Associations of changes in reported and estimated protein and energy intake with changes in insulin resistance, glycated hemoglobin, and BMI during the PREVIEW lifestyle intervention study

Role of Eating Behavior and Stress in Maintenance of Dietary Changes During the PREVIEW Intervention

OBJECTIVE

To examine whether eating behavior and perceived stress predict the maintenance of self-reported dietary change and adherence to dietary instructions during an intervention.

DESIGN

A secondary analysis of the behavior maintenance stage (6-36 months) of the 3-year PREVIEW intervention (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World).

PARTICIPANTS

Adults (n = 1,311) with overweight and prediabetes at preintervention baseline.

VARIABLES MEASURED

Eating behavior (Three-Factor Eating Questionnaire), stress (Perceived Stress Scale), and dietary intake (4-day food records on 4 occasions) were reported.

ANALYSIS

Associations between predictors and dietary outcomes were examined with linear mixed-effects models for repeated measurements.

RESULTS

Eating behaviors and stress at 6 months did not predict the subsequent change in dietary outcomes, but higher cognitive restraint predicted lower energy intake, and both higher disinhibition and hunger predicted higher energy intake during the following behavior maintenance stage. In addition, higher disinhibition predicted higher saturated fat intake and lower fiber intake, and higher hunger predicted lower fiber intake. Stress was not associated with energy intake or dietary quality. Eating behaviors and stress were not consistently associated with adherence to dietary instructions.

CONCLUSIONS AND IMPLICATIONS

Higher cognitive restraint predicted lower energy intake (food quantity), but disinhibition and hunger were also associated with dietary quality.

Circadian rhythm parameters and physical activity associated with cardiometabolic risk factors in the PREVIEW lifestyle study

OBJECTIVE

The aim of this study was an assessment of post hoc associations among circadian rhythm parameters, physical activity (PA), and cardiometabolic risk factors in adults with obesity and prediabetes after 3 years of weight loss maintenance.

METHODS

Circadian rhythm parameters (continuous wrist-temperature measurements), PA, systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), plasma high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, remnant cholesterol, triacylglycerol, and C-reactive protein (CRP) concentrations were determined in 91 free-living participants (mean [SD], age = 56.6 [10] years; BMI = 28.2 [4.0]; homeostatic model assessment of insulin resistance [HOMA-IR] = 3.2 [3.1]) and in 38 participants in sedentary respiration chamber conditions (age = 56.6 [10] years; BMI = 28.5 [4.0]; HOMA-IR = 3.3 [1.4]). Associations of circadian rhythm parameters and PA with cardiometabolic risk factors were determined using factor analyses followed by Pearson correlations.

RESULTS

Values of cardiometabolic risk factors were similar, whereas circadian rhythm parameters and PA differed significantly (p < 0.05) between conditions. In both conditions, parameters indicating a robust circadian rhythm associated inversely with CRP and positively with plasma HDL-C concentrations. In free-living conditions, PA associated inversely with SBP and HR and positively with HDL-C and robust circadian rhythm parameters. In sedentary conditions, PA associated positively with HR and inversely with robust circadian rhythm parameters. PA mediated the inverse association of parameters indicating a robust circadian rhythm with SBP in free-living conditions.

CONCLUSIONS

In adults with obesity and prediabetes, parameters indicating a robust circadian rhythm were, independently of PA, associated with lower cardiometabolic risk and CRP. Only in free-living conditions, PA mediated the association of higher circadian stability with lower SBP.

Perceived stress as a predictor of eating behavior during the 3-year PREVIEW lifestyle intervention

Background

To better support participants to achieve long-lasting results within interventions aiming for weight loss and maintenance, more information is needed about the maintenance of behavioral changes. Therefore, we examined whether perceived stress predicts the maintenance of changes in eating behavior (flexible and rigid restraint of eating, disinhibition, and hunger).

Methods

The present study was a secondary analysis of the PREVIEW intervention including participants with overweight (BMI ≥ 25 kg/m²) at baseline and high risk of type 2 diabetes (n = 1311). Intervention included a 2-month low-energy diet phase and a 34-month subsequent weight maintenance phase. The first 6 months were considered an active behavior change stage and the remaining 2.5 years were considered a behavior maintenance stage. Eating behavior was measured using the Three Factor Eating Questionnaire and stress using the Perceived Stress Scale. The associations between stress and eating behavior were analyzed using linear mixed effects models for repeated measurements.

Results

Perceived stress measured after the active behavior change stage (at 6 months) did not predict changes in eating behavior during the behavior maintenance stage. However, frequent high stress during this period was associated with greater lapse of improved flexible restraint (p = 0.026). The mean (SD) change in flexible restraint from 6 to 36 months was −1.1 (2.1) in participants with frequent stress and −0.7 (1.8) in participants without frequent stress (Cohen’s d_s (95% CI) = 0.24 (0.04–0.43)). Higher perceived stress at 6 months was associated with less flexible restraint and more disinhibition and hunger throughout the behavior maintenance stage (all p < 0.001).

Conclusions

Perceived stress was associated with features of eating behavior that may impair successful weight loss maintenance. Future interventions should investigate, whether incorporating stress reduction techniques results in more effective treatment, particularly for participants experiencing a high stress level.