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PubMed2004

What are the key food groups to target for preventing obesity and improving nutrition in schools?

OBJECTIVE: To determine differences in the contribution of foods and beverages to energy consumed in and out of school, and to compare consumption patterns between school canteen users and noncanteen users. DESIGN: Cross-sectional National Nutrition Survey, 1995. SETTING: Australia. SUBJECTS ON SCHOOL DAYS: A total of 1656 children aged 5-15 y who had weekday 24-h dietary recall data. RESULTS: An average of 37% of total energy intake was consumed at school. Energy-dense foods and beverages such as fat spreads, packaged snacks, biscuits and fruit/cordial drinks made a greater contribution to energy intake at school compared to out of school (P< or =0.01). Fast foods and soft drinks contributed 11 and 3% of total energy intake; however, these food groups were mostly consumed out of school. Fruit intake was low and consumption was greater in school. In all, 14% of children purchased food from the canteen and they obtained more energy from fast food, packaged snacks, desserts, milk and confectionary (P< or =0.05) than noncanteen users. CONCLUSIONS: : Energy-dense foods and beverages are over-represented in the Australian school environment. To help prevent obesity and improve nutrition in schools, biscuits, snack bars and fruit/cordial drinks brought from home and fast food, packaged snacks, and confectionary sold at canteens should be replaced with fruit and water.

Adolescent↗

PubMed2006

Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old children.

BACKGROUND: The family food environment (FFE) is likely to exert important influences on young children's eating. Examination of multiple aspects of the FFE may provide useful insights regarding which of these might most effectively be targeted to prevent childhood obesity. OBJECTIVE: To assess the associations between the FFE and a range of obesity-promoting dietary behaviors in 5-6-year-old children. DESIGN: Cross-sectional study. SUBJECTS: Five hundred and sixty families sampled from three socio-economically distinct areas. MEASUREMENTS: Predictors included parental perceptions of their child's diet, food availability, child feeding practices, parental modeling of eating and food preparation and television (TV) exposure. Dietary outcomes included energy intake, vegetable, sweet snack, savory snack and high-energy (non-dairy) fluid consumption. RESULTS: Multiple linear regression analyses, adjusted for all other predictor variables and maternal education, showed that several aspects of the FFE were associated with dietary outcomes likely to promote fatness in 5-6-year-old children. For example, increased TV viewing time was associated with increased index of energy intake, increased sweet snack and high-energy drink consumption, and deceased vegetable intake. In addition, parent's increased confidence in the adequacy of their child's diet was associated with increased consumption of sweet and savory snacks and decreased vegetable consumption. CONCLUSION: This study substantially extends previous research in the area, providing important insights with which to guide family-based obesity prevention strategies.

Beverages↗

PubMed1999

The relationship between lifestyle, social characteristics and obesity in 3-year-old Japanese children.

It has been observed that obese children receive genetic and environmental effects that are associated with them being overweight. With regard to the latter, lifestyles such as eating habits and physical activity have been focused on. In the present study, the social characteristics which would dominate their lifestyles were investigated as background variables. For this purpose, 9668 Japanese children aged three years who were all born in Toyama prefecture, Japan, in 1998, served as birth cohort subjects. For the comparison between obese (Kaup Index; mass in kg/(height in m)2 > or = 18) and nonobese (Kaup index < 18) children, irregular snack intake, physical inactivity and reduced sleeping hours were chosen as statistically significant obesity-related lifestyle indicators for the children. For social characteristics, family construction (expanded family with grandparents/nonexpanded family), main caregiver (mother/other), attending a nursery school (yes/no) and mother's employment (full-time worker/other) were chosen. These were significantly associated with the obesity-related lifestyles mentioned above using multiple logistic regression analysis adjusted for other variables of social characteristics as well as for gender and birth month (July-December/January-June). The two greatest population-attributable risk percentages were observed for mother as main caregiver (-36.5%) and attending a nursery school (-28.9%) for irregular snack intake. Therefore, these two social characteristics substantially reduced the number of children with irregular snack intake. On the other hand, the two social characteristics were reversed in children with reduced sleeping hours (population-attributable risk percentage of mother as main caregiver: 15.4%; attending a nursery school: 17%). In contrast with favourable effects on snack intake these social characteristics showed an adverse influence on the sleeping habits of children.

