Poster Topical Area: Medical Nutrition
Location: Hall D
Poster Board Number: 640
Background: Diabetes prevention trials promoting a low-fat diet have been less successful in South Asian compared to other populations, which may be due to pre-existing low fat intake. This study evaluated the impact of a diabetes prevention intervention on diet and risk of diabetes in Asian Indians.
Methods:Data were included from the Diabetes Community Lifestyle Improvement Program (D-CLIP), a randomized control trial and translational study of the Diabetes Prevention Program. Overweight Asian Indian adults (20-65 years) with prediabetes were randomized to receive standard treatment (control; n=283) or the 6-month intervention (n=295) which included structured education and support to reduce intakes of fat (to <30% of total energy) and total calories. At baseline, 6, 12 and 24 months, diet was measured using a FFQ, and incident diabetes was determined using fasting plasma glucose and 2-hour plasma glucose from oral glucose tolerance test. Random-effects linear regression was used to evaluate intervention-related changes in intakes of foods and nutrients. Cox proportional hazards were used to compare one-year hazards of diabetes in the intervention and control groups, with and without adjustment for intervention-related dietary changes.
Results: The sample included 485 respondents (control=240; intervention=245) who consumed an average of 27.7% of total energy from fat at baseline. At 6 months, there were no changes in relative intakes of fat, carbs or protein. However, the intervention was associated with decreased intakes of total energy (-185.6 kcal/d; 95% CI: -353.6, -17.5 kcal/d) and refined cereals (-7.2 g/1,000 kcal; 95% CI: -12.7, -1.7 g/1,000 kcal), and increased intake of fruits and vegetables (33.4 g/1,000 kcal; 95% CI: 16.0, 50.8 g/1,000 kcal). Those in the intervention group were half (HR: 0.49; 95% CI: 0.24, 0.94) as likely to develop diabetes at one year. The hazard ratio was significantly attenuated (12.2%; p=0.015) after adjusting for intakes of fruits and vegetables.
Conclusion: Pre-existing low fat intake in Asian Indians may delimit the impact of diabetes prevention trials that emphasize a low-fat diet. Interventions that promote increased intake of fruits and vegetables, and decreased intakes of refined grains and total calories, may be more likely to prevent diabetes in Asian Indians.
Department of Global Health, Rollins School of Public Health, Emory University