Article

Diabetologia

, Volume 57, Issue 8, pp 1552-1560

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study

  • Hana KahleovaAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine Email author 
  • , Lenka BelinovaAffiliated withDiabetes Centre, Institute for Clinical and Experimental MedicineFirst Faculty of Medicine, Charles University
  • , Hana MalinskaAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine
  • , Olena OliyarnykAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine
  • , Jaroslava TrnovskaAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine
  • , Vojtech SkopAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine
  • , Ludmila KazdovaAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine
  • , Monika DezortovaAffiliated withDepartment of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine
  • , Milan HajekAffiliated withDepartment of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine
    • , Andrea TuraAffiliated withMetabolic Unit, Institute of Biomedical Engineering, National Research Council
    • , Martin HillAffiliated withDepartment of Steroid Hormones and Proteohormones, Institute of Endocrinology
    • , Terezie PelikanovaAffiliated withDiabetes Centre, Institute for Clinical and Experimental Medicine

Abstract

Aims/hypothesis

The aim of the study was to compare the effect of six (A6 regimen) vs two meals a day, breakfast and lunch (B2 regimen), on body weight, hepatic fat content (HFC), insulin resistance and beta cell function.

Methods

In a randomised, open, crossover, single-centre study (conducted in Prague, Czech Republic), we assigned 54 patients with type 2 diabetes treated with oral hypoglycaemic agents, both men and women, age 30–70 years, BMI 27–50 kg/m2 and HbA1c 6–11.8% (42–105 mmol/mol), to follow two regimens of a hypoenergetic diet, A6 and B2, each for 12 weeks. Randomisation and allocation to trial groups (n = 27 and n = 27) were carried out by a central computer system. Individual calculations of energy requirements for both regimens were based on the formula: (resting energy expenditure × 1.5) − 2,092 kJ. The diet in both regimens had the same macronutrient and energy content. HFC was measured by proton magnetic resonance spectroscopy. Insulin sensitivity was measured by isoglycaemic–hyperinsulinaemic clamp and calculated by mathematical modelling as oral glucose insulin sensitivity (OGIS). Beta cell function was assessed during standard meal tests by C-peptide deconvolution and was quantified with a mathematical model. For statistical analysis, 2 × 2 crossover ANOVA was used.

Results

The intention-to-treat analysis included all participants (n = 54). Body weight decreased in both regimens (p < 0.001), more for B2 (−2.3 kg; 95% CI −2.7, −2.0 kg for A6 vs −3.7 kg; 95% CI −4.1, −3.4 kg for B2; p < 0.001). HFC decreased in response to both regimens (p < 0.001), more for B2 (−0.03%; 95% CI −0.033%, −0.027% for A6 vs −0.04%; 95% CI −0.041%, −0.035% for B2; p = 0.009). Fasting plasma glucose and C-peptide levels decreased in both regimens (p < 0.001), more for B2 (p = 0.004 and p = 0.04, respectively). Fasting plasma glucagon decreased with the B2 regimen (p < 0.001), whereas it increased (p = 0.04) for the A6 regimen (p < 0.001). OGIS increased in both regimens (p < 0.01), more for B2 (p = 0.01). No adverse events were observed for either regimen.

Conclusions/interpretation

Eating only breakfast and lunch reduced body weight, HFC, fasting plasma glucose, C-peptide and glucagon, and increased OGIS, more than the same caloric restriction split into six meals. These results suggest that, for type 2 diabetic patients on a hypoenergetic diet, eating larger breakfasts and lunches may be more beneficial than six smaller meals during the day.

Trial registration ClinicalTrials.gov number, NCT01277471, completed.

Funding Grant NT/11238-4 from Ministry of Health, Prague, Czech Republic and the Agency of Charles University – GAUK No 702312.

Keywords

Hepatic fat content Insulin sensitivity Two meals a day Type 2 diabetes