How Important Is Eating Rate in the Physiological Response to Food Intake, Control of Body Weight, and Glycemia?

Association between fast eating speed and metabolic dysfunction-associated steatotic liver disease: a multicenter cross-sectional study and meta-analysis

BACKGROUND

With the fast pace of modern life, people have less time for meals, but few studies have examined the association between the habit of fast eating and metabolic diseases.

OBJECTIVE

Combining the results of the current study and the prior ones, we aimed to investigate the possible relationship between fast eating and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

This is a sub-analysis of a multicenter cross-sectional study of 1965 participants investigated the association between fast eating and MASLD in Chinese. Fast eating was defined as meal time less than five minutes and participants were divided into three categories based on their self-reported frequency of fast eating: ≤1 time/month, ≤1 time/week and ≥2 times/week. We further conducted a literature search for available studies published before November, 2023 as well as a meta-analysis to investigate the association between fast eating and MASLD.

RESULTS

The proportion of MASLD was 59.3%, 50.5%, and 46.2% in participants with fast eating ≥2 times/week, ≤1 time/week and ≤1 time/month, respectively (P for trend <0.001). The frequency of fast eating was independently associated with risk of MASLD after multiple adjustment for sex, age, demographics, smoking and drinking status, BMI and clinical metabolic parameters (OR, 1.29; 95%CI, 1.09-1.53). Participants who ate fast frequently (≥2 times/week) had 81% higher risk of MASLD (P = 0.011). A meta-analysis of five eligible studies confirmed that frequent fast eating was associated with increased risk of MASLD (pooled OR, 1.22; 95%CI, 1.07-1.39).

CONCLUSIONS

Frequent fast eating was associated with an increased risk of MASLD.

Association between Self-Perception of Chewing, Chewing Behavior, and the Presence of Gastrointestinal Symptoms in Candidates for Bariatric Surgery

Given the changes in the digestive tract post-bariatric surgery, adapting to a new pattern of eating behavior becomes crucial, with special attention to the specifics of chewing mechanics. This study aimed to investigate the association between self-perception of chewing, chewing behavior, and the presence of gastrointestinal symptoms in preoperative patients undergoing bariatric surgery. Sixty adult candidates for bariatric surgery at a public hospital in Belém (Brazil) were analyzed. Participants predominantly exhibited unilateral chewing patterns (91.6%), a fast chewing rhythm (73.3%), a large food bolus (80%), liquid intake during meals (36.7%), and 41.7% reported that chewing could cause some issue. Significant associations were found between the perception of causing problems and chewing scarcity (p = 0.006), diarrhea (p = 0.004), absence of slow chewing (p = 0.048), and frequent cutting of food with front teeth (p = 0.034). These findings reveal a relationship between the perception of chewing problems and chewing scarcity, presence of diarrhea, and fast chewing.

Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management

BACKGROUND

Diabesity, the intersection of obesity and diabetes, presents a global health crisis with profound implications. Addressing diabesity requires multifaceted strategies, with diet playing a pivotal role. Over the last 15 years, clinical studies have intensified their exploration of various dietary approaches in diabesity management. This literature review aims to synthesize findings from clinical studies conducted in the last 15 years, shedding light on the efficacy, mechanisms, and nuances of different diet types in diabesity management with special focus on the Mediterranean diet (MD).

METHODS

Thorough research of academic databases yielded a collection of relevant clinical studies. These studies encompassed a range of dietary strategies, including the MD, low-carbohydrate diets, plant-based diets, high-protein diets, low-fat regimens, and intermittent fasting. Key findings, methodologies, and outcomes were thoroughly extracted and analyzed.

RESULTS

The last 15 years have witnessed considerable improvements in recognizing the role of human nutritional habits in diabesity management. The MD appears to be the most well-recognized diet, exerting favorable effects against both obesity and diabetes. Low-carbohydrate diets were found to enhance glycemic regulation and decrease insulin resistance. Plant-based diets demonstrated potential benefits in weight management and cardiometabolic health. High-protein, low-fat dietary models exhibited positive effects on satiety and body weight decline. Intermittent fasting regimens also exerted metabolic improvements and body weight decline. Personalization emerged as a crucial factor in dietary recommendations.

