Diet, physical activity, and sleep in relation to postprandial glucose responses under free-living conditions: an intensive longitudinal observational study

Abstract

Background: It remains unclear what lifestyle behaviors are optimal for controlling postprandial glucose responses under real-world circumstances in persons without diabetes. We aimed to assess associations of diet, physical activity, and sleep with postprandial glucose responses in Asian adults without diabetes under free-living conditions.

Methods: We conducted an observational study collecting intensive longitudinal data using smartphone-based ecological momentary assessments, accelerometers, and continuous glucose monitors over nine free-living days in Singaporean men and women aged 21-69 years without diabetes. The outcome was the 2-h postprandial glucose incremental area under the curve (mmol/l*min). Associations were estimated using linear mixed-effect models.

Results: The analyses included 11,333 meals in 789 participants. Greater variations in glucose and lifestyle measures were observed within individuals than between individuals. Higher consumption of carbohydrate-rich and deep-fried foods and lower consumption of protein-rich foods were significantly associated with higher postprandial glucose levels (incremental area under the curve). The strongest association was observed for including refined grains (46.2 [95% CI: 40.3, 52.1]) in meals. Longer postprandial light-intensity physical activity (-24.7 [(-39.5, -9.9] per h) and moderate-to-vigorous-intensity physical activity (-58.0 [-73.8, -42.3]) were associated with substantially lower postprandial glucose levels. Longer daily light-intensity physical activity (-7.5 [-10.7, -4.2]) and sleep duration (-2.7 [-4.4, -1.0]) were also associated with lower postprandial glucose levels. Furthermore, postprandial glucose levels were the lowest in the morning and the highest in the afternoon. The results were largely consistent for males and females and for participants with and without prediabetes.

Conclusions: Consuming less refined grains and more protein-rich foods, getting more physical activity (particularly during the postprandial period), and having a longer sleep duration were associated with lower postprandial glucose levels in Asian adults without diabetes. Our findings support multi-component lifestyle modifications for postprandial glucose control and highlight the importance of the timing of eating and physical activity.

Keywords: Continuous glucose monitoring; Free-living; Mobile health; Nutrition; Physical activity; Postprandial glucose response; Sleep.

Fig. 1

Overview of study design

Fig. 2

Relative contribution of within-person (in blue) and between-person (in orange) variation in longitudinal free-living measures. Postprandial measures were for the 2-h window after eating. Daily LPA and daily MVPA were measured during the 24 h before the meal. iAUC: incremental area under the curve; LPA: light-intensity physical activity; MVPA: moderate-to-vigorous-intensity physical activity

Fig. 3

Associations of lifestyle exposures and meal time with postprandial glucose iAUC, stratified by sex and prediabetes status subgroups. The models were adjusted for age, sex, ethnicity, education level, smoking, alcohol, body mass index, and mean 2-h pre-prandial glucose level, except when the covariate was used to stratify. The models were also mutually adjusted for meal time, diet, physical activity, and sleep measures. The ▲ symbol indicates a significant interaction term (p-value < 0.05), and the △ symbol indicates a marginally significant interaction term (0.05 < = p-value < 0.1) (for details, see Supplementary eTable 3). Postprandial measures were for the 2-h window after eating. Daily LPA and daily MVPA were measured during the 24 h before the meal. iAUC: incremental area under the curve. LPA: light-intensity physical activity; MVPA: moderate-to-vigorous-intensity physical activity