TY - JOUR

T1 - 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

AU - Raben, Anne

AU - Vestentoft, Pia Siig

AU - Brand-Miller, Jennie

AU - Jalo, Elli

AU - Drummen, Mathjis

AU - Simpson, Liz

AU - Martinez, J Alfredo

AU - Handjieva-Darlenska, Teodora

AU - Stratton, Gareth

AU - Huttunen-Lenz, Maija

AU - Lam, Tony

AU - Sundvall, Jouko

AU - Muirhead, Roslyn

AU - Poppitt, Sally

AU - Ritz, Christian

AU - Pietiläinen, Kirsi H

AU - Westerterp-Plantenga, Margriet

AU - Taylor, Moira A

AU - Carretero, Santiago Navas

AU - Handjiev, Svetoslav

AU - McNarry, Melitta A

AU - Hansen, Sylvia

AU - Råman, Laura

AU - Brodie, Shannon

AU - Silvestre, Marta P

AU - Adam, Tanja C

AU - Macdonald, Ian A

AU - San-Cristobal, Rodrigo

AU - Boyadjieva, Nadka

AU - Mackintosh, Kelly A

AU - Schlicht, Wolfgang

AU - Liu, Amy

AU - Larsen, Thomas Meinert

AU - Fogelholm, Mikael

N1 - This article is protected by copyright. All rights reserved.

PY - 2021

Y1 - 2021

N2 - 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-weeks 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 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. Signficantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycemia 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. 

AB - 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-weeks 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 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. Signficantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycemia 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. 

KW - Faculty of Science

KW - Behaviour change

KW - Carbohydrate

KW - Dietary intervention

KW - Exercise intervention

KW - Glycaemic control

KW - Obesity

U2 - 10.1111/dom.14219

DO - 10.1111/dom.14219

M3 - Journal article

C2 - 33026154

VL - 23

SP - 324

EP - 337

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

SN - 1462-8902

IS - 2

ER -