The Impact of Low-fat and Full-fat Dairy Consumption on Glucose Homeostasis (DAIRY Study)

This randomized controlled feeding trial aims to determine whether the consumption of different amounts and types of dairy products affects blood sugar regulation and cardiometabolic health in men and women with the metabolic syndrome.

Study Overview

• Status: Completed
• Conditions: Inflammation; Obesity; Diabetes; Metabolic Syndrome; Insulin Resistance; NAFLD
• Intervention / Treatment: Other: Limited dairy diet; Other: Low-fat dairy diet; Other: Full-fat dairy diet

Detailed Description

This is a randomized controlled feeding trial designed to investigate whether the consumption of a diet rich in low-fat dairy vs. full-fat dairy vs. a limited dairy diet differentially affects glucose homeostasis. The researchers will also begin an investigation into the mechanisms by which dairy may affect glucose tolerance and its determinants. The investigators will study 60 men and women with the metabolic syndrome who will consume diets differing in their type and content of dairy foods, in a parallel-design randomized controlled trial consisting of a 4-week wash-in diet period and a 12-week dietary intervention period.

Subjects will be randomized using block randomization stratified by gender and insulin resistance (low insulin resistance vs. high insulin resistance or manifest diabetes) to one of three diet groups, which they will follow for 12 weeks: the limited dairy diet, the low-fat dairy diet, or the full-fat dairy diet. During the dietary intervention, participants will be provided with specific amounts and types of dairy products by the Human Nutrition Lab (HNL) at Fred Hutchinson Cancer Research Center (FHCRC). In the limited dairy diet arm, participants will be asked not to consume any dairy, other than three servings of nonfat milk per week, which will be provided. In the two dairy diet arms, participants will be asked to consume 3.3 servings per day of either nonfat/low-fat or full-fat milk, yogurt, and cheese. Participants will be asked to consume all of the dairy products they receive, not to consume any other dairy products for 12 weeks, and to continue consuming their habitual diet ad libitum (i.e., to eat only when hungry, and to stop eating when comfortably satiated).

Prior to randomization, subjects will complete a wash-in diet period of 4 weeks during which they will be asked to consume the limited dairy diet (i.e., consume 3 servings of nonfat milk per week, and not consume any other dairy products). In the third week of the wash-in diet period, subjects will also complete their first of two 5-day controlled feeding periods (i.e., consume study dairy products alongside a provided standard American diet) to measure ad libitum energy intake. During the last week of the wash-in diet period, participants will be admitted to clinic for a baseline visit (clinic visit #1). After clinic visit #1, subjects will be randomized to one of the three study arms, as outlined above. They will follow their randomly assigned study diet for the next 12 weeks. In the second week of the main intervention period, subjects will complete their second 5-day controlled feeding period to again measure ad libitum energy intake, this time on the specific intervention diet they had been randomized to. In the last week of the 12-week diet phase, subjects will be admitted for the follow-up clinic visit (clinic visit #2). At both clinic visits, the researchers will collect fasting blood; measure body weight and height, waist and hip circumference, and blood pressure; conduct a 3-hour FS-OGTT to assess glucose tolerance, insulin sensitivity, and pancreatic beta-cell function; conduct a whole-body DEXA scan to assess body fat mass, lean mass, and body fat distribution; and an abdominal MRI scan to assess liver triglyceride content and the ratio of intra-abdominal to subcutaneous adipose tissue. Subjects will also complete five Food Frequency Questionnaires (FFQ's) and five unannounced 24-hour dietary recalls during the study to assess dietary intakes.

