Precision medicine is changing the way people are diagnosed and treated into a more personalized approach. Using a novel statistical approach, we demonstrate how two diets cause differential weight loss depending on pre-treatment fasting plasma glucose (FPG) and fasting insulin (FI) levels.
One hundred and eighty-one overweight people with increased waist circumference were randomly assigned to receive an ad libitum New Nordic Diet (NND) high in dietary fiber and whole grain or an Average Danish (Western) Diet (ADD) for 26 weeks. All foods were provided free of charge. Body weight was measured throughout the study and blood was drawn before randomization from where FPG and FI were analyzed. Weight was described by linear mixed models including biomarker (FPG or FI) diet group interactions. Individualized predictions were estimated as contrasts of intercepts and slopes of pre-treatment biomarkers.
Every mmol/L increase in baseline FPG predicted a between-diet difference of 3.00 (1.18;4.83, n = 181, P = 0.001) kg larger weight loss from choosing NND over ADD. For instance, a baseline FPG level of 4.7 mmol/L would lead to an average of 1.42 kg larger weight loss on NND vs. ADD (above 0.41 kg with 95% certainty), whereas the average effect size would be 8.33 kg (above 5.50 kg with 95% certainty) among subjects with FPG level of 7.0 mmol/L. Among individuals with FPG <5.6 mmol/L, each pmol/L lower baseline FI predicted a 0.039 (95% CI 0.017;0.061, n = 143, P < 0.001) kg larger weight loss from choosing NND over ADD.
Use of pre-treatment FPG and FI led to truly individualized predictions of treatment effect of introducing more fiber and whole grain in the diet on weight loss, ranging from almost no effect to losing >8 kg. These findings suggest that this novel statistical approach has great potential when re-evaluating data from existing randomized controlled trials.
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The Nordea Foundation Denmark funded the study and local food companies provided foods for the shop. Neither the funder nor the food sponsors had any influence on the study design, data collection, data analysis, data interpretation or the content and submission of this paper. We thank Sanne Kellebjerg Korndal that coordinated and executed the study as part of her PhD at the Department of Nutrition, Exercise and Sports, University of Copenhagen.
The overall study was supported by the Nordea Foundation (grant no. 02–2010–0389) and sponsors who provided foods to the shop.
Conflict of interest
CR, AA and MFH are co-inventors on a pending provisional patent application for the use of biomarkers to predict responses to weight loss diets. AA is co-inventor of other related patents and patent applications that are owned by UCPH, in accordance with Danish law. AA is consultant or member of the advisory boards of Gelesis Inc., Groupe Ethique et Sante, France; Weight Watchers, United States; BioCare, Copenhagen; Zaluvida, Switzerland; Novo Nordisk, Denmark; Pfizer, New Jersey, USA; and Saniona, Denmark. MFH and AA are co-authors of the book Spis dig slank efter dit blodsukker (Eat according to your blood sugar and be slim), published by Politikens Forlag, Denmark, and of other books about personalized nutrition for weight loss. AA is co-owner and member of the board of the consultancy company Dentacom ApS, Denmark, and cofounder and co-owner of the UCPH spin-off Mobile Fitness A/S and Flax-Slim ApS. MFH and AA are co-founders and co-owners of the UCPH spin-off Personalized Weight Management Research Consortium ApS (http://Gluco-diet.dk). TML serves as an advisor for Sense diet program.
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Ritz, C., Astrup, A., Larsen, T.M. et al. Weight loss at your fingertips: personalized nutrition with fasting glucose and insulin using a novel statistical approach. Eur J Clin Nutr 73, 1529–1535 (2019). https://doi.org/10.1038/s41430-019-0423-z
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