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Cited by 199Dietary Effects on HealthDiabetes, Cardiovascular Risks, and LipoproteinsDiet, Metabolism, and Disease

Effects of diet, lifestyle, Chrononutrition and alternative dietary interventions on postprandial Glycemia and insulin resistance

Open access
Papakonstantinou, Emilia, Oikonomou, Christina, Nychas, George, Dimitriadis, George D.·2022·Nutrients
DOI 10.3390/nu14040823PMC PMC8878449
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Abstract

As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes evidence that diet, chrononutrition, lifestyle/exercise, and alternative dietary interventions can improve postprandial glycemia and insulin resistance, with weight loss and Mediterranean-style/low-GL eating patterns positioned as central strategies. It emphasizes individualization and notes that many areas remain controversial or need longer, better-designed trials.

Key findings

  • Lifestyle intervention can prevent or remit type 2 diabetes: in the U.S. Diabetes Prevention Program, a low-fat diet plus ≥150 min/week moderate exercise reduced T2DM incidence by 58% over 3 years; in DiRECT, 1-year remission was 46%, rising from 7% to 86% as weight loss increased from <5% to >15%.
  • A network meta-analysis of 9 dietary approaches found all significantly reduced HbA1c and fasting glucose; low-carbohydrate and Mediterranean-style diets were most effective for HbA1c, while Mediterranean-style and vegetarian diets were most effective for fasting glucose.
  • Chrononutrition matters: eating most calories and carbohydrates at lunch/early afternoon, avoiding late evening dinner, and keeping consistent meal times appear beneficial; in impaired glucose tolerance, a high-carbohydrate breakfast increased postprandial glucose excursions, and 6 vs 3 meals/day improved glycemic control in obese treatment-naive T2DM.
  • Alternative interventions show promise but mixed evidence: polyphenol supplementation reduced HbA1c by ~0.5% in T2DM; whey protein decreased HbA1c, insulin, triglycerides, total cholesterol, and IR in metabolic syndrome; vinegar, yogurt, peanuts, and tree nuts may also ameliorate postprandial hyperglycemia.

Methods

  • Design: narrative review aiming to describe available evidence on diet, chrononutrition, alternative dietary interventions, and exercise effects on postprandial glycemia and insulin resistance.
  • Data/sample: not a primary study; synthesizes RCTs, meta-analyses, and observational studies, with Tables 1–5 summarizing studies in healthy, IGT, prediabetes, T2DM, obesity, PCOS, and metabolic syndrome populations.
  • Main analysis: narrative synthesis of selected clinical outcomes; no systematic search strategy, inclusion/exclusion criteria, or new meta-analysis is reported in the provided text.

Limitations

  • Paper-stated: more RCTs are needed to identify optimal meal/snack timing and mechanisms; long-term studies are needed for meal frequency; intermittent fasting protocols are variable, often short, and studied in heterogeneous populations; evidence does not identify one clearly superior eating plan; reverse causality cannot be ruled out for breakfast skipping.
  • Paper-stated: long-term sustainability of low-carbohydrate diets is questionable, and many alternative interventions require larger, longer, higher-quality RCTs.
  • Evident from text: as a narrative review without a reported systematic search or formal risk-of-bias assessment, findings depend on selected studies and may not comprehensively capture all available evidence.

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Integrity signals

Registry

Crossref · 10.3390/nu14040823

Cites

433 of 433 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 392 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Out of the only four long-term clinical trials investigating the effects of meal frequency in T2DM, the three with caloric restrictive diets provided contradictory results.

    “Out of the only four long-term clinical trials investigating the effects of meal frequency in T2DM, the three with caloric restrictive diets provided contradictory results:”
    Quote in the paperNot a substantial claim
  • Premisecitation

    If circulating glucose exceeds the capacity of skeletal muscle for oxidation/storage, muscle cells convert glucose to lactate/alanine/glutamine which are delivered back to the liver and incorporate their carbons to glycogen (indirect pathway of glycogen synthesis).

    “If circulating glucose exceeds the capacity of skeletal muscle for oxidation/storage, muscle cells convert glucose to lactate/alanine/glutamine which are then delivered back to the liver and incorporate their carbons to glycogen (indirect pathway of glycogen synthesis) [34,48,49].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Woerle, 2003, Pathways for glucose disposal after meal ingestion in humans, Am. J. Physiol. Endocrinol. Metab. source

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    • cites [48] Meyer, 2002, Role of human liver, kidney, and skeletal muscle in postprandial glucose homeostasis, Am. J. Physiol. Endocrinol. Metab. source

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    • cites [49] Taylor, 1993, Direct measurement of change in muscle glycogen concentration after a mixed meal in normal subjects, Am. J. Physiol.

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  • Premisecitation

    In conditions such as IGT, T2DM or obesity, insulin-stimulated rates of blood flow in adipose tissue and muscle are severely impaired.

    “In conditions such as IGT, T2DM or obesity, insulin-stimulated rates of blood flow in adipose tissue and muscle are severely impaired [54,55,56].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [54] Lambadiari, 2012, Increases in muscle blood flow after a mixed meal are impaired at all stages of type 2 diabetes, Clin. Endocrinol. source

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    • cites [55] Dimitriadis, 2007, Impaired postprandial blood flow in adipose tissue may be an early marker of insulin resistance in type 2 diabetes, Diabetes Care source

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    • cites [56] Mitrou, 2009, Rates of glucose uptake in adipose tissue and muscle in vivo after a mixed meal in women with morbid obesity, J. Clin. Endocrinol. Metab. source

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  • Premisecitation

    If the sensitivity of insulin-sensitive tissues to insulin is increased, the management of an increased entry of glucose into the bloodstream after meals could be achieved in the absence of marked increases in plasma insulin levels.

    “Therefore, if the sensitivity of these tissues to insulin is increased, the management of an increased entry of glucose into the bloodstream after meals could be achieved in the absence of marked increases in the plasma levels of insulin [57].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] LeRoith, D., Taylor, S., and Olefsky, J. (2003). Integration of Biochemical and Physiologic Effects of Insulin on the Control of Blood Glucose Concentrations. Diabetes Mellitus a Fundamental and Clinical Text, Lippincott Williams & Wilkins. [3rd ed.]. Chapter 12.

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    • Rests on an assumption: The amount of insulin release from the β-cells under all circumstances depends on the metabolic requirements of the insulin-sensitive tissues.
  • Premisecitation

    Glucose can regulate its own metabolism in tissues independently of insulin.

    “Glucose can regulate its own metabolism in tissues independently of insulin [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Basu, 2001, Glucose effectiveness: Measurement in diabetic and nondiabetic humans, Exp. Clin. Endocrinol. Diabetes source

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  • May combine two claims. 132
  • Classified as probably not a substantial claim. 28
  • The quote only partly states this claim. 6

  • May combine two claims.

    Findingcitation

    Foods such as Ceratonia siliqua (carob) and characteristics such as large bran size or the sucrose to oligosaccharide ratio in honey varieties of similar botanical origin are able to reduce glucose excursions and overall postprandial glycemic responses.

    “We have shown in a series of studies that foods (such as Ceratonia siliqua, carob) and characteristics (such as large bran size or the sucrose to oligosaccharide ratio in honey varieties of similar botanical origin and characterization explaining 30% of the postprandial glucose differences) are able to reduce glucose excursions and overall postprandial glycemic responses [293,294,295]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [293] Papakonstantinou, 2018, Effects of bran size and carob seed flour of optimized bread formulas on glycemic responses in humans: A randomized clinical trial, J. Funct. Foods source

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    • cites [294] Papakonstantinou, 2017, Short-term effects of a low glycemic index carob-containing snack on energy intake, satiety, and glycemic response in normal-weight, healthy adults: Results from two randomized trials, Nutrition source

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    • cites [295] Gourdomichali, 2018, Short-term effects of six Greek honey varieties on glycemic response: A randomized clinical trial in healthy subjects, Eur. J. Clin. Nutr. source

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  • May combine two claims.

    Findingcitation

    In a long-term crossover study in subjects with early and late-stage IGT and naïve T2DM receiving weight maintenance diets, 6 versus 3 meals per day improved glycemic control in obese naïve T2DM subjects, resulting in significant reductions in HbA1c, peak glucose, postprandial glycemia, and hunger, and stabilized or at least improved glycemic excursions reducing hunger and desire to eat in the IGT

    “We demonstrated that 6 vs 3 meals per day improved glycemic control in obese naïve T2DM subjects, resulting in significant reductions in HbA1c, peak glucose, postprandial glycemia and hunger, and stabilized or at least improved glycemic excursions reducing hunger and desire to eat in the subjects with IGT [324].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [324] Papakonstantinou, 2018, Effects of 6 vs 3 eucaloric meal patterns on glycaemic control and satiety in people with impaired glucose tolerance or overt type 2 diabetes: A randomized trial, Diabetes Metab. source

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  • May combine two claims.

    Premisecitation

    Diet is the cornerstone of prevention and treatment of glucose dysmetabolism and insulin resistance, and food has major effects on postprandial glycemia and overall physical health.

    “Diet is considered the cornerstone of prevention and treatment of glucose dysmetabolism and insulin resistance (IR), and food has major effects on postprandial glycemia and overall physical health [1].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Shapira, N. (2019). The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss and regular moderate intensity physical activity/exercise are significant factors for IR prevention and/or treatment.

    “Weight loss and regular moderate intensity physical activity/exercise are significant factors for IR prevention and/or treatment [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Kokkinos, 2019, Exercise metabolism in health and disease, Cardiorespiratory Fitness in Cardiometabolic Diseases

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    After a meal, insulin plays a primary role in the regulation of glucose homeostasis through its effect on insulin-sensitive tissues (liver/skeletal muscle/adipose tissue).

    “After a meal, insulin plays a primary role in the regulation of glucose homeostasis through its effect on insulin-sensitive tissues (liver/skeletal muscle/adipose tissue) [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Dimitriadis, 2011, Insulin effects in muscle and adipose tissue, Diabetes Res. Clin. Pr. source

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  • May combine two claims.

    Premisecitation

    The preferential use of the liver to dispose a significant amount of the ingested glucose during first pass, along with a 60-70% hepatic clearance of insulin, protect the peripheral circulation from excessive hyperglycemia/hyperinsulinemia in the postprandial period.

    “The preferential use of the liver to dispose a significant amount of the ingested glucose during first pass, along with a 60–70% hepatic clearance of insulin, protect the peripheral circulation from excessive hyperglycemia/hyperinsulinemia in the postprandial period [35,36,37,38,39,40,41,42,43].”
    Quote in the paperNot a substantial claim0 of 9 sources checked
    • cites [35] Tesfamariam, 1992, Free radicals mediate endothelial cell dysfunction caused by elevated glucose, Am. J. Physiol.

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    • cites [36] Nishikawa, 2000, Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage, Nature source

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    • cites [37] Ceriello, 2004, Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited, Arter. Thromb. Vasc. Biol. source

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    • cites [38] Stegenga, 2006, Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans, Diabetes source

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    • cites [39] Lemkes, 2010, Hyperglycemia: A prothrombotic factor?, J. Thromb. Haemost. source

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    • cites [40] King, 1985, Receptors and growth-promoting effects of insulin and insulinlike growth factors on cells from bovine retinal capillaries and aorta, J. Clin. Investig. source

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    • cites [41] Monnier, 2008, Glycemic variability: Should we and can we prevent it?, Diabetes Care source

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    • cites [42] Stout, 1968, Insulin-stimulated lipogenesis in arterial tissue in relation to diabetes and atheroma, Lancet source

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    • cites [43] Gamble, 2017, Association of insulin dosage with mortality or major adverse cardiovascular events: A retrospective cohort study, Lancet Diabetes Endocrinol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The prevailing view is that IR precedes causing a progressive increase in insulin secretion to compensate for IR and maintain glucose tolerance, and in the long term β-cell function declines and hyperglycemia follows.

    “The prevailing view in the physical history of T2DM is that IR precedes causing a progressive increase in insulin secretion to compensate for IR and maintain glucose tolerance (IGT-prediabetes). In the long term β-cell function declines, and hyperglycemia follows (overt T2DM) [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Defronzo, 2009, Banting Lecture. From the triumvirate to the ominous octet: A new paradigm for the treatment of type 2 diabetes mellitus, Diabetes source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    These hormonal changes rapidly inhibit hepatic glucose production to allow incorporation of more than 30% of the ingested glucose into liver glycogen (direct pathway of glycogen synthesis).

