The DPP: $Huge NIH-funded trial (N=3200) in the 1990s. Conclusion: randomized diet/lifestyle significantly reduced T2D more than metformin or placebo. Big 58% reduction.

The diet? Reduce total fat as much as possible. Be hypocaloric and lose weight. Exercise.

As guess what. They did that. At 1y total fat went down. And as a result % kcal from carbs went up.

Based on just those metrics, wouldn't that have been a recipe for disaster? Carbs = wt gain and diabetes! Not the opposite!

But not only was T2D lower, they did lose more wt. And I'm impressed how well it sustained (on avg) well beyond the 24 week behavioral intervention TBH.

But hold up, does this mean I am "pro low-fat"?! Are we circling back to the 1980s/1990s Snackwells era?? No, of course not. Check out what really changed in these pts when told to reduce total fat.

See where I'm going with this? Those are some nice improvements in diet quality!

DPP wasn't successful because it identified some optimal low-cal macronutrient pattern for T2D prevention. It worked because compared to the pretty dismal diets at baseline that were sustained in the control group, some fairly attainable shifts in food choices actually helped.

Do we still want keep *carbs vs. fat* at the center of the health food universe? Or are there perhaps more efficient messages and policies that can instead get straight to the point of diet quality?