Poster Topical Area: Medical Nutrition

Location: Hall D

Poster Board Number: 640

P14-015 - Dietary changes in a diabetes prevention program among people with prediabetes – the D-CLIP Trial

Monday, Jun 11
8:00 AM – 3:00 PM

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.




Funding Source: This project is supported by a BRiDGES grant from the International Diabetes Federation (LT07-115). BRiDGES, an International Diabetes Federation project, is supported by an educational grant from Lilly Diabetes. Additional support was provided by the Global Health Institute at Emory University. C.N.F. received funding from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R21DL105891. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. M.B.W. received funding from two National Institute of Diabetes and Digestive and Kidney Diseases T32 grants (5T3-2DK-007298-33 and T32-DK-007734-16). L.R.S. received funding from the Human Health Molecules to Humankind program funded by the Burroughs Wellcome Fund grant (BWF 1008188).

CoAuthors: Mary Beth Weber, PhD, MPH – Rollins School of Public Health, Emory University; Lisa Staimez, PhD, MPH – Rollins School of Public Health, Emory University; Ranjit Anjana, PhD – Madras Diabetes Research Foundaion & Dr. Mohan's Diabetes Specialties Centre; Karthikeyan Lakshmi, MPhil – Mardas Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Center; Viswanathan Mohan, MD – Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre; K.M. Venkat Narayan, MD – Emory Global Diabetes Research Center, Emory University

Christopher N. Ford

Postdoctoral Fellow
Department of Global Health, Rollins School of Public Health, Emory University
Atlanta, Georgia