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Pretreatment fasting plasma glucose and insulin modify dietary weight loss success: results from 3 randomized clinical trials
Open accessAbstract
Background: Which diet is optimal for weight loss and maintenance remains controversial and implies that no diet fits all patients.Objective: We studied concentrations of fasting plasma glucose (FPG) and fasting insulin (FI) as prognostic markers for successful weight loss and maintenance through diets with different glycemic loads or different fiber and whole-grain content, assessed in 3 randomized trials of overweight participants.Design: After an 8-wk weight loss, participants in the DiOGenes (Diet, Obesity, and Genes) trial consumed ad libitum for 26 wk a diet with either a high or a low glycemic load. Participants in the Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) Supermarket intervention (SHOPUS) trial consumed ad libitum for 26 wk the New Nordic Diet, which is high in fiber and whole grains, or a control diet. Participants in the NUGENOB (Nutrient-Gene Interactions in Human Obesity) trial consumed a hypocaloric low-fat and high-carbohydrate or a high-fat and low-carbohydrate diet for 10 wk. On the basis of FPG before treatment, participants were categorized as normoglycemic (FPG <5.6 mmol/L), prediabetic (FPG 5.6-6.9 mmol/L), or diabetic (FPG ≥7.0 mmol/L). Modifications of the dietary effects of FPG and FI before treatment were examined with linear mixed models.Results: In the DiOGenes trial, prediabetic individuals regained a mean of 5.83 kg (95% CI: 3.34, 8.32 kg; P < 0.001) more on the high- than on the low-glycemic load diet, whereas normoglycemic individuals regained a mean of 1.44 kg (95% CI: 0.48, 2.41 kg; P = 0.003) more [mean group difference: 4.39 kg (95% CI: 1.76, 7.02 kg); P = 0.001]. In SHOPUS, prediabetic individuals lost a mean of 6.04 kg (95% CI: 4.05, 8.02 kg; P < 0.001) more on the New Nordic Diet than on the control diet, whereas normoglycemic individuals lost a mean of 2.20 kg (95% CI: 1.21, 3.18 kg; P < 0.001) more [mean group difference: 3.84 kg (95% CI: 1.62, 6.06 kg); P = 0.001]. In NUGENOB, diabetic individuals lost a mean of 2.04 kg (95% CI: -0.20, 4.28 kg; P = 0.07) more on the high-fat and low-carbohydrate diet than on the low-fat and high-carbohydrate diet, whereas normoglycemic individuals lost a mean of 0.43 kg (95% CI: 0.03, 0.83 kg; P = 0.03) more on the low-fat and high-carbohydrate diet [mean group difference: 2.47 kg (95% CI: 0.20, 4.75 kg); P = 0.03]. The addition of FI strengthened these associations.Conclusion: Elevated FPG before treatment indicates success with dietary weight loss and maintenance among overweight patients consuming diets with a low glycemic load or with large amounts of fiber and whole grains. These trials were registered at clinicaltrials.gov as NCT00390637 (DiOGenes) and NCT01195610 (SHOPUS), and at ISRNCT.com as ISRCTN25867281 (NUGENOB).
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“Further, overall fi ndings tend to support evidence from existing clinical trials and observational studies showing that people with markers indicating higher risk for diabetes, prediabetes, or insulin resistance have lower risk when they reduce calorie, carbohydrate, or saturated fat intake and/or increase fi ber or protein intake compared with their peers (333 -337).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [334]
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“After a mean weight loss of 10.3 kg in the DIOGENES study, they found a mean (95% CI) difference of 4.4 (1.8; 7.0, p = 0.001) kg in responsiveness to the high protein diet (21 E% protein) vs. the standard protein diet (17 E% protein) between participants of normoglycemia (n = 225) and prediabetes (n = 41) based on fasting plasma glucose.”
From Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein (2021) · cites this paper as [59]
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“This is suggested by the associations between consumption of low glycemic load diets high in protein, fiber, and whole grains a with improved body weight management observed in individuals with prediabetes, but less so in individuals with normoglycemia (retrospective analyses by Ballesteros-Pomar et al. and Hjorth et al. [19,37,59].”
From Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein (2021) · cites this paper as [59]
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“Thereby, HOMA-IR and fasting plasma glucose seem to be important biomarkers for successful dietary weight loss and weight loss maintenance.”
From Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein (2021) · cites this paper as [59]
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“Two studies were identified that assessed differences between normoglycemic and prediabetic individuals in body weight management [37,59].”
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“The non-significant difference in responsiveness observed by Ballesteros-Pomar et al. is probably due to the lower number of individuals assessed (n = 36) as compared to the analyses by Hjorth et al. (n = 266) [37,59].”
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“Studies using personalized nutrition approaches to examine genetic, metabolomic, and microbiome variations have not yet identi fi ed speci fi c factors that consistently improve outcomes in type 1 diabetes, type 2 diabetes, or prediabetes.”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [334]
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Metadata
- Authors
- Hjorth, M. F., Ritz, C., Blaak, E. E., Saris, W. H., Langin, D., Poulsen, S. K., Larsen, T. M., Sørensen, T. I., Zohar, Y., & Astrup, A.
- Affiliations
- Maastricht University Medical Centre (NL)
- Université Toulouse III - Paul Sabatier (FR)
- Steno Diabetes Center Copenhagen (DK)
- University of Copenhagen (DK)
- Gelesis, Inc. (United States) (US)
- Corresponding author
- Hjorth, Mads F
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 106
- Issue
- 2
- Pages
- 499-505
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2732617776
- Cited by
- 165
- References
- 18
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 16 · 2021: 12 · 2020: 66 · 2019: 18 · 2018: 19 · 2017: 7
- FWCI
- 19.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Steno Diabetes Center Copenhagen (SDCC 3.A Complications)
- Nordea-fonden
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- fasting blood glucose, fasting insulin, prediabetes, weight loss, weight maintenance, glycemic load, New Nordic Diet, dietary fiber, whole grains, low-fat high-carbohydrate diet, low-carbohydrate high-fat diet, hypocaloric diet, insulin resistance, prognostic factors, overweight, obesity, weight regain, gene-diet interaction
- MeSH terms
- Whole Grains, Glycemic Load, Body Weight Maintenance, Adult, Blood Glucose, Energy Intake, Diabetes Mellitus, Diet, Reducing, Dietary Fiber, Feeding Behavior, Female, Humans, Insulin, Male, Middle Aged, Obesity, Weight Loss
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