Effect of Meal Dilution on the Postprandial Glycemic Response: Implications for glycemic testing

Sievenpiper, John L.; Vuksan, Vladimir; Wong, Erin Oi-Yan; Mendelson, Rena A; Bruce-Thompson, C.

doi:10.2337/diacare.21.5.711

Cited by 18 publications

(10 citation statements)

References 36 publications

(47 reference statements)

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“…Current and previous studies of gastric emptying suggest that the initial rate of gastric emptying of glucose is the major determinant of the glycemic response (8,25,26); in healthy subjects, the blood glucose concentrations at 120 min are inversely, rather than directly, related to gastric emptying (8), reflecting the greater initial rise in plasma insulin. The current observations conflict with two studies reporting dilution of oral glucose increases postprandial glycemia in healthy subjects (33,34). It should be recognized, however, that in these studies gastric emptying of the drinks was not measured (33,34) and the cause of the different glycemic responses remains uncertain.…”

Section: Discussioncontrasting

confidence: 53%

“…The current observations conflict with two studies reporting dilution of oral glucose increases postprandial glycemia in healthy subjects (33,34). It should be recognized, however, that in these studies gastric emptying of the drinks was not measured (33,34) and the cause of the different glycemic responses remains uncertain.…”

Section: Discussioncontrasting

confidence: 53%

“…It has been suggested that a lack of standardization of the volume of water ingested in an oral glucose tolerance test accounts for some of its documented variability (4,6,(32)(33)(34). Whereas increases in volume have been associated with higher peak blood glucose concentrations, reports are inconsistent and interpretation has been limited by the lack of concurrent measurement of gastric emptying (33,34).…”

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confidence: 99%

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Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

Jones

O’Donovan

Russo

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

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. Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects. Am J Physiol Gastrointest Liver Physiol 289: G240 -G248, 2005. First published March 17, 2005 doi:10.1152/ajpgi.00030.2005.-Postprandial hypotension (PPH) occurs frequently in the elderly; the magnitude of the fall in blood pressure (BP) is related to the rate of glucose entry into the duodenum during intraduodenal glucose infusion and spontaneous gastric emptying (GE). It is unclear if glucose concentration affects the hypotensive response. Gastric distension may attenuate PPH; therefore, meal volume could influence the BP response. We aimed to determine the effects of 1) drink volume, 2) glucose concentration, and 3) glucose content on the BP and heart rate (HR) responses to oral glucose. Ten subjects (73.9 Ϯ 1.2 yr) had measurements of BP, GE, and blood glucose on 4 days after 1) 25 g glucose in 200 ml (12.5%), 2) 75 g glucose in 200 ml (37.5%), 3) 25 g glucose in 600 ml (4%), and 4) 75 g glucose in 600 ml (12.5%). GE, BP, HR, and blood glucose were measured for 180 min. After all drinks, duodenal glucose loads were similar in the first 60 min. Regardless of concentration, 600-ml (but not 200-ml) drinks initially increased BP, and in the first 30 min, systolic BP correlated (P Ͻ 0.01) with volume in both the proximal and total stomach. At the same concentration (12.5%), systolic BP fell more (P ϭ 0.02) at the smaller volume; at the same volumes, there were no effects of concentration on BP. There was no difference in the glycemic response to drinks of identical glucose content. We conclude that 1) ingestion of glucose at a higher volume attenuates and 2) under constant duodenal load, glucose concentration (4 -37%) does not affect the fall in BP. postprandial hypotension; gastric emptying; elderly POSTPRANDIAL HYPOTENSION, leading to syncope and falls, is an important clinical problem, particularly in the elderly and patients with autonomic dysfunction (7,12,14,19). The mechanisms responsible for postprandial hypotension are poorly defined, and current treatments are less than optimal (7,12,14,19). The magnitude of the postprandial fall in blood pressure is known to be dependent on meal compositioningestion of carbohydrate, particularly glucose, has the greatest effect on blood pressure (27), whereas the effects of fat and protein appear to be much less (10).Changes in splanchnic blood flow, sympathetic nerve activity, and release of gastrointestinal peptides are all thought to play a role in postprandial hypotension (7,12,14,19). Onset of the fall in blood pressure is evident soon after a meal, with a maximum response at 30 -60 min (14). While oral ingestion of glucose leads to a fall in blood pressure, intravenous infusion of glucose has little, if any, effect (13) indicating that the response is mediated from the gastrointestinal tract. We have reported that in both healthy older subjects and patients with type 2 diabetes managed by diet alone, the hypotensive and heart rate responses t...

