12.10.2013

by Salynn Boyles
Contributing Writer, MedPage Today

Eating a big, high-protein breakfast may be an effective strategy for improving glycemic control in overweight patients with type 2 diabetes, findings from a small study suggested.

When such patients were randomized to eat either small, carbohydrate-heavy breakfasts or larger fat- and protein-centric morning meals for 3 months, the big-breakfast group showed greater mean hemoglobin A1c (HbA1c) reductions (-4.62% versus -1.46%; P=0.047) and reductions in systolic blood pressure (-9.58 versus -2.48 mmHg; P=0.04).

Big-Breakfast Eaters Reduced Meds

Almost a third of overweight diabetics in the big-breakfast group were able to reduce their type 2 diabetes medication use during the study, while none of the patients in the smaller breakfast group achieved this goal (31% versus 0%; P=0.002), researcher Zecharia Madar, MD, of Hebrew University in Jerusalem, and colleagues wrote online in the journal Obesity.

The findings were also presented in late September at the annual meeting of the European Association for the Study of Diabetes in Madrid.

“It appeared that the big breakfast eaters ate less during the rest of the day, which explains why they didn’t gain weight,” said staff endocrinologist Spyros Mezitis, MD, PhD, of Lenox Hill Hospital and New York Presbyterian Hospital, both in New York, who was not involved with the study. “These researchers make a good case that eating a substantial, protein-rich diet can lower blood sugar and improve satiety.”

Breakfast, Energy Intake Data Mixed

Results from several studies indicate that eating a big breakfast is associated with lower overall energy intake throughout the day and lower weight gain, but at least one study has suggested that higher energy intake early in the day leads to greater overall energy intake in normal-weight and obese individuals.

“Given the mixed results, further examination of the association between breakfast consumption and body weight and diabetes is warranted,” the researchers wrote.

Their study included 58 adult, overweight, or obese type 2 diabetics who agreed to eat either small, carbohydrate-heavy breakfasts (30 patients) or a large, fat- and protein-heavy breakfasts (29 patients) every day for 3 months.

The small breakfast constituted roughly 13% of total daily energy intake and included 12% to 18% protein, 14% to 22% fat and 60% to 70% carbohydrates. The big breakfast accounted for a third (33%) of daily calories and was made up of 23% to 30% protein, 29% to 37% fat and 37% to 48% carbohydrates.

Study subjects were weighed every 1 to 3 weeks, blood analysis was performed after overnight fasting on day zero and at the end of month three, and the subjects completed hunger-satiety questionnaires at various times during the 3-month study.

A total of 13 participants (six in the big- and seven in the small-breakfast groups, respectively), dropped out prior to the end of the study, leaving 23 patients in each of the groups.
Although mean body weight reductions were modest and similar in both groups (big breakfast versus small, -2.43 kg versus -1.86 kg), other measures of glycemic control favored those who ate the higher-energy breakfasts.

Big Breakfast Group Less Hungry

In addition to HbA1c and blood pressure changes:

• Marginally greater reductions in estimated average glucose were also observed in the big-breakfast versus small-breakfast group (-13.2 versus -4 mg/dL, P=0.061).
• After adjusting for differences in baseline values, there were significantly greater decreases in HbA1c and estimated average glucose in the big-breakfast compared with the small-breakfast group (P=0.047 and P=0.044, respectively).
• A significantly greater proportion of small-breakfast eaters increased their type 2 diabetes medication doses during the study compared with big-breakfast eaters (16.7% versus 3.4%; P=0.002).
• The big breakfast eaters reported significantly reduced urges to eat over time, while the small-breakfast group reported increased urges: after breakfast (P=0.049), before lunch (P<0.0001), and before dinner (P<0.0001). Preoccupation with food also decreased over time in the big-breakfast group, while it increased over time in the smaller-breakfast eaters; before breakfast (P=0.046), before lunch (P<0.0001), and before dinner (P=0.001).

Weight-loss was minimal in both groups and not statistically significant, and overall calorie intake in both groups was also higher than recommended.

Weight Loss Didn’t Explain Findings

“Metabolic improvements in our trial occurred despite the fact that the mean between-group difference in weight loss was less than 1 kg; therefore, the improvement in glycemic control in the big-breakfast group cannot be attributed to this factor,” the researchers wrote.

They concluded that additional research is needed to confirm the findings and clarify the mechanisms by which “this relatively simple diet approach enhances satiety and leads to better glycemic outcomes,” compared with conventional dietary approaches.

But Mezitis said the idea that eating regular meals, as the study subjects did, and including protein with each meal and snack to slow sugar absorption is in line with conventional dietary wisdom.
“We already tell diabetics that they should eat regular small meals and snacks and that they should not skip meals,” he told MedPage Today. “We also tell them to replace simple carbohydrates with complex ones and to include some protein with meals and snacks. This is not new, and this paper makes the point rather dramatically that this advice is sound.”

The researchers declared no conflicts of interest.

• Primary Source

  Obesity

  Source Reference: Rabinovitz HR, et al “Big breakfast rich in protein and fat improves glycemic control in type 2 diabetics” Obesity 2013; DOI: 10.1002/oby.20654.

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