    “These hormonal changes, rapidly inhibit hepatic glucose production (HGP) to allow incorporation of more than 30% of the ingested glucose into liver glycogen (direct pathway of glycogen synthesis) [33,34].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Gerich, 2000, Physiology of glucose homeostasis, Diabetes Obes. Metab. source

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    • cites [34] Woerle, 2003, Pathways for glucose disposal after meal ingestion in humans, Am. J. Physiol. Endocrinol. Metab. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    T2DM development stems from various genetic and/or environmental factors and is characterized by deficient pancreatic β-cell insulin secretion and decreased sensitivity/responsiveness of insulin-sensitive tissues to insulin.

    “T2DM development stems from various genetic and/or environmental factors and is characterized by deficient pancreatic β-cell insulin secretion and decreased sensitivity/responsiveness of insulin-sensitive tissues to insulin [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Skyler, 2017, Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis, Diabetes source

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    Premisecitation

    In some individuals, hyperinsulinemia may not be a compensatory response to insulin resistance but rather a primary defect due to hypersensitivity of β-cells explained by genetic/environmental factors, gastrointestinal/neural signals, or various substrates.

    “However, in some individuals, hyperinsulinemia may not be a compensatory response to insulin resistance but rather a primary defect due to hypersensitivity of β-cells explained by genetic/environmental factors, gastrointestinal/neural signals, or various substrates such as lactate, non-esterified fatty acids (NEFA)/triglycerides, or amino acids [20,21,22,23].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [20] Trico, 2018, Identification, pathophysiology, and clinical implications of primary insulin hypersecretion in nondiabetic adults and adolescents, JCI Insight source

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    • cites [21] Newsholme, 2014, Nutrient regulation of insulin secretion and action, J. Endocrinol. source

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    • cites [22] Natali, 2017, Plasma HDL-cholesterol and triglycerides, but not LDL-cholesterol, are associated with insulin secretion in non-diabetic subjects, Metabolism source

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    • cites [23] Dankner, 2009, Basal-state hyperinsulinemia in healthy normoglycemic adults is predictive of type 2 diabetes over a 24-year follow-up: A preliminary report, Diabetes Care source

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  • May combine two claims.

    Premisecitation

    If the liver is overpowered by increased amounts of carbohydrate in the meal, the escape of glucose to the peripheral circulation will be much higher engaging skeletal muscle for its removal; this will require a substantial increase in insulin secretion and plasma insulin levels which, in the long term, may lead to the development/aggravation of IR.

    “However, if the liver is overpowered by increased amounts of carbohydrate in the meal, the escape of glucose to the peripheral circulation will be much higher engaging skeletal muscle for its removal; this will require a substantial increase in insulin secretion and plasma insulin levels which, in the long term, may lead to the development/aggravation of IR [45,46,47].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [45] Jenkins, 1987, Metabolic effects of a low-glycemic-index diet, Am. J. Clin. Nutr. source

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    • cites [46] Brynes, 2005, The beneficial effect of a diet with low glycaemic index on 24 h glucose profiles in healthy young people as assessed by continuous glucose monitoring, Br. J. Nutr. source

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    • cites [47] Agius, 2013, High-carbohydrate diets induce hepatic insulin resistance to protect the liver from substrate overload, Biochem. Pharm. source

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  • May combine two claims.

    Premisecitation

    Overall, the liver disposes more than 50% of the ingested glucose and hence allows a much smaller amount to remain in the peripheral circulation.

    “Considering both the direct (first pass) and indirect pathways (through muscle) of glycogen synthesis, overall, the liver disposes more than 50% of the ingested glucose and hence allows a much smaller amount to remain in the peripheral circulation [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Ferrannini, 1980, The role of fractional glucose extraction in the regulation of splanchnic glucose metabolism in normal and diabetic man, Metabolism source

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  • May combine two claims.

    Premisecitation

    In response to a meal the intestinal tract secretes several peptides (incretins) that regulate its motility/absorption capacity, and insulin/glucagon secretion and action.

    “Furthermore, in response to a meal the intestinal tract secretes several peptides (incretins) that regulate its motility/absorption capacity, and insulin/glucagon secretion and action [65,66].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [65] Holst, 2013, Incretin hormones and the satiation signal, Int. J. Obes. source

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    • cites [66] Nauck, 2018, Incretin hormones: Their role in health and disease, Diabetes Obes. Metab. source

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  • May combine two claims.

    Interpretationreasoning

    Lifestyle interventions are important to improve tissue sensitivity to insulin and hence avoid marked hyperglycemia and hyperinsulinemia after meals.

    “Therefore, lifestyle interventions, such as those described in the present review, are important to improve tissue sensitivity to insulin and hence avoid marked hyperglycemia and hyperinsulinemia after meals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The subtle increase in plasma glucose levels seen after meals in physiological conditions may serve to collaborate with insulin to minimize the amount of insulin required for its effects on insulin-sensitive tissues and, hence, reduce the secretory burden on β-cells.

    “Therefore, as suggested by Kowalski et al. [51], the subtle increase in plasma glucose levels seen after meals in physiological conditions, may serve to collaborate with insulin to minimize the amount of insulin required for its effects on insulin-sensitive tissues and, hence, reduce the secretory burden on β-cells.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Kowalski, 2017, The Effect of Ingested Glucose Dose on the Suppression of Endogenous Glucose Production in Humans, Diabetes source

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  • May combine two claims.

    Premisecitation

    The pancreatic β-cells and insulin-sensitive tissues interact in a tightly regulated manner so that when insulin sensitivity is high, insulin secretion is low and vice versa.

    “Indeed, Kahn et al. [58] provided experimental evidence showing that the pancreatic β-cells and insulin-sensitive tissues interact in a tightly regulated manner so that when insulin sensitivity is high, insulin secretion is low and vice versa.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Kahn, 1993, Quantification of the relationship between insulin sensitivity and beta-cell function in human subjects. Evidence for a hyperbolic function, Diabetes source

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    Premisecitation

    In the liver, hyperglycemia per se increases the rates of glucose uptake and suppresses HGP, thus facilitating glucose storage, whereas in muscle it increases the rates of glucose uptake and phosphorylation.

    “In the liver, hyperglycemia per se increases the rates of glucose uptake and suppresses HGP, thus facilitating glucose storage [60], whereas in muscle it increases the rates of glucose uptake and phosphorylation [61].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [60] Petersen, 1998, Mechanism by which glucose and insulin inhibit net hepatic glycogenolysis in humans, J. Clin. Investig. source

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    • cites [61] Mandarino, 1993, Differential regulation of intracellular glucose metabolism by glucose and insulin in human muscle, Am. J. Physiol.

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  • May combine two claims.

    Premisecitation

    The rate of gastric emptying is a major determinant of the glycemic/insulin responses following a meal and correlates positively with postprandial hyperglycemia.

    “The rate of gastric emptying is a major determinant of the glycemic/insulin responses following a meal and has been shown to correlate positively with postprandial hyperglycemia [63,64].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [63] Doran, 2004, Effect of variations in small intestinal glucose delivery on plasma glucose, insulin, and incretin hormones in healthy subjects and type 2 diabetes, J. Clin. Endocrinol. Metab. source

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    • cites [64] Jenkins, 1990, Metabolic effects of reducing rate of glucose ingestion by single bolus versus continuous sipping, Diabetes source

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    Premisecitation

    GLP-1 and GIP collaborate to increase glucose-dependent insulin secretion and insulin sensitivity.

    “Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) have been heavily investigated due to their clinical application in T2DM; they collaborate to increase glucose-dependent insulin secretion and insulin sensitivity [67,68].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [67] Gutniak, 1992, Antidiabetogenic effect of glucagon-like peptide-1 (7-36)amide in normal subjects and patients with diabetes mellitus, N. Engl. J. Med. source

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    • cites [68] Rowlands, 2018, Pleiotropic Effects of GLP-1 and Analogs on Cell Signaling, Metabolism, and Function, Front Endocrinol. source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In IGT, a high-carbohydrate meal at breakfast should be avoided and a low carbohydrate meal should be recommended instead.

    “this study concluded that in IGT a high-carbohydrate meal at breakfast should be avoided and a low carbohydrate meal should be recommended instead [84].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [84] Kang, 2013, Effects of different proportion of carbohydrate in breakfast on postprandial glucose excursion in normal glucose tolerance and impaired glucose regulation subjects, Diabetes Technol. source

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  • May combine two claims.

    Premisecitation

    Consumption of foods and meals that induce a lower GL and delay gastric emptying leads to decreased insulin requirements and postprandial glucose excursions and may also reduce hunger and desire to eat.

    “Moreover, another important strategy to consider is the consumption of foods and meals that induce a lower GL and delay gastric emptying, thus leading to decreased insulin requirements and postprandial glucose excursions and may also reduce hunger and desire to eat [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Dimitriadis, G.D., Maratou, E., Kountouri, A., Board, M., and Lambadiari, V. (2021). Regulation of Postabsorptive and Postprandial Glucose Metabolism by Insulin-Dependent and Insulin-Independent Mechanisms: An Integrative Approach. Nutrients, 13. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2017, the ADA proposed consuming whole grain cereal products, nuts, yogurt, coffee and tea and limiting consumption of red meat and sodas containing sugar for preventing T2DM along with weight loss.

    “In 2017, the American Diabetes Association (ADA) proposed consuming the following foods for preventing T2DM along with weight loss: whole grain cereal products, nuts, yogurt, coffee and tea and limit consumption of red meat and sodas containing sugar [93].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] American Diabetes Association (2017). 4. Lifestyle Management. Diabetes Care, 40, S33–S43. source

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  • May combine two claims.

    Interpretationreasoning

    The type, total amount, other macronutrients consumed in parallel, physiological organic function, the GI/GL of carbohydrate containing foods, the extent of glucose excursions and fluctuations, and the time of day that the majority of carbohydrates is consumed, are determinant factors of postprandial glucose and insulin increases and amelioration or not of IR.

    “However, the type, total amount, other macronutrients consumed in parallel, physiological organic function, the GI/GL of carbohydrate containing foods, the extent to glucose excursions and fluctuations, and the time of day that the majority of carbohydrates is consumed, will be determinant factors of postprandial glucose and insulin increases and amelioration or not of IR.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In DIRECT, HbA1c was lowest in the low carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style group than in the lower-fat group.

    “Results from the Dietary Intervention Randomized Controlled Trial (DIRECT) assigning obese adults with T2DM to a calorie-restricted Mediterranean-style, a calorie-restricted lower-fat, or a low carbohydrate eating pattern (28% of calories from carbohydrate), showed that HbA1c was lowest in the low carbohydrate group after 2 years, whereas fasting plasma glucose was lower in the Mediterranean-style”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [105] Shai, 2008, Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, N. Engl. J. Med. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent ADA consensus report recommended a 7-10% of initial body weight reduction, if required, and maintenance to prevent progression from prediabetes to T2DM, and noted the potential for diabetes remission.

    “A recent consensus report of the ADA recommended a 7–10% of initial body weight reduction, if required, and maintenance to prevent progression from prediabetes to T2DM, and noted the potential for diabetes remission [114].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] Evert, 2019, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care source

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  • May combine two claims.

    Interpretationreasoning

    Impairments in the regulation of substrate utilization by skeletal muscle can be reversible and contribute to improvements in metabolic health and glycemia.

    “This suggests that impairments in the regulation of substrate utilization by skeletal muscle can be reversible and contribute to improvements in metabolic health and glycemia.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Weight loss has been proposed as a key strategy for the treatment of postprandial hyperglycemia, hyperinsulinemia, and IR.

    “Weight loss has been proposed as a key strategy for the treatment of postprandial hyperglycemia, hyperinsulinemia, and IR [108].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108] Ferrannini, 2009, Impact of different bariatric surgical procedures on insulin action and beta-cell function in type 2 diabetes, Diabetes Care source

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  • May combine two claims.

    Premisecitation

    In a network meta-analysis of RCTs in T2DM adults, all dietary approaches significantly reduced HbA1c and fasting blood glucose, with low carbohydrate and Mediterranean-style diets most effective for HbA1c, and Mediterranean-style and vegetarian diets most effective for fasting glucose reduction.

