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

Published:January 06, 2015DOI:



      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.


      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.


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


      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.


      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.


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


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      H. A. Raynor is an associate professor, Department of Nutrition, University of Tennessee, Knoxville.


      A. M. Anderson is a biostatistician, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.


      M. Z. Vitolins is a professor and vice chair, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC.


      G. D. Miller is an associate professor, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC.


      R. Reeves is an adjunct assistant professor, The University of Texas School of Public Health, Austin.


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


      P. Harper is a consultant, P. Harper & Associates, North Huntingdon, PA.


      C. Mobley is an associate dean of research and a professor, Department of Biomedical Studies, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas.


      K. Konersman is a project coordinator, Baylor University Medical Center, Diabetes Health and Wellness Institute, Dallas, TX.


      E. Mayer-Davis is a professor, Department of Nutrition, University of North Carolina at Chapel Hill.