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Type 2 diabetes: less hungry and less depressed patients with two large fiber-rich meals a day? (2015-04-09)

The size and frequency of meals are important elements of nutrition, with considerable effects on the human health. A hypocaloric diet is a key component in both prevention and treatment of type 2 diabetes and it is usually apportioned into three main meals and two or three snacks in between.

Eating two large, fiber-rich meals a day as part of a calorie-restricted diet - rather than six smaller meals spread throughout the day - could help people with type 2 diabetes feel less hungry and less depressed, according to a secondary analysis of a crossover trial comparing both meal schedules.

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

In a randomised, open, crossover, single-centre study (conducted in Prague, Czech Republic), researchers assigned 54 patients with type 2 diabetes treated with oral hypoglycaemic agents, both men and women, age 30–70 years to follow two regimens of a hypoenergetic diet, each for 12 weeks.

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.

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.

The authors say: "Novel therapeutic strategies should incorporate not only the energy and macronutrient content but also the frequency and timing of food. Further larger scale, long-term studies are essential before offering recommendations in terms of meal frequency."

In the new findings, published April 1 as a Letter to the Editor in the European Journal of Clinical Nutrition, the researchers looked at quality of life, depressive symptoms, and eating behavior in the study participants.
With both meal schedules, patients had improvements in quality of life and decreases in depressive symptoms. However, the decrease in depressive symptoms was significantly greater when study participants followed the two-meal-a-day plan; they also felt significantly less hungry. Disinhibition also decreased when people ate twice a day.

For more information
European Journal of Clinical Nutrition
Do patients with type 2 diabetes still need to eat snacks?

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.