[Paper] Effects of substituting eggs for high-carbohydrate breakfast foods on the cardiometabolic risk-factor profile in adults at risk for type 2 diabetes mellitus

This was one of the papers referenced in @xep@fedia.io 's cholesterol paper from a few days ago. Thought it was interesting for its own post.

Notes:

evidence from the Kuopio Ischemic Heart Disease Risk-Factor Study suggested that egg protein intake was associated with significantly reduced risk for T2D in Finnish men [6].

Subjects who were pregnant, planning to be pregnant during the study period, lactating, or of child-bearing potential and unwilling to commit to the use of a medically approved form of contraception throughout the study period were also excluded.

That really complicates analysis, if someone is using hormonal birth control that will change the hormones, but also if they start it for the study then it's skewing the results.

However, HOMA-IR was significantly increased following the Non- Egg (24.4%) compared with the Egg condition (1.4%). Although this finding suggests that replacing higher-CHO (primarily sugar) foods with egg-based foods at breakfast may have a favorable effect on whole-body insulin sen-sitivity, caution is warranted. The HOMA-IR value is calculated using a linear model based on population-derived estimates, whereas HOMA2-%S is calculated using a nonlinear model, which is theoretically more robust [19, 20, 27]. No significant differences were present between the Egg and Non-Egg conditions for HOMA2-% S based on fasting values, or the ISI from the short IVGTT

Short intervention study, where the Egg population was still consuming carbohydrates saw a very modest improvement in insulin sensitivity. I speculate this is because of the reduction of carbohydrates for a single meal.

Another potentially relevant factor regarding effects of different meals on CHO metabolism is time of day. Dif-ferences in sympathetic nervous system activity and/or diurnal patterns related to the release of incretin hormones (e.g., glucagon-like peptide-1 and gastric inhibitory poly-peptide in response to a meal) may affect insulin sensitivity [31], and markedly higher (~40%) insulin sensitivity has been observed in the morning compared with mid-afternoon or evening [32]. Jakubowicz et al. conducted a randomized crossover trial where subjects with T2D were fed either a meal pattern that included a high-energy breakfast plus a low-energy dinner (breakfast: 2946 kJ, lunch: 2523 kJ, and dinner: 858 kJ) or a meal pattern with a low-energy break-fast plus a high-energy dinner (breakfast: 858 kJ, lunch: 2523 kJ, and dinner: 2946 kJ) [32]. Despite isoenergetic intakes, those consuming the higher energy breakfast meal pattern had reduced postprandial hyperglycemia and higher levels of intact and total glucagon-like peptide-1. In the present trial, study products were consumed at the breakfast meal, when insulin sensitivity would be expected to be at its highest. It is uncertain whether similar results would be obtained with consumption of the study products in the afternoon or evening.

This is a curious result, and speaks to the point Xep made about eating and time of day, I'm still very curious if this holds in a fully ketogenic diet.

I think the variability of thus study compared to other egg studies indicates that the eggs are not the main variable of interest, its the carbohydrates that are accounting for the fluctuating signal across these studies.

2 comments

This was one of the papers referenced in @xep@fedia.io 's cholesterol paper from a few days ago. Thought it was interesting for its own post.
Notes:
evidence from the Kuopio Ischemic Heart Disease Risk-Factor Study suggested that egg protein intake was associated with significantly reduced risk for T2D in Finnish men [6].
Subjects who were pregnant, planning to be pregnant during the study period, lactating, or of child-bearing potential and unwilling to commit to the use of a medically approved form of contraception throughout the study period were also excluded.
That really complicates analysis, if someone is using hormonal birth control that will change the hormones, but also if they start it for the study then it's skewing the results.
However, HOMA-IR was significantly increased following the Non- Egg (24.4%) compared with the Egg condition (1.4%). Although this finding suggests that replacing higher-CHO (primarily sugar) foods with egg-based foods at breakfast may have a favorable effect on whole-body insulin sen-sitivity, caution is warranted. The HOMA-IR value is calculated using a linear model based on population-derived estimates, whereas HOMA2-%S is calculated using a nonlinear model, which is theoretically more robust [19, 20, 27]. No significant differences were present between the Egg and Non-Egg conditions for HOMA2-% S based on fasting values, or the ISI from the short IVGTT
Short intervention study, where the Egg population was still consuming carbohydrates saw a very modest improvement in insulin sensitivity. I speculate this is because of the reduction of carbohydrates for a single meal.
Another potentially relevant factor regarding effects of different meals on CHO metabolism is time of day. Dif-ferences in sympathetic nervous system activity and/or diurnal patterns related to the release of incretin hormones (e.g., glucagon-like peptide-1 and gastric inhibitory poly-peptide in response to a meal) may affect insulin sensitivity [31], and markedly higher (~40%) insulin sensitivity has been observed in the morning compared with mid-afternoon or evening [32]. Jakubowicz et al. conducted a randomized crossover trial where subjects with T2D were fed either a meal pattern that included a high-energy breakfast plus a low-energy dinner (breakfast: 2946 kJ, lunch: 2523 kJ, and dinner: 858 kJ) or a meal pattern with a low-energy break-fast plus a high-energy dinner (breakfast: 858 kJ, lunch: 2523 kJ, and dinner: 2946 kJ) [32]. Despite isoenergetic intakes, those consuming the higher energy breakfast meal pattern had reduced postprandial hyperglycemia and higher levels of intact and total glucagon-like peptide-1. In the present trial, study products were consumed at the breakfast meal, when insulin sensitivity would be expected to be at its highest. It is uncertain whether similar results would be obtained with consumption of the study products in the afternoon or evening.
This is a curious result, and speaks to the point Xep made about eating and time of day, I'm still very curious if this holds in a fully ketogenic diet.
I think the variability of thus study compared to other egg studies indicates that the eggs are not the main variable of interest, its the carbohydrates that are accounting for the fluctuating signal across these studies.
Alright, this is actually somewhat sensible. Simple carbs are generally not great for you, doubly so for pre-diabetics.