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Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial - 22/04/15

Doi : 10.1016/j.jand.2014.11.003 
Hollie A. Raynor, PhD, RD , Andrea M. Anderson, MS, Gary D. Miller, PhD, RD, Rebecca Reeves, PhD, RD, Linda M. Delahanty, MS, RD, Mara Z. Vitolins, DrPH, RD, Patricia Harper, MS, RD, Connie Mobley, PhD, RD, Kati Konersman, MA, Elizabeth Mayer-Davis, PhD, RD
the

Look AHEAD Research Group

Frederick L. Brancati, MD, MHS , Jeff Honas, MS , Lawrence Cheskin, MD , Jeanne M. Clark, MD, MPH , Kerry Stewart, EdD , Richard Rubin, PhD , Jeanne Charleston, RN, Kathy Horak, RD, George A. Bray, MD , Kristi Rau , Allison Strate, RN , Brandi Armand, LPN , Frank L. Greenway, MD , Donna H. Ryan, MD , Donald Williamson, PhD , Amy Bachand, Michelle Begnaud, Betsy Berhard, Elizabeth Caderette, Barbara Cerniauskas, David Creel, Diane Crow, Helen Guay, Nancy Kora, Kelly LaFleur, Kim Landry, Missy Lingle, Jennifer Perault, Mandy Shipp, RD, Marisa Smith, Elizabeth Tucker, Cora E. Lewis, MD, MSPH , Sheikilya Thomas, MPH , Monika Safford, MD , Vicki DiLillo, PhD, Charlotte Bragg, MS, RD, LD, Amy Dobelstein, Stacey Gilbert, MPH, Stephen Glasser, MD, Sara Hannum, MA, Anne Hubbell, MS, Jennifer Jones, MA, DeLavallade Lee, Ruth Luketic, MA, MBA, MPH, Karen Marshall, L. Christie Oden, Janet Raines, MS, Cathy Roche, RN, Janet Truman, Nita Webb, MA, Audrey Wrenn, MAEd, David M. Nathan, MD , Heather Turgeon, RN, CDE , Kristina Schumann , Enrico Cagliero, MD , Linda Delahanty, MS, RD , Kathryn Hayward, MD , Ellen Anderson, MS, RD , Laurie Bissett, MS, RD, Richard Ginsburg, PhD, Valerie Goldman, MS, RD, Virginia Harlan, MSW, Charles McKitrick, RN, CDE, Alan McNamara, Theresa Michel, DPT, DSc, CCS, Alexi Poulos, Barbara Steiner, EdM, Joclyn Tosch, Edward S. Horton, MD , Sharon D. Jackson, MS, RD, CDE , Osama Hamdy, MD, PhD , A. Enrique Caballero, MD , Sarah Bain, Elizabeth Bovaird, RN, Ann Goebel-Fabbri, PhD, Lori Lambert, MS, RD, Sarah Ledbury, MEd, RD, Maureen Malloy, Kerry Ovalle, MS, RCEP, CDE, George Blackburn, MD, PhD , Christos Mantzoros, MD, DSc , Kristinia Day, RD, Ann McNamara, RN, James O. Hill, PhD , Marsha Miller, MS, RD , JoAnn Phillipp, MS , Robert Schwartz, MD , Brent Van Dorsten, PhD , Judith Regensteiner, PhD , Salma Benchekroun, MS, Ligia Coelho, Paulette Cohrs, RN, Elizabeth Daeninck, MS, RD, Amy Fields, MPH, Susan Green, April Hamilton, CCRC, Jere Hamilton, Eugene Leshchinskiy, Michael McDermott, MD, Lindsey Munkwitz, Loretta Rome, TRS, Kristin Wallace, MPH, Terra Worley, John P. Foreyt, PhD , Rebecca S. Reeves, DrPH, RD , Henry Pownall, PhD , Ashok Balasubramanyam, MBBS , Peter Jones, MD , Michele Burrington, RD, Chu-Huang Chen, MD, PhD , Allyson Clark, RD, Molly Gee, MEd, RD, Sharon Griggs, Michelle Hamilton, Veronica Holley, Jayne Joseph, RD, Patricia Pace, RD, Julieta Palencia, RN, Olga Satterwhite, RD, Jennifer Schmidt, Devin Volding, LMSW, Carolyn White, Mohammed F. Saad, MD , Siran Ghazarian, MD , Ken C. Chiu, MD , Medhat Botrous, Michelle Chan, Kati Konersman, MA, RD, CDE, Magpuri Perpetua, RD, Karen C. Johnson, MD, MPH , Carolyn Gresham, RN , Stephanie Connelly, MD, MPH , Amy Brewer, RD, MS, Mace Coday, PhD, Lisa Jones, RN, Lynne Lichtermann, RN, Shirley Vosburg, RD, MPH, J. Lee Taylor, MEd, MBA, Abbas E. Kitabchi, PhD, MD , Helen Lambeth, RN , Debra Clark, LPN, Andrea Crisler, MT, Gracie Cunningham, Donna Green, RN, Debra Force, MS, RD, LDN, Robert Kores, PhD, Renate Rosenthal, PhD, Elizabeth Smith, MS, RD, LDN, Maria Sun, MS, RD, LDN, Judith Soberman, MD. , Robert W. Jeffery, PhD , Carolyn Thorson, CCRP , John P. Bantle, MD , J. Bruce Redmon, MD , Richard S. Crow, MD , Scott Crow, MD , Susan K. Raatz, PhD, RD , Kerrin Brelje, MPH, RD, Carolyne Campbell, Jeanne Carls, MEd, Tara Carmean-Mihm, Emily Finch, MA, Anna Fox, MA, Elizabeth Hoelscher, MPH, RD, CHES, La Donna James, Vicki A. Maddy, RD, Therese Ockenden, RN, Birgitta I. Rice, MS, RPh CHES, Tricia Skarphol, Ann D. Tucker, Mary Susan Voeller, Cara Walcheck, RD, Xavier Pi-Sunyer, MD , Jennifer Patricio, MS , Stanley Heshka, PhD , Carmen