Abstract (1) Background: Prior research in individuals with overweight/obesity and prediabetes or type 2 diabetes has shown that the ingestion of protein-rich food and non-starchy vegetables before concentrated carbohydrates (a carbohydrate-last food order) led to lower postprandial glucose excursions over 180 min, compared to eating the same foods in the reverse order. To expand upon this research, we sought to examine the feasibility and impact of carbohydrate-last food order behavioral intervention on glucose tolerance (GT), HbA1c, weight, and nutrient intake in adults with prediabetes in the real world over a 16-week span. (2) Methods: A total of 45 adults with overweight/obesity and prediabetes were randomized to receive 4-monthly standard nutritional counseling (C) or standard nutritional counseling plus carbohydrate-last food order counseling (FO) sessions (NCT# NCT03896360 ). (3) Results: The FO group decreased in body weight (−3.6 ± 5.7 lbs, p = 0.017), and trended toward lower HbA1c (−0.1 ± 0.2, p = 0.054). The C group weight trended lower (−2.6 ± 6.8 lbs, p = 0.102) without altering HbA1c (−0.03 ± 0.3, p = 0.605). GT was unchanged in both groups after 16 weeks. Changes in weight, HbA1c, and GT were similar between groups. Sensitivity analysis of pre-COVID participants showed significant weight loss in the FO group (−5.9 ± 5.3 lbs, p = 0.003) but not in C group (−1.0 ± 6.8 lbs, p = 0.608). After 16 weeks, the C group significantly reduced its daily intake of calories, fat, protein, and grains whereas the FO group increased its daily intake of vegetables and protein. There were 17 (94%) FO participants that reported high intervention adherence and 13 (72%) reported it was easy to eat protein/vegetables before carbohydrates. (4) Conclusions: A carbohydrate-last food order is a feasible behavioral strategy in individuals with prediabetes that improves diet quality, notably increasing protein and vegetable intake. Keywords: diet quality, body weight, HbA1c, glucose tolerance, dietary counseling
SHOW FULL ABSTRACT CITATION BIBTEX RIS
Alpana P Shukla, Ampadi Karan, Katie C Hootman et al.. A Randomized Controlled Pilot Study of the Food Order Behavioral Intervention in Prediabetes. Nutrients. (2023). https://doi.org/10.3390/nu15204452 Alpana P Shukla, Ampadi Karan, Katie C Hootman, Maya Graves, Ian Steller, Brittany Abel, Ashley Giannita, Jamie Tils, Lauren Hayashi, Madlen O’Connor, Anthony J Casper, Debra D’Angelo, Louis J Aronne
1Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY 10021, USA; [email protected] (A.K.); [email protected] (B.A.); [email protected] (A.G.); [email protected] (J.T.); [email protected] (A.J.C.); [email protected] (L.J.A.) 2Clinical & Translational Science Center, Weill Cornell Medicine, New York, NY 10021, USA 3Institute of Human Nutrition, Columbia University, New York, NY 10032, USA; [email protected] (M.G.); [email protected] (I.S.); [email protected] (L.H.); [email protected] (M.O.) 4NewYork Presbyterian-Weill Cornell Medicine Psychiatry, New York, NY 10021, USA 5Western University of Health Sciences, Pomona, CA 91766, USA 6Department of Medicine, University of California San Francisco Health, San Francisco, CA 94143, USA 7University of Florida College of Medicine, Gainesville, FL 32610, USA 8Queen’s University School of Medicine, Kingston, ON K7L 3L4, Canada 9Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10021, USA; [email protected] 