Postprandial Metabolic and Appetite Responses to Different Food Intake Sequences in Athletes

NCT06365385 | Completed

• 1 other identifier: FOODSEQ-MARS
• Study Type: interventional
• Target: 14
• Locations: 1 country
• Sites: 1

Brief Summary

Emerging evidence suggests that following a 'carbohydrate-last meal pattern', wherein foods rich in protein, fat, fiber, and/or polyphenols are consumed before sources of simple carbohydrate (CHO) in a meal, results in reduced postprandial glycaemic responses than the reverse food order or a co-ingestion pattern. This effect has been observed across the spectrum of glucose tolerance, from patients with diabetes to individuals with normal glucose tolerance (Kuwata et al., 2016; Nishino et al., 2018; Lu et al., 2019; Sun et al., 2020). Furthermore, reduced glucose excursions have been linked to decreased subsequent hunger and energy intake (Lu et al., 2019; Wyatt et al., 2021). However, to date, no studies on food intake sequence have targeted athletes, despite their increased CHO demands (Thomas et al., 2016) which could expose them to repeated episodes of hyperglycaemia and high glycaemic variability, known to increase the risk of adverse cardiovascular outcomes and all-cause mortality (Loader et al., 2015; Cavero-Redondo et al., 2017; Faerch et al., 2018). Additionally, athletes often face pressure to meet body composition standards and may benefit from strategies that enhance satiety and craving control. Finally, there is reason to believe that better glycaemic control could lead to improved performance, given that enhancements in endurance activities have been observed with a low-glycemic-index diet compared to a high-glycemic-index diet (Heung-Sang Wong et al., 2017). Therefore, this randomised crossover trial is part of a wider project which seeks to explore the impact of food intake sequence on metabolic health and performance in athletes. Specifically, this trial aims to investigate the acute, postprandial metabolic and appetite responses to consuming an identical meal in two intake sequences (CHO-last versus CHO-first) in athletes, while in the resting state.

Conditions

Healthy; Nutrition, Healthy; Postprandial Hyperglycemia; Hunger; Craving

Keywords

food order; meal sequence; glucose metabolism; lipid metabolism; satiety; sport nutrition

Outcome Measures

Primary Outcomes (1)

• Postprandial blood glucose concentrations

  Difference between food intake sequences in the incremental area under the curve 0-120 and 0-180 min; peak concentrations (mmol/L); time-to-peak (min); and change from baseline data (mmol/L) of capillary blood glucose measured by a validated glucometer

  Baseline and 15, 30, 45, 60, 90, 120, 180 minutes following the test meal

Secondary Outcomes (10)

• Postprandial subjective appetite ratings

  Baseline and 15, 30, 45, 60, 90, 120, 180 minutes following the test meal

• Prospective ad libitum energy intake

  0-3 hours post-trial

• Prospective ad libitum nutritional intake

  0-3 hours post-trial

• Postprandial serum insulin concentrations

  Baseline and 30, 60, 90, 120, 180 minutes following the test meal

• Postprandial plasma total GLP-1 concentrations

  Baseline and 30, 60, 90, 120, 180 minutes following the test meal

Study Arms (2)

CL - CF

EXPERIMENTAL

The interventions (carbohydrate-last meal pattern (CL) or carbohydrate-first meal pattern (CF)) will be delivered in random order at two study visits, separated by a wash-out period of 7 days. If participants are allocated to this study arm, they will receive the CL on the first visit and the CF on the second visit. The nutritional composition of the test-meal will comply to the current sports nutrition guidelines for the pre-exercise meal (i.e., 1-4 g of CHO/kg of body mass, moderate amounts of protein, low-fat and fibre content, 5-10 mL/kg of body mass of fluids) (Thomas et al., 2016). Participants will be encouraged to consume the meal in full within 15 minutes, at a comfortable pace, to mimic real eating circumstances.