    “Results from a network meta-analysis of RCTs in T2DM adults examining 9 different dietary approaches (vegetarian, Mediterranean-style diet, high protein, moderate-carbohydrate, low carbohydrate, low-GI/GL, paleolithic, low-fat and control diet) with a duration of at least 12 weeks, showed that all dietary approaches significantly reduced Hb1Ac and fasting blood glucose levels, although the low”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [107] Schwingshackl, 2018, A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus, Eur. J. Epidemiol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    A low-calorie diet may be used to reach adequate weight loss rapidly; however, for maintenance of the lost weight a less restrictive diet is used, typically a more balanced, lower fat diet.

    “Therefore, a low-calorie diet may be used to reach adequate weight loss rapidly; however, for maintenance of the lost weight a less restrictive diet is used, typically a more balanced, lower fat diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Follow-up of 3 large studies of lifestyle intervention for diabetes prevention has shown sustained reduction in the rate of conversion to T2DM: 43% reduction at 20 years in Da Qing, 43% at 7 years and 34% at 10 years in Finnish DPS, and 27% at 15 years in DPP.

    “Moreover, follow-up of 3 large studies of lifestyle intervention for diabetes prevention has shown sustained reduction in the rate of conversion to T2DM: 43% reduction at 20 years in the Da Qing Diabetes Prevention Study [134]; 43% reduction at 7 years in the Finnish Diabetes Prevention Study [135] and 34% reduction at 10 years [132], and 27% reduction at 15 years extended follow-up in the DPP [”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [134] Li, 2008, The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20-year follow-up study, Lancet source

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    • cites [135] Lindstrom, 2006, Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow-up of the Finnish Diabetes Prevention Study, Lancet source

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    • cites [132] Knowler, 2009, 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Look AHEAD, DiRECT and DIADEM-I trials highlighted the potential for T2DM remission with a weight loss of 15 kg or more within one year following a low or very low-calorie diet, and also using meal replacements.

    “The Look AHEAD Trial, the Diabetes Remission Clinical Trial (DiRECT) and the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) highlighted the potential for T2DM remission, defined as the maintenance of euglycemia (complete remission) or prediabetes level of glycemia (partial remission) with no diabetes medication for at least 1 year, with a weight loss of 15 kg or more”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [125] Gregg, 2012, Association of an intensive lifestyle intervention with remission of type 2 diabetes, JAMA source

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    • cites [126] Buse, 2009, How do we define cure of diabetes?, Diabetes Care source

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    • cites [127] Zaghloul, 2020, Clinical and metabolic characteristics of the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) randomised clinical trial cohort, BMJ Open source

      Not checked in the free run.

    • cites [128] Taheri, 2020, Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): An open-label, parallel-group, randomised controlled trial, Lancet Diabetes Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The typical dietary scheme used in almost all weight loss studies is a balanced, low-fat diet, and its beneficial effects on weight loss (about 3.2 kg greater weight loss with a low-fat ad libitum diet) and maintenance have been well documented.

    “The typical dietary scheme used in almost all weight loss studies, either as the primary diet or as the control diet is a balanced, low-fat diet, and its beneficial effects on weight loss (of about 3.2 kg greater weight loss as a result of consuming a low-fat ad libitum diet) and maintenance have been well documented: compliance is easier in the long-term, and its reported effects are more”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Astrup, 2000, The role of low-fat diets in body weight control: A meta-analysis of ad libitum dietary intervention studies, Int. J. Obes. Relat. Metab. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A lifestyle intervention combining a low-fat diet with at least 150 min of moderate intensity weekly exercise led to weight loss and decreased T2DM incidence for adults with overweight/obesity and IGT by 58% over 3 years.

    “The strongest evidence for T2DM prevention using a low-fat diet approach comes from several studies, including the U.S. Diabetes Prevention Program (DPP) [115,132] and the Finnish Diabetes Prevention Study [133], demonstrating that a lifestyle intervention (combination of a low-fat diet combined with at least 150 min of moderate intensity weekly exercise) led to weight loss and decreased T2DM”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [115] Knowler, 2002, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, N. Engl. J. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Overall findings tend to support evidence from existing RCTs and observational studies showing that people with markers indicating higher risk for diabetes, prediabetes or IR have lower risk when they reduce calorie, carbohydrate, or saturated fat intake and/or increase fiber or protein intake (lean animal protein or plant protein) compared with their peers.

    “Overall findings tend to support evidence from existing RCTs and observational studies showing that people with markers indicating higher risk for diabetes, prediabetes or IR have lower risk when they reduce calorie, carbohydrate, or saturated fat intake and/or increase fiber or protein intake (lean animal protein or plant protein) compared with their peers [114].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [114] Evert, 2019, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lowering total fat intake did not consistently improve glycemia or CVD risk factors in T2DM, but the benefit from a low-fat eating pattern appeared to be mostly related to weight loss and not to the eating pattern itself.

    “A systematic review in people with T2DM [139], several studies [140,141,142,143], and a meta-analysis [144] suggested that lowering total fat intake did not consistently improve glycemia or CVD risk factors in T2DM, but the benefit from a low-fat eating pattern appeared to be mostly related to weight loss and not to the eating pattern itself [145,146].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [139] Wheeler, 2012, Macronutrients, food groups, and eating patterns in the management of diabetes: A systematic review of the literature, 2010, Diabetes Care source

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    • cites [140] Brehm, 2009, One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes, Diabetes Care source

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    • cites [141] Davis, 2009, Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [142] Guldbrand, 2012, In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss, Diabetologia source

      Not checked in the free run.

    • cites [143] Papakonstantinou, 2010, A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes, Eur. J. Clin. Nutr. source

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    • cites [144] Kodama, 2009, Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: A meta-analysis, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The follow-up of the Da Qing study demonstrated a reduction in CVD and all-cause mortality.

    “The follow-up of the Da Qing study also demonstrated a reduction in CVD and all-cause mortality [137].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [137] Li, 2014, Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: A 23-year follow-up study, Lancet Diabetes Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Weight loss can be achieved with low(er)-fat diets, but this seems to be inferior to low carbohydrate diets, and remission is expected to be lower than that achieved with low carbohydrate diets.

    “In conclusion, weight loss can be achieved with low(er)-fat diets, but this seems to be inferior to low carbohydrate diets, and remission is expected to be lower than that achieved with low carbohydrate diets.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The sequence of meals plays an important role in postprandial glycemic responses; preceding meals sensitize the metabolic and incretin system to the following ones, thereby improving glucose tolerance during the day.

    “The sequence of meals plays an important role in postprandial glycemic responses; preceding meals sensitize the metabolic and incretin system to the following ones, thereby improving glucose tolerance during the day (Figure 3) [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Dimitriadis, G.D., Maratou, E., Kountouri, A., Board, M., and Lambadiari, V. (2021). Regulation of Postabsorptive and Postprandial Glucose Metabolism by Insulin-Dependent and Insulin-Independent Mechanisms: An Integrative Approach. Nutrients, 13. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Premeal consumption of nutrients such as water, fat, protein, or fiber as "preloads" delay the rate of postprandial glucose absorption from the small intestine and attenuate insulin secretion and glucose excursions.

    “There is some evidence suggesting that premeal consumption of nutrients such as water, fat, protein, or fiber as “preloads” delay the rate of postprandial glucose absorption from the small intestine and attenuate insulin secretion and glucose excursions [74,180,181,182,183,184,185].”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [74] Nesti, 2019, Impact of Nutrient Type and Sequence on Glucose Tolerance: Physiological Insights and Therapeutic Implications, Front Endocrinol. source

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    • cites [180] Trico, 2015, Mechanisms through which a small protein and lipid preload improves glucose tolerance, Diabetologia source

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    • cites [181] Gentilcore, 2006, Effects of fat on gastric emptying of and the glycemic, insulin, and incretin responses to a carbohydrate meal in type 2 diabetes, J. Clin. Endocrinol. Metab. source

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    • cites [182] Ma, 2009, Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled type 2 diabetes, Diabetes Care source

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    • cites [183] Shukla, 2015, Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels, Diabetes Care source

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    • cites [184] Sun, 2020, Postprandial glucose, insulin and incretin responses differ by test meal macronutrient ingestion sequence (PATTERN study), Clin. Nutr. source

      Not checked in the free run.

    • cites [185] Weickert, 2008, Metabolic effects of dietary fiber consumption and prevention of diabetes, J. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The combination of diet and exercise is the most effective for reducing body weight and achieving better metabolic control compared to diet or exercise alone.

    “The combination of diet and exercise is the most effective for reducing body weight and achieving better metabolic control compared to diet or exercise alone [148,153,193].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [148] Johansen, 2017, Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial, Jama source

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    • cites [153] Slentz, 2016, Effects of exercise training alone vs a combined exercise and nutritional lifestyle intervention on glucose homeostasis in prediabetic individuals: A randomised controlled trial, Diabetologia source

      Not checked in the free run.

    • cites [193] American Diabetes Association (2019). 5. Lifestyle Management: Standards of Medical Care in Diabetes-2019. Diabetes Care, 42, S46–S60. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The magnitude of food and meal sequence is greater in T2DM than in healthy people, being comparable and additive to current antidiabetic medications and has been shown to sustain over time, offering a simple, effective, safe, and inexpensive tool for treating postprandial hyperglycemia and IR.

    “The magnitude of food and meal sequence is greater in T2DM than in healthy people, being comparable and additive to current antidiabetic medications and has been shown to sustain over time, offering a simple, effective, safe, and inexpensive tool for treating postprandial hyperglycemia and IR [31,74].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] Dimitriadis, G.D., Maratou, E., Kountouri, A., Board, M., and Lambadiari, V. (2021). Regulation of Postabsorptive and Postprandial Glucose Metabolism by Insulin-Dependent and Insulin-Independent Mechanisms: An Integrative Approach. Nutrients, 13. source

      Not checked in the free run.

    • cites [74] Nesti, 2019, Impact of Nutrient Type and Sequence on Glucose Tolerance: Physiological Insights and Therapeutic Implications, Front Endocrinol. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Meal and food sequence may play an important role in ameliorating postprandial hyperglycemia and IR and may be included in the dietary recommendations.

    “Therefore, it seems that meal and food sequence may play an important role in ameliorating postprandial hyperglycemia and IR and may be included in the dietary recommendations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Lifestyle interventions were more effective than standard care regarding glycemic control of subjects with T2DM, particularly when there was weight loss.

    “A more recent meta-analysis of 28 RCTs showed that lifestyle interventions were more effective than the standard care regarding the glycemic control of subjects with T2DM, particularly when there was weight loss [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] 2020, Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: A systematic review and meta-analysis, Eur. J. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In trials up to 6 months long, the low carbohydrate eating pattern improved HbA1c more, and in trials of varying lengths, lowered triglycerides, raised HDL cholesterol, lowered BP, and resulted in greater reductions in diabetes medications.

    “Another meta-analysis of RCTs [158] compared a low carbohydrate eating pattern (defined as <40% of calories from carbohydrate) to a low-fat eating pattern (defined as <30% of calories from fat). In trials up to 6 months long, the low carbohydrate eating pattern improved HbA1c more, and in trials of varying lengths, lowered triglycerides, raised HDL cholesterol, lowered BP, and resulted in greater”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [158] Fedorowicz, 2018, Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: A systematic review including GRADE assessments, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lifestyle interventions lowered T2DM risk by 20% in people with IGT after 10 years of follow-up but did not reduce all-cause mortality in T2DM.

    “Another meta-analysis of 20 RCTs (9 with people with IGT, and 11 with T2DM) with diagnosis of 6–48 months duration showed that lifestyle interventions lowered T2DM risk by 20% in people with IGT after 10 years of follow-up but did not reduce all-cause mortality in T2DM [204].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [204] Schellenberg, 2013, Lifestyle interventions for patients with and at risk for type 2 diabetes: A systematic review and meta-analysis, Ann. Intern. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss alone is effective in improving insulin sensitivity, but it is more likely to improve fasting fat oxidation and mitochondrial function if combined with exercise training.

    “It has been shown that weight loss alone is effective in improving insulin sensitivity, but it is more likely to improve fasting fat oxidation and mitochondrial function if combined with exercise training [111].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [111] Corpeleijn, 2009, Metabolic flexibility in the development of insulin resistance and type 2 diabetes: Effects of lifestyle, Obes. Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Beneficial metabolic changes (body weight loss of 6%, decreased HbA1c by ~0.4%, decreased insulin resistance/HOMA-IR index, ameliorated postprandial hyperglycemia, decreased BP, increased HDL cholesterol, and decreased plasma triglycerides) may last in the long-term.