Child, Preschool↗

PubMed2006

Accuracy of food intake reporting in obese subjects with metabolic risk factors.

The aim of the present study was to determine the accuracy of reported energy intake according to a food-frequency questionnaire (FFQ) and dietary records (DR) in obese subjects with metabolic syndrome risk factors. Subjects were twenty-three men and twenty-seven women with mean BMI of 35.7 (range 30.5-43.8) kg/m(2) who participated in a dietary interview based on a FFQ and completed weighed DR. Total energy expenditure was measured with the doubly labelled water method. Total energy expenditure, measured RMR and physical activity level did not differ between under-reporters (50 % of the sample) and non-under-reporters. Under-reporters had lower median intake of sweets, desserts and snacks than non-under-reporters (100 v. 161 g/d (P = 0.0008) and 61 v. 128 g/d (P = 0.0002) according to the FFQ and DR, respectively). The DR also showed lower energy density (6.7 (sd 1.3) v. 7.9 (SD 1.6) kJ/g; P = 0.0064), lower intake of sugary drinks (0 v. 167 g/d; P = 0.0063) and higher scores for dietary restraint (9.0 (sd 5.0) v. 6.1 (SD 3.5); P = 0.0285) in under-reporters. Energy density was associated with accuracy according to the FFQ (Spearman's rank correlation coefficient (RS) 0.406; P = 0.0034) and the DR (RS 0.537; P < 0.0001). In multivariate analysis, consumption of bread and sweets, desserts and snacks measured by the FFQ was positively associated with accuracy (R(2)adjusted 0.46 (95 % CI 0.32, 0.70)). According to the DR, consumption of sweets, desserts and snacks was also associated with accuracy, as was dietary restraint (inversely) (R(2)adjusted 0.67 (95 % CI 0.54, 0.83)). In obese subjects with metabolic risk factors, intake of sweets, desserts and snacks, bread and dietary restraint were determinants of reporting accuracy.

Adult↗

PubMedDate not supplied

Nutrition and shiftwork: the use of meal classification as a new tool for qualitative/quantitative evaluation of dietary intake in shiftworkers.

Established nutritional science methods and a new concept for meal-classification were applied to shiftworkers (rotating 3-shift) data. The frequency of meals and snacks of different nutritional quality as a function of work schedule was evaluated, as well as the content of selected nutrients (energy, fat, sucrose, dietary fibres, ascorbic acid) in these meals and snacks. The results do not indicate that rotating 3-shift work affects the nutritional quality of the diet or the frequency of different types of meals and snacks. A qualitative classification of meals and snacks might be a cost-effective strategy for data-evaluation in field studies of shift workers' eating habits when quantitative estimations of the dietary intake are to be complicated.

Adult↗

PubMed2004

Carbohydrates and fat for training and recovery.

An important goal of the athlete's everyday diet is to provide the muscle with substrates to fuel the training programme that will achieve optimal adaptation for performance enhancements. In reviewing the scientific literature on post-exercise glycogen storage since 1991, the following guidelines for the training diet are proposed. Athletes should aim to achieve carbohydrate intakes to meet the fuel requirements of their training programme and to optimize restoration of muscle glycogen stores between workouts. General recommendations can be provided, preferably in terms of grams of carbohydrate per kilogram of the athlete's body mass, but should be fine-tuned with individual consideration of total energy needs, specific training needs and feedback from training performance. It is valuable to choose nutrient-rich carbohydrate foods and to add other foods to recovery meals and snacks to provide a good source of protein and other nutrients. These nutrients may assist in other recovery processes and, in the case of protein, may promote additional glycogen recovery when carbohydrate intake is suboptimal or when frequent snacking is not possible. When the period between exercise sessions is < 8 h, the athlete should begin carbohydrate intake as soon as practical after the first workout to maximize the effective recovery time between sessions. There may be some advantages in meeting carbohydrate intake targets as a series of snacks during the early recovery phase, but during longer recovery periods (24 h) the athlete should organize the pattern and timing of carbohydrate-rich meals and snacks according to what is practical and comfortable for their individual situation. Carbohydrate-rich foods with a moderate to high glycaemic index provide a readily available source of carbohydrate for muscle glycogen synthesis, and should be the major carbohydrate choices in recovery meals. Although there is new interest in the recovery of intramuscular triglyceride stores between training sessions, there is no evidence that diets which are high in fat and restricted in carbohydrate enhance training.

