A Randomized Controlled Trial of Precision Nutrition Counseling for Service Members at Risk for Metabolic Syndrome

Metabolic syndrome (MetS) is a threat to the active component military as it impacts health, readiness, retention, and cost to the Military Health System. The most prevalent risk factors documented in service members' health records are high blood pressure (BP), low high-density lipoprotein cholesterol, and elevated triglycerides. Other risk factors include abdominal obesity and elevated fasting blood glucose. Precision nutrition counseling and wellness software applications have demonstrated positive results for weight management when coupled with high levels of participant engagement and motivation.

In this prospective randomized controlled trial, trained registered dietitians conducted nutrition counseling using results of targeted sequencing, biomarkers, and expert recommendations to reduce the risk for MetS. Upon randomization, the treatment arm initiated six weekly sessions and the control arm received educational pamphlets. An eHealth application captured diet and physical activity. Anthropometrics and BP were measured at baseline, 6 weeks, and 12 weeks, and biomarkers were measured at baseline and 12 weeks. The primary outcome was a change in weight at 12 weeks. Statistical analysis included descriptive statistics and t-tests or analysis of variance with significance set at P < .05.

Overall, 138 subjects enrolled from November 2019 to February 2021 between two military bases; 107 completed the study. Demographics were as follows: 66% male, mean age 31 years, 66% married, and 49% Caucasian and non-Hispanic. Weight loss was not significant between groups or sites at 12 weeks. Overall, 27% of subjects met the diagnostic criteria for MetS on enrollment and 17.8% upon study completion. High deleterious variant prevalence was identified for genes with single-nucleotide polymorphisms linked to obesity (40%), cholesterol (38%), and BP (58%). Overall, 65% of subjects had low 25(OH)D upon enrollment; 45% remained insufficient at study completion. eHealth app had low adherence yet sufficient correlation with a valid reference.

Early signs of progress with weight loss at 6 weeks were not sustained at 12 weeks. DNA-based nutrition counseling was not efficacious for weight loss.