Other: Carbohydrate-last meal pattern; Other: Carbohydrate-first meal pattern

CF - CL

ACTIVE COMPARATOR

The interventions (carbohydrate-last meal pattern (CL) or carbohydrate-first meal pattern (CF)) will be delivered in random order at two study visits, separated by a wash-out period of 7 days. If participants are allocated to this study arm, they will receive the CF on the first visit and the CL on the second visit. The test-meal will be identical and isocaloric in both interventions of the study.

Other: Carbohydrate-last meal pattern; Other: Carbohydrate-first meal pattern

Interventions

Carbohydrate-last meal pattern OTHER

Skyr yoghurt, whey protein and almonds over \~5 min, immediately followed by white bread, strawberry jam, banana and pulp-free orange juice over \~10 min.

Also known as: CL; CHO-last

CF - CL; CL - CF

Carbohydrate-first meal pattern OTHER

White bread, strawberry jam, banana and pulp-free orange juice over \~10 min, immediately followed by skyr yoghurt, whey protein and almonds over \~5 min.

Also known as: CF; CHO-first

CF - CL; CL - CF

Eligibility Criteria

• Age: 18 Years - 64 Years
• Sex: male
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Adult (18-64 years old)
• Male
• Trained (meeting training and performance caliber criteria ≥Tier 2; McKay et al., 2022)

You may not qualify if:

• Normal glucose tolerant according to the latest criteria established by the American Diabetes Association (ElSayed et al., 2023): HbA1c \<5.7%, fasting plasma glucose \<5.6 mmol/L (100 mg/dL) and 2-h plasma glucose \<7.8 mmol/L (140 mg/dL) during a 75-g OGTT
• Able and willing to provide informed consent and safely comply with study procedures
• Any medical condition or behaviour deemed either to pose undue personal risk to the participant or introduce bias into the experiment (e.g. anaemia and other haematological disorders; alcohol or substance abuse; any condition affecting the glucose and lipid metabolism or appetite, reviewed on a case by case basis)
• Any reported medication or supplementation that may interfere with the glucose metabolism (e.g., acarbose, insulin, metformin, semaglutide, thiazolidinediones, sulfonylureas, corticosteroids, thiazide diuretics); lipid metabolism (e.g., statins, nicotinic acid, colestyramine anhydrous, ezetimibe, fibrates, L-carnitine); or appetite (e.g., metoclopramide, carbamazepine, phenobarbital, phenytoin, primidone). Other medication and supplementation will be reviewed on a case by case basis.
• Known food allergy, intolerance or hypersensitivity to any of the test-meal ingredients
• Recent change in body mass (± 2 kg in the last 2 months)
• Smoking
• Having donated more than 400 ml of blood within 3 months of the screening visit or more than 1500ml of blood in the previous 12 months

Sponsors & Collaborators

• Universidade do Porto: lead
• Federação Portuguesa de Futebol: collaborator
• Fundação para a Ciência e a Tecnologia: collaborator

Study Sites (1)

Cidade do Futebol, Avenida das Seleções

Oeiras, Lisbon District, 1495-433, Portugal

Location

MeSH Terms

Conditions

Hyperglycemia

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases

Study Officials

• Rita Giro

  FCNAUP, University of Porto; Portugal Football School, Federação Portuguesa de Futebol

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: This is a non-blind trial, since both participants and the investigator delivering the test-meal will be able to see the ingredients and the order in which they are consumed. However, outcome assessors will be blinded to the intervention sequence.
• Purpose: BASIC SCIENCE
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study is a randomised controlled trial with a counterbalanced crossover design. Block randomisation will be performed by an external researcher, and allocation concealment will be ensured through the use of sequentially numbered, opaque, sealed envelopes.

Study Record Dates

• First Submitted: April 9, 2024
• First Posted: April 15, 2024
• Study Start: April 22, 2024
• Primary Completion: December 16, 2024
• Study Completion: December 16, 2024
• Last Updated: December 24, 2024

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will not share

Locations

PT (1)