Impact of First Meal Size During Prolonged Sitting on Postprandial Glycaemia in Individuals with Prediabetes: A Randomised, Crossover Study

We compared the impact of a high versus low energy intake first meal on glucose and insulin responses during prolonged sitting in individuals with prediabetes. Thirteen adults with overweight/obesity and prediabetes (mean ± SD age: 60 ± 6 years, BMI: 33 ± 4 kg/m²; 2 h OGTT: 8.9 ± 1.1 mmol/L) completed two randomised trials: 10 h uninterrupted sitting, incorporating three meals with matching macronutrient compositions but different energy distributions: High-Energy Breakfast (HE-BF; breakfast: 50%, lunch: 30%, dinner: 20% energy intake), Low-Energy Breakfast (LE-BF: 20%/30%/50% energy intake). Venous blood was sampled from 08:00⁻18:00 h for determination of plasma glucose and insulin concentrations, with 24 h continuous glucose monitoring (CGM). Total glucose area under the curve (AUC; +5.7 mmol/L/h, = 0.019) and mean plasma glucose concentrations (+0.5 mmol/L, = 0.014) were greater after HE-BF compared to LE-BF. In the HE-BF condition, compared to LE-BF, there was a greater incremental area under the curve (iAUC) for plasma glucose post-breakfast (+44 ± 59%, = 0.007), but lower iAUC post-lunch (&minus;55 ± 36%, < 0.001). Total insulin AUC was greater (+480 mIU/mL/h, < 0.01) after HE-BF compared to LE-BF. Twenty-four-hour (24 h) CGM revealed no differences in mean glucose and total AUC between conditions. Compared to a low-energy first meal, a high-energy first meal elicited exaggerated plasma insulin and glucose responses until lunch but had little effect on 24 h glycaemia. During periods of prolonged sitting, adults with prediabetes may have more beneficial postprandial insulin responses to a low-energy first meal.