The influence of the glucagon-like peptide-1 receptor agonist, liraglutide, on dietary patterns and nutrient intakes in patients with obesity and prediabetes: A secondary analysis of a randomized controlled trial

Aims: To evaluate changes in dietary intake following liraglutide treatment, compared to dietitian-supported caloric restriction and a weight-neutral control, and to assess dietary intake against nutrition recommendations. Materials and Methods: Participants with obesity and prediabetes were randomly assigned 2:1:1 to liraglutide (1.8 mg/day), dietitian-supported caloric restriction (−390 kcals/day) or dipeptidyl peptidase-4 inhibitor (100 mg/day) for 14 weeks. Dietary intake was assessed via a single 24-h dietary recall pre- and postintervention. Within-group changes and between-group differences in macronutrient and micronutrient intake, diet quality and food sources were evaluated, and the proportion of participants meeting nutrition recommendations was calculated. Results: Seventy participants (69% female, 83% white) were included. Average age was 49.4 ± 11.3 years, and mean BMI was 39.5 ± 6.1 kg/m². Significant differences in change in percent calories from protein (p = 0.037), carbohydrates (p = 0.019) and added sugar (p = 0.002) were observed across groups, with those in the caloric restriction group having the greatest increase in protein and decreases in carbohydrates and added sugar. Micronutrient intake did not significantly differ between groups nor did Total Healthy Eating Index (HEI)-2020 scores. However, the caloric restriction group significantly improved their HEI component score for added sugar compared to the liraglutide group (p = 0.002) when adjusted for baseline intake. Despite the treatment group, participants failed to meet several of the same nutrition recommendations, including those for fruit, vegetable and dairy intake. Conclusions: Overall diet quality was poor across all groups. However, the caloric restriction group significantly reduced its added sugar intake, highlighting a potential benefit nutrition counselling may have for AOM users. Future research is needed to examine the long-term impact of AOM use on dietary intake, with and without nutrition guidance, to better inform clinical recommendations.