The acute effects of dietary carbohydrate reduction on postprandial responses of non-esterified fatty acids and triglycerides: a randomized trial

Amirsalar Samkani, Mads J Skytte, Christian Anholm, Arne Astrup, Carolyn F Deacon, Jens J Holst, Sten Madsbad, Ray Boston, Thure Krarup, Steen B Haugaard, Amirsalar Samkani, Mads J Skytte, Christian Anholm, Arne Astrup, Carolyn F Deacon, Jens J Holst, Sten Madsbad, Ray Boston, Thure Krarup, Steen B Haugaard

Abstract

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 μmol/Lx270 min (p = 0.024) after breakfast but reduced by 141 ± 33 μmol/Lx180 min (p < 0.001) after lunch on the CRHP compared with CD diet. Likewise, TG net AUC was increased by 80 ± 28 μmol/Lx270 min (p = 0.012) after breakfast but reduced by 320 ± 60 μmol/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://ichgcp.net/clinical-trials-registry/NCT02472951 . Registered June 16, 2015.

Keywords: Dietary carbohydrate reduction; Non-esterified fatty acids; Postprandial triglycerides.

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from all participants prior to any study related procedures. The study protocol was approved by the Health Ethics Committee of Copenhagen in accordance with the Helsinki-II declaration, and the trial was registered at Consent for publication

Written informed consent was obtained from all participants.

Competing interests

The authors declare that they have no competing interests to declare related to the present study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Concentration of non-esterified fatty acid (NEFA) in sixteen well-controlled patients with type 2 diabetes after intake of a carbohydrate-reduced high-protein (CRHP) or conventional diabetes (CD) breakfast (0–270 min) and lunch (270–450 min), respectively (means of 2 consecutive days on each diet). Values are presented as means with their standard errors. Bar charts show net area under curve for breakfast and lunch, respectively. *Significant difference (p < 0.05) between diets
Fig. 2
Fig. 2
Incremental concentration of triglyceride in sixteen well-controlled patients with type 2 diabetes after intake of a carbohydrate-reduced high-protein (CRHP) or conventional diabetes (CD) breakfast (0–270 min) and lunch (270–450 min), respectively (means of 2 consecutive days on each diet). Values are presented as means with their standard errors. Bar charts show net area under curve for breakfast and lunch, respectively. *Significant difference (p < 0.05) between diets
Fig. 3
Fig. 3
Concentration of insulin in sixteen well-controlled patients with type 2 diabetes after intake of a carbohydrate-reduced high-protein (CRHP) or conventional diabetes (CD) breakfast (0–270 min) and lunch (270–450 min), respectively (means of 2 consecutive days on each diet). Values are presented as means with their standard errors. Bar charts show net area under curve for breakfast and lunch, respectively. *Significant difference (p < 0.05) between diets. (Reproduced from Samkani et al., BJN, 2018, with approval from British Journal of Nutrition)

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