    “Studies have also shown that the beneficial metabolic changes (body weight loss of 6%, decreased HbA1c by ~0.4%, decreased insulin resistance/HOMA-IR index, ameliorated postprandial hyperglycemia, decreased BP, increased HDL cholesterol, and decreased plasma triglycerides) may last in the long-term [123,154,155].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [123] Look AHEAD Research Group, and Wing, R.R. (2010). Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD trial. Arch. Intern. Med., 170, 1566–1575. source

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    • cites [154] Mensink, 2003, Lifestyle intervention according to general recommendations improves glucose tolerance, Obes. Res. source

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    • cites [155] Roumen, 2008, Impact of 3-year lifestyle intervention on postprandial glucose metabolism: The SLIM study, Diabetes Med. source

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  • May combine two claims.

    Premisecitation

    For each kg of mean weight loss, there is a mean HbA1c reduction of 0.1% in obese and overweight subjects with T2DM; and HbA1c lowering is greater in poor glycemic controlled vs well controlled populations with the same degree of weight loss.

    “It has been shown that for each kg of mean weight loss, there is a mean HbA1c reduction of 0.1% in obese and overweight subjects with T2DM; and that HbA1c lowering is greater in poor glycemic controlled vs well controlled populations with the same degree of weight loss [198].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [198] Gummesson, 2017, Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes, Diabetes Obes. Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Very low carbohydrate diets were less effective than less restrictive low carbohydrate diets for weight loss at 6 months, explained by low dietary adherence.

    “Very low carbohydrate diets were found to be less effective than less restrictive low carbohydrate diets for weight loss at 6 months, explained by low dietary adherence [163].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [163] Goldenberg, 2021, Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: Systematic review and meta-analysis of published and unpublished randomized trial data, BMJ source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regular resistance exercise improves insulin sensitivity by mechanisms including greater muscle vascularization and increases in blood flow rates.

    “As these authors [233] conclude, regular resistance exercise improves insulin sensitivity by a number of mechanisms, including greater muscle vascularization and increases in blood flow rates.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [233] Paquin, 2021, Exercising for Insulin Sensitivity—Is There a Mechanistic Relationship With Quantitative Changes in Skeletal Muscle Mass?, Front Physiol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    At 6 months, compared with control diets, low carbohydrate diets achieved higher rates of diabetes remission (57% vs 31%; defined as HbA1c <6.5%), but data on remission at 12 months were sparse.

    “A recent meta-analysis of 23 trials with 1357 participants examining the efficacy and safety of low carbohydrate diets and very low carbohydrate diets in T2DM, reported that at 6 months, compared with control diets, low carbohydrates diets achieved higher rates of diabetes remission (57% vs 31%; defined as HbA1c <6.5%), but data on remission at 12 months were sparse, ranging from a small effect to”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [163] Goldenberg, 2021, Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: Systematic review and meta-analysis of published and unpublished randomized trial data, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In rats, IGF-1 increases the apparent sensitivity of skeletal muscle to insulin in vitro and after acute or chronic (10 days) administration in vivo.

    “Earlier studies in rats showed that IGF-1, with its insulin-like effects, increases the apparent sensitivity of skeletal muscle to insulin either in-vitro [230] or after acute or chronic (10 days) administration in-vivo [231].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [230] Dimitriadis, 1992, Effects of insulin-like growth factor I on the rates of glucose transport and utilization in rat skeletal muscle in vitro, Biochem. J. source

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    • cites [231] Dimitriadis, 1992, Effects of in-vivo administration of insulin-like growth factor-I on the rate of glucose utilization in the soleus muscle of the rat, J. Endocrinol. source

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  • May combine two claims.

    Premisecitation

    In another meta-analysis, the larger the carbohydrate restriction, the greater the reduction in HbA1c, though HbA1c was similar at duration of 1 year and longer for both eating patterns.

    “Finally, in another meta-analysis comparing low carbohydrate to high carbohydrate eating patterns, the larger the carbohydrate restriction, the greater the reduction in HbA1c, though HbA1c was similar at duration of 1 year and longer for both eating patterns [164].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [164] Snorgaard, 2017, Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes, BMJ Open Diabetes Res. Care source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most living organisms exhibit circadian rhythms that control rhythmicity in physiological activities such as rest/active and feeding/fasting cycles.

    “Most living organisms exhibit circadian (diurnal) rhythms, which essentially control rhythmicity in physiological activities, such as rest/active, and feeding/fasting cycles [243,244].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [243] Sulli, 2018, Training the Circadian Clock, Clocking the Drugs, and Drugging the Clock to Prevent, Manage, and Treat Chronic Diseases, Trends Pharm. Sci. source

      Not checked in the free run.

    • cites [244] Voigt, 2019, Circadian rhythms: A regulator of gastrointestinal health and dysfunction, Expert Rev. Gastroenterol. Hepatol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In subjects with diabetes or obesity, exercise improves metabolic control, contributes to decrease in body weight, decreases risk for cardiovascular/kidney complications and hypertension, and improves physical fitness and well-being.

    “improves metabolic control, contributes to the decrease in body weight, decreases the risk for cardiovascular/kidney complications and hypertension, and improves physical fitness and well-being [234,235,236,237,238,239,240,241,242].”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [234] Tjonna, 2008, Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: A pilot study, Circulation source

      Not checked in the free run.

    • cites [235] Garber, 2011, American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise, Med. Sci. Sports Exerc. source

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    • cites [236] Kirwan, 2017, The essential role of exercise in the management of type 2 diabetes, Cleve. Clin. J. Med. source

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    • cites [237] Riddell, 2017, Exercise management in type 1 diabetes: A consensus statement, Lancet Diabetes Endocrinol. source

      Not checked in the free run.

    • cites [238] Vieira, 2018, High-Intensity Interval Training Improves Markers of Oxidative Metabolism in Skeletal Muscle of Individuals With Obesity and Insulin Resistance, Front Physiol. source

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    • cites [239] Acosta, 2020, Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis, Obes. Rev. source

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    • cites [240] Iaccarino, 2021, Modulation of Insulin Sensitivity by Exercise Training: Implications for Cardiovascular Prevention, J. Cardiovasc. Transl. Res. source

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    • cites [241] Palermi, S., Iacono, O., Sirico, F., Modestino, M., Ruosi, C., Spera, R., and De Luca, M. (2021). The complex relationship between physical activity and diabetes: An overview. J. Basic Clin. Physiol. Pharm., (Online ahead of print). source

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    • cites [242] American Diabetes Association Professional Practice Committee (2022). 17. Diabetes Advocacy: Standards of Medical Care in Diabetes-2022. Diabetes Care, 45, S254–S255. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some data suggest that pancreatic β-cell function may peak during lunch hours, indicating that carbohydrate intake is better metabolized during these hours resulting in ameliorated postprandial hyperglycemia.

    “The time of day that the function of the pancreatic β-cells peaks is still unknown, but some data suggest that it may peak during lunch hours; indicating that carbohydrate intake is better metabolized during these hours resulting in ameliorated postprandial hyperglycemia [83].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Pearce, 2008, Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Synchronizing food consumption, food quality, and metabolic rhythms in a day may provide optimal metabolism and positively impact health.

    “Synchronizing food consumption, food quality, and metabolic rhythms in a day may provide optimal metabolism and positively impact health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cortisol follows a daily rhythmicity, and adrenal gland cells have cellular clocks to temporally influence production and release of cortisol.

    “Finally, cortisol, a steroid hormone involved in metabolism and stress responses, also follows a daily rhythmicity. Adrenal gland cells have cellular clocks to temporally influence production and release of cortisol [249,255].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [249] Manoogian, 2017, Circadian rhythms, time-restricted feeding, and healthy aging, Ageing Res. Rev. source

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    • cites [255] Dickmeis, 2009, Glucocorticoids and the circadian clock, J. Endocrinol. source

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  • May combine two claims.

    Premisecitation

    Significant variations from circadian rhythmicity disrupt metabolism and homeostasis in many organs and can manifest in different ways ranging from irritability and fatigue to chronic diseases including obesity, T2DM, CVD, and inflammation.

    “Significant variations from this circadian rhythmicity have been shown to disrupt metabolism and homeostasis in many organs and can manifest in different ways ranging from irritability and fatigue to several chronic diseases, including obesity, T2DM, CVD, and inflammation [243].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [243] Sulli, 2018, Training the Circadian Clock, Clocking the Drugs, and Drugging the Clock to Prevent, Manage, and Treat Chronic Diseases, Trends Pharm. Sci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Insulin follows a temporal control of production, and its release is controlled by both feeding-fasting patterns and circadian rhythms.

    “Insulin follows a temporal control of production, and its release is controlled by both feeding-fasting patterns and circadian rhythms [250].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [250] Goel, 2009, Circadian rhythm profiles in women with night eating syndrome, J. Biol. Rhythm. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In mammals, functions of nearly all organs and systems are regulated by circadian rhythms and may exhibit daily oscillations.

    “In mammals, the functions of nearly all organs and systems, such as the pancreas, the gastrointestinal system (including the intestinal microbiome), the adipose tissue, the immune system, the endocrine system, the cardiovascular system, thermoregulation, brain activity, etc. are regulated by circadian rhythms, and may exhibit daily oscillations [243,244].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [243] Sulli, 2018, Training the Circadian Clock, Clocking the Drugs, and Drugging the Clock to Prevent, Manage, and Treat Chronic Diseases, Trends Pharm. Sci. source

      Not checked in the free run.

    • cites [244] Voigt, 2019, Circadian rhythms: A regulator of gastrointestinal health and dysfunction, Expert Rev. Gastroenterol. Hepatol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    In addition to the amount and content of food ingested, the time of ingestion itself is critical for the well-being of an organism.

    “This concept reflects the basic idea that, in addition to the amount and content of food ingested, the time of ingestion itself is also critical for the well-being of an organism.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    A modern lifestyle with late eating, lack of stable eating patterns, and skipping meals can lead to circadian misalignment and negatively impact metabolism and glucose control.

    “This type of lifestyle can lead to circadian misalignment and negatively impact metabolism and glucose control.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Late eating (in many cases with over 30% of the daily calories being consumed after 18:00), lack of stable eating patterns, and skipping meals are very common, particularly in western societies.

  • May combine two claims.

    Premisecitation

    Circadian misalignment has been observed in chronic jet lag and night shift workers, who exhibit lowered glucose and lipid tolerance, increased liver lipogenesis, higher BMI, and are prone to various metabolic diseases such as obesity, CVD, gastrointestinal disorders, and T2DM.

    “Circadian misalignment has been observed in chronic jet lag and night shift workers, who exhibit a lowered glucose and lipid tolerance, increased liver lipogenesis, higher body mass index (BMI), and are prone to various metabolic diseases such as obesity, CVD, gastrointestinal disorders, and T2DM [258,259,260].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [258] Lund, 2001, Postprandial hormone and metabolic responses amongst shift workers in Antarctica, J. Endocrinol. source

      Not checked in the free run.

    • cites [259] Zimberg, 2012, Metabolic impact of shift work, Work source

      Not checked in the free run.

    • cites [260] Henry, 2020, Chrononutrition in the management of diabetes, Nutr. Diabetes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In humans, a circadian misalignment protocol with a 12-h shift of all meals resulted in elevated blood glucose and reduced insulin levels after the evening dinner.

    “In humans, a circadian misalignment protocol with a 12-h shift of all meals resulted in elevated blood glucose and reduced insulin levels after the evening dinner [263].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [263] Morris, 2015, Endogenous circadian system and circadian misalignment impact glucose tolerance via separate mechanisms in humans, Proc. Natl. Acad. Sci. USA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In modern times a tendency for late-eating patterns has been observed and in many cases it is accompanied by skipping breakfast.

    “In modern times a tendency for late-eating patterns has been observed and in many cases, it is accompanied by skipping breakfast [257].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [257] Gill, 2015, A Smartphone App Reveals Erratic Diurnal Eating Patterns in Humans that Can Be Modulated for Health Benefits, Cell Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Skipping breakfast may be associated with increased BMI, altered lipid and glucose homeostasis, increased LDL, metabolic syndrome and T2DM.

    “Several studies have suggested that skipping breakfast may be associated with increased BMI (change in BMI from baseline over time), altered lipid and glucose homeostasis, increased LDL, metabolic syndrome and T2DM [260,275,276,277,278]”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [260] Henry, 2020, Chrononutrition in the management of diabetes, Nutr. Diabetes source

      Not checked in the free run.

