A whole-grain diet reduces peripheral insulin resistance and improves glucose kinetics in obese adults: A randomized-controlled trial

Background: Whole-grain intake is associated with lower risk of type 2 diabetes but the mechanisms are unclear. Purpose: We tested the hypothesis that a WG diet reduces insulin resistance and improves glucose use in individuals at risk for type 2 diabetes compared with an isocaloric-matched refined-grain diet. Methods: A double-blind, randomized, controlled, crossover trial of 14 moderately obese adults (Age, 38 +/- 2 y; BMI, 34.0 +/- 1.1 kg/m(2)). Insulin resistance and glucose metabolism was assessed using an oral glucose tolerance test combined with isotopic tracers of [6,6-H-2(2)]-glucose and [U-C-13]-glucose, and indirect calorimetry. Peripheral and hepatic insulin resistance was assessed as 1/(rate of disposal/insulin), and endogenous glucose rates of appearance (R-a) iAUC(60-240) x insulin iAUC(60-240), respectively. Both diets met ADA nutritional guidelines and contained either whole-grain (50 g per 1000 kcal) or equivalent refined-grain. All food was provided for 8 wk. with an 8-10 wk. washout period between diets. Results: Post-prandial glucose tolerance, peripheral insulin sensitivity, and metabolic flexibility (insulin-stimulated-fasting carbohydrate oxidation) improvements were greater after whole-grain compared to the refined-grain diet (P<0.05). Compared to baseline, body fat (similar to 2 kg) and hepatic R-a insulin resistance was reduced by both diets, while fasting glucose and exogenous glucose-meal were unchanged after both interventions. Changes in peripheral insulin resistance and metabolic flexibility correlated with improved glucose tolerance (P<0.05). Conclusion: Whole-grains reduced diabetes risk and the mechanisms appear to work through reduced post-prandial blood glucose and peripheral insulin resistance that were statistically linked to enhanced metabolic flexibility. (C) 2018 Elsevier Inc. All rights reserved.