Postprandial Glucose and Insulin Response to Meal Sequence Among Healthy UAE Adults: A Randomized Controlled Crossover Trial.

Background: Dietary patterns that lower postprandial glycemia have been effective in preventing type 2 diabetes. Consuming macronutrients in a specific sequence within a meal has been considered as a novel strategy to reduce post-meal glucose spikes. Therefore, this study aimed to investigate the effect of meal sequence on postprandial glucose and insulin response among healthy adults in the United Arab Emirates.

Methods: Eighteen healthy adults participated in a cross-over randomized controlled trial. Two isocaloric meals were consumed separately in a different order: a standard mixed meal (SMM) vs vegetables and protein first followed by carbohydrates (VPF) meal. The postprandial glucose and insulin levels were determined at Fasting, 30, 60, and 120 min. Visual Analog Scale (VAS) rating was used to assess hunger at similar frequencies.

Results: The mean glucose and insulin levels significantly reduced (p = 0.001) following VPF meal compared to SMM at 30 min. The incremental area under the curve (iAUC0-120) for glucose following the VPF meal sequence was 40.9% lower (p = 0.03) compared with the SMM (572.83; 95% CI 157.3 to 988.2) vs (968.5; 95% CI 692.4 to 1244.8 mg/dL). Furthermore, the iAUC0-120 for insulin following the VPF meal sequence was 31.7% lower than the SMM meal sequence. (2184; 95% CI 1638.30 to 2729) vs (3196.94; 95% CI 2328.19 to 4065.69) mIU/mL × 120 min, P = 0.023). The feeling of fullness measured by the hunger scale showed that the feeling of fullness was higher after 60 and 120 minutes (p = 0.05, p = 0.04) with the VPF meal sequence compared to the SMM sequence. Although, there is no significant difference in the Area under the curve (AUC) for hunger rating between the two meals.

Conclusion: The VPF meal sequence could significantly reduce postprandial glucose and insulin levels and sustain fullness after a meal. Meal sequencing could be an effective dietary strategy for improving the postprandial glucose and insulin response in healthy adults.