Accepted Manuscript A meal-replacement regimen improves blood glucose levels in prediabetic healthy subjects with impaired fasting glucose Daniel König, MD Sadaf Kookhan, MSC Denise Schaffner, MSC Peter Deibert, MD Aloys Berg, MD PII:
S0899-9007(14)00148-8
DOI:
10.1016/j.nut.2014.03.014
Reference:
NUT 9261
To appear in:
Nutrition
Received Date: 9 October 2013 Revised Date:
20 February 2014
Accepted Date: 16 March 2014
Please cite this article as: König D, Kookhan S, Schaffner D, Deibert P, Berg A, A meal-replacement regimen improves blood glucose levels in prediabetic healthy subjects with impaired fasting glucose, Nutrition (2014), doi: 10.1016/j.nut.2014.03.014. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI PT
A meal-replacement regimen improves blood glucose levels in prediabetic healthy subjects with impaired fasting glucose
Daniel König MD1,2, Sadaf Kookhan MSC1, Denise Schaffner MSC1, Peter Deibert MD2,
SC
Aloys Berg MD1
1 University of Freiburg,
Department for Nutrition Schwarzwaldstr. 175 79117 Freiburg
Centre for Internal Medicine
TE D
2 University Hospital Freiburg
M AN U
Institute for Sports and Sports Science
Department of Rehabilitation, Prevention and Sports Medicine, Germany
AC C
79106 Freiburg
EP
Hugstetterstr. 175
Address for correspondence Prof Dr. Daniel König
Email: [email protected]
ACCEPTED MANUSCRIPT Objektive To investigate the effect of a 6 week intervention with either lifestyle intervention (increased physical activity/low calorie diet) or a meal-replacement regimen on glycemic control in prediabetic subjects with impaired fasting glucose.
RI PT
Research Methods and Procedures 42 overweight or obese men and women (age 54 ± 8 y; weight 95.1 ± 11.9 kg; BMI 32.8 ± 2.89 kg/m2) were included in this randomized controlled clinical trial. Subjects in the lifestyle group (LS) n=14) received dietary counselling sessions (fat restricted low calorie diet) and
SC
instructions how to increase physical activity. Subjects in the meal replacement group (MR
M AN U
n=28) were instructed to replace two daily meals by a low-caloric high soy-protein drink with a low glycemic index. Results
Both interventions resulted in a significant decrease in body weight and BMI, although this reduction was more pronounced (p100 mg/dl) that do not meet the criteria for diabetes mellitus (> 126 mg/dl) should be diagnosed with prediabetes (1). In addition, the presence of impaired glucose tolerance (IGT)
RI PT
(2-h values in the OGTT of 140 mg/dl to 199 mg/dl and an A1C range of 5.7–6.4%) also identifies people with prediabetes. In individuals with prediabetes the postprandial phase is characterized by a large and more prolonged increase in blood glucose concentrations. It is estimated that approximately 10 % of the adult population in western societies have
SC
prediabetes (2). Although persons with prediabetes are healthy and per definition not diabetic, there is good scientific evidence to suggest that subjects with prediabetes have an
M AN U
increased risk for the conversion to diabetes mellitus type 2 (3).
It has been demonstrated that the reconversion from the prediabetic state to normoglycemia may substantially reduce the risk for the development of type 2 diabetes mellitus and associated complications (4). Furthermore, it has been shown that also the prediabetic state
TE D
is associated with early forms of neuropathy, nephropathy or retinopathy (5). Therefore, there is general agreement that subjects with prediabetes should be treated by therapeutic lifestyle interventions (TLC) or - in the case of malcompliance with TLC - by pharmacotherapy (6).
EP
The Diabetes Prevention Program and further clinical trials have shown that pre-diabetic conditions and insulin resistance can be improved (7). Increasing evidence suggests that the
AC C
risk for type 2 diabetes can be substantially reduced by being physically active, losing weight and making wise food choices (8). It has been demonstrated that meal replacement regimens are associated with fast weight loss and improvements in metabolic risk factors (911). A recent Medline research has shown that the effect of meal replacements on glycemic control and measures of insulin resistance has not been fully investigated in subjects with prediabetes. Therefore, in the present study, the influence of a very low calorie meal replacement regimen by a soy-protein drink on changes in fasting glucose and insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) HOMA-IR were investigated. The effects of the meal replacement regimen were compared against a lifestyle
ACCEPTED MANUSCRIPT intervention with a fat restricted low calorie diet in combination with increased physical activity.
