Diet quality, weight loss, and diabetes incidence in the Diabetes Prevention Program (DPP)
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RESEARCH ARTICLE
Open Access
Diet quality, weight loss, and diabetes incidence in the Diabetes Prevention Program (DPP) Benjamin T. Allaire1, Ashley H. Tjaden2* , Elizabeth M. Venditti3, John W. Apolzan4, Dana Dabelea5, Linda M. Delahanty6, Sharon L. Edelstein2, Mary A. Hoskin7, Karla A. Temple8, Judith Wylie-Rosett9, Lindsay M. Jaacks10,11 and DPP Research Group
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 1year (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, Prediabetes, Type 2 diabetes, Lifestyle intervention, Obesity, Diabetes prevention, Dietary pattern, Race
* Correspondence: [email protected] 2 Department of Epidemiology and Biostatistics, The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit lin
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