The size and frequency of meals are important
elements of nutrition, with considerable effects on
the human health. A hypocaloric diet is a key
component in both prevention and treatment of type 2
diabetes and it is usually apportioned into three
main meals and two or three snacks in between.
Eating two large, fiber-rich meals a day as part of
a calorie-restricted diet - rather than six smaller
meals spread throughout the day - could help people
with type 2 diabetes feel less hungry and less
depressed, according to a secondary analysis of a
crossover trial comparing both meal schedules.
The aim of the original study was to compare the
effect of six vs two meals a day, breakfast and
lunch, on body weight, hepatic fat content (HFC),
insulin resistance and beta cell function.
In a randomised, open, crossover, single-centre
study (conducted in Prague, Czech Republic),
researchers assigned 54 patients with type 2
diabetes treated with oral hypoglycaemic agents,
both men and women, age 30–70 years to follow two
regimens of a hypoenergetic diet, each for 12 weeks.
The diet in both regimens had the same macronutrient
and energy content. HFC was measured by proton
magnetic resonance spectroscopy. Insulin sensitivity
was measured by isoglycaemic–hyperinsulinaemic clamp
and calculated by mathematical modelling as oral
glucose insulin sensitivity (OGIS). Beta cell
function was assessed during standard meal tests by
C-peptide deconvolution and was quantified with a
mathematical model. For statistical analysis, 2×2
crossover ANOVA was used.
Eating only breakfast and lunch reduced body weight,
HFC, fasting plasma glucose, C-peptide and glucagon,
and increased OGIS, more than the same caloric
restriction split into six meals.
The authors say: "Novel therapeutic strategies
should incorporate not only the energy and
macronutrient content but also the frequency and
timing of food. Further larger scale, long-term
studies are essential before offering
recommendations in terms of meal frequency."
In the new findings, published April 1 as a Letter
to the Editor in the European Journal of Clinical
Nutrition, the researchers looked at quality of
life, depressive symptoms, and eating behavior in
the study participants.
With both meal schedules, patients had improvements
in quality of life and decreases in depressive
symptoms. However, the decrease in depressive
symptoms was significantly greater when study
participants followed the two-meal-a-day plan; they
also felt significantly less hungry. Disinhibition
also decreased when people ate twice a day.
For more information
European Journal of Clinical Nutrition
Do patients with type 2 diabetes still need to eat
Eating two larger meals a day (breakfast and lunch)
is more effective than six smaller meals in a
reduced-energy regimen for patients with type 2
diabetes: a randomised crossover study.