Dietary Carbohydrates↗

PubMed2003

Analysis of acrylamide by LC-MS/MS and GC-MS in processed Japanese foods.

Acrylamide concentrations in processed foods (63 samples covering 31 product types) from Japan were analysed by LC-MS/MS and GC-MS methods. The limit of detection and limit of quantification of acrylamide were 0.2 ng x ml(-1) (6 fmol) and 0.8 ng x ml(-1) (22 fmol), respectively, by LC-MS/MS, and those of 2,3-dibromopropionamide derived from acrylamide were 12 ng x ml(-1) (52 fmol) and 40 ng x ml(-1) (170 fmol), respectively, by GC-MS. Repeatability given as RSD was <5 and <15% for the LC-MS/MS and GC-MS methods, respectively. High correlation (r(2) - 0.946) was observed between values obtained by the two methods. Most potato crisps and whole potato-based fried snacks showed acrylamide concentrations >1000 microg x kg(-1). The concentrations in non-whole potato-based snacks, rice crackers processed by grilling or frying, and candied sweet potatoes were lower compared with those in the potato crisps and the whole potato-based fried snacks. One of the whole potato-based fried snacks, however, showed low acrylamide concentration (<50 microg x kg(-1)) suggesting the formation of acrylamide is strongly influenced by processing conditions. Acrylamide concentrations in instant precooked noodles and won-tons were <100 microg x kg(-1) with only one exception. Roasted barley grains for 'Mugi-cha' tea contained 200-600 microg x kg(-1) acrylamide.

Acrylamide↗

PubMed2004

Associations between food variety and body fatness in Hong Kong Chinese adults.

BACKGROUND: Food variety is reported to be closely associated with body fatness in Caucasians. The association has not been examined in a Chinese population. OBJECTIVE: To examine the association between food variety and body fatness in Hong Kong Chinese adults. DESIGN: One hundred and twenty Hong Kong Chinese adults (aged 18-50 y). Usual dietary intake over a one-week period of all subjects was assessed by using a food frequency questionnaire. Anthropometric parameters were measured using standardized methods. RESULTS: Varieties of grain and meat were negatively correlated with obesity indices (grain vs. BMI/body fat/waist/hip circumferences: partial r = -47/-0.43/-0.46/-0.42, p < 0.001; meat vs. BMI/body fat/waist/hip circumferences: partial r = -0.31/-0.24/-0.25/-0.29, p < 0.01). In contrast, there was a positive relationship between variety of snack and obesity indices (snack vs. BMI/body fat/waist/hip circumferences: partial r = 0.35/0.42/0.42/0.36, p < 0.001). A food variety ratio derived from varieties of snack, grain and meat, was a stronger predictor of body fat compared with dietary fat in a regression model. CONCLUSION: Food variety may contribute to the local escalation in the prevalence of obesity. The variety of snack is the promoting factor for obesity while the variety of grains and meats may counteract its development. The findings of this study may have implications for treatment of obesity and the prevention of further weight gain.

Adipose Tissue↗

PubMed2006

The extent and nature of food promotion directed to children in Australian supermarkets.

The aim of this study was to describe the nature and amount of sales promotion use on food packaging in selected Australian supermarkets, specifically those directed at children through the use of premium offers, such as giveaways and competitions, and cartoon and movie character promotions. The study also examined the promotion of healthy versus unhealthy foods. Nine supermarkets located across the metropolitan area of Sydney, Australia were surveyed to assess the extent and nature of food promotion directed at children. The number and types of promotions were measured within seven food categories: sweet biscuits, snack foods, confectionery, chips/savoury snacks, cereals, dairy snacks and ice cream. Any foods that utilized promotional tactics were categorized as either healthy or unhealthy, according to set criteria. The study found that within the seven food categories between 9 and 35% of food products used promotional tactics. The use of television, movie celebrities and cartoon characters for promotion was most common, making up 75% of all promotions. Giveaways accounted for 13% of all promotions. When used, giveaways were commonly used in conjunction with another promotional method. Data from this study also confirmed that 82% of all food promotions were for unhealthy foods and only 18% were used to promote healthy foods. However, for dairy snacks and ice cream the majority of promotions, 99 and 65%, respectively, were healthier choices. This was the first study to describe the extent and nature of food promotions used in supermarkets. The promotion of unhealthy foods in supermarkets is common and is one of the many factors contributing to today's obesity promoting environment. Further research is required to determine the impact of food promotions on children's dietary intake, and to determine the most effective ways to restrict the promotion of unhealthy foods.

