A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Eligibility
2.2. Randomization and Study Groups
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Characteristics of the Participants
3.2. Physical Activity and Dietary Intake
3.3. Body Mass Index and Body Composition
3.4. Laboratory Variables
3.5. Beta-Cell Function
3.6. Insulin Resistance
3.7. The Effect of BMI and Adiposity
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
BMI | body mass index |
Gxt | the interaction between the factors group and time in the ANOVA model |
HbA1c | glycated hemoglobin |
HOMA-IR | Homeostasis Model Assessment Insulin Resistance |
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Characteristic | Intervention Group (n = 38) | Control Group (n = 37) |
---|---|---|
Age (years) | 52.6 ± 14.7 | 54.3 ± 9.9 |
Sex (number, %) | ||
Male | 2 (5%) | 6 (16%) |
Female | 36 (95%) | 31 (84%) |
Race, (number, %) | ||
White | 15 (39%) | 19 (51%) |
Black | 20 (53%) | 14 (38%) |
Asian, Pacific Islander | 0 | 4 (11%) |
American Indian, Eskimo, Aleut | 2 (5%) | 0 |
N/A—did not disclose | 1 (3%) | 0 |
Ethnicity, (number, %) | ||
Non-hispanic | 33 (87%) | 31 (84%) |
Hispanic | 3 (8%) | 3 (8%) |
N/A—did not disclose | 2 (5%) | 3 (8%) |
Marital status | ||
Not married | 22 (58%) | 19 (51%) |
Married | 16 (42%) | 17 (46%) |
NA | 0 | 1 (3%) |
Education | ||
High school | 0 | 0 |
College | 17 (45%) | 20 (54%) |
Graduate degree | 20 (53%) | 17 (46%) |
NA | 1 (2%) | 0 |
Occupation | ||
Service occupation | 5 (13%) | 1 (3%) |
Technical, sales, administrative | 15 (39%) | 10 (27%) |
Professional or managerial | 10 (26%) | 16 (43%) |
Retired | 4 (11%) | 6 (16%) |
Other | 4 (11%) | 4 (11%) |
Medications | ||
Lipid-lowering therapy (%) | 5 (13) | 4 (11) |
Antihypertensive therapy (%) | 11 (29) | 7 (19) |
Thyroid medications (%) | 6 (16) | 3 (8) |
Control Group | Intervention Group | Treatment Effect | p-Value | |||
---|---|---|---|---|---|---|
Baseline | Week 16 | Baseline | Week 16 | |||
Total physical activity (METs) | 2642 (1476–3809) | 2575 (1169–3980) | 2207 (1444–2969) | 2490 (1586–3395) | +351 (−1143 to +1846) | 0.46 |
Dietary intake | ||||||
Caloric intake (kcal/day) | 1923 (1627–2219) | 1582 (1368–1795) ** | 1851 (1695–2007) | 1450 (1249–1652) *** | −60 (−352 to +233) | 0.69 |
Carbohydrates (% of daily energy) | 45.5 (42.6–48.4) | 46.6 (42.9–50.4) | 46.1 (43.5–48.8) | 69.6 (67.3–71.8) *** | +22.3 (+17.7 to +26.9) | <0.001 |