    • cites [275] Maki, 2016, The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism, Adv. Nutr. source

      Not checked in the free run.

    • cites [276] Dhurandhar, 2016, True, true, unrelated? A review of recent evidence for a causal influence of breakfast on obesity, Curr. Opin. Endocrinol. Diabetes Obes. source

      Not checked in the free run.

    • cites [277] Ballon, 2019, Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies, J. Nutr. source

      Not checked in the free run.

    • cites [278] Mekary, 2012, Eating patterns and type 2 diabetes risk in men: Breakfast omission, eating frequency, and snacking, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a large cross-sectional study with 11,594 subjects with T2DM, evening vs morning chronotype was independently associated with T2DM, and people had lower odds of having HbA1c at the recommended levels of <7%.

    “In a large cross-sectional study with 11.594 subjects with T2DM, evening vs morning chronotype was independently associated with T2DM, and people had lower odds of having HbA1c at the recommended levels of <7% [274].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [274] Xue, 2021, Chronotype preference and glycemic control in type 2 diabetes, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In healthy adults, eating in the evening (at 17:00) vs morning (at 9:00) resulted in higher postprandial glucose concentrations and GIP, and lower levels of five glycolysis/tricarboxylic acid cycle/nucleotide-related metabolites, and eighteen amino acid-related metabolites, all involved in an exacerbation of postprandial hyperglycemia.

    “Another study in healthy adults showed that eating in the evening (at 17:00) vs morning (at 9:00) resulted in higher postprandial glucose concentrations and GIP, and lower levels of five glycolysis/tricarboxylic acid cycle/nucleotide-related metabolites, and eighteen amino acid-related metabolites, all involved in an exacerbation of postprandial hyperglycemia [272].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [272] Takahashi, M., Ozaki, M., Kang, M.I., Sasaki, H., Fukazawa, M., Iwakami, T., Lim, P.J., Kim, H.K., Aoyama, S., and Shibata, S. (2018). Effects of Meal Timing on Postprandial Glucose Metabolism and Blood Metabolites in Healthy Adults. Nutrients, 10. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Feeding time (day vs night), hours of daily fasting until the first meal, and irregular meal patterns may play a significant role in postprandial hyperglycemia and IR.

    “In conclusion, the feeding time (day vs night), the hours of daily fasting until the first meal is consumed and irregular meal patterns may play a significant role in postprandial hyperglycemia and IR”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A combination of carbohydrate and protein is essential to reset the liver clock and cause a phase-shift, whereas protein, carbohydrates, or lipids, when consumed alone, are insufficient.

    “Regarding the effect of nutrients on the liver clock, a combination of carbohydrate and protein is essential to reset it and cause a phase-shift, whereas protein, carbohydrates, or lipids, when consumed alone, are insufficient [270].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [270] Oike, 2014, Nutrients, Clock Genes, and Chrononutrition, Curr. Nutr. Rep. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Late evening dinners or midnight snacks change the length of the fasting period and thus alter the phase of peripheral clocks.

    “On the other hand, late evening dinners or midnight snacks change the length of the fasting period and thus alter the phase of peripheral clocks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Reverse causality cannot be ruled out for the association between skipping breakfast and increased risk for IR and T2DM, i.e., the increased risk may be due to higher BMI and not to skipping breakfast.

    “However, reverse causality cannot be ruled out, i.e., the increased risk for IR and T2DM may be due to the higher BMI and not to skipping breakfast.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Reverse causality cannot be ruled out for the association between skipping breakfast and increased BMI/metabolic outcomes, i.e., people may feel fuller when obese and so more likely to skip breakfast.

    “although reverse causality cannot be ruled out, i.e., people may feel fuller when obese and so more likely to skip breakfast.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In T2DM, overweight or obese individuals, breakfast omission and continued fast until lunch resulted in reduced insulin and GLP-1 after lunch, and lower glycemic and insulinemic responses, leading to postprandial hyperglycemia after lunch consumption.

    “Breakfast omission, and thus continued fast until lunch in T2DM, overweight or obese individuals was shown to result in reduced insulin and GLP-1 after lunch (the first meal of the day in one study), and lower glycemic and insulinemic responses, leading to postprandial hyperglycemia after lunch consumption [72,283,285].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [72] Jakubowicz, 2015, Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: A randomized clinical trial, Diabetes Care source

      Not checked in the free run.

    • cites [283] Chowdhury, 2016, The causal role of breakfast in energy balance and health: A randomized controlled trial in obese adults, Am. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [285] Jakubowicz, 2017, Influences of Breakfast on Clock Gene Expression and Postprandial Glycemia in Healthy Individuals and Individuals With Diabetes: A Randomized Clinical Trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Regular breakfast consumption has been shown to increase satiety and thermogenesis and improve the quality of the diet by inclusion of fibers and nutrient-rich foods.

    “Regular breakfast consumption has also been shown to increase satiety and thermogenesis and improve the quality of the diet by inclusion of fibers and nutrient-rich foods [279,280].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [279] Odegaard, 2013, Breakfast frequency and development of metabolic risk, Diabetes Care source

      Not checked in the free run.

    • cites [280] Betts, 2014, The causal role of breakfast in energy balance and health: A randomized controlled trial in lean adults, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In both healthy individuals and T2DM, breakfast consumption vs breakfast skipping affected positively clock and clock-controlled gene expression leading to normal oscillation patterns, while skipping breakfast resulted in increased postprandial glycemic responses.

    “Another study examining the acute effects of breakfast consumption or omission in both healthy individuals and T2DM, reported that breakfast consumption vs breakfast skipping affected positively clock and clock-controlled gene expression leading to normal oscillation patterns, while skipping breakfast resulted in increased postprandial glycemic responses [285].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [285] Jakubowicz, 2017, Influences of Breakfast on Clock Gene Expression and Postprandial Glycemia in Healthy Individuals and Individuals With Diabetes: A Randomized Clinical Trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In healthy individuals, breakfast omission together with late-evening dinner consumption, but not breakfast skipping alone, resulted in hyperglycemia.

    “A Japanese study in healthy individuals showed that breakfast omission together with late-evening dinner consumption, but not breakfast skipping alone, resulted in hyperglycemia [288].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [288] Nakajima, 2015, Association of hyperglycemia in a general Japanese population with late-night-dinner eating alone, but not breakfast skipping alone, J. Diabetes Metab. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of fibers at breakfast (i.e., beta glucans, whole grain cereals) may slow the rates of gastric emptying and intestinal glucose absorption, and contribute to increased satiety, thus reducing postprandial glucose responses in a dose-dependent manner.

    “Consumption of fibers at breakfast (i.e., beta glucans, whole grain cereals) may slow the rates of gastric emptying and intestinal glucose absorption, and contribute to increased satiety, thus reducing postprandial glucose responses in a dose-dependent manner [292].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [292] Kim, 2009, Glucose and insulin responses to whole grain breakfasts varying in soluble fiber, beta-glucan: A dose response study in obese women with increased risk for insulin resistance, Eur. J. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In healthy individuals, skipping breakfast resulted in better glycemic control after lunch, with blood glucose levels slightly elevated or unchanged and insulin secretion and sensitivity slightly increased.

    “In contrast, healthy individuals skipping breakfast had better glycemic control after lunch, with blood glucose levels slightly elevated or unchanged and insulin secretion and sensitivity slightly increased [286,287]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [286] Nas, 2017, Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk, Am. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [287] Kobayashi, 2014, Effect of breakfast skipping on diurnal variation of energy metabolism and blood glucose, Obes. Res. Clin Pr.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Protein and fat consumption at breakfast have been shown to increase satiety and better regulate post-meal glucose responses.

    “Accordingly, protein and fat consumption at breakfast have been shown to increase satiety and better regulate post-meal glucose responses [275,276].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [275] Maki, 2016, The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism, Adv. Nutr. source

      Not checked in the free run.

    • cites [276] Dhurandhar, 2016, True, true, unrelated? A review of recent evidence for a causal influence of breakfast on obesity, Curr. Opin. Endocrinol. Diabetes Obes. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Having a caloric rich breakfast results in increased postprandial insulin secretion and GLP-1 responses, and smaller plasma glucose peaks after breakfast consumption; these effects are not present when the majority of calories is consumed at the evening dinner.

    “Having a caloric rich breakfast was found to result in increased postprandial insulin secretion and GLP-1 responses, and smaller plasma glucose peaks after breakfast consumption [301]; these effects were not present when the majority of calories was consumed at the evening dinner.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [301] Jakubowicz, 2015, High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: A randomised clinical trial, Diabetologia source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    A late supper (18:00 vs 23:00) was associated with a worse effect on postprandial glucose profiles the following morning in healthy young females.

    “showed that a late supper was associated with a worse effect on postprandial glucose profiles the following morning [307].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [307] Tsuchida, 2013, Effects of a late supper on digestion and the absorption of dietary carbohydrates in the following morning, J. Physiol. Anthr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Long term substitution of available carbohydrates at breakfast with proteins decreased blood triglycerides and regulated BP.

    “Long term substitution of available carbohydrates at breakfast with proteins also decreased blood triglycerides and regulated BP [275].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [275] Maki, 2016, The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism, Adv. Nutr. source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    Moving the evening dinner to an earlier time may improve glucose tolerance due to a causal role of endogenous melatonin in the impairment of glucose tolerance, particularly in MTNR1B carriers.

    “It has also been shown that moving the evening dinner to an earlier time may improve glucose tolerance due to a causal role of endogenous melatonin in the impairment of glucose tolerance, particularly in MTNR18 carriers [310].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [310] Saxena, 2018, Late dinner impairs glucose tolerance in MTNR1B risk allele carriers: A randomized, cross-over study, Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Skipping the evening dinner may improve glucose intolerance and lower IR.

    “On the other hand, skipping the evening dinner (Table 3) may improve glucose intolerance, and lower IR [286,308].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [286] Nas, 2017, Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk, Am. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [308] Grant, 2017, Timing of food intake during simulated night shift impacts glucose metabolism: A controlled study, Chronobiol. Int. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Eating a rich or a late dinner may aggravate IR and hyperglycemia and deteriorate blood glucose levels the following morning.

    “In contrast, eating a rich or a late dinner may aggravate IR and hyperglycemia and deteriorate blood glucose levels the following morning [307,309].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [307] Tsuchida, 2013, Effects of a late supper on digestion and the absorption of dietary carbohydrates in the following morning, J. Physiol. Anthr. source

      Not checked in the free run.

    • cites [309] Bandin, 2015, Meal timing affects glucose tolerance, substrate oxidation and circadian-related variables: A randomized, crossover trial, Int. J. Obes. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Although some carbohydrates must be consumed at breakfast to improve glucose tolerance in the following meals, placing the majority of carbohydrates at breakfast may not be a good idea; breakfast and evening dinner should have the minority of carbohydrates with lunch taking the most.

    “although some carbohydrates must be consumed at breakfast to improve glucose tolerance in the following meals, placing the majority of carbohydrates at breakfast may not be a good idea; actually, breakfast and evening dinner should have the minority of carbohydrates with lunch taking the most.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [318] Chen, 2016, Relationship between frequency of eating and cardiovascular disease mortality in U.S. adults: The NHANES III follow-up study, Ann. Epidemiol. source

      Not checked in the free run.

    • cites [319] Mattson, 2005, The need for controlled studies of the effects of meal frequency on health, Lancet source

      Not checked in the free run.

    • cites [320] Kahleova, 2014, 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, Diabetologia source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Prolonging the fasting interval to 16 h prolongs the release of NEFAs and fat oxidation.

    “the fasting interval should be prolonged to 16 h, which prolongs the release of NEFAs and fat oxidation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Ghrelin, an orexigenic hormone, increases just before a meal and especially at night.

    “Ghrelin, an orexigenic hormone, increases just before a meal and especially at night [316]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [316] Scheer, 2013, The internal circadian clock increases hunger and appetite in the evening independent of food intake and other behaviors, Obesity source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Frequent meals may reduce body weight and produce lower postprandial glycemic/insulinemic responses, lower blood lipids, improve metabolic control, and reduce appetite.

    “In contrast, others support the idea that frequent meals may reduce body weight and produce lower postprandial glycemic/insulinemic responses, lower blood lipids, improve metabolic control, and reduce appetite [321,322].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [321] Jenkins, 1989, Nibbling versus gorging: Metabolic advantages of increased meal frequency, N. Engl. J. Med. source

      Not checked in the free run.

