Cited by 229Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsDietary Effects on Health

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

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Kahleova, Hana, Belinova, Lenka, Malinska, Hana, Oliyarnyk, Olena, Trnovska, Jaroslava, Skop, Vojtech, Kazdova, Ludmila, Dezortova, Monika +4 more·2014·Diabetologia

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/m(2) 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.

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Authors
Kahleova, H., Belinova, L., Malinska, H., Oliyarnyk, O., Trnovska, J., Skop, V., Kazdova, L., Dezortova, M., Hajek, M., Tura, A., Hill, M., & Pelikanova, T.
Affiliations
  • Charles University (CZ)
  • Institute of Clinical and Experimental Medicine (CZ)
  • National Research Council (IT)
  • Institute of Endocrinology (CZ)
Venue
Diabetologia
Published
2014-05-18
Volume
57
Issue
8
Pages
1552-1560
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
OpenAlex
W2031153362
Cited by
229
References
50
Citations by year
2026: 21 · 2025: 15 · 2024: 22 · 2023: 31 · 2022: 26 · 2021: 25 · 2020: 27 · 2019: 10 · 2018: 16 · 2017: 13 · 2016: 7 · 2015: 11 · 2014: 5
FWCI
9.65
Type
journal article
Language
en
Open access
Locations
  • Diabetologia (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Univerzita Karlova v Praze
  • European Association for the Study of Diabetes
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
Keywords
type 2 diabetes, meal frequency, hypocaloric diet, hepatic fat content, insulin resistance, beta-cell function, weight loss, weight loss maintenance, energy requirements, C-peptide
MeSH terms
Adult, Aged, Blood Glucose, C-Peptide, Diabetes Mellitus, Type 2, Diet, Reducing, Female, Glucagon, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Treatment Outcome, Cross-Over Studies, Meals, Breakfast, Lunch

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