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
Open accessAbstract
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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One RCT of time-restricted dieting reported 1.4 kg greater weight loss than conventional energy restriction (high risk of bias).
“one for time-restricted dieting reported 1.4 kg greater weight loss than conventional energy restriction (high-risk-of-bias RCT) [48].”
The current study's weight results agree with two recent interventional studies that found favorable effects of earlier eating on weight loss.
“The results of the current study on the effect of high energy intake at dinner on weight are in agreement with those of 2 recent interventional studies (24,36) that indicated the favorable effects of early eating throughout the day on weight loss.”
More frequent meals increase weight gain due to postprandial fat deposition, thereby worsening hyperglycemia, insulin resistance, hyperlipidemia, and appetite.
“Several studies suggest that more frequent meals increase weight gain due to postprandial fat deposition [318,319], thereby worsening hyperglycemia, IR, hyperlipidemia, and appetite [319,320].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [320]
Clinical trials, both short-term and long-term, with or without caloric restriction, in various populations, have produced contradictory results regarding the association of meal frequency with body weight, postprandial glycemia, insulin resistance, and overall glycemic control.
“Clinical trials, both short-term (14–28 days) [321,325,328,329,330,331,332] and long-term [323,324] with no caloric restriction in non-obese and obese women with PCO syndrome at an early or late stage IGT or overt early-stage T2DM, and long-term studies with caloric restriction in T2DM without [333] or with antidiabetic treatment [320,326], have produced contradictory results regarding the associ”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [320]
In T2DM subjects receiving anti-diabetic medications, 2 large versus 6 smaller meals decreased body weight and fasting plasma glucose/C-peptide/glucagon levels, with no differences in HbA1c, insulin, insulin sensitivity, and blood lipids.
“in T2DM subjects receiving anti-diabetic medications, 2 large vs 6 smaller meals decreased body weight, fasting plasma glucose/C-peptide/glucagon levels, with no differences in HbA1c, insulin, insulin sensitivity and blood lipids [320].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [320]
Three isocaloric studies showed that front loading (high caloric intake at breakfast) vs evening dinner improved weight loss.
“Three isocaloric studies showed that front loading (high caloric intake at breakfast) vs evening dinner improved weight loss [317,320,358].”
From Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance (2022) · cites this paper as [320]
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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
- PMC
- PMC4079942
- 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
- Update notices
- correction (2014-10-15)
- Open access
- hybrid
- doi.org
- 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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