(OR34-02-24) Sex and Menopausal Status Modulate the Impact of Meal Timing on Postprandial Glucose: Data From the ZOE PREDICT 1 Study

Objectives: Postprandial glucose metabolism displays a diurnal rhythm potentially modulated by physiological characteristics. The impact of sex and menopausal status is unknown. We therefore investigated the impact of  these factors on diurnal variation in postprandial glucose responses.

Methods: In the PREDICT 1 study, N = 769 participants (Mean ± SD; Age: 46 ± 11 years, BMI: 25.6 ± 4.9, 226 M/543 F) consumed an identical standardised meal (71 g CHO/22 g Fat/10 g Pro) at breakfast or lunch on separate days. Interstitial postprandial glucose (2h) iAUC was measured using continuous glucose monitors. The effect of meal timing (breakfast, lunch) on median postprandial glucose (2h) iAUC was compared (Wilcoxon Rank test), and subsequently stratified by sex (M/F) and menopausal status (pre/post; age-matched n=108).

Results: Median [IQR] glucose iAUC was 51% lower following breakfast (6397 mmol/L𑛀2h; [4327-8805]) in comparison to lunch (12913 mmol/L𑛀2h; 9161-17206;  p< 0.001). While breakfast responses were similar between sexes (p=0.40), higher lunch responses in females lead to a greater difference between meals (52%; median ΔiAUC: 6931 mmol/L𑛀2h IQR: 3204-10933) versus males (47%; 5197 mmol/L𑛀2h [2614-5789]; p=0.001). In an age-matched sub-cohort of pre- and post-menopausal women, breakfast responses were similar between pre- and post-menopausal women (p=0.06) yet pre-menopausal women exhibited a smaller difference in glucose responses between breakfast and lunch meals (44%, 5277 mmol/L𑛀2h [2426-9285]) compared to post-menopausal women (62%, 8249 mmol/L𑛀2h [IQR: 4278-11482]) (p = 0.03).

Conclusions: Sex and menopausal status influence the effect of meal timing on postprandial glucose. The apparent effect is greater in women compared to men, and in post-menopausal women relative to pre-menopausal women. This underscores the potential importance of personalised dietary strategies that accommodate meal timing and inherent phenotypic differences.

Funding Sources: Work supported by ZOE Ltd and TwinsUK, which is funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation (CDRF), ZOE Ltd, and the National Institute for Health research, Clinical Research Network, Guy’s and St Thomas’ NHS Foundation Trust in partnership with Kings’ College London.