DIETFITS Study (Diet Intervention Examining the Factors Interacting With Treatment Success

NCT ID: NCT01826591

Last Updated: 2023-02-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

609 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-01-31

Study Completion Date

2016-05-31

Brief Summary

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Genomics research is advancing rapidly, and links between genes and obesity continue to be discovered and better defined. A growing number of single nucleotide polymorphisms (SNPs) in multiple genes have been shown to alter an individual's response to dietary macronutrient composition. Based on prior genetic studies evaluating the body's physiological responses to dietary carbohydrates or fats, the investigators identified multi-locus genotype patterns with SNPs from three genes (FABP2, PPARG, and ADRB2): a low carbohydrate-responsive genotype (LCG) and a low fat-responsive genotype (LFG). In a preliminary, retrospective study (using the A TO Z weight loss study data), the investigators observed a 3-fold difference in 12-month weight loss for initially overweight women who were determined to have been appropriately matched vs. mismatched to a low carbohydrate (Low Carb) or low fat (Low Fat) diet based on their multi-locus genotype pattern. The primary objective of this study is to confirm and expand on the preliminary results and determine if weight loss success can be increased if the dietary approach (Low Carb vs. Low Fat) is appropriately matched to an individual' s genetic predisposition (Low Carb Genotype vs. Low Fat Genotype) toward those diets.

Detailed Description

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If the intriguing preliminary retrospective results are confirmed in this full scale study, the results will demonstrate that inexpensive DNA testing could help dieters predict whether they will have greater weight loss success on a Low Carb or a Low Fat diet. Commensurate with increasing scientific interest in personalized medicine approaches to intervention development, this would provide an example of the potentially substantial health impacts that could be obtained through understanding specific gene-environment interactions that have been anticipated from the unraveling of the human genome.

Mobile App Sub-Study-For the purpose of augmenting adherence to high vegetable consumption in both diet groups, we will develop a theory-based mobile app to increase vegetable consumption through goal-setting, self-monitoring, and social comparison. Participants from both diet groups with iPhones will be re-randomized to receive the app at either months 4-5 or months 7-8. The first phase during months 4-7 will be used to compare the effect of a mobile app (intervention) vs. no mobile app (waiting-list control). The a priori hypothesis is that vegetable consumption will increase among those who receive the app in both diet arms. The investigator and outcomes assessor will be blinded to group assignment. Intention-to-treat analysis will be used.

Conditions

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Obesity Insulin Resistance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Experimental: Low-Carbohydrate Diet

Healthy, Low-Carbohydrate Diet

Group Type EXPERIMENTAL

Low-Carbohydrate Diet

Intervention Type BEHAVIORAL

Counseling/instruction on how to follow a low-carbohydrate diet.

Mobile App

Intervention Type BEHAVIORAL

Mobile app to increase vegetable consumption. Participants with iPhones will be re-randomized to receive a mobile app beginning at either months 4-5 or months 7-8. The first phase during months 4-7 will be used to compare the effect of a mobile app (intervention) vs. no mobile app (waiting-list control). The a priori hypothesis is that vegetable consumption will increase among those who receive the app in both diet groups.

Experimental: Low-Fat Diet

Healthy, Low-Fat Diet

Group Type EXPERIMENTAL

Low-Fat Diet

Intervention Type BEHAVIORAL

Counseling/instruction on how to follow a low-fat diet.

Mobile App

Intervention Type BEHAVIORAL

Mobile app to increase vegetable consumption. Participants with iPhones will be re-randomized to receive a mobile app beginning at either months 4-5 or months 7-8. The first phase during months 4-7 will be used to compare the effect of a mobile app (intervention) vs. no mobile app (waiting-list control). The a priori hypothesis is that vegetable consumption will increase among those who receive the app in both diet groups.

Interventions

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Low-Carbohydrate Diet

Counseling/instruction on how to follow a low-carbohydrate diet.

Intervention Type BEHAVIORAL

Low-Fat Diet

Counseling/instruction on how to follow a low-fat diet.

Intervention Type BEHAVIORAL

Mobile App

Mobile app to increase vegetable consumption. Participants with iPhones will be re-randomized to receive a mobile app beginning at either months 4-5 or months 7-8. The first phase during months 4-7 will be used to compare the effect of a mobile app (intervention) vs. no mobile app (waiting-list control). The a priori hypothesis is that vegetable consumption will increase among those who receive the app in both diet groups.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Age: \> 18 years of age
* Women: Pre-menopausal (self-report) and \<50 years of age
* Men: \<50 years of age
* BMI (body mass index): 27-40 kg/m2 (need to lose \>10% body weight to achieve healthy BMI)
* Body weight stable for the last two months, and not actively on a weight loss plan
* No plans to move from the area over the next two years
* Available and able to participate in the evaluations and intervention for the study period
* Willing to accept random assignment
* To enhance study generalizability, people on medications not noted below as specific exclusions can
* participate if they have been stable on such medications for at least three months
* Ability and willingness to give written informed
* No known active psychiatric illness

