{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:14:03Z","timestamp":1775060043476,"version":"3.50.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>Recent studies advocate prediabetes remission as a goal in diabetes prevention, but the optimal dietary composition for prediabetes remission over the long term is unknown. We aimed to examine the long-term effects on prediabetes remission of a prudent diet with moderate protein and a moderate glycaemic index (GI) (akin to general dietary guidelines) vs a high-protein, low-GI diet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study is a secondary analysis of PREVIEW, which is a 3 year, multicentre, parallel, randomised trial. Adults with overweight\/obesity (BMI \u2265 25 and &lt;30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      or BMI \u2265 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively) and prediabetes (fasting glucose 5.6\u20136.9 mmol\/l and\/or 2\u00a0h glucose 7.8\u201311.0 mmol\/l determined using an OGTT) were recruited. Eligible participants underwent an 8-week rapid weight loss programme comprising a low-energy diet, followed by a 3 year weight maintenance phase comprising lifestyle intervention. At baseline, participants were randomly assigned to a high-protein (25% of energy from protein), low-GI (GI&lt;50) diet, or a prudent diet with moderate protein (15% of energy from protein) and moderate GI (GI&gt;56). The primary outcome of the current analysis was the number of participants who achieved prediabetes remission (i.e. a return to normal fasting glucose and normal glucose tolerance) at 1 year or 3 years. Secondary outcomes were changes in body weight and composition over 3 years (continuous variables) and maintenance of a \u22658% weight loss target (binary variable). Modified intention-to-treat analyses were performed on all participants who received the dietary intervention (\n                      <jats:italic>n<\/jats:italic>\n                      =1856). Risk ratios and 95% CI for prediabetes remission and maintaining the weight loss target in each diet group were estimated using multilevel modified Poisson regression adjusted for age and sex. Linear mixed models were used to estimate the dietary effects on changes in body weight and composition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The moderate-protein, moderate-GI group (\n                      <jats:italic>n<\/jats:italic>\n                      =923) had a higher rate of remission than the high-protein, low-GI group (\n                      <jats:italic>n<\/jats:italic>\n                      =933) at both 1 year (rate of remission 26.3% vs 20.7%; RR 1.26; 95% CI 1.04, 1.53;\n                      <jats:italic>p<\/jats:italic>\n                      =0.025) and 3 years (20.6% vs 15.5%; RR 1.26; 95% CI 1.06, 1.50;\n                      <jats:italic>p<\/jats:italic>\n                      =0.015). However, body weight and composition changes were similar for participants on the moderate-protein, moderate-GI vs high-protein, low-GI diet at 1 year (54.0% vs 57.3% of participants met the weight loss maintenance target [\u22658% of initial body weight];\n                      <jats:italic>p<\/jats:italic>\n                      =0.215) and 3 years (31.4% vs 30.4%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      =0.793). The differences in remission rates of the two dietary patterns were independent of body weight and composition changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Following rapid weight loss, a prudent diet with moderate protein and moderate GI was more effective for long-term prediabetes remission than a high-protein, low-GI diet, irrespective of weight change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT01777893<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-025-06560-x","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T20:27:10Z","timestamp":1760560030000},"page":"81-92","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-term effects of dietary protein and carbohydrate quality on prediabetes remission: results from the PREVIEW randomised multinational diabetes prevention trial"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2170-4667","authenticated-orcid":false,"given":"Ruixin","family":"Zhu","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6104-9957","authenticated-orcid":false,"given":"Jie","family":"Guo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1034-1613","authenticated-orcid":false,"given":"Maija","family":"Huttunen-Lenz","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9327-2897","authenticated-orcid":false,"given":"Marta","family":"Silvestre","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5618-0803","authenticated-orcid":false,"given":"Gareth","family":"Stratton","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7540-9850","authenticated-orcid":false,"given":"Ian A.","family":"Macdonald","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8307-343X","authenticated-orcid":false,"given":"Teodora","family":"Handjieva-Darlenska","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9717-7106","authenticated-orcid":false,"given":"Svetoslav","family":"Handjiev","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5163-2230","authenticated-orcid":false,"given":"Santiago","family":"Navas-Carretero","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2214-8378","authenticated-orcid":false,"given":"Sally D.","family":"Poppitt","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8110-102X","authenticated-orcid":false,"given":"Mikael","family":"Fogelholm","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0530-7349","authenticated-orcid":false,"given":"Diego","family":"Martinez-Urbistondo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5218-6941","authenticated-orcid":false,"given":"J. 