Methods
RI PT
Pre-obese and obese men (n=16) and women (n=26) (age 54 ± 8 y; weight 95.1 ± 11.9 kg; BMI 32.8 ± 2.89 kg/m2) with increased fasting blood glucose levels (>100 mg/dl and
S0899-9007(14)00148-8
DOI:
10.1016/j.nut.2014.03.014
Reference:
NUT 9261
To appear in:
Nutrition
Received Date: 9 October 2013 Revised Date:
20 February 2014
Accepted Date: 16 March 2014
Please cite this article as: König D, Kookhan S, Schaffner D, Deibert P, Berg A, A meal-replacement regimen improves blood glucose levels in prediabetic healthy subjects with impaired fasting glucose, Nutrition (2014), doi: 10.1016/j.nut.2014.03.014. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI PT
A meal-replacement regimen improves blood glucose levels in prediabetic healthy subjects with impaired fasting glucose
Daniel König MD1,2, Sadaf Kookhan MSC1, Denise Schaffner MSC1, Peter Deibert MD2,
SC
Aloys Berg MD1
1 University of Freiburg,
Department for Nutrition Schwarzwaldstr. 175 79117 Freiburg
Centre for Internal Medicine
TE D
2 University Hospital Freiburg
M AN U
Institute for Sports and Sports Science
Department of Rehabilitation, Prevention and Sports Medicine, Germany
AC C
79106 Freiburg
EP
Hugstetterstr. 175
Address for correspondence Prof Dr. Daniel König
Email: [email protected]
ACCEPTED MANUSCRIPT Objektive To investigate the effect of a 6 week intervention with either lifestyle intervention (increased physical activity/low calorie diet) or a meal-replacement regimen on glycemic control in prediabetic subjects with impaired fasting glucose.
RI PT
Research Methods and Procedures 42 overweight or obese men and women (age 54 ± 8 y; weight 95.1 ± 11.9 kg; BMI 32.8 ± 2.89 kg/m2) were included in this randomized controlled clinical trial. Subjects in the lifestyle group (LS) n=14) received dietary counselling sessions (fat restricted low calorie diet) and
SC
instructions how to increase physical activity. Subjects in the meal replacement group (MR
M AN U
n=28) were instructed to replace two daily meals by a low-caloric high soy-protein drink with a low glycemic index. Results
Both interventions resulted in a significant decrease in body weight and BMI, although this reduction was more pronounced (p100 mg/dl) that do not meet the criteria for diabetes mellitus (> 126 mg/dl) should be diagnosed with prediabetes (1). In addition, the presence of impaired glucose tolerance (IGT)
RI PT
(2-h values in the OGTT of 140 mg/dl to 199 mg/dl and an A1C range of 5.7–6.4%) also identifies people with prediabetes. In individuals with prediabetes the postprandial phase is characterized by a large and more prolonged increase in blood glucose concentrations. It is estimated that approximately 10 % of the adult population in western societies have
SC
prediabetes (2). Although persons with prediabetes are healthy and per definition not diabetic, there is good scientific evidence to suggest that subjects with prediabetes have an
M AN U
increased risk for the conversion to diabetes mellitus type 2 (3).
It has been demonstrated that the reconversion from the prediabetic state to normoglycemia may substantially reduce the risk for the development of type 2 diabetes mellitus and associated complications (4). Furthermore, it has been shown that also the prediabetic state
TE D
is associated with early forms of neuropathy, nephropathy or retinopathy (5). Therefore, there is general agreement that subjects with prediabetes should be treated by therapeutic lifestyle interventions (TLC) or - in the case of malcompliance with TLC - by pharmacotherapy (6).
EP
The Diabetes Prevention Program and further clinical trials have shown that pre-diabetic conditions and insulin resistance can be improved (7). Increasing evidence suggests that the
AC C
risk for type 2 diabetes can be substantially reduced by being physically active, losing weight and making wise food choices (8). It has been demonstrated that meal replacement regimens are associated with fast weight loss and improvements in metabolic risk factors (911). A recent Medline research has shown that the effect of meal replacements on glycemic control and measures of insulin resistance has not been fully investigated in subjects with prediabetes. Therefore, in the present study, the influence of a very low calorie meal replacement regimen by a soy-protein drink on changes in fasting glucose and insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) HOMA-IR were investigated. The effects of the meal replacement regimen were compared against a lifestyle
ACCEPTED MANUSCRIPT intervention with a fat restricted low calorie diet in combination with increased physical activity.
Methods
RI PT
Pre-obese and obese men (n=16) and women (n=26) (age 54 ± 8 y; weight 95.1 ± 11.9 kg; BMI 32.8 ± 2.89 kg/m2) with increased fasting blood glucose levels (>100 mg/dl and
