A big breakfast rich in protein and fat appears to offer more benefits to people with type 2 diabetes than a smaller low calorie breakfast, concludes research presented at this year's annual meeting of the European Association for the Study of Diabetes. The research is by Professor Daniela Jakubowicz, Tel Aviv University, Israel, and Dr Hadas Rabinovitz, The Hebrew University of Jerusalem, Rehovot , Israel, and colleagues.

Previous research has shown that people who regularly eat breakfast tend to have lower BMI than those who go without, as well as more favourable fasting blood glucose levels and post-meal insulin sensitivity. In this study, the researchers analysed the effect of reakfast size and composition on blood glucose control, and its association with hormone profile in adults with type 2 diabetes.

This randomised, controlled, open clinical trial, including overweight/obese, non-insulin-dependent adults with type 2 diabetes. Participants were randomised to balanced low calorie diabetic diets with either a big breakfast (BB) or small breakfast (SB), (33% vs. 12.5% of total daily energy intake). The BB diet included a higher percentage of protein and fat. Anthropometric measures were assessed every 2 weeks. Fasting markers of inflammation, hormones, and lipid profile were performed at baseline and after a follow-up period (13 weeks later).

Of the 59 enrolled participants, 47 completed the study. At end of follow-up, greater HbA1c and systolic blood pressure (SBP) reductions were observed in the BB than SB group (HbA1c: -4.62% vs. -1.46 %; SBP -9.6 vs. -2.4 mmHg). Additionally, diabetic medication doses were reduced in a greater proportion of the BB participants (31% vs. 0%) while in the SB, a greater proportion of participants had their diabetic medication dose increased (17% vs. 3%). Hunger scores were lower in the BB group and greater improvements in fasting glucose were observed in the BB group comparison to the SB group.

Dr Jakubowicz says: "A simple dietary manipulation of BB diet rich in protein and fat appears to have additional benefits compared to a conventional low-calorie diet in individuals with type 2 diabetes."

"We hypothesise these findings are related to reduction in markers of inflammation," says Dr Hadas Rabinovitz: "As the study progressed, we found that hunger scores increased significantly in the SB group while satiety scores increased in the BB group. In addition, the BB group reported a reduced urge to eat and a less preoccupation with food, while the SB group had increased preoccupation with food and a greater urge to eat over time It is possible that a big breakfast rich in protein causes suppression of ghrelin secretion, which is reflected in enhanced satiety ratings."

Dr Rabinovitz concludes: "Further research is required to confirm and clarify the mechanisms by which this relatively simple diet approach enhances satiety, leads to better glycemic outcomes compared to a more conventional dietary approach."