    • cites [322] Seagle, 2009, Position of the American Dietetic Association: Weight management, J. Am. Diet. Assoc. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    A late large evening dinner shortens the fasting interval, increasing the possibility of morning hyperglycemia.

    “A late large evening dinner shortens the fasting internal increasing the possibility of morning hyperglycemia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Having a large, rich breakfast may contribute to hunger, cravings, and postprandial ghrelin reduction.

    “Therefore, having a large, rich breakfast may also contribute to hunger, cravings, and postprandial ghrelin reduction [266].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [266] Solomon, 2008, The effect of feeding frequency on insulin and ghrelin responses in human subjects, Br. J. Nutr. source

      Not checked in the free run.

    • Rests on an assumption: Ghrelin is suppressed by increases in insulin.

  • May combine two claims.

    Premisecitation

    Consumption of high GI foods is better managed during daytime hours, whereas high GI food intake at dark hours (late afternoon-evening hours) results in greater blood glucose peaks and total blood glucose concentrations after meals.

    “a short-term trial in healthy individuals demonstrated that consumption of high GI foods was better managed during daytime hours, whereas high GI food intake at dark hours (late afternoon-evening hours) resulted in greater blood glucose peaks and total blood glucose concentrations after meals [315].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [315] Gibbs, 2014, Diurnal postprandial responses to low and high glycaemic index mixed meals, Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [320] Kahleova, 2014, 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, Diabetologia source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Both weight loss and antidiabetic medications have a significant impact on glucose/lipid metabolism.

    “it is well known that both weight loss and antidiabetic medications have a significant impact on glucose/lipid metabolism [334]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [334] Franz, 2007, Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up, J. Am. Diet. Assoc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An 11-week study in overweight participants following a 6-h early TRF plan (08:00-14:00) resulted in a decrease in night glycemia, 24-h blood glucose fluctuations, fasting plasma glucose/insulin levels, HOMA-IR, and increased evening plasma insulin levels, without changes in day plasma glucose concentrations.

    “A study of 11 weeks duration in which overweight participants followed a 6-h early TRF plan (08:00–14:00) resulted in a decrease in night glycemia, 24-h blood glucose fluctuations, fasting plasma glucose/insulin levels, HOMA-IR, and increased evening plasma insulin levels, without changes in day plasma glucose concentrations [344].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [344] Jamshed, H., Beyl, R.A., Della Manna, D.L., Yang, E.S., Ravussin, E., and Peterson, C.M. (2019). Early Time-Restricted Feeding Improves 24-Hour Glucose Levels and Affects Markers of the Circadian Clock, Aging, and Autophagy in Humans. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Although there is evidence suggesting benefit from many regular smaller meals on glucose metabolism, it remains a controversial issue.

    “although there is evidence suggesting benefit from many regular smaller meals on glucose metabolism, it remains a controversial issue”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Two short-term (2-week) trials comparing 9-10 h early or late eating windows reported that early-eating improved blood pressure and glucose tolerance (decreased blood glucose areas under the curve, mean fasting and postprandial glucose levels), while late-eating increased plasma glucose, insulin, and triglyceride levels during the night.

    “Two short-term (2-week) trials compared the effects of a 9–10 h early or late eating window and reported that early-eating improved BP and glucose tolerance (decreased blood glucose areas under the curve, mean fasting and postprandial glucose levels), while late-eating increased plasma glucose, insulin, and triglyceride levels during the night [342,343].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [342] Hutchison, 2019, Time-Restricted Feeding Improves Glucose Tolerance in Men at Risk for Type 2 Diabetes: A Randomized Crossover Trial, Obesity source

      Not checked in the free run.

    • cites [343] Wehrens, 2017, Meal Timing Regulates the Human Circadian System, Curr. Biol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Long-term fasting diets can lead to ketosis, during which glucose reserves run out and glycogen stores are insufficient to provide energy to the brain and the CNS, using ketone bodies and acetone as alternative fuels.

    “The concept behind IF is that long-term fasting diets can also lead to ketosis, during which glucose reserves run out and glycogen stores are insufficient to provide energy to the brain and the CNS, using ketone bodies and acetone as alternative fuels [338].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [338] Paoli, A., Tinsley, G., Bianco, A., and Moro, T. (2019). The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In T2DM subjects, a 2-week TRF plan with a 9-h eating window reduced HbA1c by 3% and glucose by 3.6%, and increased insulin by 18%, without weight loss.

    “T2DM subjects, who followed a 2-week TRF plan with a 9-h eating window per day demonstrated reductions in hyperglycemia and HbA1c, and increases in plasma insulin levels, even though there was no weight loss observed [356].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [356] Parr, E.B., Devlin, B.L., Lim, K.H.C., Moresi, L.N.Z., Geils, C., Brennan, L., and Hawley, J.A. (2020). Time-Restricted Eating as a Nutrition Strategy for Individuals with Type 2 Diabetes: A Feasibility Study. Nutrients, 12. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smaller duration studies from 8 to 12 weeks examining ADF have shown that it is a safe and tolerable approach to weight loss, although it provided conflicting evidence regarding markers for CVD protection.

    “Smaller duration studies from 8 to 12 weeks examining ADF have shown that it is a safe and tolerable approach to weight loss, although it provided conflicting evidence regarding markers for CVD protection [348,349].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [348] Varady, 2013, Alternate day fasting for weight loss in normal weight and overweight subjects: A randomized controlled trial, Nutr. J. source

      Not checked in the free run.

    • cites [349] Catenacci, 2016, A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity, Obesity source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with metabolic syndrome following a 10-h TRF demonstrated reductions in body weight and improvements in glycemia (reduced HbA1c, plasma glucose/insulin levels, and HOMA-IR).

    “Patients with metabolic syndrome following a 10-h TRF also demonstrated reductions in body weight and improvements in glycemia (reduced HbA1c, plasma glucose/insulin levels and HOMA-IR) [345].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [345] Wilkinson, 2020, Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patients with Metabolic Syndrome, Cell Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a group that received a caloric restricted diet, weight loss and decreased insulin responses were observed, but these reductions were smaller than those of the IF group.

    “Weight loss and decreased insulin responses were also observed in a group that received a caloric restricted diet, but these reductions were smaller than those of the IF group”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [347] Carter, 2019, The effect of intermittent compared with continuous energy restriction on glycaemic control in patients with type 2 diabetes: 24-month follow-up of a randomised noninferiority trial, Diabetes Res. Clin. Pr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In uncontrolled subjects with diabetes treated with insulin, 3 versus 6 meals per day resulted in decreased body weight, HbA1c, total daily insulin requirements, and higher expression of clock genes.

    “In uncontrolled subjects with diabetes treated with insulin, 3 vs 6 meals per day resulted in decreased body weight, HbA1c, total daily insulin requirements and higher expression of clock genes [326].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [326] Jakubowicz, 2019, Reduction in Glycated Hemoglobin and Daily Insulin Dose Alongside Circadian Clock Upregulation in Patients With Type 2 Diabetes Consuming a Three-Meal Diet: A Randomized Clinical Trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the same study, eTRF reduced fasting insulin by 3.4 ± 1.6 mU/L, mean insulin by 26 ± 9 mU/L, and peak insulin by 35 ± 13 mU/L.

    “Fasting Ins −3.4 ± 1.6 mU/L Mean Ins−26 ± 9 mU/LPeak Ins−35 ± 13 mU/L”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [355] Sutton, 2018, Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes, Cell Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In T2DM, 5 versus 3 meals per day resulted in decreased BMI and HbA1c, without significant differences in fasting plasma glucose, insulin, and lipids.

    “another study in T2DM reported that 5 vs 3 meals per day resulted in decreased BMI and HbA1c, without significant differences in fasting plasma glucose, insulin, and lipids [333].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [333] Salehi, 2014, The effects of 6 isocaloric meals pattern on blood lipid profile, glucose, hemoglobin a1c, insulin and malondialdehyde in type 2 diabetic patients: A randomized clinical trial, Iran J. Med. Sci.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two years after that intervention, both groups had regained some of the weight, HbA1c was lower in the IF group, and both groups presented a reduction in plasma TG levels.

    “two years after that intervention, both groups had regained some of the weight, HbA1c was lower in the IF group, and both groups now presented a reduction in plasma TG levels [347].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [347] Carter, 2019, The effect of intermittent compared with continuous energy restriction on glycaemic control in patients with type 2 diabetes: 24-month follow-up of a randomised noninferiority trial, Diabetes Res. Clin. Pr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Premisecitation

    In healthy athletes, an 8-week TRF (8-h feeding/16-h fasting) reduced fat mass by 16.4%, glucose by 11%, and insulin by 36.3%, whereas the normal diet group had smaller reductions (fat mass −2.8%, insulin −13%) and no change in glucose.

    “TRF’s favorable glycemic and insulinemic effects were reported in healthy athletes performing resistance training [357].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [357] Moro, 2016, Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males, J. Transl. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the same study, eTRF increased insulinogenic index by 14 ± 7 mu/mg and reduced insulin resistance (iAUC) by 36 ± 10 mU/mg.

    “Insulinogenic index+14 ± 7 mu/mgIR (iAUC)−36 ± 10 mU/mg”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [355] Sutton, 2018, Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes, Cell Metab. source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In overweight subjects with impaired glucose tolerance, a 5-week eTRF intervention (6-h eating window, dinner before 15:00) produced no significant changes in fasting or mean glucose compared to a 12-h control feeding period.

    “Improved insulinemia was observed in overweight subjects with IGT who followed a 6-h TRF, but in this study significant changes in fasting or mean glycemia were not observed [355].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [355] Sutton, 2018, Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes, Cell Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies in mice have reported beneficial effects of intermittent fasting against diabetes and obesity with improvements in glucose tolerance and insulin sensitivity, maintenance of insulinemia within normal levels, and improvements in CREB, mTOR, and AMPK pathways, even in mice fed high-fat diets.

    “Studies in mice have reported beneficial effects of IF against diabetes and obesity with improvements in glucose tolerance and insulin sensitivity, maintenance of insulinemia within normal levels, and improvements in the phosphorylated cyclic AMP response element-binding protein (CREB), rapamycin complex (mTOR), and AMP-activated protein kinase (AMPK) pathways, even in mice fed high-fat diets [256”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [256] Asher, 2015, Time for food: The intimate interplay between nutrition, metabolism, and the circadian clock, Cell source

      Not checked in the free run.

    • cites [335] Chaix, 2014, Time-restricted feeding is a preventative and therapeutic intervention against diverse nutritional challenges, Cell Metab. source

      Not checked in the free run.

    • cites [336] Hatori, 2012, Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet, Cell Metab. source

      Not checked in the free run.

    • cites [337] Adamovich, 2014, Circadian clocks and feeding time regulate the oscillations and levels of hepatic triglycerides, Cell Metab. source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In a 12-month study, ADF (25% of daily energy needs on fasting days: one day on, one day off) compared with a calorie-restricted (75% of energy needs every day) and a control diet resulted in weight loss in the two intervention groups, but insulin sensitivity, blood lipid levels and blood glucose were not improved.

    “It was demonstrated that although the two intervention groups lost weight, insulin sensitivity, blood lipid levels and blood glucose were not improved.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [350] Trepanowski, 2017, Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial, JAMA Intern. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An isocaloric study showed that more body fat was lost with 6-h vs 12-h feeding with significant differences in weight loss (1.5 kg), plasma adiponectin, testosterone, interleukin-1β, and IGF-1 levels, but no changes in fat free mass, resting energy expenditure, and plasma thyroid hormone/glucose levels.

    “An isocaloric study showed that more body fat was lost with 6-h vs 12-h feeding with significant differences in weight loss (1.5 kg), plasma adiponectin, testosterone, interleukin-1β, and IGF-1 levels, but no changes in fat free mass, resting energy expenditure, and plasma thyroid hormone/glucose levels [357].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [357] Moro, 2016, Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males, J. Transl. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Various plant-derived foods, plant compounds and functional ingredients/foods have been linked with ameliorated postprandial hyperglycemia, and they may be considered "alternative" dietary interventions for diabetes management.

    “Various plant-derived foods, plant compounds and functional ingredients/foods have been linked with ameliorated postprandial hyperglycemia, and they may be considered “alternative” dietary interventions for diabetes management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a study of 54 obese individuals with T2DM randomized into three groups (VLCD 5 days then 1 day/week VLCD for 15 weeks; VLCD 5 days then 5 days VLCD every 5 weeks; control), both VLCD groups lost significantly more body weight, with the second group losing >5 kg.

