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

(Marc) #1

From the US National Library of Medicine

Observational trials in humans indicate that eating more often than three times a day may play a role in overweight and obesity [7] and that frequent eating predisposes to a higher energy intake by increasing food stimuli and difficulty controlling energy balance [8]. In a randomised controlled study, more frequent eating was not related to a greater reduction in energy intake or body weight [9]. In type 2 diabetic patients it has been demonstrated that it may be more beneficial for glycaemic control to eat one larger instead of two smaller meals, provided the diet is rich in fibre [10].

It has been demonstrated that a large isocaloric mixed meal causes a greater postprandial thermogenic response than the same food consumed in six smaller portions [11]. Observational data suggest that eating meals later in the day may influence the success of weight-loss therapy, even in humans [12]. It has also been shown that fat storage increases during the day and is the greatest after an evening meal [13]. It has been observed that eating breakfast regularly may protect against weight gain, despite a higher total daily energy intake [14].

To the best of our knowledge, no interventional trials have investigated the relationship between eating frequency and weight change together with hepatic fat content (HFC), glucose tolerance and insulin resistance in humans, especially in patients with type 2 diabetes. The aim of our study was to compare the effect of six vs two meals a day (breakfast and lunch, as this regimen allows a reasonable fasting time, yet is sustainable in the long term) with the same caloric restriction on body weight, HFC, insulin resistance and beta cell function in individuals with type 2 diabetes. It was hypothesised that eating only breakfast and lunch would reduce body weight and HFC (and consequently, improve insulin resistance and beta cell function) more than six meals a day would.