Fats (% of daily energy) | 35.6 (32.3–38.9) | 35.0 (31.5–38.4) | 36.1 (34.0–38.1) | 17.5 (15.5–19.4) *** | −17.9 (−22.3 to −13.6) | <0.001 |
Proteins (% of daily energy) | 16.1 (15.0–17.1) | 17.0 (15.5–18.5) | 16.8 (15.4–18.2) | 12.3 (11.3–13.3) *** | −5.4 (−7.8 to −3.0) | <0.001 |
Fiber intake (g/day) | 25.2 (20.9–29.6) | 23.5 (19.6–27.4) | 24.2 (21.0–27.4) | 37.8 (31.4–44.1) *** | +15.3 (+8.0 to +22.6) | <0.001 |
Cholesterol intake (mg/day) | 290 (220–360) | 212 (149–275) | 264 (213–315) | 6.5 (2.5–10.5) *** | −180 (−278 to −82) | <0.001 |
Saturated fatty acids (g/day) | 25.5 (19.8–31.1) | 17.9 (13.6–22.2) ** | 24.5 (21.2–27.7) | 5.6 (4.6–6.7) *** | −11.2 (−16.5 to −5.9) | <0.001 |
Monounsaturated fatty acids (g/day) | 30.5 (23.8–37.2) | 24.9 (19.8–30.0) | 28.9 (25.1–32.7) | 9.5 (7.8–11.2) *** | −13.8 (−19.5 to −8.2) | <0.001 |
Polyunsaturated fatty acids (g/day) | 20.9 (15.3–26.5) | 17.9 (14.8–21.1) | 18.2 (15.2–21.1) | 10.6 (9.0–12.2) *** | −4.6 (−10.1 to +0.9) | 0.10 |
Glycemic index | 58.1 (56.2–59.9) | 57.4 (55.3–59.5) * | 57.7 (55.5–59.9) | 54.4 (53.4–55.5) ** | −2.6 (−5.7 to +0.5) | 0.10 |
Anthropometric variables | ||||||
BMI (kg/m2) | 33.6 (32.5–34.8) | 33.4 (32.2–34.6) | 33.1 (31.8–34.3) | 31.2 (29.9–32.5) *** | −2.0 (−2.6 to −1.5) | <0.001 |
Lean mass (kg) | 49.8 (46.2–53.4) | 48.8 (45.4–52.2) ** | 50.6 (48.6–52.5) | 48.3 (46.5–50.1) *** | −1.2 (−2.0 to −0.5) | 0.002 |
Fat mass (kg) | 39.1 (35.6–42.5) | 39.5 (36.0–43.0) | 42.0 (39.3–44.7) | 38.1 (35.6–40.7) *** | −4.3 (−5.4 to −3.2) | <0.001 |
Visceral fat volume (cm3) | 1434 (1154–1714) | 1459 (1173–1744) | 1289 (1040–1539) | 1090 (864–1315) *** | −224 (−328 to −120) | <0.001 |
Laboratory variables | ||||||
Total cholesterol (mmol/L) | 5.4 (5.0–5.8) | 5.3 (5.0–5.6) | 5.4 (5.1–5.7) | 4.8 (4.4–5.2) *** | −1.1 (−2.0 to −0.2) | 0.02 |
HDL-cholesterol (mmol/L) | 1.6 (1.4–1.8) | 1.6 (1.4–1.8) | 1.6 (1.5–1.8) | 1.4 (1.3–1.6) *** | −0.4 (−0.6 to −0.2) | 0.002 |
LDL-cholesterol (mmol/L) | 3.2 (2.9–3.6) | 3.2 (2.9–3.5) | 3.2 (2.9–3.5) | 2.7 (2.3–3.1) ** | −0.9 (−1.8 to −0.1) | 0.03 |
Triglycerides (mmol/L) | 1.1 (0.9–1.4) | 1.2 (0.9–1.6) | 1.2 (1.0–1.3) | 1.4 (1.2–1.7) ** | +0.9 (−0.3 to +2.2) | 0.16 |
Fasting plasma glucose (mmol/L) | 5.5 (5.3–5.7) | 5.6 (5.4–5.8) | 5.3 (5.1–5.6) | 5.1 (4.9–5.2) ** | −0.4 (−0.6 to −0.2) | <0.001 |
Fasting plasma insulin (pmol/L) | 72.9 (56.9–88.2) | 88.9 (38.9–135.4) | 91.7 (72.9–111.8) | 71.5 (55.6–87.5) ** | −85.4 (−170.8 to +0.7) | 0.05 |
Fasting plasma C-peptide (ng/mL) | 2.5 (2.2–2.8) | 3.0 (2.2–3.8) | 2.6 (2.3–2.9) | 2.1 (1.9–2.4) *** | −1.0 (−1.6 to −0.4) | 0.003 |