    “This study showed that both VLCD groups lost significantly more body weight with the second group losing >5 kg [363].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [363] Williams, 1998, The effect of short periods of caloric restriction on weight loss and glycemic control in type 2 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    ADF studies in normal weight, overweight, and obese subjects with a duration of 3-12 weeks were effective in achieving an approximately 3-7% weight loss, 3-5.5 kg body fat loss, and lowering blood lipids (approximately 10-21% for total cholesterol and 14-42% for triglycerides).

    “It has been reported that ADF studies in normal weight, overweight, and obese subjects with a duration of 3–12 weeks were effective in achieving an approximately 3–7% weight loss, 3–5.5 kg body fat loss, lowering blood lipids (approximately 10–21% for total cholesterol and 14–42% for triglycerides) [360].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [360] Tinsley, 2015, Effects of intermittent fasting on body composition and clinical health markers in humans, Nutr. Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study of 63 overweight and obese T2DM subjects randomized to consume 400-600 kcal/day 2 days/week and typical energy intake for 5 days/week vs whole day energy restriction to 1200-1550 kcal/day, after 12 weeks there were similar reductions in HbA1c, body weight, antidiabetic medications, body composition, and appetite in both groups.

    “after 12 weeks there were similar reductions in HbA1c, body weight, antidiabetic medications, body composition, and appetite in both groups [364].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [364] Carter, 2016, The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial, Diabetes Res. Clin. Pr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A 5-week crossover study in men with prediabetes showed that early-time IF (6 h feeding period, with dinner before 15:00) was in alignment with circadian rhythms in metabolism compared to a control schedule (12 h feeding period), and improved insulin sensitivity, β-cell responsiveness, BP, oxidative stress, and appetite, independently of weight loss.

    “A 5-week crossover study in men with prediabetes showed the early-time IF (6 h feeding period, with dinner before 15:00) to be in alignment with circadian rhythms in metabolism compared to a control schedule (12 h feeding period), improved insulin sensitivity, β-cell responsiveness, BP, oxidative stress, and appetite, independently of weight loss [355].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [355] Sutton, 2018, Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes, Cell Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Even low amounts (1 g/day) of cinnamon powder were enough to reduce fasting glucose and improve blood lipid profiles of T2DM patients.

    “It has been shown that even low amounts (1 g/day) of cinnamon powder was enough to reduce fasting glucose and improve blood lipid profiles of T2DM patients [375].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [375] Khan, 2003, Cinnamon improves glucose and lipids of people with type 2 diabetes, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Some practical strategies from IF trials that seem to be effective in body weight and postprandial glycemia support consuming the evening dinner earlier in the day, consuming most of the energy at breakfast and lunch, avoiding snacks late at night, and reducing feeding time by 1-2 h with the last meal before 18:00 or the latest at 20:00.

    “In conclusion, some practical strategies from IF trials that seem to be effective in body weight and postprandial glycemia support consuming the evening dinner earlier in the day, consuming most of the energy at breakfast and lunch, avoiding snacks late at night, and reducing feeding time by 1–2 h with the last meal before 18:00 or the latest at 20:00.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Consumption of meals containing beta-glucan, fermented in the colon, resulted in decreased postprandial glucose concentrations due to a delayed and somewhat reduced carbohydrate absorption from the gut, not from the effects of fermentation in the colon.

    “Results from one study reported that consumption of meals containing beta-glucan, fermented in the colon, resulted in decreased postprandial glucose concentrations due to a delayed and somewhat reduced carbohydrate absorption from the gut not from the effects of fermentation in the colon [389].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [389] Battilana, 2001, Mechanisms of action of beta-glucan in postprandial glucose metabolism in healthy men, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Feeding periods after 16:00 had either no effect or unfavorable effects on postprandial glycemia, β-cell responsiveness, BP, and blood lipids.

    “Feeding periods after 16:00 had either no effect or unfavorable effects on postprandial glycemia, β-cell responsiveness, BP, and blood lipids [360,361,362].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [360] Tinsley, 2015, Effects of intermittent fasting on body composition and clinical health markers in humans, Nutr. Rev. source

      Not checked in the free run.

    • cites [361] Carlson, 2007, Impact of reduced meal frequency without caloric restriction on glucose regulation in healthy, normal-weight middle-aged men and women, Metabolism source

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    • cites [362] Stote, 2007, A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults, Am. J. Clin. Nutr. source

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  • May combine two claims.

    Premisecitation

    Sourdough fermentation of wheat dough lowers the GI of bread and postprandial glucose excursions, due to formation of organic acids, leading to reduced rate of starch digestion and delayed gastric emptying.

    “Sourdough fermentation of wheat dough has been repeatedly reported to lower the GI of bread and postprandial glucose excursions, due to the formation of organic acids, leading to reduced rate of starch digestion and delayed gastric emptying [383,385,386,387,388].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [383] Liljeberg, 1996, Delayed gastric emptying rate as a potential mechanism for lowered glycemia after eating sourdough bread: Studies in humans and rats using test products with added organic acids or an organic salt, Am. J. Clin. Nutr. source

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    • cites [385] Capurso, 2020, The Mediterranean way: Why elderly people should eat wholewheat sourdough bread-a little known component of the Mediterranean diet and healthy food for elderly adults, Aging Clin. Exp. Res. source

      Not checked in the free run.

    • cites [386] Liljeberg, 1998, Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar, Eur. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [387] Liljeberg, 1995, Sourdough fermentation or addition of organic acids or corresponding salts to bread improves nutritional properties of starch in healthy humans, J. Nutr.

      Not checked in the free run.

    • cites [388] Poutanen, 2009, Sourdough and cereal fermentation in a nutritional perspective, Food Microbiol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Whole day fasting studies with a duration of 12-24 weeks achieved a 3-9% body weight loss, body fat loss, and lowering of blood lipids (approximately 5-20% for total cholesterol and 17-50% for triglycerides).

    “Whole day fasting studies with a duration of 12–24 weeks also achieved a 3–9% body weight loss, body fat loss and lowering of blood lipids (approximately 5–20% for total cholesterol and 17–50% for triglycerides) [360].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [360] Tinsley, 2015, Effects of intermittent fasting on body composition and clinical health markers in humans, Nutr. Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lactic acid may lead to slower starch absorption due to inhibition of amylolytic enzymes, interaction between starch and gluten, and delay of gastric emptying, leading to lower postprandial glycemic responses.

    “Lactic acid may lead to slower starch absorption due to inhibition of amylolytic enzymes, thus, reducing its bioavailability due to the interaction between starch and gluten, and the delay of gastric emptying, leading to lower postprandial glycemic responses [385,386].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [385] Capurso, 2020, The Mediterranean way: Why elderly people should eat wholewheat sourdough bread-a little known component of the Mediterranean diet and healthy food for elderly adults, Aging Clin. Exp. Res. source

      Not checked in the free run.

    • cites [386] Liljeberg, 1998, Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fasting until 12:00 results in increased postprandial hyperglycemia and impaired insulin responses after lunch and evening dinner in healthy and T2DM subjects.

    “It has been shown that fasting until 12:00 results in increased postprandial hyperglycemia and impaired insulin responses after lunch and evening dinner in healthy and T2DM subjects [72]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Jakubowicz, 2015, Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: A randomized clinical trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Allowing people to consume the fast day meal at the evening dinner (or dividing it into smaller meals) produced similar weight loss and CVD protection as consuming the meal at lunch.

    “another study showed that allowing people to consume the fast day meal at the evening dinner (or dividing it into smaller meals) produced similar weight loss and CVD protection as consuming the meal at lunch”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [352] Hoddy, 2014, Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults, Obesity source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    A balanced diet such as a Mediterranean-style, low GL diet may be a suitable approach to achieve both weight loss and maintenance and ameliorate postprandial hyperglycemia and IR.

    “However, a balanced diet such as a Mediterranean-style, low GL diet may be a suitable approach to achieve both weight loss and maintenance and ameliorate postprandial hyperglycemia and IR.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Lactic acid in fermented milk products did not lower the postprandial glycemic responses, and the presence of organic acids may counteract the insulinotropic effect of milk in mixed meals.

    “another study reporting that the lactic acid in fermented milk products did not lower the postprandial glycemic responses and concluded that the presence of organic acids may counteract the insulinotropic effect of milk in mixed meals [391].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [391] Ostman, 2001, Inconsistency between glycemic and insulinemic responses to regular and fermented milk products, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 12 trials showed reductions in postprandial blood glucose and HDL cholesterol levels, and BP, only at high doses of chia seeds/oil, and only in subgroup analysis, with effects being modest and probably not clinically significant, and with low or very low quality of evidence.

    “A systematic review and meta-analysis of 12 trials with healthy individuals, athletes, and subjects with T2DM or metabolic syndrome, showed reductions in postprandial blood glucose and HDL cholesterol levels, and BP, only at the high doses, and only in subgroup analysis with the effects being modest and probably not clinically significant, and with the quality of evidence of the studies being low”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [415] Teoh, 2018, Clinical evidence on dietary supplementation with chia seed (Salvia hispanica L.): A systematic review and meta-analysis, Nutr. Rev. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 22 RCTs reported that consumption of whey protein significantly decreased HbA1c, insulin/triglyceride/total cholesterol levels, and IR without effects on HDL cholesterol and fasting blood glucose levels in patients with metabolic syndrome.

    “A recent systematic review and meta-analysis of 22 RCTs examining the effects of whey protein on glycemic status in patients with metabolic syndrome, reported that consumption of whey protein decreased significantly HbA1c, insulin/triglyceride/total cholesterol levels, and IR without effects on HDL cholesterol and fasting blood glucose levels [427].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [427] Amirani, 2020, Effects of whey protein on glycemic control and serum lipoproteins in patients with metabolic syndrome and related conditions: A systematic review and meta-analysis of randomized controlled clinical trials, Lipids Health Dis. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 40 RCTs reported that consumption of peanuts or tree nuts significantly decreased IR and fasting insulin, without effects on HbA1c or fasting glucose levels.

    “Another systematic review and meta-analysis of 40 RCTs examining the effects of tree nuts on indices of glycemic control, reported that consumption of peanuts or tree nuts significantly decreased IR and fasting insulin, without effects on HbA1c or fasting glucose levels [424].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [424] Tindall, 2019, The effect of nuts on markers of glycemic control: A systematic review and meta-analysis of randomized controlled trials, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary polyphenols' beneficial reported effects on postprandial hyperglycemia and IR may be due to inhibition of α-amylase and α-glucosidases, inhibition of intestinal glucose absorption by sodium-dependent glucose transporter-1, stimulation of insulin secretion, and reduction of hepatic glucose output.

    “Dietary polyphenols’ beneficial reported effects on postprandial hyperglycemia and IR may be due to inhibition of α-amylase and α-glucosidases, inhibition of intestinal glucose absorption by sodium-dependent glucose transporter-1, stimulation of insulin secretion, and reduction of hepatic glucose output [414].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [414] Kim, Y., Keogh, J.B., and Clifton, P.M. (2016). Polyphenols and Glycemic Control. Nutrients, 8. source

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  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 6 RCTs reported a significant reduction in fasting glucose and IR with pistachio nuts in people with T2DM, prediabetes, or metabolic syndrome, without differences from controls on HbA1c and fasting plasma insulin.

    “A systemic review and meta-analysis of 6 RCTs examining the effects of pistachio nuts on glycemic control and insulin sensitivity in people with T2DM, prediabetes, or metabolic syndrome, reported a significant reduction in fasting glucose and IR, without differences from controls on HbA1c and fasting plasma insulin”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [416] Hassanipour, 2020, The effectiveness of pistachio on glycemic control and insulin sensitivity in patients with type 2 diabetes, prediabetes and metabolic syndrome: A systematic review and meta-analysis, Diabetes Metab. Syndr source

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  • May combine two claims.

    Premisecitation

    Whey protein is an excellent source of branched-chain amino acids (BCAAs), and after its digestion, a rapid increase in amino acids, particularly BCAAs, leads to insulin release, which may improve postprandial hyperglycemia.

