Aim: This study investigated the effect of macronutrient composition of meals on postprandial peptide YY_3–36 (PYY_3–36) response in obese hyperinsulinemic females. Methods: Eight obese females consumed three iso-energetic meals of different macronutrient composition, high carbohydrate (HC; 60% CHO, 20% protein, 20% fat), high fat (HF; 30% CHO, 20% protein, 50% fat) and high protein (HP; 30% CHO, 50% protein, 20% fat), on three separate occasions, 1 month apart. PYY_3–36, insulin and glucosewere measured before and 15, 30, 60, 120 and 180 min following each meal. Results: PYY_3–36 levelsincreased significantly following the three meals, with the HC meal resulting in a sustained postprandial increase in PYY_3–36 level throughout the experimental period. Comparing the three meals, the HF meal induced a significantly higher increase in postprandial PYY_3–36 levels, at 15 and 30 min as compared to the HP meal (p < 0.05), whereas the postprandial increase following the HP meal became significantly higher than that following the HF meal at 120 min. Postprandial increase in PYY_3–36 was highest in the first hour following the HF meal, while that following the HP meal was delayed by 1 h. Conclusion: Increasing both protein and fat content of a meal may induce an immediate and prolonged increase in PYY_3–36, resulting in increased satiety and its maintenance for a longer period of time.

It is recommended that while the HFRM had adequate sensitivity, it is not seamless, and as such, nurses should not rely entirely on it. Rather, nurses should use their expert clinical judgement, their ethical obligations and cultural considerations to implement a safer environment of care for the patient.

No abstract

Multidisciplinary management of DKD has the potential for improving glycemic control and thus preventing complications. Its effect on other clinical and patient-oriented outcomes, especially on delaying the progression of the disease through preserving and preventing the decline in kidney function, has yet to be determined. There is not enough evidence to recommend multidisciplinary management for preserving kidney function. Further studies are needed.