Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial

Abstract

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement (PMR) plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a PMR plan in the intensive lifestyle intervention (ILI). Objective Compare dietary intake and percent meeting fat-related and food group dietary recommendations in ILI and diabetes support and education (DSE) groups at 12 months. Design Randomized controlled trial, comparing ILI to DSE, at 0- and 12-months. Participants/setting From 16 United States sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available on 2,397 participants (46.6% of total participants), with 1,186 randomized to DSE and 1,211 randomized to ILI. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids (PUFA), and saturated fats; trans fatty acids; cholesterol; fiber; weekly meal replacements (MRs); and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance (ANCOVA), using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted chi-square tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, ILI had a significantly lower fat and cholesterol intake and greater fiber intake than DSE. ILI consumed more servings/day of fruits; vegetables; and milk, yogurt & cheese; and fewer servings/day of fats, oils & sweets than DSE. A greater percentage of ILI than DSE participants met fat-related and most food group recommendations. Within ILI, a greater percentage of participants consuming ≥ 2 MRs/day than < 1 MR/day met most fat-related and food group recommendations. Conclusions The PMR plan consumed by ILI was related to superior diet quality.

James Lind Alliance research priorities: what role do carbohydrates, fats and proteins have in the management of Type 2 diabetes, and are there risks and benefits associated with particular approaches?

“…High‐carbohydrate diets (>45% total energy intake from carbohydrate or >225g carbohydrate per day) typically represent ‘healthy’ or ‘prudent’ eating patterns and are recommended for the general population. One challenge of using either %total energy intake or absolute amount of carbohydrate was demonstrated in the Look AHEAD trial, in which the dietary intervention provided 50.8% total energy intake from carbohydrate , although, as total energy intake was restricted to induce weight loss, the absolute amount of carbohydrate met the definition of a moderate carbohydrate diet.…”

“…High-carbohydrate diets (>45% total energy intake from carbohydrate or >225g carbohydrate per day) typically represent 'healthy' or 'prudent' eating patterns and are recommended for the general population. One challenge of using either %total energy intake or absolute amount of carbohydrate was demonstrated in the Look AHEAD trial, in which the dietary intervention provided 50.8% total energy intake from carbohydrate [27], although, as total energy intake was restricted to induce weight loss, the absolute amount of carbohydrate met the definition of a moderate carbohydrate diet. Nine recent systematic reviews and meta-analyses of the effects of carbohydrate restriction on HbA 1c considered in the present review consistently reported a short-term improvement, maintained over 6-12 months, but which was not maintained over the longer term [16][17][18][19][20][21][22][23][24].…”

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

“…Use of meal replacement plans prescribed by trained practitioners, with close patient monitoring, can be beneficial. Within the intensive lifestyle intervention group of the Look AHEAD trial, for example, use of a partial meal replacement plan was associated with improvements in diet quality (34). The diet choice should be based on the patient's health status and preferences.…”

7. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2018

“…Use of meal replacement plans prescribed by trained practitioners, with close patient monitoring, can be beneficial. Within the intensive lifestyle intervention group of the Look AHEAD trial, for example, use of a partial meal replacement plan was associated with improvements in diet quality (23). The diet choice should be based on the patient's health status and preferences.…”