The Second-Meal Effect Under Free-Living Conditions: A Continuous Glucose Monitoring Study of Meal History and Postprandial Glycemia
9 affiliations
- 1Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599, Singapore
- 2School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
- 3Department of Food Science and Technology, National University of Singapore, Singapore 117542, Singapore
- 4Department of Surgery, National University Hospital, Singapore 119074, Singapore
- 5Department of Cardiology, National University Hospital, Singapore 119074, Singapore
- 6Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- 7Asia Longevity Medical Centre, Singapore 238859, Singapore
- 8Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- 9Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Abstract
Background/Objectives: Excess adiposity is associated with abnormal postprandial glucose responses (PPGRs), and controlled studies show that one meal can influence the PPGR of the next. Whether this carry-over occurs in everyday eating is unclear. We examined whether the timing, composition, and PPGR of the preceding meal were associated with the subsequent PPGR. Methods: This observational secondary analysis included 55 Southeast Asian adults with excess body weight and 342 within-day consecutive eating-occasion pairs recorded using a smartphone app and continuous glucose monitoring. Participant fixed-effects linear regression examined 12 preceding-meal characteristics, including intermeal interval (IMI), glycemic load, total sugar, protein, and saturated fat. The outcome was the log-transformed positive incremental area under the glucose curve ln(1 + positive 0–120 min iAUC after the subsequent meal. Each characteristic was examined separately per within-person standard deviation (SD), adjusting for current-meal characteristics, premeal glucose, and temporal factors. Confidence intervals and p values used 2000 participant-cluster bootstrap resamples; Benjamini–Hochberg q values addressed the 12 tests. Results: Higher preceding-meal protein was associated with lower iAUC (−13.9%; 95% confidence interval (CI), −23.1 to −4.2; p = 0.008; q = 0.032), whereas total sugar was associated with higher iAUC (+29.6%; 95% CI, +16.9 to +45.2; p = 0.001; q = 0.006). A 1 SD (1.9 h) longer IMI was associated with 29.1% higher iAUC (95% CI, 15.0 to 48.8; p = 0.001; q = 0.006). The saturated-fat estimate was uncertain (+14.8%; 95% CI, −0.8 to +35.2; p = 0.066; q = 0.198). Conclusions: Preceding-meal sugar, IMI and protein were associated with subsequent glucose responses. Protein was sensitive to additional macronutrient adjustment; saturated fat remained uncertain. Incomplete metabolic and dietary information limits causal interpretation.
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BibTeX
@article{la2026secondmeal,
title = {{The Second-Meal Effect Under Free-Living Conditions: A Continuous Glucose Monitoring Study of Meal History and Postprandial Glycemia}},
author = {Thu Trang La and Jennell Jia Ying Koh and Wen Wei Ang and Jing Xuan Ng and Karishma Chandramohan Amudha and Jessie Jun Min Lim and Diana-Lyn Baptiste and Mei Hui Liu and Asim Shabbir and Roger Foo and Su Lin Lim and Kee Yuan Ngiam and Han Shi Jocelyn Chew},
journal = {Nutrients},
year = {2026},
month = nov,
doi = {10.3390/nu18213697},
url = {https://www.mdpi.com/2072-6643/18/21/3697},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Second-Meal Effect Under Free-Living Conditions: A Continuous Glucose Monitoring Study of Meal History and Postprandial Glycemia
AU - Thu Trang La
AU - Jennell Jia Ying Koh
AU - Wen Wei Ang
AU - Jing Xuan Ng
AU - Karishma Chandramohan Amudha
AU - Jessie Jun Min Lim
AU - Diana-Lyn Baptiste
AU - Mei Hui Liu
AU - Asim Shabbir
AU - Roger Foo
AU - Su Lin Lim
AU - Kee Yuan Ngiam
AU - Han Shi Jocelyn Chew
PY - 2026
DA - 2026/11/07
JO - Nutrients
DO - 10.3390/nu18213697
UR - https://www.mdpi.com/2072-6643/18/21/3697
AB - Background/Objectives: Excess adiposity is associated with abnormal postprandial glucose responses (PPGRs), and controlled studies show that one meal can influence the PPGR of the next. Whether this carry-over occurs in everyday eating is unclear. We examined whether the timing, composition, and PPGR of the preceding meal were associated with the subsequent PPGR. Methods: This observational secondary analysis included 55 Southeast Asian adults with excess body weight and 342 within-day consecutive eating-occasion pairs recorded using a smartphone app and continuous glucose monitoring. Participant fixed-effects linear regression examined 12 preceding-meal characteristics, including intermeal interval (IMI), glycemic load, total sugar, protein, and saturated fat. The outcome was the log-transformed positive incremental area under the glucose curve ln(1 + positive 0–120 min iAUC after the subsequent meal. Each characteristic was examined separately per within-person standard deviation (SD), adjusting for current-meal characteristics, premeal glucose, and temporal factors. Confidence intervals and p values used 2000 participant-cluster bootstrap resamples; Benjamini–Hochberg q values addressed the 12 tests. Results: Higher preceding-meal protein was associated with lower iAUC (−13.9%; 95% confidence interval (CI), −23.1 to −4.2; p = 0.008; q = 0.032), whereas total sugar was associated with higher iAUC (+29.6%; 95% CI, +16.9 to +45.2; p = 0.001; q = 0.006). A 1 SD (1.9 h) longer IMI was associated with 29.1% higher iAUC (95% CI, 15.0 to 48.8; p = 0.001; q = 0.006). The saturated-fat estimate was uncertain (+14.8%; 95% CI, −0.8 to +35.2; p = 0.066; q = 0.198). Conclusions: Preceding-meal sugar, IMI and protein were associated with subsequent glucose responses. Protein was sensitive to additional macronutrient adjustment; saturated fat remained uncertain. Incomplete metabolic and dietary information limits causal interpretation.
SN - 2072-6643
ER -