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Section: Discussioncontrasting

confidence: 53%

Section: Discussioncontrasting

confidence: 53%

mentioning

confidence: 99%

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Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

Jones

O’Donovan

Russo

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…It is known that the rate of gastric emptying accounts for approximately 35% of the variance in postprandial blood glucose concentrations in healthy subjects and patients with type 2 diabetes mellitus [17,18]; the initial rate of gastric emptying appears to be predominantly important in the glycemic response to oral carbohydrate [19,20]. Despite this, there is a lack of standardization in both the volume of glucose drink and the subject posture in oral glucose tolerance tests [21].…”

Section: Abstract Gastric Emptying Transpyloric Flow Posturementioning

confidence: 99%

Effects of Posture on Gastric Emptying, Transpyloric Flow, and Hunger After a Glucose Drink in Healthy Humans

et al. 2006

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Previous studies suggest that posture has relatively little effect on gastric emptying of high-nutrient liquids; these studies have, however, only assessed overall rates of gastric emptying, whereas gastric emptying is known to be predominantly a pulsatile phenomenon. In healthy subjects perceptions of appetite, such as hunger, are inversely related to antral area and content; hence, changes in intragastric meal distribution induced by posture may affect appetite. Gastric emptying is a major determinant of postprandial glycemia. The aims of this study were to evaluate the effects of posture on patterns of transpyloric flow (TF), gastric emptying (GE), antral area (AA), hunger, and the glycemic response to oral glucose. Eight healthy young subjects (five males, three females; mean age, 24.0 +/- 2.4 years; BMI, 21.2 +/- 0.6 kg/m2) were studied twice in random order, once in the sitting position and once in the lying (supine) position. After consuming 600 ml water with 75 g glucose, labeled with 20 MBq 99mTc-sulfur colloid, subjects had simultaneous measurements of (i) TF during consumption of the drink by Doppler ultrasonography, (ii) GE with scintigraphy, (iii) AA at t = -5 and t = 30 min by ultrasonography, and (iv) perceptions of appetite with a visual analogue scale. During drink ingestion TF was greater in the sitting, compared with the lying, position (586 +/- 170 vs. 177 +/- 65 [cm/sec] x sec; P < 0.05). Posture affected intragastric distribution; more of the drink was retained in the distal stomach in the sitting position (e.g., at 30 min: sitting, 29 +/- 3%, vs. lying, 12 +/- 3%; P < 0.0001) but had no effect on the overall rate of GE or the blood glucose response. AA at t = 30 min (P < 0.005) was greater in the sitting position; there was an inverse relationship between hunger and AA at 30 min (r = -0.53, P < 0.05). We conclude that posture influences initial TF and intragastric distribution, but not the overall rate of GE of, or the glycemic response to, a large-volume nutrient liquid. The increases in AA and content in the sitting position are associated with a reduction in hunger.

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“…Dose appropriate (also volume appropriate if a liquid)? Studies employing a dose over the 95th percentile limit were rejected; also, studies utilizing large volumes of fructose in solution were graded lower than others, based on findings of Sievenpiper et al (1998a;1998b) that the glycemic response to fructose in solution is highly dependent on volume. B.…”

Section: Subjectsmentioning

confidence: 99%

Evidence-Based Review on the Effect of Normal Dietary Consumption of Fructose on Blood Lipids and Body Weight of Overweight and Obese Individuals

Dolan¹,

Potter²,

Burdock³

2010

Critical Reviews in Food Science and Nutrition

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Although some investigators have hypothesized that ingestion of fructose from foods and beverages is responsible for the development of hyperlipidemia or obesity, a recent evidence-based review demonstrated that there was no relationship between the consumption of fructose in a normal dietary manner and the development of hyperlipidemia or increased weight in normal weight individuals. Because overweight and obese individuals may exhibit metabolic abnormalities such as insulin resistance, impaired glucose tolerance, hyperlipedemia, and/or alterations in gut hormones involved in appetite regulation, the findings of fructose studies performed in normal weight subjects may not be particularly relevant for overweight or obese subjects. A systematic assessment of the strength and quality of the studies and their relevance for overweight or obese humans ingesting fructose in a normal dietary manner has not been performed. The purpose of this review was to critically evaluate the existing database for a causal relationship between the ingestion of fructose in a normal, dietary manner and the development of hyperlipidemia or increased body weight in overweight or obese humans, using an evidence-based approach. The results of the analysis indicate that there is no evidence which shows that the consumption of fructose at normal levels of intake causes biologically relevant changes in triglycerides (TG) or body weight in overweight or obese individuals.

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Effect of Meal Dilution on the Postprandial Glycemic Response: Implications for glycemic testing

Abstract: Varying the volume of liquid sugar meals alters PGR. Understanding this concept may help to reduce variability both in the glycemic testing of foods and oral glucose tolerance testing.

Cited by 18 publications

References 36 publications

Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects

Effects of Posture on Gastric Emptying, Transpyloric Flow, and Hunger After a Glucose Drink in Healthy Humans

Evidence-Based Review on the Effect of Normal Dietary Consumption of Fructose on Blood Lipids and Body Weight of Overweight and Obese Individuals

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