Measuring flow-mediated dilation (FMD) or 'Pat score' only at two hours post-meal may be insufficient, and a drop might be observed if measured later due to decreased gastric emptying with added fat and fiber.

“when they measured flow media dilatation which in this study they call a Pat score which is a similar measure of arterial reactivity but when they measure the arterial reactivity postprandial II they they only did it at two hours and they probably should have done it out to five and what I suspect and I think what Natan suspects is that they would have seen a drop in the Pats core or the flow meter dilatation if they waited just a little bit longer likely because of decreased gastric emptying and slowed gastric emptying when the fat and fiber were added to the protein