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Specifically, we would like to thank E. Feskens (Wageningen University, the Netherlands), T. Larsen and P. Vestentoft (University of Copenhagen, Denmark) and W. Schlicht (University of Stuttgart, Germany).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The datasets analysed during the current study are available from the corresponding author on reasonable request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"Open Access funding enabled and organized by CAUL and its Member Institutions. This study was funded by EU Framework Programme\u00a07 (FP7\/2007-2013, grant agreement number 312057), the Australian National Health and Medical Research Council (EU Collaborative Grant, AUS\u00a08, ID 1067711), the Glycemic Index Foundation Australia through royalties to the University of Sydney, the New Zealand Health Research Council (grant number 14\/191), the University of Auckland Faculty Research Development Fund, the Danish Agriculture & Food Council, the Danish Meat and Research Institute, the UK National Institute for Health Research Biomedical Research Centre (NIHR BRC), the UK Biotechnology and Biological Sciences Research Council (BBSRC), the UK Engineering and Physical Sciences Research Council (EPSRC), the Juho Vainio Foundation (Finland), the Academy of Finland (grant numbers: 272376, 314383, 266286 and 314135), the Finnish Medical Foundation, the Gyllenberg Foundation, the Novo Nordisk Foundation, the Finnish Diabetes Research Foundation, University of Helsinki, Government Research Funds for Helsinki University Hospital, the Jenny and Antti Wihuri Foundation (Finland), the Emil Aaltonen Foundation (Finland), the China Postdoctoral Science Foundation (grant numbers 2023T00376 and 2023M743787), the National Natural Science Foundation of China (grant number 82404349) and the China Talent Postdoctoral Researcher Program (Overseas). The Cambridge Weight Plan donated all products for the 8-week weight loss period. Nutritics (Dublin) donated all dietary analysis software used by the University of Nottingham. The study sponsors\/funders were not involved in the design of the study, the collection, analysis and interpretation of data, or writing the report, and did not impose any restrictions regarding publication of the report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"IAM was a member of the UK Government Scientific Advisory Committee on Nutrition, the Mars Scientific Advisory Council, the Mars Europe Nutrition Advisory Board, the Nestl\u00e9 Research Scientific Advisory Board and the Novozymes Scientific Advisory Board, and was a Scientific Advisor to the Waltham Centre for Pet Nutrition until 2020. On 1 August 2020, he became Professor Emeritus at the University of Nottingham and took up the post of Scientific Director of the Nestl\u00e9 Institute of Health Sciences in Lausanne, Switzerland, which terminated in August 2022. SDP was the Fonterra Chair in Human Nutrition during the PREVIEW intervention. AR has received honoraria from the International Sweeteners Association, Nestl\u00e9 and Unilever, and research funds from Novo Nordisk A\/S. JB-M reports a relationship with the China National Research Institute of Food and Fermentation Industries that includes consulting or advisory roles, speaking and lecture fees, and travel reimbursement. She also reports a relationship with the Novo Nordisk Foundation that includes consulting or advisory roles, and a relationship with Hachette Livre that includes being a co-author of books about the glycaemic index of foods and diabetes. She oversees a glycaemic index testing service at the University of Sydney. She was President of the Glycemic Index Foundation between 2002 and 2024. She is on the editorial boards of the\n                      American Journal of Clinical Nutrition\n                      and the\n                      International Journal of Obesity\n                      and the scientific board of Zoe Global, a personalised nutrition company. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"JB-M, RZ and AR contributed to conception and design of the present study. RZ and JG analysed the data and was responsible for the statistical considerations. RZ wrote the manuscript. MH-L, MS, GS, IAM, TH-D, SH, SN-C, SDP, MF, DM-U and JAM contributed to acquisition and interpretation of data, and critically revised the manuscript for important intellectual content. All authors agreed that the accuracy and integrity of the work has been appropriately investigated and resolved, and all approved the final version of the manuscript. All authors had full access to all the data associated with this study. All authors had final responsibility for the decision to submit for publication. The corresponding author JB-M attests that all listed authors meet authorship criteria, and that no others meeting the criteria have been omitted. JB-M and RZ are the guarantors of this work, and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data. RZ and JG take responsibility for the accuracy of the data analysis.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}