Original Article

European Journal of Clinical Nutrition (2009) 63, 398–404; doi:10.1038/sj.ejcn.1602953; published online 7 November 2007

Meal composition affects insulin secretion in women with type 2 diabetes: a comparison with healthy controls. The Hoorn prandial study

Contributors: JMD and RJH were responsible for the design and funding of the study. GN was responsible for recruitment and management of the patients with DM2. MA and RKS were responsible for acquisition of the data; MA performed statistical analyses and is the first author. JMR advised on interpreting the data. PJK provided advise for statistical analyses. TT and all of the other authors provided input in writing the manuscript.

M Alssema1, R K Schindhelm2, J M Rijkelijkhuizen1, P J Kostense1,3, T Teerlink4, G Nijpels1,5, R J Heine1,2 and J M Dekker1

  1. 1EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Endocrinology/Diabetes Center, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
  4. 4Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
  5. 5Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: Dr M Alssema, EMGO Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands. E-mail: m.alssema@vumc.nl

Received 12 June 2007; Revised 18 August 2007; Accepted 8 October 2007; Published online 7 November 2007.

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Abstract

Background/Objective:

 

Early insulin secretion following a meal is representative for normal physiology and may depend on meal composition. To compare the effects of a fat-rich and a carbohydrate-rich mixed meal on insulinogenic index as a measure of early insulin secretion in normoglycemic women (NGM) and in women with type 2 diabetes mellitus (DM2), and to assess the relationship of anthropometric and metabolic factors with insulinogenic index.

Subjects/Methods:

 

Postmenopausal women, 76 with NGM and 64 with DM2, received a fat-rich meal and a carbohydrate-rich meal on separate occasions. Early insulin response was estimated as insulinogenic index (triangleinsulin0–30 min/triangleglucose0-30 min) for each meal. Associations of fasting and postprandial triglycerides, body mass index, waist and hip circumference and alanine aminotransferase with insulinogenic indices were determined.

Results:

 

Women with NGM present with higher insulinogenic index than women with DM2. The insulinogenic index following the fat-rich meal (triangleI30/triangleG30 (fat)) was higher than the index following the carbohydrate-rich meal (triangleI30/triangleG30 (CH)) (P<0.05 in women with DM2, and not significant in women with NGM). In women with DM2, homeostasis model assessment for insulin resistance was positively associated with triangleI30/triangleG30 (CH). In women with NGM, waist circumference was independently and inversely associated with triangleI30/triangleG30 (fat) and with triangleI30/triangleG30 (CH); hip circumference was positively associated with triangleI30/triangleG30 (fat).

Conclusions:

 

The insulinogenic index following the fat-rich meal was higher than following the isocaloric carbohydrate-rich meal, which might favorably affect postprandial glucose excursions, especially in women with DM2. The association between a larger waist circumference and a lower meal-induced insulinogenic index in women with NGM requires further mechanistic studies.

Keywords:

carbohydrates, fat, hyperglycemia, insulin secretion, postprandial glucose regulation, type 2 diabetes

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