title: Dietary changes and associations with metabolic improvements in adults with type 2 diabetes during a patient-centred dietary intervention: an exploratory analysis.
abstract: OBJECTIVE
  Describe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated haemoglobin (HbA1c), weight, lipids and blood pressure.
  
  
  METHODS
  Secondary analysis of data from the Early ACTivity in Diabetes randomised controlled trial.
  
  
  METHODS
  262 patients with newly diagnosed type 2 diabetes randomised to the dietary intervention.
  
  
  METHODS
  Changes in energy intake, macronutrients, fibre and alcohol and in weight, waist circumference, lipids, HbA1c and blood pressure at baseline and 6 months. Multivariate models were used to examine associations between dietary changes and metabolic variables.
  
  
  RESULTS
  Men reported reducing mean energy intake from 1903±462 kcal to 1685 kcal±439 kcal (p<0.001), increasing carbohydrate intake from 42.4±6.6% to 43.8±6.6% (p=0.002) and reducing median alcohol intake from 13 (0-27) g to 5 (0-18) g (p<0.001). Women reported reducing mean energy intake from 1582±379 kcal to 1459±326 kcal (p<0.001) with no change to macronutrient distribution and alcohol. Fibre intake was maintained. In men (n=148), weak and clinically insignificant associations were found between increased carbohydrates and reduction in HbA1c (β=-0.003 (-0.006, -0.001); p=0.009), increased fibre and reduction in total cholesterol (β=-0.023 (-0.044, -0.002); p=0.033), decreased total fat and reduction in low-density lipoprotein (LDL)-cholesterol (β=0.024 (0.006, 0.001); p=0.011), and decreased alcohol and reduction in diastolic blood pressure (β=0.276 (0.055, 0.497); p=0.015). In women (n=75), associations were found between a decrease in transfats and reductions in waist circumference (β=-0.029 (0.006, 0.052); p=0.015), total cholesterol (β=0.399 (0.028, 0.770); p=0.036) and LDL cholesterol (β=0.365 (0.042, 0.668); p=0.028).
  
  
  CONCLUSIONS
  Clinically important metabolic improvements observed in a patient-centred dietary intervention were not explained by changes in macronutrients. However, a non-prescriptive approach may promote a reduction in total energy intake while maintaining fibre consumption.
  
  
  BACKGROUND
  The Early ACTID trial number ISRCTN92162869.
authors.affiliation: Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: C Y
authors.initials: CY
authors.lastname: England
authors.affiliation: University of Birmingham, School of Sport, Exercise & Rehabilitation Sciences, Birmingham, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Jago
authors.affiliation: Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Cooper
authors.affiliation: School of Clinical Sciences, University of Bristol, Learning and Research, Southmead Hospital, Bristol, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Andrews
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care
keywords: Dietary analysis; Dietary change; Type 2 diabetes