Objectives: The implications of the circadian system on nutrition to improve glucose homeostasis in type 2 diabetes is crucial. The study examines the relationship between validated and reliable six behavioral indicators of chrononutrition on glucose homeostasis of people with diabetes (PWDs).
Methods: A sample size of 227(age: 35-60 years, years of diabetes : < 5, no comorbidities) was calculated considering the prevalence of diabetes in the district. A total of 4086 meals of 681 days of 227 PWDs reported in dietary records were studied. Chrononutrition questionnaire assessed eating window, breakfast skipping, evening latency, evening eating, night eating, and largest meal of PWDs. Scoring ranged from 0 to 12 with 0 indicating good chrononutrition status and 12 indicating poor chrononutrition status. Chronotype, physical activity, stress, and sleep quality were assessed using the Horne and Ostberg morningness-eveningness questionnaire, GPAQ, perceived stress scale by Sheldon Cohen and PSQI, respectively. Body composition was assessed by BIA. Glycemic control was assessed using the gold standard method- HbA1c, FBS and PP2BS. LDL and TG/HDL were assessed. Chi-square, spearman’s correlation, AUC, linear regression, and multinomial logistic regression were used for statistical analysis.
Results: PWDs who consumed low GI breakfast contributing 20% of total daily energy intake before 10 am rather than between 10 am-12 pm (p < 0.05) and within one hour of waking up (p < 0.05), correlated positively and were significantly associated with low adiposity, controlled FBS, PP2BS, HbA1c, and lipid profile. PWDs who had 3 times more complex carbohydrates in lunch compared to breakfast showed poor glycaemic control (p < 0.05). Total energy contribution from carbohydrates was higher between 7-10 pm than 7-10 am in PWDs with poor chrononutrition status (p < 0.05) which negatively affected the glucose homeostasis (p < 0.05). Multinomial logistic regression analysis after adjustments for age, sex, body mass index, sleep quality, and physical activity, showed that poorer the chrononutrition status, higher was the HbA1c(p=0.001), and the AIP(p=0.004).
Conclusions: PWDs who followed an early eating pattern along with consuming low GI meals had controlled blood glucose levels than those who consumed low GI meals but followed the later eating pattern.
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