The primary analysis will be a per protocol analysis that will include at least 60 participants (at least 20 in each intervention arm) who comply with all study procedures per protocol. The investigators anticipate enrolling up to 72 participants to achieve this goal. In a secondary analysis, the researchers will analyze the impact of the dietary intervention on all enrolled participants, including those who dropped out, were excluded, or non-compliant with the study protocol, in an intent-to-treat (ITT) analysis that will be reported and interpreted together with the per protocol analysis.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Washington
    • Seattle, Washington, United States, 98109
      • Fred Hutchinson Cancer Research Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Metabolic syndrome (three of the following five criteria):

  • Increased waist circumference: In Asians: ≥ 90 cm in men, ≥ 80 cm in women; in all other races: ≥ 102 cm in men, ≥ 88 cm in women
  • Fasting plasma triglycerides ≥ 150 mg/dL, or drug treatment for elevated triglycerides
  • High-density lipoprotein (HDL)-cholesterol <40 mg/dL in males or <50 mg/dL in females, or drug treatment for reduced HDL-cholesterol
  • Systolic blood pressure ≥ 135 mm Hg or diastolic blood pressure ≥ 85 mm Hg or drug treatment for hypertension
  • Fasting plasma glucose ≥ 100 mg/dL or previous diagnosis of diabetes
• Body weight within 10% of current weight over the last 6 months before starting the study
• Able to come to the FHCRC regularly to pick up food
• Able and willing to attend a study initiation meeting of ~1.5 hour duration at the FHCRC, two clinic visits of ~5 hours duration each at the University of Washington (UW) Medial Center Clinical Research Center (CRC), and two clinic visits of ~2 hours duration each at the UW Bio-Molecular Imaging Center (BMIC)
• Willing to follow the dietary regimen
• Able to provide informed consent

Exclusion Criteria:

• Antidiabetic medications or insulin within the last 6 months
• Uncontrolled diabetes, defined as HbA1c > 8.0%
• Allergy to milk protein
• Presence of major chronic inflammatory or autoimmune disease (with acute symptoms or CRP > 10 mg/L), or malabsorption syndromes
• Presence or history of liver disease or end-stage renal disease requiring dialysis
• Uncontrolled thyroid disease
• Inability or unwillingness to eat the provided foods
• Contraindications for MRI scan other than body size
• Intake of drugs likely to interfere with study endpoints, including corticosteroids, anabolic steroids, antiretroviral drugs, anti-psychotic drugs and immunosuppressive drugs (within 3 months of starting the study)
• Regular high-dose use of non-steroidal anti-inflammatory drugs (more than 3 times per week and more than 600 mg per day, within 3 months of starting the study)
• Presence or recent history of anemia (within 3 months of starting the study)
• History of bariatric surgery
• Participation in an intervention study or weight-loss program (within 3 months of starting the study)
• Alcohol intake > 2 drinks per day (within 12 months of starting the study)
• Use of tobacco products, eCigarettes, or recreational drugs on more than 2 days per month (within 12 months of starting the study)
• Current or recent (within 12 months of starting the study) pregnancy or breastfeeding, or intention of becoming pregnant in the next 6 months
• Fasting Triglycerides >1000mg/dL
• Any cancer other than non-melanoma skin cancer in the last 3 years
• Other significant health condition, as determined by researcher and Physician of Record, that makes the individual unfit to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Limited dairy diet; Three 8 oz. servings per week of non-fat milk. Participants will otherwise eat their usual diet, but will be asked not to consume any dairy products not provided by the study.	Other: Limited dairy diet; Consumption of no dairy foods other than 3 servings per week of nonfat milk for 12 weeks
Experimental: Low-fat dairy diet; 3.3 daily servings of non-fat and low-fat dairy products in the form of fluid milk, cheese and yogurt. Participants will otherwise eat their usual diet, and will be asked not to consume any dairy products not provided by the study.	Other: Low-fat dairy diet; Consumption of 3.3 servings per day of low-fat milk, yogurt, and cheese for 12 weeks
Experimental: Full-fat dairy diet; 3.3 daily servings of full-fat dairy products in the form of fluid milk, cheese and yogurt. Participants will otherwise eat their usual diet, and will be asked not to consume any dairy products not provided by the study.	Other: Full-fat dairy diet; Consumption of 3.3 servings per day of full-fat milk, yogurt, and cheese for 12 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in glucose tolerance	As measured by glucose area under the curve during a frequently sampled 3-hour oral glucose tolerance test (FS-OGTT).	Difference between pre- and post 12-week intervention period

