Faculty Mentor: Katherine Baucom (Psychology, University of Utah)

Past research has demonstrated the effectiveness of lifestyle interventions with the National Diabetes Prevention Program (National DPP) to prevent or delay the progression of diabetes in highrisk individuals (Ely et al., 2017). However, despite evidence of social context influencing health behaviors, there has been limited research involving romantic partners in diabetes prevention programs (Whitaker et al., 2023). Including romantic partners of individuals at risk for type 2 diabetes may improve participant engagement and outcomes in prevention programs (Whitaker et al., 2023).

A randomized pilot feasibility trial was conducted from 2022 to 2023. National DPP-eligible adults at high risk for type 2 diabetes (n=12) and their romantic partners were recruited for the study (n=24 total participants). Couples were randomized to either the CDC’s individual PreventT2 curriculum (that only National DPP-eligible partners attended) or a couple-based adaptation that both partners in each couple attended, PreventT2 Together. Both 22-class curricula instructed participants on nutrition, fitness, mindfulness, and more.

Prior to (Pre) and after completing the year-long intervention classes (Post), participants individually completed a series of online questionnaires including the Automated Self-Administered 24-hour (ASA24) dietary self-assessment tool (Kirkpatrick et al., 2014). The ASA24 allows for multiple and automatically coded diet recalls broken down into different macronutrients, micronutrients, and food groups for analysis. After completing the intervention, the Primary Investigator (Dr. Katherine Baucom) conducted qualitative joint-couple interviews with participants to understand their study experiences, including completion of the ASA24.

A literature search was carried out to determine how the ASA24 has been used to assess changes in nutrition pre and post lifestyle intervention. In the literature search, nine studies utilizing ASA24 in research on nutrition, diabetes prevention programs, or lifestyle changes were reviewed, with a focus on the specific ASA24 variables analyzed. Sugar (added sugar or total sugar intake) and fat were tracked in 6 out of 9 studies. Healthy Eating Index {HEI} (Krebs-Smith et al., 2018), fiber, and carbohydrates were analyzed in 5 out of 9 studies. Further, in a review of the National DPP curricula delivered in the pilot trial (PreventT2 and PreventT2 Together), commonly mentioned ASA24 variables included total calorie intake, vegetables, fruits, grains, added sugar, and fiber. Based on the findings from the literature search and the review of the DPP curriculum, the following seven ASA24 measures will be considered secondary (nutrition) outcomes in the pilot study: HEI, total vegetables (V_TOTAL), added sugars (ADD_SUGARS), fiber (FIBE), whole grains (G_WHOLE), refined grains (G_REFINED), and total calorie intake (KCAL).

This study’s findings will inform a larger randomized clinical trial set to enroll participants in early 2025. Possible changes for the future include having a study team member instruct participants through a demonstration usage of the ASA24 to reduce confusion. Additionally, having participants complete the ASA24 online for multiple days at Pre and Post is also being considered, which may produce more reliable and consistent data. Documented limitations of the ASA24 include the number of possible outcomes and participant dissatisfaction with the format and length of the survey (described in joint couple interviews). Additionally, participants were unable to complete the ASA24 in multiple sittings, causing them to lose their progress and creating significant burden.

In the coming weeks, ASA24 data from the pilot trial will be imported from Excel into IBM SPSS. The data will be cleaned, HEI calculated (using established methods described by Shams-White et al., 2023) and processed for descriptive analysis of the seven ASA24 variables identified above as nutrition outcomes. This descriptive data will facilitate additional assessment of the feasibility of using the dietary recall as a measure of nutrition. Additionally, it will inform potential changes in ASA24 procedures and analysis in the larger trial.

Bibliography

Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., Rolka, D. B., & Albright, A. L. (2017). A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC’s National Diabetes Prevention Program. Diabetes care, 40(10), 1331–1341. https://doi.org/10.2337/dc16-2099

Kirkpatrick, S. I., Subar, A. F., Douglass, D., Zimmerman, T. P., Thompson, F. E., Kahle, L. L., George, S. M., Dodd, K. W., & Potischman, N. (2014). Performance of the Automated SelfAdministered 24-hour Recall relative to a measure of true intakes and to an intervieweradministered 24-h recall. The American journal of clinical nutrition, 100(1), 233–240. https://doi.org/10.3945/ajcn.114.083238

Krebs-Smith, S. M., Pannucci, T. E., Subar, A. F., Kirkpatrick, S. I., Lerman, J. L., Tooze, J. A., Wilson, M. M., & Reedy, J. (2018). Update of the Healthy Eating Index: HEI-2015. Journal of the Academy of Nutrition and Dietetics, 118(9), 1591–1602. https://doi.org/10.1016/j.jand.2018.05.021

Shams-White, M. M., Pannucci, T. E., Lerman, J. L., Herrick, K. A., Zimmer, M., Meyers Mathieu, K., Stoody, E. E., & Reedy, J. (2023). Healthy Eating Index-2020: Review and Update Process to Reflect the Dietary Guidelines for Americans, 2020-2025. Journal of the Academy of Nutrition and Dietetics, 123(9), 1280–1288. https://doi.org/10.1016/j.jand.2023.05.015

Whitaker, M., Aguirre, M. C., Gutierrez Chavez, M., Beaulieu, E., Arones, Y. B., Gershenoff, D., Hinton, K., Klein, N., Munezerou Uwizeye, J., Napia, E., Ramos, C., Tavake-Pasi, O. F., Villalta, J., Wolfsfeld, C., Witte, B., Maxfield, E., Raphael, K., Simmons, D. L., Clark, L., Sher, T., & Baucom, K. J. (2023). Couple-based lifestyle intervention to prevent type 2 diabetes: protocol for a randomised pilot trial. BMJ open, 13(2), e068623. https://doi.org/10.1136/bmjopen-2022-068623