at al., 2013 [84] | Subjects with prediabetes and normal (NGR) Glu regulation 46.4 ± 13.8 18.5–24.9 |
3 days Cross-sectional study |
133 | LC (low CHO) MC (medium CHO) HC (high CHO) |
Diet of 30 kcal/kg/day calorie intake from three daily meals According to CHO in B: Low carbohydrate (LC) meal with <45%CHO Medium-carbohydrate (MC) meal with CHO between 45% and 65% High-carbohydrate (HC) meal with >65% CHO |
In subjects with impaired Glu regulation: Significantly ↑ ppd Glu, Glu peak, Glu excursion, and iAUCGLU in subjects with impaired Glu regulation after B with >50% CHO |
| Rosi, et al., 2018 [282] | Healthy 24 ± 2 23.4 ± 1.6 |
7 weeks Randomized, crossover, and controlled trial |
15 | F-CTRL BR-BREAD BR-MUESLI BR-RICE |
Energy-free meal with a cup of decaf coffee (~fasting) 3 isoenergetic meals with similar PRO: with a cup of semi-skimmed milk, an apple, and cereal foods as indicated below: White bread with chocolate hazelnut spread, GI <55, GL~22 Muesli with dark chocolate chips and nuts,↑fiber, GI <55, GL~23 Chocolate-flavored puffed rice, ↓FAT, ↑CHO, GI >55, GL~38 |
The RICE group had significantly higher: -AUCIns 120 min after B -AUCGlu 120 min after B -Plasma Glu after B |
| Jakubowicz, et al., 2017 [296] | T2DM 59.0 ± 0.7 32.11 ± 0.1 |
12 weeks Randomized, open-label, parallel-arm clinical trial |
48 | 42 g total PRO: WBdiet (whey, 28 g) PBdiet (42 g various PRO sources) CBdiet (high CHO B, 17 g PRO from various sources) |
At B: WBdiet: 25% PRO (mainly whey), 50% CHO, 25% FAT PBdiet: 25% PRO (mainly from eggs, tuna, soy), 50% CHO, 25% FAT CBdiet: 11% PRO (soy), 64% CHO, 29% FAT Hypocaloric diets: B 660 ± 25 kcal L 560 ± 20 kcal (23% PRO, 48% CHO, 29% FAT) D 280 ± 15 kcal (31% PRO, 31% CHO, 38% FAT) B at 6:00–8:30 h, L at 12:30–14:30 h, D at 18:30–20:30 h |
HbA1C (%) WB −0.89 ± 0.05 PB −0.6 ± 0.04 CB −0.36 ± 0.04 Fasting Glu (mmol/L) WB −0.73 ± 0.06 PB −0.43 ± 0.06 CB −0.12 ± 0.04 Overall glycemia was −12% in PB and −19% in WB Glu peak was −18% in PB and −31% in WB Rapid Glu levels decrease after B in PB and WB Overall AUCIns was +37% in PB and 62% in WB (same for after L and D) AUCC-pept was +53% in PB and 96% in WB (same for after L and D) AUCiGLP_1 was +70% in WB and +33% in PB after B, L, and D HbA1C reduced in all grps |
| Jakubowicz, et al., 2012 [297] | 20–65 32.3 ± 1.8 |
32 weeks Randomized, treatment controlled, openclinical trial |
144 | LCb HCPb |
Low kcal and low CHO diet (LCb) with low kcal and low HCO B High CHO and high PRO diet (HCPb) with daily dessert for B Similar L & D composition, differences for B |
BW (kg) 70.6 ± 8.7 (HCPb) vs 86.9 ± 9.7 (LCb) Fasting Glu (mg/dL) 84.2 ± 4.6 (HCPb) vs 95.5 ± 4.9 (LCb) Fasting Ins (μU/mL) 8.9 ± 3.9 (HCPb) vs 23.69 ± 3.8 (LCb) HOMA-IR 1.6 ± 0.4 (HCPb) vs 5.9 ± 0.9 (LCb) Total Chol (mg/dL) 179.2 ± 11.1 (HCPb) vs 190.8 ± 18.2 (LCb) TG (mg/dL) 122.6 ± 9.7 (HCPb) vs 174.5 ± 20.9 (LCb) ↑ hunger in LCb |
| Neumann, et al., 2016 [298] | Healthy 24.1 ± 2 n/a |
8 days Randomized, controlled study |
24 | SKP (Skipping breakfast) CHO PRO |
SKP group CHO group: 351 kcal; 59 g CHO, 10 g PRO, 8 g fat PRO group: 350 kcal; 39 g CHO, 30 g PRO, 8 g Fat B consumed as first meal of the day, before 10:00 am |
No difference in fasting blood Glu CHO and PRO groups lead to greater ppd Glu vs SKP ↓10% Glu in PRO vs CHO at 30 min ppd Ffter B |
| Pedersen, et al., 2016 [299] | Obese/T2DM 63.9 ± 2.15 33 ± 1.25 |
4 exp. days Randomized crossover study |
28 | CHO-B noCHO-B |
Fast ≥8 h before the test diets The diets were consumed on 2 sequential days on separate weeks 3 identical meals with CHO 3 meals, no CHO breakfast, lunch and dinner with CHO –similar to other group |
Peak blood Glu (mmol/L) 11.3 ± 0.5 after CHO-B 9.4 ± 0.4 after noCHO-B Mean blood Glu (mmol/L)—5 h after B 8.4 ± 0.5 after CHO-B 7.5 ± 0.4 after noCHO-B no sig. differences in Glu measurements after lunch and dinner no sig. differences in gastric emptying |
| Rabinovitz, et al., 2014 [300] | Overweight/obese with T2DM 60.7 ± 6.35 32.37 ± 3.7 |
3 months Randomized, treatment-controlled, open clinical trial |
46 | SB (small breakfast) BB (big breakfast) |
At B: 12–18% PRO, 14–22% FAT, 60–70% CHO, 13% of total E was recommended in the SM, Lunch and Dinner had 33% of total daily E, 2–3 snacks same as in BB At B: 23–30% PRO, 29–37% FAT, 37–48% CHO 33% of total E was recommended in the BB, Lunch and Dinner had 25% of total daily E, 2–3 snacks same as in SM |
BW no sign. difference HbA1c (%) −0.58 ± 0.18 in BB −0.13 ± 0.08 in SB Estimated average glucose (mg/dL) −16.6 ± 5.2 in BB −3.43 ± 2.4 in SB no sign. changes in Glu, Ins, C-peptide, total Chol, TG, CRP, IL-6, TNF-α |
Abbreviations: B: Breakfast; L: Lunch; D: Dinner; YesB: had breakfast; NoB: skipped breakfast; T2DM: type 2 diabetes; ppd: postprandial; GI: Glycemic Index, GL: Glycemic Load; BSD: breakfast skipping day; DSD: dinner skipping day; PRO: protein; CHO: carbohydrates; FAT: fat/lipids; HOMA-IR: homeostatic model assessment for insulin resistance; AUC: area under the curve; iAUC: incremental area under the curve; Ins: insulin concentrations; Glu: glucose concentrations; HbA1c: glycated hemoglobin A1c; ISI: insulin sensitivity index; WB: body weight; E: total energy intake; SKP: skipping breakfast. An arrow pointing upwards or downwards indicates an increase or decrease.