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The Prediabetes Nutritionist

two meals per day and pancreas fat

Two Meals Per Day May Raise Pancreas Fat in Type 2 Diabetes

Excess pancreas fat reduces insulin release and worsens blood sugar control.

Eating two meals per day may increase pancreas fat in people with type 2 diabetes, new findings suggest.

“These findings support current diabetes treatment guidelines that skipping meals should be avoided and may lead a novel approach to treatment of diabetes focusing on intrapancreatic fat deposition,” the researchers wrote.

The study, “Consumption of two meals per day is associated with increased intrapancreatic fat deposition in patients with type 2 diabetes: a retrospective study,” was published in BMJ Open Diabetes Research & Care.

The pancreas and liver have small quantities of fat in healthy individuals. An excessive build-up of fat in these organs reduces insulin release, worsens glucose tolerance, and raises the risk of diabetes, high blood pressure and metabolic syndrome – a cluster of diseases that raise the risk of heart disease. Excess pancreas fat also increases the risk of pancreatic cancer.

Lifestyle factors, including diet and smoking, are known risk factors for fat storage in the liver. However, it is unclear which lifestyle factors contribute to excess pancreas fat in people with type 2 diabetes.

A team of Japanese scientists analysed patients with type 2 diabetes hospitalized at the Department of Metabolic Medicine, Osaka University Hospital, between January 2008 and April 2020. All patients completed questionnaires and interviews assessing lifestyle factors, including diet, exercise, smoking, alcohol intake, night shift working, sleeping patterns and sleep apnoea. They also had abdominal computed tomography (CT) scans to measure pancreas and liver fat.

A total of 185 patients [101 male, median age of 63] were included in the study. Their median BMI was 26.5, and glycated haemoglobin (HbA1c) was 74 mmol/mol or 8.9%. Sixty-eight (43.9%) exercised daily, and 20 performed manual labour. Most participants were non-smokers and non-drinkers, with some reporting sleep disturbances [12.4% insomnia and 20.6% sleep apnoea].

The participants’ median visceral fat area (VFA)­– the estimated amount of fat stored surrounding the organs in the abdomen– was 118.1 cm2. Notably, a visceral fat area below 100cm2 is recommended for optimal health. Excess fat in the pancreas and liver was linked to VFA, but the link between excess liver fat and VFA was stronger than that between excess pancreas fat and VFA. There was no link between excess liver fat and excess pancreas fat.

Twenty-two participants ate two meals daily, while the others ate three. Of those eating two meals daily, 14 skipped breakfast, five skipped lunch, two skipped dinner, and one ate between 6 p.m. and midnight.

Participants eating two meals were younger, less likely to exercise regularly, more likely to work night shifts, have higher fasting glucose, lower pancreas function and lower HDL ‘good’ cholesterol. They also had significantly higher pancreas fat than those eating three meals, even after considering their age, sex, HbA1c and BMI.

No other lifestyle factor was linked to pancreas fat levels. And besides sleep apnoea, no other lifestyle factors, including the number of daily meals, were associated with excess liver fat.

“An interesting finding of the present study is that intrapancreatic fat deposition [pancreas fat storage] seems to be independent of obesity, which is known to be closely related to the development of non-alcoholic fatty liver disease. We found that the association between the number of meals consumed per day and intrapancreatic fat deposition persisted after adjustment for BMI, whereas there were no significant relationships between obesity-related factors, such as SAS [sleep apnoea syndrome], and intrapancreatic fat deposition,” the researchers wrote.

The researchers proposed a pathway to explain why eating two meals causes extra fat storage in the pancreas. They noted that patients eating two meals might eat unhealthier diets containing more sugar and fat, which could cause excess insulin release from the pancreas. Notably, excess insulin release is associated with excess pancreas fat.

The researchers highlighted some limitations of the study. First, the study was retrospective [looking at past events], and the lifestyle assessment was based on interviews and non-validated questionnaires.

“In the current dietary guidelines for patients with diabetes, skipping meals is not recommended because this worsens glycaemic control and increases the risk of arteriosclerosis [heart disease]. The present findings are supportive of the current recommendations,” they wrote.

Future studies assessing nutrient intake and diet patterns may help researchers to better understand the pathways contributing to fat accumulation in the pancreas.  

The Take-home Message

Scientists have found that eating two meals per day may increase pancreas fat. This finding is significant because excess pancreas fat can worsen blood sugar control, leading to complications. The adverse effect of eating only two meals is not necessarily about skipping meals but that fewer meals make it more likely for people to eat large portions of less healthy meals, which worsens blood sugar control.

That said, if you can eat two meals per day while ensuring you choose healthy foods and eat small quantities to avoid blood sugar spikes while getting enough nutrients, two meals per day might be OK.

But that’s tricky to achieve if you have diabetes. A better (and more sustainable approach) may be to eat three healthy, balanced and portion-controlled meals daily.

Please note that this study was observational, so it does not necessarily prove that eating two meals a day increases pancreas fat.

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