RESEARCH Open Access Postprandial changes in cardiometabolic disease risk in young Chinese men following isocaloric high or low protein diets, stratified by either high or low meal frequency - a randomized controlled crossover trial Alexander Mok 1† , Sumanto Haldar 1† , Jetty Chung-Yung Lee 4 , Melvin Khee-Shing Leow 1,2,5 and Christiani Jeyakumar Henry 1,2,3* Abstract Background: Cardio-Metabolic Disease (CMD) is the leading cause of death globally and particularly in Asia. Postprandial elevation of glycaemia, insulinaemia, triglyceridaemia are associated with an increased risk of CMD. While studies have shown that higher protein intake or increased meal frequency may benefit postprandial metabolism, their combined effect has rarely been investigated using composite mixed meals. We therefore examined the combined effects of increasing meal frequency (2-large vs 6-smaller meals), with high or low-protein (40 % vs 10 % energy from protein respectively) isocaloric mixed meals on a range of postprandial CMD risk markers. Methods: In a randomized crossover study, 10 healthy Chinese males (Age: 29 ± 7 years; BMI: 21.9 ± 1.7 kg/m 2 ) underwent 4 dietary treatments: CON-2 (2 large Low-Protein meals), CON-6 (6 Small Low-Protein meals), PRO-2 (2 Large High-Protein meals) and PRO-6 (6 Small High-Protein meals). Subjects wore a continuous glucose monitor (CGM) and venous blood samples were obtained at baseline and at regular intervals for 8.5 h to monitor postprandial changes in glucose, insulin, triglycerides and high sensitivity C-reactive protein (hsCRP). Blood pressure was measured at regular intervals pre- and post- meal consumption. Urine was collected to measure excretion of creatinine and F 2 -isoprostanes and its metabolites over the 8.5 h postprandial period. Results: The high-protein meals, irrespective of meal frequency were beneficial for glycaemic health since glucose incremental area under the curve (iAUC) for PRO-2 (185 ± 166 mmol.min.L -1 ) and PRO-6 (214 ± 188 mmol.min.L -1 ) were 66 and 60 % lower respectively (both p < 0.05), compared with CON-2 (536 ± 290 mmol.min.L -1 ). The iAUC for insulin was the lowest for PRO-6 (13.7 ± 7.1 U.min.L -1 ) as compared with CON-2 (28.4 ± 15.6 U.min.L - 1), p < 0.001. There were no significant differences in postprandial responses in other measurements between the dietary treatments. (Continued on next page) * Correspondence: jeya_henry@sics.a-star.edu.sg Alexander Mok and Sumanto Haldar are joint-first authors. † Equal contributors 1 Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, 14 Medical Drive, #07-02, Singapore 117599, Singapore 2 Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore 117609, Singapore Full list of author information is available at the end of the article © 2016 Mok et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mok et al. Nutrition Journal (2016) 15:27 DOI 10.1186/s12937-016-0141-5