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

S. Navas-Carretero*, R. San-Cristobal*, P.S. Vestentoft, J.C. Brand-Miller, E. Jalo, M. Westerterp-Plantenga, E.J. Simpson, T. Handjieva-Darlenska, G. Stratton, M. Huttunen-Lenz, T. Lam, R. Muirhead, S. Poppitt, K.H. Pietilainen, T. Adam, M.A. Taylor, S. Handjiev, M.A. McNarry, S. Hansen, S. BrodieM.P. Silvestre, I.A. Macdonald, N. Boyadjieva, K.A. Mackintosh, W. Schlicht, A. Liu, T.M. Larsen, M. Fogelholm, A. Raben, J.A. Martinez

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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) x 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.<br>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 & GE;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.<br>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.<br>Conclusions: Two novel indices of insulin resistance (TyG and TyG-waist) may allow for a more personalized approach to avoiding progression to T2D.<br>
Original languageEnglish
Article number733697
Number of pages12
JournalFrontiers in nutrition
Publication statusPublished - 1 Nov 2021


  • obesity
  • pre-diabetes
  • triglycerides (PubChem CID
  • 5460048)
  • hypertriglyceridemic-waist phenotype
  • precision nutrition
  • diabetes
  • carbohydrate metabolism
  • lipid markers
  • DIET


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