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Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial
IMPORTANCE: Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520362/ https://www.ncbi.nlm.nih.gov/pubmed/36169954 http://dx.doi.org/10.1001/jamanetworkopen.2022.33760 |
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author | Popp, Collin J. Hu, Lu Kharmats, Anna Y. Curran, Margaret Berube, Lauren Wang, Chan Pompeii, Mary Lou Illiano, Paige St-Jules, David E. Mottern, Meredith Li, Huilin Williams, Natasha Schoenthaler, Antoinette Segal, Eran Godneva, Anastasia Thomas, Diana Bergman, Michael Schmidt, Ann Marie Sevick, Mary Ann |
author_facet | Popp, Collin J. Hu, Lu Kharmats, Anna Y. Curran, Margaret Berube, Lauren Wang, Chan Pompeii, Mary Lou Illiano, Paige St-Jules, David E. Mottern, Meredith Li, Huilin Williams, Natasha Schoenthaler, Antoinette Segal, Eran Godneva, Anastasia Thomas, Diana Bergman, Michael Schmidt, Ann Marie Sevick, Mary Ann |
author_sort | Popp, Collin J. |
collection | PubMed |
description | IMPORTANCE: Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss. OBJECTIVE: To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity. DESIGN, SETTING, AND PARTICIPANTS: The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A(1c) level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m(2) using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes. INTERVENTIONS: Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app. MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling. RESULTS: Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was −4.31% (95% CI, −5.37% to −3.24%) for the standardized group and −3.26% (95% CI, −4.25% to −2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, −0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05). CONCLUSIONS AND RELEVANCE: A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03336411 |
format | Online Article Text |
id | pubmed-9520362 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-95203622022-10-18 Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial Popp, Collin J. Hu, Lu Kharmats, Anna Y. Curran, Margaret Berube, Lauren Wang, Chan Pompeii, Mary Lou Illiano, Paige St-Jules, David E. Mottern, Meredith Li, Huilin Williams, Natasha Schoenthaler, Antoinette Segal, Eran Godneva, Anastasia Thomas, Diana Bergman, Michael Schmidt, Ann Marie Sevick, Mary Ann JAMA Netw Open Original Investigation IMPORTANCE: Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss. OBJECTIVE: To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity. DESIGN, SETTING, AND PARTICIPANTS: The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A(1c) level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m(2) using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes. INTERVENTIONS: Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app. MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling. RESULTS: Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was −4.31% (95% CI, −5.37% to −3.24%) for the standardized group and −3.26% (95% CI, −4.25% to −2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, −0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05). CONCLUSIONS AND RELEVANCE: A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03336411 American Medical Association 2022-09-28 /pmc/articles/PMC9520362/ /pubmed/36169954 http://dx.doi.org/10.1001/jamanetworkopen.2022.33760 Text en Copyright 2022 Popp CJ et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Popp, Collin J. Hu, Lu Kharmats, Anna Y. Curran, Margaret Berube, Lauren Wang, Chan Pompeii, Mary Lou Illiano, Paige St-Jules, David E. Mottern, Meredith Li, Huilin Williams, Natasha Schoenthaler, Antoinette Segal, Eran Godneva, Anastasia Thomas, Diana Bergman, Michael Schmidt, Ann Marie Sevick, Mary Ann Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title | Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title_full | Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title_fullStr | Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title_full_unstemmed | Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title_short | Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial |
title_sort | effect of a personalized diet to reduce postprandial glycemic response vs a low-fat diet on weight loss in adults with abnormal glucose metabolism and obesity: a randomized clinical trial |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520362/ https://www.ncbi.nlm.nih.gov/pubmed/36169954 http://dx.doi.org/10.1001/jamanetworkopen.2022.33760 |
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