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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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