Lower Fat Intake Is Associated With Lower Weight and Cholesterol at 4 Months in Adults With Impaired Glucose Metabolism

Several large clinical trials in diverse high-risk populations have demonstrated that participation in intensive lifestyle interventions can reduce prediabetes or prevent its progression to type 2 diabetes.1–5 In the largest of these clinical trials, the Diabetes Prevention Program (DPP), significant differences in dietary intake (e.g., lower percentage of energy from fat, higher number of fruit and vegetable servings, and higher fiber content) were observed in participants in the lifestyle intervention group compared to those in the metformin and placebo groups at 1 year after randomization.6 Furthermore, achievement and maintenance of weight loss was associated with selfmonitoring of dietary fat intake and meeting physical activity goals.7 Although translation of a structured diabetes prevention program, including dietary changes, moderatelevel physical activity, and weight loss of 5–7% of body weight, has been successful in various community settings,8–17 only one study to date has examined the individual-level factors associated with successful achievement and maintenance of weight loss.13,17 This study used trained health professionals as lifestyle coaches. In contrast, our previous research translating the DPP used trained YMCA fitness or wellness instructors and has proven successful in achieving and maintaining meaningful levels of weight loss and reductions in overall cardiometabolic risk for adults with abnormal glucose metabolism.8,14 The Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA (DEPLOY) study was designed to achieve modest weight loss, in part through reduced intake of total dietary calories beginning with strategies to reduce dietary fat. In this article, we explore whether change in nutrition intake, particularly in percentage of energy from dietary fat (PEF), is associated with observed changes in our primary outcomes—total cholesterol and body weight—after participating in the DEPLOY study.