CONCLUSIONS

Clinical studies from the last 15 years underscore the intricate relationship between diet types and diabesity management. The above results contribute to an increasing body of evidence, emphasizing the need for tailored dietary approaches and especially the MD. Healthcare providers can utilize this knowledge to offer personalized dietary recommendations for individuals with diabesity, potentially curbing the rise of these twin epidemics and improving the well-being of affected populations.

Physicochemical properties and anti-diabetic ability of polysaccharides from a thinned peach fruit

Thinned peach fruit is a by-product with abundant yields. However, it is barely utilized. This study aimed to study the physicochemical properties and anti-diabetic ability of polysaccharides (PPSs) from a thinned peach fruit to investigate its application potential. Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM) characterizations were performed together with tests to determine rheology properties, monosaccharide composition, and molecular weight of the obtained polysaccharide. Moreover, the antioxidant activity, α-amylase inhibitory activity, binding abilities to bile salts, and effects on type 2 diabetic mice were analyzed. The results indicated that PPS consisted of two components with molecular weights of 287.38 kDa and 12.02 kDa, accounting for 89.83% and 10.17% of the composition, respectively. The dominant monosaccharides were galactose, galacturonic acid, and arabinose, exhibiting α-configurations. The concentration was positively related to the viscosity of PPS. As the temperature was increased from 25 °C to 37 °C and the pH from 2.0 to 7.0, the viscosity decreased. The IC50 values for scavenging DPPH and ABTS were around 0.22 and 1.47 mg mL-1. Also, PPS could inhibit α-amylase ability and bind bile salts. The administration of PPS significantly inhibited emaciation, organ damage, improved oral glucose tolerance and insulin resistance, enhanced the content of short-chain fatty acids (SCFAs), and regulated blood lipid profiles and the composition and structure of colon microbiota in type-2 diabetic mice. These results provide new evidence for the potential of PPS as a bioactive ingredient with anti-diabetic properties for use in the food industry.

Eating behaviors and incident cardiovascular disease in Japanese people: The population-based Panasonic cohort study 14

Evidence on common eating behaviors to support the prevention of cardiovascular disease (CVD) in Japanese people is insufficient. This retrospective cohort study aimed to investigate the association of diet behaviors (e.g., skipping breakfast, eating speed, snack after dinner, and alcohol consumption) with incident CVD in Japanese individuals. Employees of Panasonic Corporation who underwent the annual health checkups and without a history of CVD at baseline were enrolled. The main outcome was incident 3-point major adverse cardiovascular events (MACE). The secondary outcomes were incident coronary artery disease (CAD) and stroke. To assess the effect of BMI, the subgroup analysis was conducted. In total, 132,795 participants were included. Overall, 3,115, 1,982, and 1,165 participants developed 3-point MACE, CAD, and stroke, respectively. Skipping breakfast (HR: 1.13, 95% CI: 1.03-1.23) and fast eating (HR: 1.23, 95% CI: 1.04-1.47) were associated with 3-point MACE in the participants overall. Skipping breakfast (HR: 1.23, 95% CI: 1.10-1.37) and fast eating (HR: 1.38, 95% CI: 1.12-1.71) were also associated with 3-point MACE in participants with BMI < 25 kg/m². In contrast, in participants with BMI ≥ 25 kg/m², these associations were not detectable (P value for the interaction between subgroups = 0.09 [skipping breakfast] and 0.03 [fast eating], respectively). The diet behavior is a potential risk factor of incident CVD in Japanese people, particularly in those with BMI < 25 kg/m².

Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment

Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations.

Fast Eating Speed Could Be Associated with HbA1c and Salt Intake Even after Adjusting for Oral Health Status: A Cross-Sectional Study

This study aimed to examine the relationship between eating speed and hemoglobin A1c (HbA1c), considering the number of teeth, using cross-sectional health examination data from community-dwelling older individuals in Japan. We used data from the Center for Community-Based Healthcare Research and Education Study in 2019. We collected data on gender, age, body mass index, blood test results, Salt intake, bone mineral density, body fat percentage, muscle mass, basal metabolic rate, number of teeth, and lifestyle information. Eating speed was evaluated subjectively as fast, normal, or slow. Overall, 702 participants were enrolled in the study and 481 participants were analyzed. Multivariate logistic regression analysis revealed a significant association between fast eating speed and being a male (odds ratio [95% confidence interval]: 2.15 [1.02-4.53]), HbA1c (1.60 [1.17-2.19]), salt intake (1.11 [1.01-1.22]), muscle mass (1.05 [1.00-1.09]), and enough sleep (1.60 [1.03-2.50]). Fast eating may be associated with overall health and lifestyle. The characteristics of fast eaters, after taking oral information into consideration, tended to increase the risk of type 2 diabetes, renal dysfunction, and hypertension. Dental professionals should provide dietary and lifestyle guidance to fast eaters.

