Food intake sequence affects postprandial metabolic, hormonal, and appetite responses in healthy male football players: a randomised crossover trial.

BACKGROUND & AIMS: Food intake sequence can influence postprandial glycaemia and appetite in non-athletic populations. However, it remains unclear whether these effects extend to athletes, who often consume high-carbohydrate diets and exhibit distinct metabolic responses. This study aimed to compare postprandial metabolic and appetite responses to two food intake sequences in athletes. METHODS: In a randomised, counterbalanced, outcome assessor-blinded crossover trial, 14 highly trained male football players [22.9 (3.1) y, 23.4 (1.7) kg.m-2, 5.3 (0.4)% HbA1c] consumed a standardised breakfast in a carbohydrate-last or carbohydrate-first meal pattern, separated by 1-2 weeks. The primary outcome was postprandial glucose; secondary outcomes included postprandial insulin, total GLP-1, GIP, ghrelin, PYY, triglycerides, NEFA, and appetite ratings serially measured over 3 h, and subsequent 3-6-h ad libitum dietary intake. Postprandial responses were analysed as summary statistics and time course data. RESULTS: The carbohydrate-last intervention elicited lower glucose incremental area under the curve (iAUC) from 0-60 min (-54 [-79 to -29] mmol.L-1×min, p < 0.001) and incremental peak (-1.7 [-2.4 to -1.0] mmol.L-1, p < 0.001), higher GIP iAUC0-60min (1705 [46 to 3363] pg.mL-1×min, p = 0.045), lower ghrelin total area under the curve from 0-180 min (-14542 [-28804 to -279] pg.mL-1×min, p = 0.046), and higher triglyceride iAUC0-180min (10.80 [0.04 to 21.56] mmol.L-1×min, p = 0.049). Despite lower ghrelin, participants reported greater mean hunger (5 [1 to 9] mm, p = 0.007), desire for sweet (-6 [-9 to -2] mm, p = 0.001) and salty foods (-5 [-9 to -2] mm, p = 0.002), and lower satiety (-5 [-8 to -2] mm, p = 0.002) than after the carbohydrate-first condition. CONCLUSIONS: In highly trained male football players, a carbohydrate-last meal pattern elicited lower postprandial glycaemia and ghrelin, but greater GIP, triglycerides, hunger, and cravings, without affecting 3-6-h ad libitum intake. Food intake sequence may alter short-term metabolic and appetite regulation in athletic populations. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT06365385.