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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt


  • Mathijs Drummen
  • Tanja C Adam
  • Ian A Macdonald
  • Elli Jalo
  • Thomas Meinert Larsen
  • J Alfredo Martinez
  • Teodora Handjiev-Darlenska
  • Jennie Brand-Miller
  • Sally D Poppitt
  • Gareth Stratton
  • Kirsi H Pietiläinen
  • Moira A Taylor
  • Santiago Navas-Carretero
  • Svetoslav Handjiev
  • Roslyn Muirhead
  • Marta P Silvestre
  • Nils Swindell
  • Maija Huttunen-Lenz
  • Wolfgang Schlicht
  • Tony Lam
  • Jouko Sundvall
  • Laura Raman
  • Edith Feskens
  • Angelo Tremblay
  • Margriet S Westerterp-Plantenga

Background: Observed associations of high-protein diets with changes in insulin resistance are inconclusive.

Objectives: We aimed to assess associations of changes in both reported and estimated protein (PRep; PEst) and energy intake (EIRep; EIEst) with changes in HOMA-IR, glycated hemoglobin (HbA1c), and BMI (in kg/m2), in 1822 decreasing to 833 adults (week 156) with overweight and prediabetes, during the 3-y PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) study on weight-loss maintenance. Eating behavior and measurement errors (MEs) of dietary intake were assessed. Thus, observational post hoc analyses were applied.

Methods: Associations of changes in EIEst, EIRep, PEst, and PRep with changes in HOMA-IR, HbA1c, and BMI were determined by linear mixed-model analysis in 2 arms [high-protein-low-glycemic-index (GI) diet and moderate-protein-moderate-GI diet] of the PREVIEW study. EIEst was derived from energy requirement: total energy expenditure = basal metabolic rate × physical activity level; PEst from urinary nitrogen, and urea. MEs were calculated as [(EIEst - EIRep)/EIEst] × 100% and [(PRep - PEst)/PEst] × 100%. Eating behavior was determined using the Three Factor Eating Questionnaire, examining cognitive dietary restraint, disinhibition, and hunger.

Results: Increases in PEst and PRep and decreases in EIEst and EIRep were associated with decreases in BMI, but not independently with decreases in HOMA-IR. Increases in PEst and PRep were associated with decreases in HbA1c. PRep and EIRep showed larger changes and stronger associations than PEst and EIEst. Mean ± SD MEs of EIRep and PRep were 38% ± 9% and 14% ± 4%, respectively; ME changes in EIRep and En% PRep were positively associated with changes in BMI and cognitive dietary restraint and inversely with disinhibition and hunger.

Conclusions: During weight-loss maintenance in adults with prediabetes, increase in protein intake and decrease in energy intake were not associated with decrease in HOMA-IR beyond associations with decrease in BMI. Increases in PEst and PRep were associated with decrease in HbA1c.

This trial was registered at as NCT01777893.

TidsskriftAmerican Journal of Clinical Nutrition
Udgave nummer5
Sider (fra-til)1847-1858
Antal sider12
StatusUdgivet - 2021

Bibliografisk note

CURIS 2021 NEXS 261
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Antal downloads er baseret på statistik fra Google Scholar og

Ingen data tilgængelig

ID: 276461805