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Raben A, Vestentoft PS, Brand‐Miller J, Jalo E, Drummen M, Simpson L, Martinez JA, Handjieva‐Darlenska T, Stratton G, Huttunen‐Lenz M, Lam T, Sundvall J, Muirhead R, Poppitt S, Ritz C, Pietiläinen KH, Westerterp‐Plantenga M, Taylor MA, Navas‐Carretero S, Handjiev S, McNarry MA, Hansen S, Råman L, Brodie S, Silvestre MP, Adam TC, Macdonald IA, San‐Cristobal R, Boyadjieva N, Mackintosh KA, Schlicht W, Liu A, Larsen TM, Fogelholm M. The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes. Diabetes Obes Metab 2021; 23:324-337. [PMID: 33026154 PMCID: PMC8120810 DOI: 10.1111/dom.14219] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022]
Abstract
AIM To compare the impact of two long-term weight-maintenance diets, a high protein (HP) and low glycaemic index (GI) diet versus a moderate protein (MP) and moderate GI diet, combined with either high intensity (HI) or moderate intensity physical activity (PA), on the incidence of type 2 diabetes (T2D) after rapid weight loss. MATERIALS AND METHODS A 3-year multicentre randomized trial in eight countries using a 2 x 2 diet-by-PA factorial design was conducted. Eight-week weight reduction was followed by a 3-year randomized weight-maintenance phase. In total, 2326 adults (age 25-70 years, body mass index ≥ 25 kg/m2 ) with prediabetes were enrolled. The primary endpoint was 3-year incidence of T2D analysed by diet treatment. Secondary outcomes included glucose, insulin, HbA1c and body weight. RESULTS The total number of T2D cases was 62 and the cumulative incidence rate was 3.1%, with no significant differences between the two diets, PA or their combination. T2D incidence was similar across intervention centres, irrespective of attrition. Significantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycaemia was lowest in HP-HI (11.9%) compared with the other three groups (20.0%-21.0%, P < .05). There were no group differences in body weight change (-11% after 8-week weight reduction; -5% after 3-year weight maintenance) or in other secondary outcomes. CONCLUSIONS Three-year incidence of T2D was much lower than predicted and did not differ between diets, PA or their combination. Maintaining the target intakes of protein and GI over 3 years was difficult, but the overall protocol combining weight loss, healthy eating and PA was successful in markedly reducing the risk of T2D. This is an important clinically relevant outcome.
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Affiliation(s)
- Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Pia Siig Vestentoft
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Jennie Brand‐Miller
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Elli Jalo
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
| | - Mathjis Drummen
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Liz Simpson
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreMRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - J. Alfredo Martinez
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN)MadridSpain
- IdisNA Instituto for Health ResearchPamplonaSpain
- Precision Nutrition and Cardiometabolic Health Program. IMDEA‐Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSICMadridSpain
| | | | - Gareth Stratton
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | - Maija Huttunen‐Lenz
- Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
- Institute of Nursing ScienceUniversity of Education Schwäbisch GmündSchwäbisch GmündGermany
| | - Tony Lam
- NetUnion sarlLausanneSwitzerland
| | - Jouko Sundvall
- Department of Government Services, Forensic Toxicology Unit, Biochemistry LaboratoryNational Institute for Health and WelfareHelsinkiFinland
| | - Roslyn Muirhead
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Sally Poppitt
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of MedicineUniversity of Helsinki and Obesity Centre, Endocrinology, Abdominal Center, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Margriet Westerterp‐Plantenga
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Moira A. Taylor
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreNational Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - Santiago Navas‐Carretero
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN)MadridSpain
- IdisNA Instituto for Health ResearchPamplonaSpain
| | - Svetoslav Handjiev
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Melitta A. McNarry
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | - Sylvia Hansen
- Exercise and Health SciencesUniversity of StuttgartStuttgartGermany
| | - Laura Råman
- Department of Government Services, Forensic Toxicology Unit, Biochemistry LaboratoryNational Institute for Health and WelfareHelsinkiFinland
| | - Shannon Brodie
