Associations of changes in reported and estimated protein and energy intake with changes in insulin resistance, glycated hemoglobin, and BMI during the PREVIEW lifestyle intervention study

M. Drummen, T.C. Adam, I.A. Macdonald, E. Jalo, T.M. Larssen, J.A. Martinez, T. Handjiev-Darlenska, J. Brand-Miller, S.D. Poppitt, G. Stratton, K.H. Pietildinen, M.A. Taylor, S. Navas-Carretero, S. Handjiev, R. Muirhead, M.P. Silvestre, N. Swindell, M. Huttunen-Lenz, W. Schlicht, T. LamJ. Sundvall, L. Raman, E. Feskens, A. Tremblay, A. Raben, M.S. Westerterp-Plantenga*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Observed associations of high-protein diets with changes in insulin resistance are inconclusive.Objectives: We aimed to assess associations of changes in both reported and estimated protein (P-Rep; P-Est) and energy intake (EIRep; EIEST) with changes in HOMA-IR, glycated hemoglobin (HbA1c), and BMI (in kg/m(2)), in 1822 decreasing to 833 adults (week 156) with overweight and prediabetes, during the 3-y PREVIEW (PREVention of diabetes through lifestyle intervention and population studies In Europe and around the World) study on weight-loss maintenance. Eating behavior and measurement errors (MEs) of dietary intake were assessed. Thus, observational post hoc analyses were applied.Methods: Associations of changes in EIEst, EIRep, P-Est, and P-Rep with changes in HOMA-1R, HbA1c, and BMI were determined by linear mixed-model analysis in 2 arms [high-protein-low-glycemicindex (GI) diet and moderate-protein-moderate-GI diet] of the PREVIEW study. EI Est was derived from energy requirement: total energy expenditure = basal metabolic rate x physical activity level; P-Est from urinary nitrogen, and urea. MEs were calculated as [EIEst - EIRep)/EIEst] x 100% and [(P-Rep- P-Est)/P-Est] x 100%. Eating behavior was determined using the Three Factor Eating Questionnaire, examining cognitive dietary restraint, disinhibition, and hunger.Results: Increases in P-Est and P-Rep and decreases in EIEst and EIRep were associated with decreases in BMI, but not independently with decreases in HOMA-IR. Increases in P-Est and P-Rep were associated with decreases in HbA1c. P-Rep and EIRep showed larger changes and stronger associations than P-Est and EIEst. Mean +/- SD MEs of EIRep and P-Rep were 38% +/- 9% and 14% +/- 4%, respectively: ME changes in EIRep and En% P-Rep were positively associated with changes in BMI and cognitive dietary restraint and inversely with disinhibition and hunger.Conclusions: During weight-loss maintenance in adults with prediabetes, increase in protein intake and decrease in energy intake were not associated with decrease in HOMA-IR beyond associations with decrease in BMI. Increases in P-Est and P-Rep were associated with decrease in HbA1c.
Original languageEnglish
Pages (from-to)1847-1858
Number of pages12
JournalAmerican Journal of Clinical Nutrition
Issue number5
Publication statusPublished - 1 Nov 2021


  • obesity
  • prediabetes
  • measurement error of dietary intake reporting
  • urinary nitrogen as biomarker
  • basal metabolic rate
  • physical activity level

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