CHICAGO — A meal schedule consisting of a high-energy breakfast and lunch with a low-energy dinner yielded greater weight loss and decreases in BMI, HbA1c, overall glycemia and total daily insulin dose in patients with uncontrolled type 2 diabetes and obesity compared with a meal schedule focused on six small meals throughout the day.
“It is believed that those people who eat more in the evening gain weight more [easily] than those who consume more calories in the morning,” Daniela Jakubowicz, MD, professor of medicine at Tel Aviv University, Israel, said during a presentation at the Endocrine Society Annual Meeting.
Jakubowicz and colleagues evaluated 29 adults with uncontrolled insulin-treated type 2 diabetes and obesity. Eighteen were men, the mean age was 69 years, mean BMI was 32 kg/m2 and mean duration of diabetes was 20 years.
Participants were randomly assigned to adhere to 3 months of a high-energy breakfast and lunch and low-energy dinner meal schedule (1,600 kcal; breakfast 50%, lunch 33%, dinner 17%) or six meals evenly distributed through the day (1,600 kcal; breakfast 20%, lunch 25%, dinner 25% plus three snacks 10% each) to compare effects of each diet on weight loss, overall glycemia, appetite and total daily insulin dose. CGM was used to assess overall glycemia for 14 days at baseline and at the end of the intervention and total daily insulin dose was titrated biweekly.
After 12 weeks, mean weight loss was 5 kg in the high-energy breakfast group, whereas mean weight increased by 0.5 kg in the six-meal group (P < .05). Further, BMI decreased by 1.9 kg/m2 in the high-energy breakfast group compared with an increase of 0.1 kg/m2 in the six-meal group (P < .05). Total daily insulin dose decreased by 20.5 units per day after the high-energy breakfast diet compared with an increase of 2.2 units per day with the six-meal diet (P < .05). Greater decreases in HbA1c (1.2% vs. 0.2%; P < .05) and overall glycemia (–38 mg/dL vs. –17 mg/dL; P < .05) were also observed with the high-energy breakfast diet vs. the six-meal diet.
“It is believed that those people who eat more in the evening gain weight more [easily] than those who consume more calories in the morning,” according to a presenter here.
“This study shows that, in insulin-treated type 2 diabetes patients, a diet with three meals per day, consisting of a big breakfast, average lunch and small dinner, had many rapid and positive effects compared to the traditional diet with six small meals evenly distributed throughout the day: better weight loss, less hunger and better diabetes control while using less insulin,” Jakubowicz said in a press release. “The hour of the day — when you eat and how frequently you eat — is more important than what you eat and how many calories you eat. Our body metabolism changes throughout the day. A slice of bread consumed at breakfast leads to a lower glucose response and is less fattening than an identical slice of bread consumed in the evening.” – by Amber Cox
Jakubowicz D, et al. OR05-2. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.
Disclosure: Jakubowicz reports no relevant financial disclosures.