Effects of Triacylglycerol Structure on Gut Hormones and Haemostatic Markers
Condition: Type 2 Diabetes Mellitus
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Type 2 diabetes mellitus (T2DM) is a chronic disorder determined by lifestyle and genes. It
      is associated with chronic hyperglycaemia along with other metabolic abnormalities. It is
      also one of the risk factors for cardiovascular disease (CVD). This disease is due to insulin
      resistance and/or deficiency as well as increased hepatic glucose output. According to the
      Third National Health and Morbidity Survey (3rd NHMS), the prevalence of T2DM for adults aged
      30 years and above is 14.9%, increased by almost 80% from 1996 to 2006. Dietary composition
      may affect insulin sensitivity, postprandial triacylglycerol concentration and the risk of
      T2DM. The role of dietary fats in T2DM is of particular interest and has been clinically
      studied for many decades. The type of fat we ingest every day consists of different types of
      fatty acids and different degree of saturation, which in turn influence glucose metabolism by
      altering cell membrane function, enzyme activity, insulin signalling and gene expression.
      Previous studies demonstrated that interesterification of dietary fat alter postprandial
      lipaemia. Saturated fat such as palm olein has been reported to display lower postprandial
      lipaemia after interesterification. Changing the structure of triacylglycerol (TAG) alters
      the physical properties of dietary fat which affects digestibility, metabolism and
      atherogenicity. A recent study conducted by Sanders and co-workers demonstrated reduced
      levels of plasma glucose-dependent insulinotropic polypeptide (GIP) following both the lard
      and interesterified palm olein (IPO) compared with the palm olein (PO) and high oleic
      sunflower oil (HOS) diets in healthy subjects. The GIP and glucagon-like peptide-1 (GLP-1)
      are major players in the modulation of postprandial insulin secretion by the pancreas.
      Although GIP secretion in response to meals is normal in patients with Type 2 diabetes
      mellitus (T2DM), GIP induced secretion of insulin is defective in diabetes. This is observed
      to be predominantly a defective stimulation of the late phase of insulin response (20-120
      minutes). The effect of IPO on GIP may be exaggerated in T2DM patients with impaired insulin
      sensitivity. Hence, IPO may change the concentrations of gut hormones, postprandial lipaemia,
      insulinaemic response and CVD related haemostatic markers.
    

Detailed description: 
      Subjects aged between 30 and 60 years old (male and female) with Type 2 diabetes mellitus
      (T2DM) will be recruited for this study. A randomized, crossover, double-blind study design
      will be carried out to investigate the acute effects of high fat meals prepared using palm
      olein (PO), chemically interesterified palm olein (IPO) and high oleic sunflower oil (HOS)
      (control) on study subjects with T2DM. Study subjects will have to undergo three postprandial
      challenges, separated by at least one week interval. Fasting blood sample and duplicate
      baseline blood samples will be taken in the morning of postprandial day. After that, subjects
      will be asked to consume a test meal consisting a high fat muffin baked using the
      aforementioned oils and a milkshake within 10 minutes. After meal, venous blood samples will
      be taken at time-points 15, 30, 60, 90, 120 min, 3 h, 4 h, 5 h, 6 h and post-heparin plasma 5
      min and 15 min for analysis. Pulse wave analysis will be conducted to evaluate central blood
      pressure and arterial stiffness. Meal appreciation will be assessed by utilising visual
      analogue scale (VAS) before eating, after eating and at each time-point.
    

Intervention name(s): Native palm olein (IV56); Chemically interesterified palm olein (IV56); High oleic sunflower oil
Intervention type(s): Other; Other; Other
Intervention description(s): Test meal consists of a high fat muffin (containing 50 g native palm olein) and a cup of milkshake, to be taken as breakfast for each postprandial study day.; Test meal consists of a high fat muffin (containing 50 g chemically interesterified palm olein) and a cup of milkshake, to be taken as breakfast for each postprandial study day.; Test meal consists of a high fat muffin (containing 50 g high oleic sunflower oil) and a cup of milkshake, to be taken as breakfast for each postprandial study day.
Other intervention name(s): PO; IPO; HOS
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Interesterified fat; Stereospecific number 2; Gut hormones; GIP; Insulin sensitivity; Postprandial lipaemia; Haemostatic markers