Exclusion Criteria

Subjects with the following conditions will be excluded (determined by self-report):

* Pregnant, lactating, within 6 months post-partum, or planning to become pregnant in the next 2 years
* Diabetes (type 1 and 2) or history of gestational diabetes or on hypoglycemic medications for any other indication
* Prevalent diseases: Malabsorption, renal or liver disease, active neoplasms, recent myocardial infarction (\<6 months)(patient self-report and, if available, review of labs from primary care provider)
* Smokers (because of effect on weight and lipids)
* History of serious arrhythmias, or cerebrovascular disease
* Uncontrolled hyper- or hypothyroidism (TSH not within normal limits)
* Medications: Lipid lowering, antihypertensive medications, and those known to affect weight/energy expenditure
* Excessive alcohol intake (self-reported, \>3 drinks/day)
* Musculoskeletal disorders precluding regular physical activity
* Unable to follow either of the two study diets for reasons of food allergies or other (e.g., vegan)
* Currently under psychiatric care, or taking psychiatric medications
* Inability to communicate effectively with study personnel
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Nutrition Science Initiative

OTHER

Sponsor Role collaborator

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

National Center for Advancing Translational Sciences (NCATS)

NIH

Sponsor Role collaborator

Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Christopher Gardner

Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christopher D Gardner, PhD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

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Stanford University School of Medicine

Stanford, California, United States

Site Status

Countries

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United States

References

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Mummah SA, Robinson TN, King AC, Gardner CD, Sutton S. IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior. J Med Internet Res. 2016 Dec 16;18(12):e317. doi: 10.2196/jmir.5927.

Reference Type BACKGROUND
PMID: 27986647 (View on PubMed)

Mummah SA, Mathur M, King AC, Gardner CD, Sutton S. Mobile Technology for Vegetable Consumption: A Randomized Controlled Pilot Study in Overweight Adults. JMIR Mhealth Uhealth. 2016 May 18;4(2):e51. doi: 10.2196/mhealth.5146.

Reference Type BACKGROUND
PMID: 27193036 (View on PubMed)

Mummah SA, King AC, Gardner CD, Sutton S. Iterative development of Vegethon: a theory-based mobile app intervention to increase vegetable consumption. Int J Behav Nutr Phys Act. 2016 Aug 8;13:90. doi: 10.1186/s12966-016-0400-z.

Reference Type BACKGROUND
PMID: 27501724 (View on PubMed)

Stanton MV, Robinson JL, Kirkpatrick SM, Farzinkhou S, Avery EC, Rigdon J, Offringa LC, Trepanowski JF, Hauser ME, Hartle JC, Cherin RJ, King AC, Ioannidis JP, Desai M, Gardner CD. DIETFITS study (diet intervention examining the factors interacting with treatment success) - Study design and methods. Contemp Clin Trials. 2017 Feb;53:151-161. doi: 10.1016/j.cct.2016.12.021. Epub 2016 Dec 24.

Reference Type BACKGROUND
PMID: 28027950 (View on PubMed)

Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JPA, Desai M, King AC. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018 Feb 20;319(7):667-679. doi: 10.1001/jama.2018.0245.

Reference Type BACKGROUND
PMID: 29466592 (View on PubMed)

Shih CW, Hauser ME, Aronica L, Rigdon J, Gardner CD. Changes in blood lipid concentrations associated with changes in intake of dietary saturated fat in the context of a healthy low-carbohydrate weight-loss diet: a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Am J Clin Nutr. 2019 Feb 1;109(2):433-441. doi: 10.1093/ajcn/nqy305.

Reference Type BACKGROUND
PMID: 30649213 (View on PubMed)

Fielding-Singh P, Patel ML, King AC, Gardner CD. Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12-Month Weight Gain in the DIETFITS Trial. Obesity (Silver Spring). 2019 Dec;27(12):1997-2004. doi: 10.1002/oby.22650. Epub 2019 Oct 21.

Reference Type BACKGROUND
PMID: 31633313 (View on PubMed)

Grembi JA, Nguyen LH, Haggerty TD, Gardner CD, Holmes SP, Parsonnet J. Gut microbiota plasticity is correlated with sustained weight loss on a low-carb or low-fat dietary intervention. Sci Rep. 2020 Jan 29;10(1):1405. doi: 10.1038/s41598-020-58000-y.

Reference Type BACKGROUND
PMID: 31996717 (View on PubMed)

Figarska SM, Rigdon J, Ganna A, Elmstahl S, Lind L, Gardner CD, Ingelsson E. Proteomic profiles before and during weight loss: Results from randomized trial of dietary intervention. Sci Rep. 2020 May 13;10(1):7913. doi: 10.1038/s41598-020-64636-7.

