Abstract
Background
Few lifestyle intervention studies examine long-term sustainability of dietary changes.
Objective
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.
Design
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.
Results
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.
Conclusions
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.
Keywords
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Biography
N. J. Davis is associate professor of clinical medicine, Albert Einstein College of Medicine, Bronx, NY.
Biography
J. Brown-Friday is clinical trials manager, Albert Einstein College of Medicine, Bronx, NY.
Biography
J. Wylie-Rosett is Atran Foundation Chair in Social Medicine and professor of epidemiology and population health, Albert Einstein College of Medicine, Bronx, NY.
Biography
Y. Ma is assistant research professor of biostatistics and epidemiology, George Washington University, Washington, DC.
Biography
H. J. Hoffman is associate professor of epidemiology and biostatistics, George Washington University, Washington, DC.
Biography
L. M. Delahanty is director of nutrition and behavioral research, Massachusetts General Hospital, Boston, and instructor of medicine, Harvard Medical School, Boston, MA.
Biography
E. Mayer-Davis is professor of medicine and nutrition, University of North Carolina, Chapel Hill.
Biography
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.
Biography
M. Isonaga is research study coordinator, University of Hawaii, Honolulu.
Biography
A. M. Kriska is professor of epidemiology, University of Pittsburgh, Pittsburgh, PA.
Biography
E. M. Vinditti is assistant professor of psychiatry and epidemiology, University of Pittsburgh, Pittsburgh, PA.
Article info
Publication history
Published online: October 18, 2013
Accepted:
June 23,
2013
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health provided funding to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data (grant no. U01 DK048489). The Southwestern American Indian Centers were supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and the Department of Veterans Affairs supported data collection at many of the clinical centers. Funding was also provided by the National Institute of Child Health and Human Development; the National Institute on Aging; the National Eye Institute; the National Heart, Lung, and Blood Institute; the Office of Research on Women's Health; the National Institute on Minority Health and Health Disparities; the Centers for Disease Control and Prevention; and the American Diabetes Association. The opinions expressed are those of the investigators and do not necessarily reflect the views of the funding agencies. Bristol-Myers Squibb and Parke-Davis provided additional funding and material support during the project, Lipha (Merck-Sante) provided medication, and LifeScan Inc. donated materials. McKesson BioServices Corp, Matthews Media Group Inc, and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center.
Identification
Copyright
© 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
