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. 2020 Dec 15;6(1):74.
doi: 10.1186/s40795-020-00400-4.

Diet quality, weight loss, and diabetes incidence in the Diabetes Prevention Program (DPP)

Benjamin T Allaire  1 , Ashley H Tjaden  2 , Elizabeth M Venditti  3 , John W Apolzan  4 , Dana Dabelea  5 , Linda M Delahanty  6 , Sharon L Edelstein  7 , Mary A Hoskin  8 , Karla A Temple  9 , Judith Wylie-Rosett  10 , Lindsay M Jaacks  11   12 ; DPP Research Group
Affiliations

Diet quality, weight loss, and diabetes incidence in the Diabetes Prevention Program (DPP)

Benjamin T Allaire et al. BMC Nutr. .

Abstract

Background: We evaluated whether diet quality is a predictor of weight loss and reduced diabetes risk, independent of caloric intake in the Diabetes Prevention Program (DPP) cohort, a randomized clinical trial of adults at risk for diabetes.

Methods: This secondary analysis included 2914 participants with available data (964 intensive lifestyle (ILS), 977 metformin, 973 placebo). Dietary intake was assessed using a 117-item food frequency questionnaire. Diet quality was quantified using the Alternative Healthy Eating Index 2010 (AHEI). AHEI ranges from 0 to 110, with higher scores corresponding to higher quality diets. ILS participants had greater improvement (p < 0.001) in AHEI over 1-year (4.2 ± 9.0) compared to metformin (1.2 ± 8.5) and placebo (1.4 ± 8.4). We examined the association between AHEI change and weight change from baseline to 1-year using linear regression, and that between 1-year AHEI change and incident diabetes, using hazard models over an average 3 years follow-up. Models were evaluated within treatment group and adjusted for relevant characteristics including caloric intake, physical activity, BMI and AHEI. Models testing incident diabetes were further adjusted for baseline fasting and 2 h glucose.

Results: An increase in AHEI score was associated with weight loss in ILS [β per 10-point increase (SE) -1.2 kg (0.3, p < 0.001)], metformin [- 0. 90 kg (0.2, p < 0.001)] and placebo [- 0.55 kg (0.2, p = 0.01)]. However, AHEI change was not associated with incident diabetes in any group before or after adjustment for weight change.

Conclusions: Controlling for weight, diet quality was not associated with diabetes incidence but helps achieve weight loss, an important factor in diabetes prevention.

Keywords: AHEI; Body weight; DPP; Diabetes prevention; Dietary pattern; Lifestyle intervention; Obesity; Prediabetes; Race; Type 2 diabetes.

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Conflict of interest statement

The authors report no relevant conflicts of interest. The sponsor of this study was represented on the Steering Committee and played a part in study design. The sponsor was not involved in analysis, and interpretation of data, or the writing of the manuscript.

Figures

Fig. 1
Fig. 1
Radar plots of AHEI subscores by treatment group and visit. Note: Each subscore adds 0–10 points to the overall score, resulting in a range of 0–110. Higher scores are associated with greater dietary quality
See this image and copyright information in PMC

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