A Conceptual Model for Mobile Health-enabled Slow Eating Strategies

Ingestive behaviors (IBs) (eg, bites, chews, oral processing, swallows, pauses) have meaningful roles in enhancing satiety, promoting fullness, and decreasing food consumption, and thus may be an underused strategy for obesity prevention and treatment. Limited IB monitoring research has been conducted because of a lack of accurate automated measurement capabilities outside laboratory settings. Self-report methods are used, but they have questionable validity and reliability. This paper aimed to present a conceptual model in which IB, specifically slow eating, supported by technological advancements, contributes to controlling hedonic and homeostatic processes, providing an opportunity to reduce energy intake, and improve health outcomes.

Eating pace instruction is effective in slowing eating rate in women with overweight and obesity

Slow eating is associated with lower body mass index (BMI), enhanced satiety, and reduced food intake in laboratory settings. This study developed and tested a 5-week slow-eating intervention, delivered either through individual or small group weekly meetings, in women with overweight and obesity. Women (n = 65; 20.5 ± 3.6 years; BMI 31.3 ± 2.7 kg/m²) were assigned to experimental or parallel non-treatment control. Main outcomes, measured pre- and post-intervention, included eating rate, meal duration, and energy intake during a standardized meal served on a universal eating monitor. Exploratory outcomes included Weight Related Eating Questionnaire (WREQ), Intuitive Eating Scale (IES), and Mindful Eating Questionnaire (MEQ) scores. All women in the experimental group underwent the same slow-eating intervention, but half had individual sessions while the other half had small group sessions. No differences were seen for any outcomes between session modalities, so experimental data were pooled (n = 25) and compared to control data (n = 25). Time-by-group interactions showed reduced eating rate (F_(1,48df) = 13.04, η² = 0.214, p = .001) and increased meal duration (F_(1,48df) = 7.949, η² = 0.142, p = .007) in the experimental group compared to the control group but change in energy intake was not significant (F_(1,48df) = 3.298, η² = 0.064, p = .076). Experimental within-group changes for WREQ subscale scores External Cues (t₍₂₃₎ = 3.779, p = .001) and Emotional Eating (t₍₂₃₎ = 2.282, p = .032) decreased over time, along with increased total and summary IES (t₍₂₃₎ = 2.6330, p = .015) and MEQ (t₍₂₃₎ = 2.663, p = .014) scores. Promising findings of reduced eating rate, increased meal duration, and improved WREQ, IES, and MEQ scores should be followed up in larger more diverse samples for longer durations.

Nutrient Composition and In Vitro Fermentation Characteristics of Sorghum Depending on Variety and Year of Cultivation in Northern Italy

Sorghum is the fifth most produced cereal in the world and is a source of nutrients and bioactive compounds for the human diet. This study examined the nutrient composition and in vitro fermentation characteristics of sorghum varieties grown in 2020 and 2021 (n = 15 × 3 × 2) across three locations in the north of Italy (Bologna, Padova, and Rovigo). In 2020, the crude protein content of sorghum was significantly higher in the region of Padova than in the region of Bologna (124 vs. 95.5 g/kg dry matter). However, crude fat, sugar, and gross energy levels showed no significant differences among the different regions in 2020. In 2021, the levels of crude protein, crude fat, sugar, and gross energy had no significant differences among different sorghum varieties harvested from the three regions. Significant differences in some mineral contents were found among the samples particularly in manganese and zinc in both years. After 24 h of fermentation of two different sorghum hybrids (hybrids 1 and 2 of both years harvested in Bologna, n = 4 × 2 × 2), the pH value was significantly higher in hybrid 1 of year 2021 (3.98) than in the other fermented samples (range: 3.71–3.88). The sorghum harvested from the region of Bologna had a significantly higher viscosity value (1.22 mPa·s) compared to other regions (1.8–1.10 mPa·s) in 2021 only. The results show that the nutritional value and viscosity of different sorghum varieties could differ depending on the location and year of cultivation.

