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Research Original Research| Volume 115, ISSUE 5, P731-742, May 2015

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

Published:January 06, 2015DOI:https://doi.org/10.1016/j.jand.2014.11.003
Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial
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      Abstract

      Background

      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.

      Objective

      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.

      Design

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

      Participants/setting

      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.

      Results

      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.

      Conclusions

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

      Keywords

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      Biography

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

      Biography

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

      Biography

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

      Biography

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

      Biography

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

      Biography

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

      Biography

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

      Biography

      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.

      Biography

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

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

      Article info

      Publication history

      Published online: January 06, 2015
      Accepted: October 29, 2014

      Footnotes

      All other Look AHEAD staffs are listed alphabetically by site.

      STATEMENT OF POTENTIAL CONFLICT OF INTEREST H. A. Raynor has received research funding from Weight Watchers, International. All other authors declare no conflicts of interest.

      FUNDING/SUPPORT This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; NIH Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service provided personnel, medical oversight, and use of facilities. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center (M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (M01RR000056 44) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The following organizations have committed to make major contributions to Look AHEAD: Federal Express; Health Management Resources; Johnson & Johnson, LifeScan Inc; Optifast-Novartis Nutrition; Roche Pharmaceuticals; Ross Product Division of Abbott Laboratories; Slim-Fast Foods Company; and Unilever.

      Identification

      DOI: https://doi.org/10.1016/j.jand.2014.11.003

      Copyright

      © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

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