- School of Life and Environmental Sciences and Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Marta P. Silvestre
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
- CINTESIS ‐ Centro de Investigação em Tecnologias e Serviços de Saúde NOVA Medical SchoolNOVA University of LisbonLisbonPortugal
| | - Tanja C. Adam
- Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtthe Netherlands
| | - Ian A. Macdonald
- Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Queen's Medical CentreMRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottinghamUK
| | - Rodrigo San‐Cristobal
- Centre for Nutrition ResearchUniversity of NavarraPamplonaSpain
- Precision Nutrition and Cardiometabolic Health Program. IMDEA‐Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSICMadridSpain
| | - Nadka Boyadjieva
- Department of Pharmacology and ToxicologyMedical University of SofiaSofiaBulgaria
| | - Kelly A. Mackintosh
- College of EngineeringApplied Sports, Technology, Exercise and Medicine (A‐STEM) Research CentreSwanseaUK
| | | | - Amy Liu
- Human Nutrition Unit, School of Biological Sciences, Department of MedicineUniversity of AucklandAucklandNew Zealand
| | - Thomas M. Larsen
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | - Mikael Fogelholm
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
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Honkanen MKM, Saukko AEA, Turunen MJ, Shaikh R, Prakash M, Lovric G, Joukainen A, Kröger H, Grinstaff MW, Töyräs J. Synchrotron MicroCT Reveals the Potential of the Dual Contrast Technique for Quantitative Assessment of Human Articular Cartilage Composition. J Orthop Res 2020; 38:563-573. [PMID: 31535728 PMCID: PMC7065106 DOI: 10.1002/jor.24479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/13/2019] [Indexed: 02/04/2023]
Abstract
Dual contrast micro computed tomography (CT) shows potential for detecting articular cartilage degeneration. However, the performance of conventional CT systems is limited by beam hardening, low image resolution (full-body CT), and long acquisition times (conventional microCT). Therefore, to reveal the full potential of the dual contrast technique for imaging cartilage composition we employ the technique using synchrotron microCT. We hypothesize that the above-mentioned limitations are overcome with synchrotron microCT utilizing monochromatic X-ray beam and fast image acquisition. Human osteochondral samples (n = 41, four cadavers) were immersed in a contrast agent solution containing two agents (cationic CA4+ and non-ionic gadoteridol) and imaged with synchrotron microCT at an early diffusion time point (2 h) and at diffusion equilibrium (72 h) using two monochromatic X-ray energies (32 and 34 keV). The dual contrast technique enabled simultaneous determination of CA4+ (i.e., proteoglycan content) and gadoteridol (i.e., water content) partitions within cartilage. Cartilage proteoglycan content and biomechanical properties correlated significantly (0.327 < r < 0.736, p < 0.05) with CA4+ partition in superficial and middle zones at both diffusion time points. Normalization of the CA4+ partition with gadoteridol partition within the cartilage significantly (p < 0.05) improved the detection sensitivity for human osteoarthritic cartilage proteoglycan content, biomechanical properties, and overall condition (Mankin, Osteoarthritis Research Society International, and International Cartilage Repair Society grading systems). The dual energy technique combined with the dual contrast agent enables assessment of human articular cartilage proteoglycan content and biomechanical properties based on CA4+ partition determined using synchrotron microCT. Additionally, the dual contrast technique is not limited by the beam hardening artifact of conventional CT systems. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:563-573, 2020.
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Affiliation(s)
- Miitu K. M. Honkanen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | - Annina E. A. Saukko
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Medical PhysicsTurku University HospitalTurkuFinland
| | - Mikael J. Turunen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- SIB LabsUniversity of Eastern FinlandKuopioFinland
| | - Rubina Shaikh
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Mithilesh Prakash
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- A.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
| | - Goran Lovric
- Centre d'lmagerie BioMédicaleÉcole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Swiss Light SourcePaul Scherrer InstituteVilligenSwitzerland
| | - Antti Joukainen
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneQueenslandAustralia
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