HbA1c (DCCT, %) | 5.8 (5.7–5.9) | 5.8 (5.7–5.9) | 5.8 (5.7–5.9) | 5.8 (5.7–5.9) | 0.0 (−0.1 to +0.1) | 0.81 |
HbA1c (IFCC, mmol/mol) | 40 (38.8–41.2) | 40.1 (38.8–41.4) | 39.9 (38.3–41.4) | 40.1 (38.9–41.4) | +0.1 (−24.6 to +22.4) | 0.81 |
Insulin secretion/ Beta-cell function | ||||||
Basal insulin secretion (pmol/min/m2) | 100.5 (94.4–107.2) | 104.1 (97.7–111.3) | 108.6 (102.2–115.8) | 83.0 (78.9–87.5) ** | −54.2 (−86.5 to −21.9) | <0.001 |
Total insulin secretion (nmol/m2) | 55.3 (52.6–58.2) | 63.3 (60.4–66.4) ** | 53.8 (51.4–56.3) | 54.8 (52.4–57.3) | −8.8 (−17.3 to +0.4) | 0.07 |
Insulin secretion at a fixed glucose value (5 mM) (pmol/min/m2) | 110.0 (99.6–121.1) | 103.1 (93.9–112.8) | 109.4 (100.1–119.4) | 116.6 (105.9–128.1) * | +14.2 (−25.0 to +63.3) | 0.10 |
Mean glucose (mmol/L) | 5.5 (5.2–5.8) | 6.1 (5.7–6.4) *** | 5.6 (5.2–6.0) | 5.4 (4.9–5.9) * | −0.8 (−1.2 to −0.4) | <0.001 |
Mean insulin (pmol/L) | 312.2 (234.4–390.0) | 406.4 (316.8–496.0) * | 330.0 (259.4–400.6) | 348.6 (274.7–422.5) | −75.7 (−180.4 to +29.1) | 0.15 |
Glucose sensitivity (pmol/min/m2/mM) | 107.5 (76.4–146.5) | 181.1 (135.3–237.2) | 108.5 (80.8–142.4) | 213.8 (167.9–268.3) ** | +65.5 (−74.4 to +205.4) | 0.13 |
Rate sensitivity (pmol/m2/mM) | 2260 (1419–3101) | 1978 (1188–2768) | 2783 (2127–3438) | 2269 (1505–3033) | −232 (−1601 to +1137) | 0.38 |
Potentiation factor ratio (dimensionless) | 1.45 (1.28–1.63) | 1.62 (1.43–1.82) | 1.32 (1.17–1.47) | 1.08 (0.95–1.22) | −0.51 (−1.04 to +0.03) | 0.08 |
Insulin sensitivity /resistance | ||||||
3 h-oral glucose insulin sensitivity (mL/min/m2) | 403.2 (389.1–417.6) | 388.2 (374.5–402.3) | 404.1 (391.7–416.8) | 406.7 (394.2–419.5) | +10.8 (−29.5 to +51.1) | 0.78 |
HOMA-IR (dimensionless) | 2.4 (2.1–2.7) | 2.8 (2.5–3.1) | 2.5 (2.3–2.8) | 1.9 (1.7–2.1) *** | −1.0 (−1.2 to −0.8) | 0.004 |
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Kahleova, H.; Tura, A.; Hill, M.; Holubkov, R.; Barnard, N.D. A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial. Nutrients 2018, 10, 189. https://doi.org/10.3390/nu10020189
Kahleova H, Tura A, Hill M, Holubkov R, Barnard ND. A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial. Nutrients. 2018; 10(2):189. https://doi.org/10.3390/nu10020189
Chicago/Turabian StyleKahleova, Hana, Andrea Tura, Martin Hill, Richard Holubkov, and Neal D. Barnard. 2018. "A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial" Nutrients 10, no. 2: 189. https://doi.org/10.3390/nu10020189