Cartoons as Topic↗

PubMed2004

Children's eating attitudes and behaviour: a study of the modelling and control theories of parental influence.

The present study compared the modelling and control theories of parental influence on children's eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their child's food intake and using food as a tool for controlling behaviour. The results showed significant correlations between parent and child for reported snack intake, eating motivations and body dissatisfaction, indicating an important role for modelling. Parents were then divided according to their control scores. Children whose parents indicated greater attempts to control their child's diets reported higher intakes of both healthy and unhealthy snack foods. In addition, those children whose parents indicated a greater use of food as a means to control their child's behaviour reported higher levels of body dissatisfaction. The results provide some support for both the modelling and control theories of parental influence. However, whereas modelling appears to have a consistent impact, parental control has a differential impact depending upon whether this control is focused on the child's diet or on other aspects of their behaviour. To conclude, a positive parental role model may be a better method for improving a child's diet than attempts at dietary control.

Adolescent↗

PubMed1997

Assessment of the nutritional effects of olestra, a nonabsorbed fat replacement: summary.

Olestra is a zero-calorie fat replacement intended to replace 100% of the fat used in the preparation of savory snacks. Olestra can affect the absorption of other dietary components, especially highly lipophilic ones, when ingested at the same time. The potential effects of olestra on the absorption of essential fat-soluble and water-soluble dietary components have been investigated in pigs and in humans. In these studies, subjects were fed daily amounts of olestra up to 10 times the estimated mean intake from savory snacks and the olestra was eaten each day of the studies. In real life, snacks are eaten on average five times in a 14-d period. Olestra did not affect the availability of water-soluble micronutrients or the absorption and utilization of macronutrients. Olestra reduced the absorption of fat-soluble vitamins A, D, E and K; however, the effects can be offset by adding specified amounts of the vitamins to olestra foods. Olestra also reduced the absorption of carotenoids; analysis of dietary patterns showed that in real life the reduction will likely be <10%. Any effect on vitamin A stores caused by a reduction in carotenoid uptake is offset by the addition of vitamin A to olestra foods. Because of the olestra-to-nutrient ratios fed and the nutritional requirements of the test subjects, the effects of olestra on nutritional status of subgroups of the population are unlikely to be different than those measured in the studies. An analysis of lipophilicity showed that olestra is unlikely to significantly affect the uptake of potentially beneficial phytochemicals from fruits and vegetables. Some people eating large amounts of olestra snacks may experience common GI symptoms such as stomach discomfort or changes in stool consistency, similar to symptoms accompanying other dietary changes. These symptoms present no health risks.

Animals↗

PubMed2000

Olestra consumption does not predict serum concentrations of carotenoids and fat-soluble vitamins in free-living humans: early results from the sentinel site of the olestra post-marketing surveillance study.

In 1996, the U.S. Food and Drug Administration approved olestra, a fat substitute, for use in snack foods. Previous studies had shown that olestra consumption could reduce absorption of carotenoids and fat-soluble vitamins. To determine the association between consumption of olestra-containing snack foods and serum concentrations of carotenoids and fat-soluble vitamins in a free-living population, we interviewed independent population-based cross-sectional samples of 1043 adults before olestra was available and 933 adults 9 mo after olestra snacks were introduced into the marketplace in Marion County, IN, the first major test market for olestra. A cohort composed of 403 adults from the first survey, oversampling those most frequently reporting olestra consumption during follow-up telephone interviews, completed a second survey. We assessed diet, lifestyle factors and olestra consumption, and collected blood for assays for the serum concentrations of six carotenoids, four fat-soluble vitamins and lipids. Nine months after the introduction of olestra into the marketplace, 15.5% of Marion County residents reported consuming an olestra-containing snack in the previous month, with a median frequency among consumers of 3.0 times per month. There were no significant associations or consistent trends for decreased serum carotenoids or fat-soluble vitamins associated with olestra consumption, although cohort members consuming >/=2 g/d of olestra had adjusted total serum carotenoids 15% lower compared with baseline. There were increases in serum vitamin K concentrations associated with olestra consumption (P = 0.03 in the cross section and P = 0.06 in the cohort). In summary, there was no statistically significant evidence in this free-living population of associations between olestra consumption and decreased serum concentrations of carotenoids and fat-soluble vitamins.