Pal, MD , Lynn Allen, MD, Diane Hirsch, RNC, MS, CDE, Mary Anne Holowaty, MS, CN, Thomas A. Wadden, PhD , Barbara J. Maschak-Carey, MSN, CDE , Stanley Schwartz, MD , Gary D. Foster, PhD , Robert I. Berkowitz, MD , Henry Glick, PhD , Shiriki K. Kumanyika, PhD, RD, MPH , Johanna Brock, Helen Chomentowski, Vicki Clark, Canice Crerand, PhD, Renee Davenport, Andrea Diamond, MS, RD, Anthony Fabricatore, PhD, Louise Hesson, MSN, Stephanie Krauthamer-Ewing, MPH, Robert Kuehnel, PhD, Patricia Lipschutz, MSN, Monica Mullen, MS, RD, Leslie Womble, PhD, MS, Nayyar Iqbal, MD, David E. Kelley, MD , Jacqueline Wesche-Thobaben, RN, BSN, CDE , Lewis Kuller, MD, DrPH , Andrea Kriska, PhD , Janet Bonk, RN, MPH, Rebecca Danchenko, Daniel Edmundowicz, MD , Mary L. Klem, PhD, MLIS , Monica E. Yamamoto, DrPH, RD, FADA , Barb Elnyczky, MA, George A. Grove, MS, Pat Harper, MS, RD, LDN, Janet Krulia, RN, CDE, Juliet Mancino, MS, RD, CDE, LDN, Anne Mathews, MS, RD, LDN, Tracey Y. Murray, Joan R. Ritchea, Jennifer Rush, MPH, Karen Vujevich, RN-BC, MSN, CRNP, Donna Wolf, MS, Rena R. Wing, PhD , Renee Bright, MS , Vincent Pera, MD , John Jakicic, PhD , Deborah Tate, PhD , Amy Gorin, PhD , Kara Gallagher, PhD , Amy Bach, PhD, Barbara Bancroft, RN, MS, Anna Bertorelli, MBA, RD, Richard Carey, Tatum Charron, Heather Chenot, MS, Kimberley Chula-Maguire, MS, Pamela Coward, MS, RD, Lisa Cronkite, Julie Currin, MD, Maureen Daly, RN, Caitlin Egan, MS, Erica Ferguson, RD, Linda Foss, MPH, Jennifer Gauvin, Don Kieffer, PhD, Lauren Lessard, Deborah Maier, MS, J.P. Massaro, Tammy Monk, MS, Rob Nicholson, PhD, Erin Patterson, Suzanne Phelan, PhD, Hollie Raynor, PhD, RD, Douglas Raynor, PhD, Natalie Robinson, MS, RD, Deborah Robles, Jane Tavares, Steven M. Haffner, MD , Maria G. Montez, RN, MSHP, CDE , Carlos Lorenzo, MD. , Steven E. Kahn, MB, ChB , Brenda Montgomery, RN, MS, CDE , Robert Knopp, MD , Edward Lipkin, MD , Matthew L. Maciejewski, PhD , Dace Trence, MD , Terry Barrett, Joli Bartell, Diane Greenberg, PhD, Anne Murillo, Betty Ann Richmond, MEd, April Thomas, MPH, RD, William C. Knowler, MD, DrPH , Paula Bolin, RN, MC , Tina Killean , Cathy Manus, LPN , Jonathan Krakoff, MD , Jeffrey M. Curtis, MD, MPH , Justin Glass, MD , Sara Michaels, MD , Peter H. Bennett, MB, FRCP , Tina Morgan , Shandiin Begay, MPH, Bernadita Fallis, RN, RHIT, CCS, Jeanette Hermes, MS, RD, Diane F. Hollowbreast, Ruby Johnson, Maria Meacham, RN, CDE, Julie Nelson, RD, Carol Percy, RN, Patricia Poorthunder, Sandra Sangster, Nancy Scurlock, MSN, ANP-C, CDE, Leigh A. Shovestull, RD, CDE, Janelia Smiley, Katie Toledo, MS, LPC, Christina Tomchee, Darryl Tonemah, PhD, Anne Peters, MD , Valerie Ruelas, MSW, LCSW , Siran Ghazarian Sengardi, MD , Kathryn Graves, MPH, RD, CDE, Kati Konersman, MA, RD, CDE, Sara Serafin-Dokhan, Mark A. Espeland, PhD , Judy L. Bahnson , Lynne Wagenknecht, DrPH , David Reboussin, PhD , W. Jack Rejeski, PhD , Alain Bertoni, MD, MPH , Wei Lang, PhD , Gary Miller, PhD , David Lefkowitz, MD , Patrick S. Reynolds, MD , Paul Ribisl, PhD , Mara Vitolins, DrPH , Michael Booth, MBA , Kathy M. Dotson , Amelia Hodges , Carrie C. Williams, MA , Jerry M. Barnes, MA, Patricia A. Feeney, MS, Jason Griffin, Lea Harvin, William Herman, MD, MPH, Patricia Hogan, MS, Sarah Jaramillo, MS, Mark King, Kathy Lane, Rebecca Neiberg, MS, Andrea Ruggiero, MS, Christian Speas, Michael P. Walkup, MS, Karen Wall, Michelle Ward, Delia S. West, PhD, Terri Windham, Michael Nevitt, PhD , Susan Ewing, MS, Cynthia Hayashi, Jason Maeda, MPH, Lisa Palermo, MS, MA, Michaela Rahorst, Ann Schwartz, PhD, John Shepherd, PhD, Santica M. Marcovina, PhD, ScD , Greg Strylewicz, MS, Ronald J. Prineas, MD, PhD , Teresa Alexander, Lisa Billings, Charles Campbell, AAS, Sharon Hall, Susan Hensley, Yabing Li, MD, Zhu-Ming Zhang, MD, Elizabeth J. Mayer-Davis, PhD , Robert Moran, PhD, Richard Foushee, PhD, Nancy J. Hall, MA, Barbara Harrison, MS, Van S. Hubbard, MD, PhD, Susan Z. Yanovski, MD, Lawton S. Cooper, MD, MPH, Jeffrey Cutler, MD, MPH, Eva Obarzanek, PhD, MPH, RD, Edward W. Gregg, PhD, David F. Williamson, PhD, Ping Zhang, PhD