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in systemic insulin sensitivity	As measured by the Matsuda-De Fronzo Insulin Sensitivity Index based on the FS-OGTT	Difference between pre- and post 12-week intervention period
Change in pancreatic beta-cell function: insulinogenic index	As measured by the insulinogenic index based on the FS-OGTT	Difference between pre- and post 12-week intervention period
Change in pancreatic beta-cell function: oral disposition index	As measured by the oral disposition index (DI), the product of insulin sensitivity (Matsuda-De Fronzo index) and beta-cell function (insulinogenic index)	Difference between pre- and post 12-week intervention period
Change in liver fat content	As measured by an abdominal magnetic resonance imaging (MRI) scan	Difference between pre- and post 12-week intervention period
Change in low-grade chronic systemic inflammation: hsCRP	As measured by fasting plasma concentration of C-reactive protein (CRP)	Difference between pre- and post 12-week intervention period
Change in low-grade chronic systemic inflammation: IL-6	As measured by fasting plasma concentration of interleukin-6 (IL-6)	Difference between pre- and post 12-week intervention period
Change in pancreatic beta-cell function: glucose sensitivity	Glucose sensitivity, as modeled from the glucose, insulin, and c-peptide data obtained from the FS-OGTT	Difference between pre- and post 12-week intervention period

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in total body fat mass	Total body fat mass (kg), as measured by whole body dual-energy x-ray absorptiometry (DEXA) scan	Difference between pre- and post 12-week intervention period
Change in abdominal fat mass	Abdominal fat mass (kg), as measured by whole body dual-energy x-ray absorptiometry (DEXA) scan	Difference between pre- and post 12-week intervention period
Change in abdominal subcutaneous-to-visceral fat ratio	Abdominal subcutaneous-to-visceral fat ratio, as measured by abdominal magnetic resonance imaging (MRI) scan	Difference between pre- and post 12-week intervention period
Change in body weight	Body weight will be measured on a calibrated digital scale in kilogram (kg) while wearing a hospital gown	Difference between pre- and post 12-week intervention period
Change in average diurnal glucose concentrations	The average diurnal glucose concentration will be assessed by measuring hemoglobin A1c (HbA1c)	Difference between pre- and post 12-week intervention period
Change in fasting glucose concentration	Glucose concentration (mg/dL) will be measured in fasting plasma	Difference between pre- and post 12-week intervention period
Change in systolic blood pressure	Systolic blood pressure (mmHg), as measured following the American Heart Association blood pressure protocol	Difference between pre- and post 12-week intervention period
Change in diastolic blood pressure	Diastolic blood pressure (mmHg), as measured following the American Heart Association blood pressure protocol	Difference between pre- and post 12-week intervention period
Change in ad libitum energy intake over 5 days	Ad libitum energy intake will be assessed during two 5-day ad libitum controlled feeding periods	Difference in energy intake during a 5-day controlled feeding period in the study wash-in period as compared to a 5-day controlled feeding period in the intervention period
Change in fasting serum total cholesterol concentration	The total cholesterol concentration (mg/dL) will be measured in fasting serum	Difference between pre- and post 12-week intervention period
Change in fasting serum high-density lipoprotein (HDL) cholesterol concentration	The cholesterol concentration in HDL (mg/dL) will be measured in fasting serum	Difference between pre- and post 12-week intervention period
Change in fasting serum triglyceride concentration	The triglyceride concentration (mg/dL) will be measured in fasting serum	Difference between pre- and post 12-week intervention period
Change in fasting serum low-density lipoprotein (LDL) cholesterol concentration	The cholesterol concentration in LDL (mg/dL) will be measured in fasting serum, or calculated by the Friedewald formula	Difference between pre- and post 12-week intervention period
Change in cholesterol concentration in 38 serum lipoprotein fractions	As assessed by measuring the cholesterol content (mg/dL) in 38 lipoprotein fractions isolated from fasting serum by KBr gradient ultracentrifugation	Difference between pre- and post 12-week intervention period
Change in fasting plasma total adiponectin	The total adiponectin concentration (ug/mL) will be measured in fasting plasma	Difference between pre- and post 12-week intervention period
Change in waist circumference	Waist circumference (cm)	Difference between pre- and post 12-week intervention period
Change in hip circumference	Hip circumference (cm)	Difference between pre- and post 12-week intervention period
Change in the waist-to-hip-ratio	Ratio of waist circumference (cm) to hip circumference (cm)	Difference between pre- and post 12-week intervention period
Change in trunk fat mass	Trunk fat mass (kg), as measured by dual-energy x-ray absorptiometry (DEXA)-scan	Difference between pre- and post 12-week intervention period
Change in peripheral fat mass	Peripheral fat mass (kg), defined as the fat mass of all limbs, as measured by dual-energy x-ray absorptiometry (DEXA)-scan	Difference between pre- and post 12-week intervention period
Change in visceral fat mass	Visceral fat mass (inches^2), as estimated by dual-energy x-ray absorptiometry (DEXA)-scan	Difference between pre- and post 12-week intervention period
Change in the low-density lipoprotein (LDL) relative flotation rate	The LDL relative flotation rate (Rf) is calculated as the fraction number of the major peak of LDL divided by the total number of fractions	Difference between pre- and post 12-week intervention period
Change in fasting insulin concentration	The insulin concentration (uU/L) measured in fasting plasma	Difference between pre- and post 12-week intervention period
Change in the homeostasis model assessment (HOMA) insulin resistance index	The HOMA insulin resistance index will be calculated from glucose and insulin concentrations measured in fasting plasma	Difference between pre- and post 12-week intervention period

