Multi-parameter comparison of a standardized mixed meal tolerance test in healthy and type 2 diabetic subjects: the PhenFlex challenge

• Published in: Genes & nutrition Vol. 12; no. 1; p. 21
• Main Authors: Wopereis, Suzan, Stroeve, Johanna H. M., Stafleu, Annette, Bakker, Gertruud C. M., Burggraaf, Jacobus, van Erk, Marjan J., Pellis, Linette, Boessen, Ruud, Kardinaal, Alwine A. F., van Ommen, Ben
• Format: Journal Article
• Language: English
• Published: London BioMed Central 29.08.2017; Springer Nature B.V; BMC
• Subjects: Biomarkers; Biomedical and Life Sciences; Biomedicine; Blood pressure; Body mass index; Cholesterol; Clinical Nutrition; Diabetes; Diabetes mellitus; Diet; fasting; Fatty acids; Flexibility; Food; Gene Function; Glucagon; Glucose; Glucose metabolism; Glucose tolerance; glucose tolerance tests; health status; Homeostasis; Human Genetics; Insulin; kidneys; Literature reviews; liver; males; Metabolic health; Metabolism; Metabolites; muscles; noninsulin-dependent diabetes mellitus; Nutrition; Nutrition research; Nutritional challenge test; optimal nutrition; Pancreas; patients; Peptides; Phenotypic flexibility; Physiology; Plasma; Proteins; systematic review; Type 2 diabetes; United States > US; Type 2 diabetes; Biomarkers; Nutritional challenge test; Phenotypic flexibility; Nutrition; Metabolic health
• ISSN: 1555-8932; 1865-3499; 1865-3499
• DOI: 10.1186/s12263-017-0570-6

Background A key feature of metabolic health is the ability to adapt upon dietary perturbations. Recently, it was shown that metabolic challenge tests in combination with the new generation biomarkers allow the simultaneous quantification of major metabolic health processes. Currently, applied challenge tests are largely non-standardized. A systematic review defined an optimal nutritional challenge test, the “PhenFlex test” (PFT). This study aimed to prove that PFT modulates all relevant processes governing metabolic health thereby allowing to distinguish subjects with different metabolic health status. Therefore, 20 healthy and 20 type 2 diabetic (T2D) male subjects were challenged both by PFT and oral glucose tolerance test (OGTT). During the 8-h response time course, 132 parameters were quantified that report on 26 metabolic processes distributed over 7 organs (gut, liver, adipose, pancreas, vasculature, muscle, kidney) and systemic stress. Results In healthy subjects, 110 of the 132 parameters showed a time course response. Patients with T2D showed 18 parameters to be significantly different after overnight fasting compared to healthy subjects, while 58 parameters were different in the post-challenge time course after the PFT. This demonstrates the added value of PFT in distinguishing subjects with different health status. The OGTT and PFT response was highly comparable for glucose metabolism as identical amounts of glucose were present in both challenge tests. Yet the PFT reports on additional processes, including vasculature, systemic stress, and metabolic flexibility. Conclusion The PFT enables the quantification of all relevant metabolic processes involved in maintaining or regaining homeostasis of metabolic health. Studying both healthy subjects and subjects with impaired metabolic health showed that the PFT revealed new processes laying underneath health. This study provides the first evidence towards adopting the PFT as gold standard in nutrition research.