A randomized crossover trial assessing time of day snack consumption and resulting postprandial glycemic response in a real-life setting among healthy adults

The postprandial glycemic response is an important metabolic health factor, which, from laboratory studies, is known to change from low to high over the course of the day, and from which negative health outcomes have been linked to nightly eating. We applied interstitial continuous glucose monitoring to examine the glycemic response to a standardized carbohydrate-rich snack (198 kcal) across the day in a real-life setting. Twenty-four healthy participants (12 men, 12 women, 27-61 y old) consumed the snack nine times during 6 d in a crossover design, altering the time of consumption between morning, afternoon and evening. The snack was consumed in the participant's own environment with a preceding fast of at least 2.5 h between their customary main meals and practices. Linear mixed models were used with fixed effect of timing, and participant as random effect, to assess incremental area under the curve, peak value and time-to-peak of the glycemic response. Overall, the highest glycemic excursions were observed in the morning, while a more dampened but prolonged response was observed in the evening. These findings do not concur with previously published laboratory studies. This implies that results obtained under controlled experimental conditions in laboratories cannot be generalized directly to predict chrononutritional effects on the glycemic response in healthy individuals and their daily routines.

Relationship between body mass index and masticatory factors evaluated with a wearable device

Numerous studies have evaluated the relationship between eating behavior and obesity, however few studies have objectively assessed eating behavior. Additionally, the association of masticatory behaviors with masticatory performance remains unclear. This study aimed to verify the relationship between masticatory performance and behavior measured by a wearable masticatory counter, and BMI. 365 healthy adults participated. Mastication behaviors, i.e. number of chews and bites, chewing rate, and chewing time, were measured using wearable masticatory counter while consuming one rice ball (100 g). Masticatory performance was evaluated using testing gummy jelly. Lifestyle habits including exercise, walking, and breakfast, were surveyed by questionnaire. The correlation coefficients between masticatory behaviors and performance and BMI were analyzed. Furthermore, multiple regression analysis was performed. The number of chews showed positive correlation with chewing rate, number of bites and chewing time, but no correlation with masticatory performance. BMI had weak but significant negative correlation with number of chews, bites, chewing time, and masticatory performance, but had no correlation with chewing rate. Multiple regression analysis revealed that BMI was associated with sex, age, number of chews, bites, masticatory performance, and walking speed. In conclusion, masticatory behavior and performance were not interrelated, but both were independently associated with BMI weakly.

The effects of metformin and alendronate in attenuating bone loss and improving glucose metabolism in diabetes mellitus mice

Background: To explore the anti-osteoporosis and anti-diabetes effects and potential underlying mechanisms of treatment with metformin and alendronate in diabetes mellitus mice.

Methods: Eight-week-old C57 BL/KS db/db and db/+ female mice were evaluated according to the following treatment group for 12 weeks: control group, diabetes mellitus group, diabetes mellitus with metformin group, diabetes mellitus with Alendronate group, diabetes mellitus with metformin plus alendronate group. Glucose level, glucose tolerance test, bone mineral density, bone microarchitecture, bone histomorphometry, serum biomarkers, and qPCR analysis.

Results: Combined metformin and alendronate can improve progression in glucose metabolism and bone metabolism, including blood glucose levels, blood glucose levels after 4 and 16 hours fasting, glucose tolerance test results, insulin sensitivity and reduces bone loss than the diabetes group. The use of alendronate alone can increase significantly serum glucagon-like peptide-1 levels than the diabetes group. The use of metformin alone can improve bone microstructure such as Tb.Sp and Tb.N of spine in diabetic mice.

Conclusion: The combined use of alendronate and metformin has an anti-diabetes and anti-osteoporotic effect compared with diabetic mice, but they appear to act no obvious synergistically between alendronate and metformin.

