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Appraisal of Triglyceride-Related Markers as Early Predictors of Metabolic Outcomes in the PREVIEW Lifestyle Intervention: A Controlled Post-hoc Trial.

Center for Nutrition Research, University of Navarra, Pamplona, Spain. Centro de Investigación Biomédica en Red (CIBER) obn, Instituto de Salud Carlos III, Madrid, Spain. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain. Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia. Department of Food and Nutrition, University of Helsinki, Helsinki, Finland. Department of Nutrition and Movement Sciences, NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands. Division of Physiology, Pharmacology and Neuroscience, MRC/ARUK Centre for Musculoskeletal Ageing Research, ARUK Centre for Sport, Exercise and Osteoarthritis, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, Queen's Medical Centre, Nottingham, United Kingdom. Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria. Applied Sports Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Swansea, United Kingdom. Institute of Nursing Science, University of Education, Schwäbisch Gmünd, Germany. NetUnion Sarl, Lausanne, Switzerland. Human Nutrition Unit, Department of Medicine, School of Biological Sciences, University of Auckland, Auckland, New Zealand. Obesity Research Unit, Diabetes and Obesity Research Program, University of Helsinki and Endocrinology, Helsinki, Finland. Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany. Center for Health Technology Services Research (CINTESIS), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal. Exercise and Health Sciences, University of Stuttgart, Nobelstraße, Germany. Steno Diabetes Centre Copenhagen, Gentofte, Denmark.

Frontiers in nutrition. 2021;:733697
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Abstract

Background: Individuals with pre-diabetes are commonly overweight and benefit from dietary and physical activity strategies aimed at decreasing body weight and hyperglycemia. Early insulin resistance can be estimated via the triglyceride glucose index {TyG = Ln [TG (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2]} and the hypertriglyceridemic-high waist phenotype (TyG-waist), based on TyG x waist circumference (WC) measurements. Both indices may be useful for implementing personalized metabolic management. In this secondary analysis of a randomized controlled trial (RCT), we aimed to determine whether the differences in baseline TyG values and TyG-waist phenotype predicted individual responses to type-2 diabetes (T2D) prevention programs. Methods: The present post-hoc analyses were conducted within the Prevention of Diabetes through Lifestyle intervention and population studies in Europe and around the world (PREVIEW) study completers (n = 899), a multi-center RCT conducted in eight countries (NCT01777893). The study aimed to reduce the incidence of T2D in a population with pre-diabetes during a 3-year randomized intervention with two sequential phases. The first phase was a 2-month weight loss intervention to achieve ≥8% weight loss. The second phase was a 34-month weight loss maintenance intervention with two diets providing different amounts of protein and different glycemic indices, and two physical activity programs with different exercise intensities in a 2 x 2 factorial design. On investigation days, we assessed anthropometrics, glucose/lipid metabolism markers, and diet and exercise questionnaires under standardized procedures. Results: Diabetes-related markers improved during all four lifestyle interventions. Higher baseline TyG index (p < 0.001) was associated with greater reductions in body weight, fasting glucose, and triglyceride (TG), while a high TyG-waist phenotype predicted better TG responses, particularly in those randomized to physical activity (PA) of moderate intensity. Conclusions: Two novel indices of insulin resistance (TyG and TyG-waist) may allow for a more personalized approach to avoiding progression to T2D. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT01777893 reference, identifier: NCT01777893.