. 2023 Aug 2;22(1):38.

doi: 10.1186/s12937-023-00864-7.

Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care

John W Apolzan¹, Corby K Martin², Robert L Newton Jr², Candice A Myers², Connie L Arnold³, Terry C Davis³, William D Johnson², Dachuan Zhang², Christoph Höchsmann^{2

4}, Vivian A Fonseca⁵, Kara D Denstel², Emily F Mire², Benjamin F Springgate^{6

7}, Carl J Lavie⁸, Peter T Katzmarzyk²; PROPEL Research Group

Collaborators, Affiliations

Collaborators

PROPEL Research Group:
Phillip Brantley, Ronald Horswell, Tina K Thethi, Jonathan Gugel, Eboni Price-Haywood, Kathleen B Kennedy, Daniel F Sarpong

Affiliations

¹ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA. John.Apolzan@pbrc.edu.
² Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA.
³ Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
⁴ Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
⁵ Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.
⁶ Department of Internal Medicine, Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA.
⁷ Program in Health Policy and Systems Management, School of Public Health, Louisiana State University, New Orleans, LA, USA.
⁸ Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA.

PMID: 37528391
PMCID: PMC10394871
DOI: 10.1186/s12937-023-00864-7

Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care

John W Apolzan et al. Nutr J. 2023.

. 2023 Aug 2;22(1):38.

doi: 10.1186/s12937-023-00864-7.

Authors

Collaborators

PROPEL Research Group:
Phillip Brantley, Ronald Horswell, Tina K Thethi, Jonathan Gugel, Eboni Price-Haywood, Kathleen B Kennedy, Daniel F Sarpong

Affiliations

¹ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA. John.Apolzan@pbrc.edu.
² Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, USA.
³ Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
⁴ Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
⁵ Department of Medicine, Division of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.
⁶ Department of Internal Medicine, Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA.
⁷ Program in Health Policy and Systems Management, School of Public Health, Louisiana State University, New Orleans, LA, USA.
⁸ Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA.

PMID: 37528391
PMCID: PMC10394871
DOI: 10.1186/s12937-023-00864-7

Abstract

Background: Currently there are limited data as to whether dietary intake can be improved during pragmatic weight loss interventions in primary care in underserved individuals.

Methods: Patients with obesity were recruited into the PROPEL trial, which randomized 18 clinics to either an intensive lifestyle intervention (ILI) or usual care (UC). At baseline and months 6, 12, and 24, fruit and vegetable (F/V) intake and fat intake was determined. Outcomes were analyzed by repeated-measures linear mixed-effects multilevel models and regression models, which included random cluster (clinic) effects. Secondary analyses examined the effects of race, sex, age, and food security status.

Results: A total of 803 patients were recruited. 84.4% were female, 67.2% African American, 26.1% received Medicaid, and 65.5% made less than $40,000. No differences in F/V intake were seen between the ILI and UC groups at months 6, 12, or 24. The ILI group reduced percent fat at months 6, 12, and 24 compared to UC. Change in F/V intake was negatively correlated with weight change at month 6 whereas change in fat intake was positively associated with weight change at months 6, 12, and 24 for the ILI group.

Conclusions: The pragmatic weight loss intervention in primary care did not increase F/V intake but did reduce fat intake in an underserved population with obesity. F/V intake was negatively associated with weight loss at month 6 whereas percent fat was positively correlated with weight loss throughout the intervention. Future efforts better targeting both increasing F/V intake and reducing fat intake may promote greater weight loss in similar populations.

Trial registration: NCT Registration: NCT02561221.

Keywords: Age; Diet; Energy Restriction; Food Insecurity; Lifestyle Intervention; Race; Sex; Underserved; Weight loss.

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Conflict of interest statement

JWA, RLN, Jr., CAM, CLA, TCD, WDJ, DZ, CH, KDD, EFM, BFS, and PTK report no conflicts of interest. CKM has interests in the energy balance models and weight graph approach that was used during the trial to promote dietary adherence. Specifically, CKM is part of a US and European patent application related to this technology and he receives royalties paid to his university from the licensing of this technology. VAF has grants to Tulane from Fratyl and Jaguar Gene Therapy. He receives honoraria for consulting and lectures from Asahi, Novo Nordisk, Sanofi, Bayer, Abbott, and Boehringer Ingelheim. He has stock options in Mellitus Health and BRAVO4Health and stock in Amgen and Abbott. VAF also has patents pending for BRAVO risk engine for predicting diabetes complications andPAX4 gene therapy for type 1 diabetes. CJL is a speaker and consultant for Amgen, Sanofi, Esperion, AstraZeneca, DSM, and GOED. He is also a consultant for Novartis.

Figures

**Fig. 1**
Change in Fruit / Vegetable Intake and % Energy from Fat during the PROPEL trial. 1A is change in fruit / vegetable servings during the PROPEL trial. 1B is change in percent fat intake during the PROPEL trial. * denotes p < 0.05

**Fig. 2**
Change in Fruit / Vegetable Intake and % Energy from Fat by Sex during the PROPEL trial. 2A and 2C are change in fruit / vegetable servings and percent fat intake in men during the PROPEL trial. 2B and 2D are change in fruit / vegetable servings and percent fat intake in women during the PROPEL trial. * denotes p < 0.05, † denote p < 0.07

**Fig. 3**
Change in Fruit / Vegetable Intake and % Energy from Fat by Race during the PROPEL trial. 2A and 2C are change in fruit / vegetable servings and percent fat intake in AA during the PROPEL trial. 2B and 2D are change in fruit / vegetable servings and percent fat intake in other races during the PROPEL trial. * denotes p < 0.05, † denote p < 0.07

**Fig. 4**
Change in Fruit / Vegetable Intake and % Energy from Fat by Age during the PROPEL trial. 4A and 4D are change in fruit / vegetable servings and percent fat intake in younger patients during the PROPEL trial. 4B and 4E is change in fruit / vegetable servings and percent fat intake in older patients during the PROPEL trial. 4C and 4F are change in fruit / vegetable servings and percent fat intake in middle aged patients during the PROPEL trial. * denotes p < 0.05, † denote p < 0.07

**Fig. 5**
Change in Fruit / Vegetable Intake and % Energy from Fat by Food Security Status during the PROPEL trial. 2A and 2C are change in fruit / vegetable servings and percent fat intake in patients with food security during the PROPEL trial. 2B and 2D are change in fruit / vegetable servings and percent fat intake in patients with food insecurity during the PROPEL trial. * denotes p < 0.05

See this image and copyright information in PMC

References

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Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care

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Dietary intake during a pragmatic cluster-randomized weight loss trial in an underserved population in primary care

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Conflict of interest statement

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