Perspective: A Framework for Addressing Dynamic Food Consumption Processes

The study of food consumption, diet, and related concepts is motivated by diverse goals, including understanding why food consumption impacts our health, and why we eat the foods we do. These varied motivations can make it challenging to define and measure consumption, as it can be specified across nearly infinite dimensions-from micronutrients to carbon footprint to food preparation. This challenge is amplified by the dynamic nature of food consumption processes, with the underlying phenomena of interest often based on the nature of repeated interactions with food occurring over time. This complexity underscores a need to not only improve how we measure food consumption but is also a call to support theoreticians in better specifying what, how, and why food consumption occurs as part of processes, as a prerequisite step to rigorous measurement. The purpose of this Perspective article is to offer a framework, the consumption process framework, as a tool that researchers in a theoretician role can use to support these more robust definitions of consumption processes. In doing so, the framework invites theoreticians to be a bridge between practitioners who wish to measure various aspects of food consumption and methodologists who can develop measurement protocols and technologies that can support measurement when consumption processes are clearly defined. In the paper we justify the need for such a framework, introduce the consumption process framework, illustrate the framework via a use case, and discuss existing technologies that enable the use of this framework and, by extension, more rigorous study of consumption. This consumption process framework demonstrates how theoreticians could fundamentally shift how food consumption is defined and measured towards more rigorous study of what, how, and why food is eaten as part of dynamic processes and a deeper understanding of linkages between behavior, food, and health.

An evolving view on food viscosity regulating gastric emptying

Viscosity is a property of most foods. The consumption of the high-viscosity food is associated with a variety of physiological responses, one of which is their ability to regulate gastric emptying and modulate postprandial glycemic response. Gastric emptying has been proven to be a key step affecting the digestion and absorption of food, whereas, the relationship between viscosity and gastric emptying is still far away from being understood. Here, we reviewed the factors that influence food viscosity and food viscosity changes during digestion. Besides, the effect of food viscosity on gastric emptying and food-viscosity-physiological response were highlighted. Finally, "quantitative relationship" of viscosity and gastric emptying was discussed. This review can contribute to the understanding that how food viscosity affects gastric emptying, and help for developing foods that could control satiety and manage body weight for the specific populations.

Increased oral processing and a slower eating rate increase glycaemic, insulin and satiety responses to a mixed meal tolerance test

PURPOSE

Variations in specific oral processing behaviours may contribute to differences in glucose, insulin and satiety responses to a standardised test meal. This study tested how natural variations in oral processing between slower and faster eaters contribute to differences in post-prandial glucose (PP glucose), insulin response (PP insulin) and post-meal satiety for a standardised test meal.

METHODS

Thirty-three participants with higher risk for type 2 diabetes consumed a standardised test-meal while being video recorded to derive specific oral processing behaviours. Plasma glucose, insulin and satiety measures were collected at baseline, during and post meal. Participants were split into slower and faster eaters using median split based on their eating rates and individual bolus properties were analysed at the point of swallow.

RESULTS

There were large variations in eating rate (p < 0.001). While there was no significant difference in PP glucose response (p > 0.05), slower eaters showed significantly higher PP insulin between 45 and 60 min (p < 0.001). Slower eaters had longer oro-sensory exposure and increased bolus saliva uptake which was associated with higher PP glucose iAUC. Faster eating rate and larger bolus particle size at swallow correlated with lower PP glucose iAUC. A slower eating rate with greater chews per bite significantly increased insulin iAUC. Faster eaters also consistently rated their hunger and desire to eat higher than slower eaters (p < 0.05).

CONCLUSIONS

Natural variations in eating rate and the associated oral processing contributed to differences in PP glucose, PP insulin and satiety responses. Encouraging increased chewing and longer oral-exposure time during consumption, may promote early glucose absorption and greater insulin and satiety responses, and help support euglycaemia.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04522063.

Eating Speed, Physical Activity, and Cardiorespiratory Fitness Are Independent Predictors of Metabolic Syndrome in Korean University Students

Background: Little is known regarding the role of eating quickly, physical inactivity, and poor cardiorespiratory fitness (CRF) in assessing the onset of metabolic syndrome (Mets) in Korean young adults. Objectives: This study examined the association between the three risk factors and Mets in 1891 Korean university students (30% female) aged 18–29 years. Methods: Eating speed (slow vs. fast) and physical activity (active vs. inactive) were assessed with a standardized questionnaire. Maximal oxygen uptake as an indicator of CRF was assessed with graded exercise testing. Components of Mets were waist circumference, systolic and diastolic blood pressures, fasting blood glucose (FBG), triglycerides (TG), and high-density lipoprotein cholesterol (HDLC). Results: All the three exposures were positively associated with abdominal obesity, elevated blood pressures, elevated FBG, elevated TG, and decreased HDLC. Logistic regression analysis showed that the odds ratio (OR) of Mets was incremental in the order of physical inactivity (odds ratio, OR = 1.666; 95% confidence interval, CI = 1.024–2.708; p = 0.040), fast eating (OR = 1.687; 95% CI = 1.094–2.601; p = 0.018), and poor CRF (OR = 5.378; 95% CI = 3.475–8.325; p < 0.001). Conclusions: The current findings suggest that a multifaceted intervention targeting at promotion of physical activity and CRF in concert with healthy eating behaviors should be implemented as a preventive strategy against Mets in Korean university students.

