title: Effects of meal composition on postprandial incretin, glucose and insulin responses after surgical and medical weight loss.
abstract: BACKGROUND
  Meal tolerance tests are frequently used to study dynamic incretin and insulin responses in the postprandial state; however, the optimal meal that is best tolerated and suited for hormonal response following surgical and medical weight loss has yet to be determined.
  
  
  OBJECTIVE
  To evaluate the tolerability and effectiveness of different test meals in inducing detectable changes in markers of glucose metabolism in individuals who have undergone a weight loss intervention.
  
  
  METHODS
  Six individuals who underwent surgical or medical weight loss (two Roux-en-Y gastric bypass, two sleeve gastrectomy and two medical weight loss) each completed three meal tolerance tests using liquid-mixed, solid-mixed and high-fat test meals. The tolerability of each test meal, as determined by the total amount consumed and palatability, as well as fasting and meal-stimulated glucagon-like peptide, glucose-dependent insulinotropic polypeptide, insulin and glucose were measured.
  
  
  RESULTS
  Among the six individuals, the liquid-mixed meal was better and more uniformly tolerated with a median meal completion rate of 99%. Among the four bariatric surgical patients, liquid-mixed meal stimulated on average a higher glucagon-like peptide (percent difference: 83.7, 89), insulin secretion (percent difference: 155.1, 158.7) and glucose-dependent insulinotropic polypeptide (percent difference: 113.5, 34.3) compared with solid-mixed and high-fat meals.
  
  
  CONCLUSIONS
  The liquid-mixed meal was better tolerated with higher incretin and insulin response compared with the high-fat and solid-mixed meals and is best suited for the evaluation of stimulated glucose homeostasis.
authors: Division of Endocrinology, Diabetes and Metabolism The Johns Hopkins University Baltimore Maryland USA.
authors: C J
authors: 0000-0002-0824-0207
authors: CJ
authors: Lee
authors: Division of Endocrinology, Diabetes and Metabolism The Johns Hopkins University Baltimore Maryland USA.
authors: T T
authors: TT
authors: Brown
authors: Department of Health, Behavior and Society The Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA.
authors: L J
authors: LJ
authors: Cheskin
authors: Department of Psychiatry The Johns Hopkins University Baltimore Maryland USA.
authors: P
authors: P
authors: Choi
authors: Department of Psychiatry The Johns Hopkins University Baltimore Maryland USA.
authors: T H
authors: TH
authors: Moran
authors: Department of Surgery The Johns Hopkins University Baltimore Maryland USA.
authors: L
authors: L
authors: Peterson
authors: Department of Surgery The Johns Hopkins University Baltimore Maryland USA.
authors: R
authors: R
authors: Matuk
authors: Department of Surgery The Johns Hopkins University Baltimore Maryland USA.
authors: K E
authors: KE
authors: Steele
keywords: GIP; GLP‐1; bariatric surgery; incretins; meal tolerance test; weight loss