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This article originally posted and appeared in  DietObesityType 2 DiabetesIssue 697

How Important is Portion Size in Diabetic Nutrition?

Portion size as opposed to the frequency of meals has significant impacts on metabolic profiles.... 


Rabinovitz et al evaluated the effect of breakfast size on diabetic control. The study included overweight and obese patients, non-insulin dependent adults with type 2 diabetes. Patients were randomized to receive either a large breakfast consisting of a higher percentage of protein and fat or a smaller breakfast. Greater HbA1c and systolic blood pressure reductions were observed with the patients consuming the larger breakfasts. Satiety was maintained longer in those consuming a larger breakfast as well. Diabetic medications were also reduced in the bigger breakfast group.

Piya et al aimed to compare the effect of eating 2 versus 5 meals high in fat on the metabolic profile in lean and obese women. Obese subjects had significantly increased insulin, glucose, and triglyceride levels throughout the day compared to the lean subjects for both the 2 and 5 meal groups. Regardless of change in meal size and frequency, there were no significant differences in either weight group for glucose, insulin, cholesterol, LDL, HDL, or TG. There was no also no significant difference in 24 hour expenditure in either treatment group. The obese group had lower fullness and higher hunger scores in the 2 meal group. This data suggests that amount of calories and content per day has a larger impact on metabolic profiles and energy expenditures than the frequency of meals.

Kolotkin et al analyzed patients after administration of natrexone and buproprion combination therapy for changes in body weight and weight related quality of life after 56 weeks of treatment. All patients included in the study were overweight or obese and over 12% of patients had T2DM. At week 56, it was found that more patients reduced body weight with the drug combination. The safety and tolerability of the drug treatment was consistent with each individual drug, with nausea being noted as the most common adverse effect.

Practice Pearls:
  • Bigger breakfast portions lower HbA1c and systolic blood pressure in T2DM patients.
  • Changing meal frequency does not have a significant impact on metabolic profiles.
  • Naltrexone and buproprion combination has a significant effect on weight loss.

EASD Barcelona, September 27 2013

  1. H. Rabinovitz, M. Boaz, T. Ganz, Z. Madar, D. Jakubowicz, J. Wainstein. Big breakfast rich in protein improved glycaemic control and satiety feeling in adults with type 2 diabetes mellitus.
  2. MK Piya, N Reddy, A Harte, A Campbell, J Hattersley, L Halder. The impact of high fat meal frequency on metabolic profile and energy expenditure in obese subjects.
  3. R.L. Kolotkin, C. Burns, B. Walsh, P. Klassen. Combination naltrexone/bupropion therapy resulted in clinically meaningful improvements in weight and quality of life (QOL): integrated analysis of four phase 3 trials. 


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This article originally posted 03 October, 2013 and appeared in  DietObesityType 2 DiabetesIssue 697

Past five issues: Diabetes Clinical Mastery Series Issue 256 | Issue 796 | Diabetes Clinical Mastery Series Issue 255 | Issue 795 | SGLT-2 Inhibitors Special Edition August 2015 |

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Thomas Tu, MD, FCSAI

Category: Nursing
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