Eating Speed, Eating Frequency, and Their Relationships with Diet Quality, Adiposity, and Metabolic Syndrome, or Its Components

Excess body weight is a major global health concern, particularly due to its associated increased health risks. Several strategies have been proposed to prevent overweight and obesity onset. In the past decade, it has been suggested that eating speed/rate and eating frequency might be related to obesity. The main aim of this narrative review was to summarize existing evidence regarding the impact of eating speed/rate and eating frequency on adiposity, metabolic syndrome (MetS), or diet quality (DQ). For this purpose, a literature search of observational and interventional trials was conducted between June and September 2020 in PubMed and Web of Sciences databases, without any data filters and no limitations for publication date. Results suggest that children and adults with a faster eating speed/rate may be associated with a higher risk of developing adiposity, MetS or its components. Furthermore, a higher eating frequency could be associated with diet quality improvement, lower adiposity, and lower risk of developing MetS or its components. Further interventional trials are warranted to clarify the mechanism by which these eating behaviors might have a potential impact on health.

Determining the glycaemic responses of foods: conventional and emerging approaches

A low-glycaemic diet is crucial for those with diabetes and cardiovascular diseases. Information on the glycaemic index (GI) of different ingredients can help in designing novel food products for such target groups. This is because of the intricate dependency of material source, composition, food structure and processing conditions, among other factors, on the glycaemic responses. Different approaches have been used to predict the GI of foods, and certain discrepancies exist because of factors such as inter-individual variation among human subjects. Besides other aspects, it is important to understand the mechanism of food digestion because an approach to predict GI must essentially mimic the complex processes in the human gastrointestinal tract. The focus of this work is to review the advances in various approaches for predicting the glycaemic responses to foods. This has been carried out by detailing conventional approaches, their merits and limitations, and the need to focus on emerging approaches. Given that no single approach can be generalised to all applications, the review emphasises the scope of deriving insights for improvements in methodologies. Reviewing the conventional and emerging approaches for the determination of GI in foods, this detailed work is intended to serve as a state-of-the-art resource for nutritionists who work on developing low-GI foods.

Regulation of Postabsorptive and Postprandial Glucose Metabolism by Insulin-Dependent and Insulin-Independent Mechanisms: An Integrative Approach

Glucose levels in blood must be constantly maintained within a tight physiological range to sustain anabolism. Insulin regulates glucose homeostasis via its effects on glucose production from the liver and kidneys and glucose disposal in peripheral tissues (mainly skeletal muscle). Blood levels of glucose are regulated simultaneously by insulin-mediated rates of glucose production from the liver (and kidneys) and removal from muscle; adipose tissue is a key partner in this scenario, providing nonesterified fatty acids (NEFA) as an alternative fuel for skeletal muscle and liver when blood glucose levels are depleted. During sleep at night, the gradual development of insulin resistance, due to growth hormone and cortisol surges, ensures that blood glucose levels will be maintained within normal levels by: (a) switching from glucose to NEFA oxidation in muscle; (b) modulating glucose production from the liver/kidneys. After meals, several mechanisms (sequence/composition of meals, gastric emptying/intestinal glucose absorption, gastrointestinal hormones, hyperglycemia mass action effects, insulin/glucagon secretion/action, de novo lipogenesis and glucose disposal) operate in concert for optimal regulation of postprandial glucose fluctuations. The contribution of the liver in postprandial glucose homeostasis is critical. The liver is preferentially used to dispose over 50% of the ingested glucose and restrict the acute increases of glucose and insulin in the bloodstream after meals, thus protecting the circulation and tissues from the adverse effects of marked hyperglycemia and hyperinsulinemia.