    “Whey protein is an excellent source of branched-chain amino acids (BCAAs) and it has been shown that after its digestion, a rapid increase in amino acids, particularly BCAAs leads to insulin release, which may improve postprandial hyperglycemia [427].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [427] Amirani, 2020, Effects of whey protein on glycemic control and serum lipoproteins in patients with metabolic syndrome and related conditions: A systematic review and meta-analysis of randomized controlled clinical trials, Lipids Health Dis. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Whey protein intake has been suggested to improve metabolic parameters due to bioactive substances, including immunoglobulins, glutamine, lactoferrin, and lactalbumin, which activate the release of incretin hormones including GIP and GLP-1, whilst peptides from whey hydrolyzation inhibit dipeptidyl peptidase-IV and inhibit degradation of GIP and GLP-1.

    “Whey protein intake has been suggested to improve metabolic parameters due to bioactive substances, including immunoglobulins, glutamine, lactoferrin, and lactalbumin, which have been shown to activate the release of incretin hormones including GIP and GLP-1, whilst peptides from whey hydrolyzation have also been shown to inhibit dipeptidyl peptidase-IV and inhibit degradation of GIP and GLP-1 [”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [427] Amirani, 2020, Effects of whey protein on glycemic control and serum lipoproteins in patients with metabolic syndrome and related conditions: A systematic review and meta-analysis of randomized controlled clinical trials, Lipids Health Dis. source

      Not checked in the free run.

    • cites [428] Adams, 2016, Insulinotropic Effects of Whey: Mechanisms of Action, Recent Clinical Trials, and Clinical Applications, Ann. Nutr. Metab. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In healthy subjects, vinegar consumption with a meal (either as dressing on salad or as a drink) resulted in generally lower postprandial glycemia and in some studies reduced insulinemia.

    “In healthy subjects, vinegar consumption with a meal (either as dressing on salad or as a drink) resulted in generally lower postprandial glycemia [386,394,395,396] and in some studies reduced insulinemia [386] as well.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [386] Liljeberg, 1998, Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar, Eur. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [394] Salbe, 2009, Vinegar lacks antiglycemic action on enteral carbohydrate absorption in human subjects, Nutr. Res. source

      Not checked in the free run.

    • cites [395] Ostman, 2005, Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects, Eur. J. Clin. Nutr. source

      Not checked in the free run.

    • cites [396] Brighenti, 1995, Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects, Eur. J. Clin. Nutr.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 36 RCTs reported significant reduction in HbA1c (~0.5%) in those with T2DM after polyphenol supplementation, without significant effects in healthy subjects and those with prediabetes.

    “A systematic review and meta-analysis of 36 RCTs examining the effects of polyphenols (extracts, supplements, and foods), supplemented in doses of 28 mg to 1.5 g, for 0.7 to 12 months on HbA1c levels in healthy subjects and individuals with prediabetes or T2DM, reported significant reduction in HbA1c (~0.5%), in those with T2DM, without significant effects in the healthy subjects and those with”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [413] Vlassopoulos, 2017, Nutritional intervention and impact of polyphenol on glycohemoglobin (HbA1c) in non-diabetic and type 2 diabetic subjects: Systematic review and meta-analysis, Crit. Rev. Food Sci. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One study conducted on almond nuts reported improvements in glycemic control and lipid profiles in T2DM, without differences in IR vs controls.

    “One study conducted on almond nuts reported improvements in glycemic control and lipid profiles in T2DM, without differences in IR vs controls [422].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [422] Li, 2011, Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus, Metabolism source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Vinegar intake before or together with a meal was associated with improved glycemia, reduced post-meal area under the curve for glucose, reduced fasting blood glucose, insulin and triglycerides, increased muscle glucose uptake, and reduced the need for fast-acting insulin in subjects with T1DM.

    “Vinegar intake before or together with a meal was associated with improved glycemia, reduced post-meal area under the curve for glucose, reduced fasting blood glucose, insulin and triglycerides, increased muscle glucose uptake, and reduced the need for fast-acting insulin in subjects with T1DM [398,399,400,401,402,403].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [398] Mitrou, 2015, Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes, J. Diabetes Res. source

      Not checked in the free run.

    • cites [399] Liatis, 2010, Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal, Eur. J. Clin. Nutr. source

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    • cites [400] Mitrou, 2010, Vinegar decreases postprandial hyperglycemia in patients with type 1 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [401] White, 2007, Vinegar ingestion at bedtime moderates waking glucose concentrations in adults with well-controlled type 2 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [402] Johnston, 2004, Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [403] Mitrou, 2015, The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Polyphenol rich extracts had a more marked effect in reducing HbA1c among the trials; 125 mg/day isoflavonoids from soy products, 1-3 g of cinnamon (27 mg/day of coumarin), and 250 mg/day resveratrol from extracts were reported to have the highest efficiency in reducing HbA1c.

    “Polyphenol rich extracts had a more marked effect in reducing HbA1c among the trials; with 125 mg/day isoflavonoids from soy products, 1–3 f of cinnamon (27 mg/day of coumarin), 250 mg/day resveratrol from extracts, reported to have the highest efficiency in reducing HbA1c [413].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [413] Vlassopoulos, 2017, Nutritional intervention and impact of polyphenol on glycohemoglobin (HbA1c) in non-diabetic and type 2 diabetic subjects: Systematic review and meta-analysis, Crit. Rev. Food Sci. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sourdough fermentation is a method able to lower the postprandial glycemic responses to bread, but this did not relate to starch accessibility or general bioavailability, but rather to bacteria-induced delayed gastric emptying.

    “another study showed that sourdough fermentation is a method able to lower the postprandial glycemic responses to bread, but this did not relate to the starch accessibility or general bioavailability, but rather to bacteria-induced delayed gastric emptying [390].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [390] Scazzina, 2009, Sourdough bread: Starch digestibility and postprandial glycemic response, J. Cereal Sci. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A systematic review and meta-analysis of 9 RCTs reported that almond-based diets have significant effects in promoting the growth of short-chain fatty acid-producing gut microbiota, and lower HbA1c and body weight, but with no observed differences on fasting or 2-h postprandial blood glucose, inflammatory markers, GLP-1, fasting blood insulin, and IR.

    “A recent systematic review and meta-analysis of 9 RCTs examining the effects of almonds on gut microbiota, glucose metabolism and inflammatory parameters in T2DM reported that almond-based diets have significant effects in promoting the growth of short-chain fatty acid-producing gut microbiota, and lower HbA1c and body weight, but with no observed differences on the levels of fasting or 2-h postpr”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [423] Ojo, O., Wang, X.H., Ojo, O.O., and Adegboye, A.R.A. (2021). The Effects of Almonds on Gut Microbiota, Glycometabolism, and Inflammatory Markers in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients, 13. source

      Not checked in the free run.

145 of 145

  • The paper relies on this without support.

    The amount of insulin release from the β-cells under all circumstances depends on the metabolic requirements of the insulin-sensitive tissues.

    “The amount of insulin release from the β-cells under all circumstances depends on the metabolic requirements of the insulin-sensitive tissues.”

  • The paper relies on this without support.

    Carbohydrates are well known to be the major macronutrients affecting postprandial glycemia.

    “Carbohydrates are well known to be the major macronutrients affecting postprandial glycemia.”

  • The paper relies on this without support.

    The mechanisms of tissue crosstalk for substrate mobilization during exercise depend on how much glycogen is stored in the liver or muscle at the beginning of exercise, which in turn depends on the amount of carbohydrates in the previous meal or prior physical activity, as well as on the intensity/duration of exercise and the physical fitness of the subjects.

    “The mechanisms described in this section regarding the crosstalk between tissues for the mobilization of substrates during exercise depend on how much glycogen is stored in the liver or muscle at the beginning of exercise, which in turn depends on the amount of carbohydrates in the previous meal or on any performance of physical activity prior to exercise, as well as on the intensity/duration of e”

  • The paper relies on this without support.

    Glucose tolerance peaks during daylight and is lower during the night/dark cycle.

    “Glucose tolerance peaks during daylight and is lower during the night/dark cycle.”

  • The paper relies on this without support.

    The carbohydrate type and content of a meal are the main determinants of postprandial hyperglycemia and insulin response.

    “The carbohydrate type and content of a meal are the main determinants of postprandial hyperglycemia and insulin response (Figure 3).”

  • The paper relies on this without support.

    Late eating (in many cases with over 30% of the daily calories being consumed after 18:00), lack of stable eating patterns, and skipping meals are very common, particularly in western societies.

    “This may be expected considering the modern way of life where late eating (in many cases with over 30% of the daily calories being consumed after 18:00), lack of stable eating patterns, and skipping meals are indeed very common, particularly in western societies (Figure 3).”

  • The paper relies on this without support.

    Hunger is intrinsically modulated and has circadian periodicity with peaks in the evening, meaning there is a higher tendency for food later in the day.

    “Hunger is intrinsically modulated and has circadian periodicity with peaks in the evening, meaning that there is higher tendency for food later in the day.”

  • The paper relies on this without support.

    Ghrelin is suppressed by increases in insulin.

    “but is being suppressed by increases in insulin.”

  • The paper relies on this without support.

    Diet is the cornerstone of glucose metabolism and weight loss is the remedy for IR.

    “Diet is the cornerstone of glucose metabolism and weight loss is the remedy for IR.”

  • The paper relies on this without support.

    Management of postprandial hyperglycemia and IR is critical for the prevention of T2DM and amelioration of cardiometabolic risk factors.

    “Their management is critical for the prevention of T2DM and amelioration of cardiometabolic risk factors.”

  • The paper relies on this without support.

    Lifestyle counseling using moderate energy restriction, regular physical activity and dietary behavior modification techniques is effective in optimally managing glycemic and insulinemic responses.

    “Lifestyle counseling using moderate energy restriction, regular physical activity and dietary behavior modification techniques has proven to be effective in optimally managing glycemic and insulinemic responses.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported meal-frequency comparison differs from Table 4

    Major

    The text describes the Salehi study as comparing five versus three meals per day. Table 4 instead identifies its groups as six meals versus five meals.

  • The 15-year diabetes-incidence reductions are assigned to opposite groups

    Major

    The narrative reports a 27% reduction at the DPP's 15-year follow-up, but Table 1 assigns 27% to metformin and 18% to the intensive lifestyle intervention. The surrounding discussion attributes the follow-up reduction to lifestyle intervention.

  • Breakfast macronutrient percentages total 104%

    Minor

    The listed protein, carbohydrate and fat shares for the CBdiet breakfast sum to 104%, not 100%.

    Reported 100 · recomputed 104

  • Small dinner macronutrient percentages total 116%

    Minor

    The listed protein, carbohydrate and fat shares for this dinner sum to 116%, not 100%. The same composition appears again for the corresponding breakfast in the Ddiet.

    Reported 100 · recomputed 116

  • Jamshed trial duration differs between text and table

    Minor

    The text calls the trial an 11-week study, whereas Table 5 lists its duration as eight days.

  • An intervention called isoenergetic adds snacks to one diet

    Minor

    Table 4 calls the three- and six-meal diets isoenergetic, but describes the six-meal diet as the three-meal diet plus 150-kcal snacks. As specified, adding snacks increases rather than preserves its energy intake.

6 of 6

Cites

Flagged first, then by citations

17 of the 450 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. LeRoith, D., Taylor, S., and Olefsky, J. (2003). Integration of Biochemical and Physiologic Effects of Insulin on the Control of Blood Glucose Concentrations. Diabetes Mellitus a Fundamental and Clinical Text, Lippincott Williams & Wilkins. [3rd ed.]. Chapter 12.

Cited by

Sorted by citations

Related

Authors
Papakonstantinou, E., Oikonomou, C., Nychas, G., & Dimitriadis, G. D.
Affiliations
  • Agricultural University of Athens (GR)
  • Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece
  • National and Kapodistrian University of Athens (GR)
Corresponding author
Papakonstantinou, Emilia
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2022-02-16
Volume
14
Issue
4
Pages
823
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu14040823
PMC
PMC8878449
OpenAlex
W4213312412
Cited by
199
References
450
Citations by year
2026: 32 · 2025: 60 · 2024: 38 · 2023: 57 · 2022: 10 · 2020: 1
FWCI
5.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
Keywords
chrononutrition, postprandial blood glucose, insulin resistance, meal timing, dietary habits, intermittent fasting, weight loss, Mediterranean diet, low-carbohydrate diet, low-fat diet, carbohydrate reduction, physical activity, behavior therapy, type 2 diabetes prevention, vinegar, yogurt, whey protein, tree nuts, groundnut, postprandial hyperglycemia
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Humans, Insulin, Insulin Resistance, Life Style, Cross-Over Studies, Diet, Fat-Restricted, Postprandial Period, Glycemic Index, Meals

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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