Reference Type BACKGROUND
PMID: 32404980 (View on PubMed)

Lai CQ, Parnell LD, Das SK, Gardner CD, Ordovas JM. Differential weight-loss responses of APOA2 genotype carriers to low-carbohydrate and low-fat diets: the DIETFITS trial. Obesity (Silver Spring). 2025 Jun;33(6):1048-1057. doi: 10.1002/oby.24288. Epub 2025 May 1.

Reference Type DERIVED
PMID: 40310284 (View on PubMed)

Krauss RM, Fisher LM, King SM, Gardner CD. Changes in soluble LDL receptor and lipoprotein fractions in response to diet in the DIETFITS weight loss study. J Lipid Res. 2024 Mar;65(3):100503. doi: 10.1016/j.jlr.2024.100503. Epub 2024 Jan 19.

Reference Type DERIVED
PMID: 38246235 (View on PubMed)

Hauser ME, Hartle JC, Landry MJ, Fielding-Singh P, Shih CW, Qin F, Rigdon J, Gardner CD. Association of dietary adherence and dietary quality with weight loss success among those following low-carbohydrate and low-fat diets: a secondary analysis of the DIETFITS randomized clinical trial. Am J Clin Nutr. 2024 Jan;119(1):174-184. doi: 10.1016/j.ajcnut.2023.10.028. Epub 2023 Nov 4.

Reference Type DERIVED
PMID: 37931749 (View on PubMed)

Soto-Mota A, Pereira MA, Ebbeling CB, Aronica L, Ludwig DS. Evidence for the carbohydrate-insulin model in a reanalysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial. Am J Clin Nutr. 2023 Mar;117(3):599-606. doi: 10.1016/j.ajcnut.2022.12.014. Epub 2023 Jan 6.

Reference Type DERIVED
PMID: 36811468 (View on PubMed)

Hartle JC, Zawadzki RS, Rigdon J, Lam J, Gardner CD. Development and evaluation of a novel dietary bisphenol A (BPA) exposure risk tool. BMC Nutr. 2022 Dec 6;8(1):143. doi: 10.1186/s40795-022-00634-4.

Reference Type DERIVED
PMID: 36474269 (View on PubMed)

Cauwenberghs N, Prunicki M, Sabovcik F, Perelman D, Contrepois K, Li X, Snyder MP, Nadeau KC, Kuznetsova T, Haddad F, Gardner CD. Temporal changes in soluble angiotensin-converting enzyme 2 associated with metabolic health, body composition, and proteome dynamics during a weight loss diet intervention: a randomized trial with implications for the COVID-19 pandemic. Am J Clin Nutr. 2021 Nov 8;114(5):1655-1665. doi: 10.1093/ajcn/nqab243.

Reference Type DERIVED
PMID: 34375388 (View on PubMed)

Fragiadakis GK, Wastyk HC, Robinson JL, Sonnenburg ED, Sonnenburg JL, Gardner CD. Long-term dietary intervention reveals resilience of the gut microbiota despite changes in diet and weight. Am J Clin Nutr. 2020 Jun 1;111(6):1127-1136. doi: 10.1093/ajcn/nqaa046.

Reference Type DERIVED
PMID: 32186326 (View on PubMed)

Oppezzo MA, Stanton MV, Garcia A, Rigdon J, Berman JR, Gardner CD. To Text or Not to Text: Electronic Message Intervention to Improve Treatment Adherence Versus Matched Historical Controls. JMIR Mhealth Uhealth. 2019 Apr 9;7(4):e11720. doi: 10.2196/11720.

Reference Type DERIVED
PMID: 30964436 (View on PubMed)

Guo J, Robinson JL, Gardner CD, Hall KD. Objective versus Self-Reported Energy Intake Changes During Low-Carbohydrate and Low-Fat Diets. Obesity (Silver Spring). 2019 Mar;27(3):420-426. doi: 10.1002/oby.22389. Epub 2019 Jan 22.

Reference Type DERIVED
PMID: 30672127 (View on PubMed)

Mummah S, Robinson TN, Mathur M, Farzinkhou S, Sutton S, Gardner CD. Effect of a mobile app intervention on vegetable consumption in overweight adults: a randomized controlled trial. Int J Behav Nutr Phys Act. 2017 Sep 15;14(1):125. doi: 10.1186/s12966-017-0563-2.

Reference Type DERIVED
PMID: 28915825 (View on PubMed)

Related Links

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Other Identifiers

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1R01DK091831

Identifier Type: NIH

Identifier Source: secondary_id

View Link

T32HL007034

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UL1TR001085

Identifier Type: NIH

Identifier Source: secondary_id

View Link

22305

Identifier Type: -

Identifier Source: org_study_id

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