Predictors of Sustained Reduction in Energy and Fat Intake in the Diabetes Prevention Program Outcomes Study Intensive Lifestyle Intervention

Published:October 18, 2013DOI:



      Few lifestyle intervention studies examine long-term sustainability of dietary changes.


      To describe sustainability of dietary changes over 9 years in the Diabetes Prevention Program and its outcomes study, the Diabetes Prevention Program Outcomes Study, among participants receiving the intensive lifestyle intervention.


      One thousand seventy-nine participants were enrolled in the intensive lifestyle intervention arm of the Diabetes Prevention Program; 910 continued participation in the Diabetes Prevention Program Outcomes Study. Fat and energy intake derived from food frequency questionnaires at baseline and post-randomization Years 1 and 9 were examined. Parsimonious models determined whether baseline characteristics and intensive lifestyle intervention session participation predicted sustainability.


      Self-reported energy intake was reduced from a median of 1,876 kcal/day (interquartile range [IQR]=1,452 to 2,549 kcal/day) at baseline to 1,520 kcal/day (IQR=1,192 to 1,986 kcal/day) at Year 1, and 1,560 kcal/day (IQR=1,223 to 2,026 kcal/day) at Year 9. Dietary fat was reduced from a median of 70.4 g (IQR=49.3 to 102.5 g) to 45 g (IQR=32.2 to 63.8 g) at Year 1 and increased to 61.0 g (IQR=44.6 to 82.7 g) at Year 9. Percent energy from fat was reduced from a median of 34.4% (IQR=29.6% to 38.5%) to 27.1% (IQR=23.1% to 31.5%) at Year 1 but increased to 35.3% (IQR=29.7% to 40.2%) at Year 9. Lower baseline energy intake and Year 1 dietary reduction predicted lower energy and fat gram intake at Year 9. Higher leisure physical activity predicted lower fat gram intake but not energy intake.


      Intensive lifestyle intervention can result in reductions in total energy intake for up to 9 years. Initial success in achieving reductions in fat and energy intake and success in attaining activity goals appear to predict long-term success at maintaining changes.


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      N. J. Davis is associate professor of clinical medicine, Albert Einstein College of Medicine, Bronx, NY.


      J. Brown-Friday is clinical trials manager, Albert Einstein College of Medicine, Bronx, NY.


      J. Wylie-Rosett is Atran Foundation Chair in Social Medicine and professor of epidemiology and population health, Albert Einstein College of Medicine, Bronx, NY.


      Y. Ma is assistant research professor of biostatistics and epidemiology, George Washington University, Washington, DC.


      H. J. Hoffman is associate professor of epidemiology and biostatistics, George Washington University, Washington, DC.


      L. M. Delahanty is director of nutrition and behavioral research, Massachusetts General Hospital, Boston, and instructor of medicine, Harvard Medical School, Boston, MA.


      E. Mayer-Davis is professor of medicine and nutrition, University of North Carolina, Chapel Hill.


      P. W. Franks is professor of genetic epidemiology and nutrition, Lund University, Malmö, Sweden, and professor of genetic epidemiology and nutrition, Harvard School of Public Health, Boston, MA.


      M. Isonaga is research study coordinator, University of Hawaii, Honolulu.


      A. M. Kriska is professor of epidemiology, University of Pittsburgh, Pittsburgh, PA.


      E. M. Vinditti is assistant professor of psychiatry and epidemiology, University of Pittsburgh, Pittsburgh, PA.