A High-Carbohydrate, High-Fiber, Low-Fat Diet Results in Weight Loss among Adults at High Risk of Type 2 Diabetes

作者：Sylvetsky Allison C^*; Edelstein Sharon L; Walford Geoffrey; Boyko Edward J; Horton Edward S; Ibebuogu Uzoma N; Knowler William C; Montez Maria G; Temprosa Marinella; Hoskin Mary; Rother Kristina I; Delahanty Linda M

来源：Journal of Nutrition, 2017, 147(11): 2060-2066.

DOI：10.3945/jn.117.252395

• diabetes
• diet
• weight
• macronutrient
• carbohydrate

Background: Weight loss is a key factor in reducing diabetes risk. The Diabetes Prevention Program (DPP) is a completed clinical trial that randomly assigned individuals at high risk of diabetes to a placebo (PLBO), metformin (MET), or intensive lifestyle intervention (ILS) group, which included physical activity (PA) and reduced dietary fat intake.
Objective: We aimed to evaluate the associations between diet and weight at baseline and to identify specific dietary factors that predicted weight loss among DPP participants.
Methods: Diet was assessed by a food frequency questionnaire. The associations between intakes of macronutrients and various food groups and body weight among DPP participants at baseline were assessed by linear regression, adjusted for race/ethnicity, age, sex, calorie intake, and PA. Models that predicted weight loss at year 1 were adjusted for baseline weight, change in calorie intake, and change in PA and stratified by treatment allocation (MET, ILS, and PLBO). All results are presented as estimates 6 SEs.
Results: A total of 3234 participants were enrolled in the DPP; 2924 had completed dietary data (67.5% women; mean age: 50.6 +/- 10.7 y). Adjusted for calorie intake, baseline weight was negatively associated with carbohydrate intake (21.14 +/- 0.18 kg bodyweight/100 kcal carbohydrate, P < 0.0001) and, specifically, dietary fiber (-1.26 +/- 0.28 kg/5 g fiber, P < 0.0001). Baseline weight was positively associated with total fat (1.25 +/- 0.21 kg/100 kcal, P < 0.0001), saturated fat (1.96 +/- 0.46 kg/100 kcal, P < 0.0001), and protein (0.21 +/- 0.05 kg/100 kcal, P < 0.0001). For all groups, weight loss after 1 y was associated with increases in carbohydrate intake, specifically dietary fiber, and decreases in total fat and saturated fat intake.
Conclusions: Higher carbohydrate consumption among DPP participants, specifically high-fiber carbohydrates, and lower total and saturated fat intake best predicted weight loss when adjusted for changes in calorie intake. Our results support the benefits of a high-carbohydrate, high-fiber, low-fat diet in the context of overall calorie reduction leading to weight loss, which may prevent diabetes in high-risk individuals. This trial was registered at clinicaltrials.gov as NCT00004992.

• 出版日期2017-11