Collaborators and Investigators

• Sponsor: Fred Hutchinson Cancer Center
• Collaborators: University of Washington
• Investigators: Principal Investigator: Mario Kratz, PhD, Fred Hutchinson Cancer Research Center, Associate Member

Publications and helpful links

General Publications

• Fernando I, Schmidt KA, Cromer G, Burhans MS, Kuzma JN, Hagman DK, Utzschneider KM, Holte S, Kraft J, Vaughan TL, Kratz M. The impact of low-fat and full-fat dairy foods on symptoms of gastroesophageal reflux disease: an exploratory analysis based on a randomized controlled trial. Eur J Nutr. 2022 Aug;61(5):2815-2823. doi: 10.1007/s00394-022-02855-6. Epub 2022 Mar 16.
• Schmidt KA, Cromer G, Burhans MS, Kuzma JN, Hagman DK, Fernando I, Murray M, Utzschneider KM, Holte S, Kraft J, Kratz M. Impact of low-fat and full-fat dairy foods on fasting lipid profile and blood pressure: exploratory endpoints of a randomized controlled trial. Am J Clin Nutr. 2021 Sep 1;114(3):882-892. doi: 10.1093/ajcn/nqab131.
• Schmidt KA, Cromer G, Burhans MS, Kuzma JN, Hagman DK, Fernando I, Murray M, Utzschneider KM, Holte S, Kraft J, Kratz M. The impact of diets rich in low-fat or full-fat dairy on glucose tolerance and its determinants: a randomized controlled trial. Am J Clin Nutr. 2021 Mar 11;113(3):534-547. doi: 10.1093/ajcn/nqaa301.

Study record dates

Study Major Dates

• Study Start: January 1, 2016
• Primary Completion (Actual): October 18, 2018
• Study Completion (Actual): October 18, 2018

Study Registration Dates

• First Submitted: January 21, 2016
• First Submitted That Met QC Criteria: January 21, 2016
• First Posted (Estimate): January 26, 2016

Study Record Updates

• Last Update Posted (Actual): January 16, 2019
• Last Update Submitted That Met QC Criteria: January 15, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: Diabetes; Obesity; Metabolic syndrome; NAFLD
• Additional Relevant MeSH Terms: Pathologic Processes; Glucose Metabolism Disorders; Metabolic Diseases; Hyperinsulinism; Inflammation; Metabolic Syndrome; Insulin Resistance
• Other Study ID Numbers: DRI2395

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Anonymized blood samples and study data may be shared with outside investigators who sign confidentiality pledges (from participants who have given written consent for the use of study specimen and data for 'other research' only).