Consumption of fruits as last meal reduces fasting blood sugar independent of DPP4 activity

Indonesia: A randomized pilot study published in the Journal of Obesity has shown the effects of the combination of a fruit-carbohydrate meal sequence and 2 min of postprandial exercise on DPP4 activity and blood sugar levels in type 2 diabetes mellitus (T2DM) patients.

The study found that the consumption of fruit as the last meal reduced the level of fasting blood sugar, while the consumption of fruits as the first meal did not remarkably reduce the one-hour postprandial blood sugar (1 h PP sugar) level. Postprandial exercise addition lowered DPP4 activity; however, both treatments had no acute effects on the action.

"The preliminary report of fruits meal sequence is plausibly involved in the acute regulation of blood sugar levels and might be independent of dipeptidyl peptidase 4 (DPP4) activity in Indonesian T2DM patients. Postprandial exercise through the mediation of DPP4 may be an important intervention for T2DM but did not acutely affect the regulation of blood glucose levels," Indarto Dono and colleagues from Indonesia wrote in their study.

Type 2 diabetes mellitus is a significant public health problem worldwide and affects millions of people. Increased two-h postprandial blood sugar and fasting blood sugar levels are associated with increased diabetic vascular complications. Elevated one-h PPG levels are also linked with increased mortality and diabetic complications. Glycemic control is essential for the prevention of diabetes complications.

A healthy diet and physical exercise have been recommended as the first line of T2DM management to lower the risk of developing T2D complications. Increased vegetable consumption, for instance, decreases diabetes complications. Also, modifying meal sequences, such as consuming vegetables before carbohydrates, causes a reduction in glycemic parameters. Fruit consumption is also predicted to enhance glycaemic parameters in T2DM patients, as fruits have the same fiber and antioxidant contents as vegetables. However, there are not many studies of modified meal sequences involving fruits.

Against the above background, the research team examined the acute effects of postprandial exercise and breakfast fruit meal sequence on the blood glucose level and DPP4 activity among patients with type 2 diabetes.

The researchers recruited T2D patients who attended primary healthcare centers in Indonesia. Eligible patients consisting of 4 men and 32 women, were divided randomly into four treatment groups:

Consumed fruit as the last meal (FL) without 2 min postprandial exercise.

Consumed fruit first as the meal (FF) without 2 min postprandial exercise.

Consumed FL combined with 2 min postprandial exercise (FL + PE).

Consumed FF, followed by 2 min postprandial exercise (FF + PE).

A food recall approach was used to measure the nutritional intake of every research participant. The researchers observed variations in the pretreatment nutritional intake among groups. However, after meal sequence treatment during breakfast and a standardized diet in two other daily meals, equal nutritional intake was achieved after seven days among the four groups, especially in dietary carbohydrate and fiber intake.

The study led to the following findings:

• No significant differences were seen in the nutritional intake of energy, fibers, carbohydrates, proteins, and lipids among groups within seven days of treatment. However, on day 1, the protein intake was significantly different between the groups.
• Fruits' last meal with or without PE decreased the levels of FBG after seven days of treatment.
• Fruits' last meal and directly followed by 2 min postprandial exercise reduced one h PPG levels after seven days of treatment.
• Fasting DPP4 activity was remarkably lower after 2 min of postprandial exercise for seven days of treatment.
• The addition of postprandial exercise reduced DPP4 activity.
• Fruits' first meal showed significantly opposite effects on FBG levels compared to fruits' last meal.
• Fruits last meal significantly reduced mean changes of 1 h DPP4 activity without affecting one h postprandial glucose level.
• Postprandial exercise combined with fruits' first meal was superior in regulating DPP4 activity.

"Further studies are needed to investigate whether or not different fruit types and longer treatment intervals can affect blood sugar levels and DPP4 activity differently," the researchers wrote in their study. "Also, the study provides insight into the feasibility of conducting food order modification with or without the combination of postprandial exercise in a primary health setting for the next studies."

Reference:

Indarto Dono, Dwipajati Dwipajati, Paramasari Dirgahayu, Yohanes Cakrapradipta Wibowo, Yoga Mulia Pratama, "Acute Effects of Breakfast Fruits Meal Sequence and Postprandial Exercise on the Blood Glucose Level and DPP4 Activity among Type 2 Diabetes Mellitus Patients: A Pilot Study", Journal of Obesity, vol. 2022, Article ID 4875993, 8 pages, 2022. https://doi.org/10.1155/2022/4875993