Single-Component Versus Multicomponent Dietary Goals for the Metabolic Syndrome: A Randomized Trial
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Abstract
Background:
Few studies have compared diets to determine whether a program focused on 1 dietary change results in collateral effects on other untargeted healthy diet components.
Objective:
To evaluate a diet focused on increased fiber consumption versus the multicomponent American Heart Association (AHA) dietary guidelines.
Design:
Randomized, controlled trial from June 2009 to January 2014. (ClinicalTrials.gov: NCT00911885)
Setting:
Worcester, Massachusetts.
Participants:
240 adults with the metabolic syndrome.
Intervention:
Participants engaged in individual and group sessions.
Measurements:
Primary outcome was weight change at 12 months.
Results:
At 12 months, mean change in weight was −2.1 kg (95% CI, −2.9 to −1.3 kg) in the high-fiber diet group versus −2.7 kg (CI, −3.5 to −2.0 kg) in the AHA diet group. The mean between-group difference was 0.6 kg (CI, −0.5 to 1.7 kg). During the trial, 12 (9.9%) and 15 (12.6%) participants dropped out of the high-fiber and AHA diet groups, respectively ( P = 0.55). Eight participants developed diabetes (hemoglobin A1c level ≥6.5%) during the trial: 7 in the high-fiber diet group and 1 in the AHA diet group (P = 0.066).
Limitations:
Generalizability is unknown. Maintenance of weight loss after cessation of group sessions at 12 months was not assessed. Definitive conclusions cannot be made about dietary equivalence because the study was powered for superiority.
Conclusion:
The more complex AHA diet may result in up to 1.7 kg more weight loss; however, a simplified approach to weight reduction emphasizing only increased fiber intake may be a reasonable alternative for persons with difficulty adhering to more complicated diet regimens.
Primary Funding Source:
National Heart, Lung, and Blood Institute.
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References
1.
Zivkovic AM, German JB, Sanyal AJ. Comparative review of diets for the metabolic syndrome: implications for nonalcoholic fatty liver disease. Am J Clin Nutr. 2007;86:285-300. [PMID: 17684197]
2.
Feldeisen SE, Tucker KL. Nutritional strategies in the prevention and treatment of metabolic syndrome. Appl Physiol Nutr Metab. 2007;32:46-60. [PMID: 17332784]
3.
Ockene IS, Hayman LL, Pasternak RC, Schron E, Dunbar-Jacob J. Task force #4—adherence issues and behavior changes: achieving a long-term solution. 33rd Bethesda Conference. J Am Coll Cardiol. 2002;40:630-40. [PMID: 12204492]
4.
Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR, et al; American Heart Association Council on Epidemiology and Prevention. American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127:1730-53. [PMID: 23519758] doi: 10.1161/CIR.0b013e31828f8a94
5.
Spring B, Schneider K, McFadden HG, Vaughn J, Kozak AT, Smith M, et al. Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology. Arch Intern Med. 2012;172:789-96. [PMID: 22636824] doi: 10.1001/archinternmed.2012.1044
6.
Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al; American Heart Association Nutrition Committee. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82-96. [PMID: 16785338]
7.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al; American Heart Association. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-52. [PMID: 16157765]
8.
Ryan P. Update to random allocation of treatment to blocks. Stata Technical Bulletin. 1999;50:36-7.
9.
Grundy SM, Hansen B, Smith SC Jr, Cleeman JI, Kahn RA; American Heart Association. Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation. 2004;109:551-6. [PMID: 14757684]
10.
Merriam PA, Persuitte G, Olendzki BC, Schneider K, Pagoto SL, Palken JL, et al. Dietary intervention targeting increased fiber consumption for metabolic syndrome. J Acad Nutr Diet. 2012;112:621-3. [PMID: 22709766] doi: 10.1016/j.jand.2012.01.024
11.
Ockene IS, Tellez TL, Rosal MC, Reed GW, Mordes J, Merriam PA, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. Am J Public Health. 2012;102:336-42. [PMID: 22390448] doi: 10.2105/AJPH.2011.300357
12.
Pagoto S, Kantor L, Bodenlos J, Gitkind M, Ma Y. Adoption of the Diabetes Prevention Program in a hospital-based weight loss clinic. Health Psychol. 2007;27 Suppl 1 S91-8.
13.
Park Y, Hunter DJ, Spiegelman D, Bergkvist L, Berrino F, van den Brandt PA, et al. Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. JAMA. 2005;294:2849-57. [PMID: 16352792]
14.
Chuwa EW, Seow-Choen F. Dietary fibre. Br J Surg. 2006;93:3-4. [PMID: 16372393]
15.
McCullough ML, Willett WC. Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. Public Health Nutr. 2006;9:152-7. [PMID: 16512963]
16.
McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76:1261-71. [PMID: 12450892]
17.
Merriam PA, Ockene IS, Hebert JR, Rosal MC, Matthews CE. Seasonal variation of blood cholesterol levels: study methodology. J Biol Rhythms. 1999;14:330-9. [PMID: 10447314]
18.
Matthews CE, Freedson PS, Hebert JR, Stanek EJ 3rd, Merriam PA, Rosal MC, et al. Seasonal variation in household, occupational, and leisure time physical activity: longitudinal analyses from the seasonal variation of blood cholesterol study. Am J Epidemiol. 2001;153:172-83. [PMID: 11159163]
19.
Matthews CE, Hebert JR, Freedson PS, Stanek EJ 3rd, Merriam PA, Ebbeling CB, et al. Sources of variance in daily physical activity levels in the seasonal variation of blood cholesterol study. Am J Epidemiol. 2001;153:987-95. [PMID: 11384955]
20.
Ma Y, Olendzki BC, Li W, Hafner AR, Chiriboga D, Hebert JR, et al. Seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population. Eur J Clin Nutr. 2006;60:519-28. [PMID: 16340952]
21.
Matthews CE, Freedson PS, Hebert JR, Stanek EJ 3rd, Merriam PA, Ockene IS. Comparing physical activity assessment methods in the Seasonal Variation of Blood Cholesterol Study. Med Sci Sports Exerc. 2000;32:976-84. [PMID: 10795789]
22.
Frison L, Pocock SJ. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med. 1992;11:1685-704. [PMID: 1485053]
23.
Feng C, Wang H, Lu N, Tu XM. Log transformation: application and interpretation in biomedical research. Stat Med. 2013;32:230-9. [PMID: 22806695] doi: 10.1002/sim.5486
24.
Roger JH. SAS code for sensitivity analysis using mutiple imputation 2014. Accessed at www.missingdata.org.uk on 28 August 2014.
25.
Carpenter JR, Roger JH, Kenward MG. Analysis of longitudinal trials with protocol deviation: a framework for relevant, accessible assumptions, and inference via multiple imputation. J Biopharm Stat. 2013;23:1352-71. [PMID: 24138436] doi: 10.1080/10543406.2013.834911
26.
Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174:516-24. [PMID: 24493081] doi: 10.1001/jamainternmed.2013.13563
27.
Pagoto SL, Appelhans BM. A call for an end to the diet debates. JAMA. 2013;310:687-8. [PMID: 23989081] doi: 10.1001/jama.2013.8601
28.
Ajani UA, Ford ES, Mokdad AH. Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. J Nutr. 2004;134:1181-5. [PMID: 15113967]
29.
King DE, Egan BM, Geesey ME. Relation of dietary fat and fiber to elevation of C-reactive protein. Am J Cardiol. 2003;92:1335-9. [PMID: 14636916]
30.
Block G, Subar AF. Estimates of nutrient intake from a food frequency questionnaire: the 1987 National Health Interview Survey. J Am Diet Assoc. 1992;92:969-77. [PMID: 1640041]
31.
Ma Y, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJ 3rd, et al. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 2006;83:760-6. [PMID: 16600925]
32.
Ma Y, Hébert JR, Li W, Bertone-Johnson ER, Olendzki B, Pagoto SL, et al. Association between dietary fiber and markers of systemic inflammation in the Women's Health Initiative Observational Study. Nutrition. 2008;24:941-9. [PMID: 18562168] doi: 10.1016/j.nut.2008.04.005
33.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6-e245. [PMID: 23239837] doi: 10.1161/CIR.0b013e31828124ad
34.
Marlett JA, McBurney MI, Slavin JL; American Dietetic Association. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc. 2002;102:993-1000. [PMID: 12146567]
35.
Lappalainen R, Sairanen E, Järvelä E, Rantala S, Korpela R, Puttonen S, et al. The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress. BMC Public Health. 2014;14:310. [PMID: 24708617] doi: 10.1186/1471-2458-14-310
36.
American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35 Suppl 1:S11-63. [PMID: 22187469] doi: 10.2337/dc12-s011
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 162 • Number 4 • 17 February 2015
Pages: 248 - 257
History
Published online: 17 February 2015
Published in issue: 17 February 2015
Keywords
Copyright
© 2015 American College of Physicians.
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Single-Component Versus Multicomponent Dietary Goals for the Metabolic Syndrome: A Randomized Trial. Ann Intern Med.2015;162:248-257. [Epub 17 February 2015]. doi:10.7326/M14-0611
Single-Component Versus Multicomponent Dietary Goals for the Metabolic Syndrome: A Randomized Trial. Ann Intern Med.2015;162:248-257. [Epub 17 February 2015]. doi:10.7326/M14-0611
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