Adolescent↗

PubMed2005

Public health strategies for dietary change: schools and workplaces.

Environmental intervention represents an effective strategy to promote the purchase and consumption of healthful foods in community-based settings. Three such studies promoted the consumption of healthier snacks and lower-fat foods at worksites and at schools. The first study examined lower prices and point-of-purchase promotion on sales of lower-fat snacks in vending machines in 12 worksites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower-fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, as compared to usual-price conditions. The second study examined the impact of a 50% price reduction on the consumption of fresh fruit and baby carrots in 2 secondary school cafeterias. In the third study, 20 secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-y period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. School-based environmental interventions to increase availability and promotion of lower-fat foods and healthier snacks can increase purchase of these foods among adolescents.

Adolescent↗

PubMed2000

Lifestyle and serum gamma-glutamyltransferase: a study of middle-aged Japanese men.

The association of lifestyle factors with serum gamma-glutamyltransferase (GGT) was examined in 1176 Japanese male office workers aged 40-59 years. Those who had serum aminotransferase levels exceeding the normal range and/or who took prescription medication for, or had a past history of, liver disease were excluded. From the logistic regression analysis, lifestyle factors showing a positive association with high serum GGT (> or = 60 U/l) were body mass index, alcohol intake, cigarette smoking, and snacking between meals. On the other hand, coffee drinking showed an inverse association with high serum GGT. As for the relationships between snacking between meals and other lifestyle factors, snacking between meals was significantly related to alcohol intake (negative) and coffee drinking. Influences of snacking between meals on serum GGT are likely to be indirectly mediated through coping mechanisms of less alcohol drinking and more coffee drinking. Our findings support the conclusions that alcohol drinking, obesity, and cigarette smoking are positively associated with raised serum GGT and that coffee consumption is inversely related to raised serum GGT.

Adult↗

PubMed2006

Television viewing practices and obesity among women veterans.

BACKGROUND: Obesity is epidemic in the U.S. and has been associated with television viewing. OBJECTIVE: To describe the association between obesity and television viewing practices among women veterans. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, mailed survey completed by 1,555 female veterans enrolled at the VA Puget Sound Health Care System in 2000. MEASUREMENTS AND METHODS: We used bivariate and multivariate analyses to assess the association of obesity (body mass index >30 kg/m2 based on self-reported height and weight) with self-reported number of hours of television or videos viewed per day, and frequency of eating meals or snacking while watching television, controlling for other covariates. RESULTS: Watching television >2 hours per typical day on week days and/or weekends was associated with obesity (P<.001), as was eating or snacking while watching television (P=.003). In multivariate logistic regression analyses, watching television >2 hours per day and eating or snacking while watching television were each associated with obesity (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1 to 1.8; and OR 1.3, 95% CI 1.0 to 1.7, respectively), after adjusting for demographic variables, smoking, physical activity, and depression. Results were similar when posttraumatic stress disorder was included in the model instead of depression. Women who both watched >2 hours of television per day and ate or snacked while viewing were almost twice as likely to be obese (OR 1.9, 95% CI 1.4 to 2.6). CONCLUSION: Watching television over 2 hours per day and eating while watching television were each associated with obesity among female VA patients and may be modifiable risk factors for obesity.

Adult↗

PubMed1989

Remineralization of artificial caries-like lesions in human enamel in situ by chewing sorbitol gum.

