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Randomized Controlled Trial
. 2014 Dec;31(12):1631-42.
doi: 10.1111/dme.12500. Epub 2014 Jul 5.

Long-term changes in dietary and food intake behaviour in the Diabetes Prevention Program Outcomes Study

L M Jaacks  1 , Y Ma, N Davis, L M Delahanty, E J Mayer-Davis, P W Franks, J Brown-Friday, M Isonaga, A M Kriska, E M Venditti, J Wylie-Rosett; Diabetes Prevention Program Research Group
Affiliations
Randomized Controlled Trial

Long-term changes in dietary and food intake behaviour in the Diabetes Prevention Program Outcomes Study

L M Jaacks et al. Diabet Med. 2014 Dec.

Abstract

Aims: To compare change in dietary intake, with an emphasis on food groups and food intake behaviour, over time across treatment arms in a diabetes prevention trial and to assess the differences in dietary intake among demographic groups within treatment arms.

Methods: Data are from the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study. Participants were randomized to a lifestyle intervention (n = 1079), metformin (n = 1073) or placebo (n = 1082) for an average of 3 years, after which the initial results regarding the benefits of the lifestyle intervention were released and all participants were offered a modified lifestyle intervention. Dietary intake was assessed using a food frequency questionnaire at baseline and at 1, 5, 6 and 9 years after randomization.

Results: Compared with the metformin and placebo arms, participants in the lifestyle arm maintained a lower total fat and saturated fat and a higher fibre intake up to 9 years after randomization and lower intakes of red meat and sweets were maintained for up to 5 years. Younger participants had higher intakes of poultry and lower intakes of fruits compared with their older counterparts, particularly in the lifestyle arm. Black participants tended to have lower dairy and higher poultry intakes compared with white and Hispanic participants. In the lifestyle arm, men tended to have higher grain, fruit and fish intakes than women.

Conclusions: Changes in nutrient intake among participants in the lifestyle intervention were maintained for up to 9 years. Younger participants reported more unhealthy diets over time and thus may benefit from additional support to achieve and maintain dietary goals.

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Conflict of interest statement

Conflicts of interest: LD has a financial interest in Omada Health, a company that develops online behavior-change programs, with a focus on diabetes. LD’s interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies.

Figures

Figure 1
Figure 1
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and race/ethnicity. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for significant pairwise comparisons between Caucasians and other racial/ethnic groups of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 1
Figure 1
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and race/ethnicity. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for significant pairwise comparisons between Caucasians and other racial/ethnic groups of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 1
Figure 1
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and race/ethnicity. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for significant pairwise comparisons between Caucasians and other racial/ethnic groups of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 1
Figure 1
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and race/ethnicity. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for significant pairwise comparisons between Caucasians and other racial/ethnic groups of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 2
Figure 2
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and gender. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for pairwise comparison (men versus women) of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 2
Figure 2
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and gender. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for pairwise comparison (men versus women) of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 2
Figure 2
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and gender. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for pairwise comparison (men versus women) of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
Figure 2
Figure 2
Median (a) percent calories from fat, (b) dietary fiber intake (g/1000 kcal), (c) fruit intake (servings/day), and (d) red meat intake (servings/day) over time according to treatment arm and gender. Line indicates approximate point at which treatment arm assignment was unmasked and all participants were offered a modified lifestyle intervention. P-values are for pairwise comparison (men versus women) of 9-year average dietary intake from generalized estimating equations, adjusted for baseline intake.
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