Address correspondence to: Hollie A. Raynor, PhD, RD, Department of Nutrition, University of Tennessee, 1215 W. Cumberland Ave, JHB 229, Knoxville, TN 37996.

Abstract

Background

Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention.

Objective

To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months.

Design

A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months.

Participants/setting

From 16 US 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 for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group.

Main outcome measures

A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans-fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid.

Statistical analyses performed

Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ2 tests compared percent meeting fat-related and food group recommendations at 12 months.

Results

At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations.

Conclusions

The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality.

Le texte complet de cet article est disponible en PDF.

Keywords : Partial meal replacement plan, Diet quality, Type 2 diabetes, Lifestyle intervention


Plan


 All other Look AHEAD staffs are listed alphabetically by site.
 STATEMENT OF POTENTIAL CONFLICT OF INTEREST H. A. Raynor has received research funding from Weight Watchers, International. All other authors declare no conflicts of interest.
 FUNDING/SUPPORT This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; NIH Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service provided personnel, medical oversight, and use of facilities. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center (M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (M01RR000056 44) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The following organizations have committed to make major contributions to Look AHEAD: Federal Express; Health Management Resources; Johnson & Johnson, LifeScan Inc; Optifast-Novartis Nutrition; Roche Pharmaceuticals; Ross Product Division of Abbott Laboratories; Slim-Fast Foods Company; and Unilever.


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