The objective of the study was to determine quantitatively the effect on the potential for in situ remineralization of artificial caries-like lesions in human enamel when sugar-free gum containing mainly sorbitol as sweetener was chewed after meals and snacks. Artificial white-spot lesions were created in extracted human premolars and divided into three parts. One part was used as reference and the other two worn consecutively for two 21-day periods by 10 volunteers in a cast silver band cemented on lower molar teeth and covered with gauze to promote plaque formation. During the experimental periods, the subjects used fluoridated toothpaste twice daily, and consumed three meals (breakfast, lunch, and dinner) and two snacks (selected from chocolate bar, raisins, chocolate wafer, and iced cupcake). Sorbitol gum was chewed for 20 min immediately after each meal or snack during one of the experimental periods. The three parts of the enamel lesions were then sectioned (congruent to 80 microns) and examined together by means of quantitative microradiography and by polarized light microscopy. All estimates of mineral content indicated that significant remineralization occurred and was approximately doubled with gum-chewing. It is suggested that sorbitol gum stimulates salivation, which is responsible for the significantly enhanced remineralization, thus contributing to a therapeutic, caries-preventive effect. Because the gum was chewed immediately after meals and snacks, inhibition of demineralization may also have occurred.

Adult↗

PubMed1992

Dietary habits of school-children in Bahrain.

A multistage stratified sampling procedure was used to select 1673 Bahraini school children (871 boys and 802 girls) to study their food habits. The results revealed that breakfast was more often skipped than lunch and supper by both sexes. Significant differences in the food consumption between boys and girls were noticed at morning snack; beef burgers, liver and egg sandwiches were more consumed by boys, while girls preferred carbonated beverages, cheese, uncarbonated canned drinks and broad beans. The foods consumed at lunch were very similar to those of the adult population in Bahrain. However, the percentage of fresh fruits consumed at lunch was almost double by girls (31.9%) than boys (17.1%). Corn-puffs, carbonated beverages, chocolates, uncarbonated canned drinks and fruits were the main foods consumed at afternoon snack. Boys were more likely to consume tea, meat, eggs, cheese and rice at supper, while girls preferred cheese, corn-puffs and carbonated beverages. Age has also a significant influence on dietary habits. The consumption of bread at breakfast decreased with age while the consumption of carbonated beverages at morning snack increased remarkably with age. In general the meal and snack patterns of school children vary considerably with age and sex.

Adolescent↗

PubMed2006

Nocturnal hypoglycemia in type 1 diabetes: an assessment of preventive bedtime treatments.

OBJECTIVE: We assessed four putative bedtime treatments in the prevention of nocturnal hypoglycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS: Plasma glucose concentrations were measured every 15 min from 2200 h through 0700 h in 21 patients with type 1 diabetes (mean +/- sd HbA(1C) = 7.1 +/- 1.0%) on five occasions with, in random sequence, bedtime (2200 h) administration of 1) no treatment, 2) a snack, 3) the snack plus the alpha-glucosidase inhibitor acarbose, 4) an uncooked cornstarch bar, or 5) the beta(2)-adrenergic agonist terbutaline. RESULTS: In the absence of a bedtime treatment, 27% of the measured nocturnal plasma glucose concentrations were less than 70 mg/dl (3.9 mmol/liter) in 12 patients; 16, 6, and 1% were less than 60, less than 50, and less than 40 mg/dl (3.3, 2.8, and 2.2 mmol/liter), respectively. Neither the snack (without or with acarbose) nor cornstarch raised the mean nadir nocturnal glucose concentration or reduced the number of low glucose levels or the number of patients with low levels. Terbutaline raised the mean nadir nocturnal glucose concentration (mean +/- se, 127 +/- 11 vs. 75 +/- 9 mg/dl; P < 0.001), eliminated glucose levels less than 50 mg/dl (P = 0.038), reduced levels less than 60 mg/dl (P = 0.005) to one, and reduced levels less than 70 mg/dl (P = 0.001) to five (four at 2215 h, one at 2230 h). However, it also raised glucose levels the following morning. CONCLUSIONS: Nocturnal hypoglycemia is common in aggressively treated type 1 diabetes. Bedtime administration of a conventional snack or of uncooked cornstarch does not prevent it. That of terbutaline prevents nocturnal hypoglycemia but causes hyperglycemia the following morning. The efficacy of a lower dose of terbutaline remains to be determined.

Acarbose↗