• Laura R Saslow, Lenette M Jones, Ananda Sen, Julia A Wolfson, Heidi L Diez, Alison O'Brien, Cindy W Leung, Hovig Bayandorian, Jennifer Daubenmier, Amanda L Missel, and Caroline Richardson.
• Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan saslowl@umich.edu.
• Ann Fam Med. 2023 May 1; 21 (3): 256263256-263.

PurposeAdults with a triple multimorbidity (hypertension, prediabetes or type 2 diabetes, and overweight or obesity), are at increased risk of serious health complications, but experts disagree on which dietary patterns and support strategies should be recommended.MethodsWe randomized 94 adults from southeast Michigan with this triple multimorbidity using a 2 × 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) diet vs a Dietary Approaches to Stop Hypertension (DASH) diet, as well as comparing results with and without multicomponent extra support (mindful eating, positive emotion regulation, social support, and cooking).ResultsUsing intention-to-treat analyses, compared with the DASH diet, the VLC diet led to greater improvement in estimated mean systolic blood pressure (-9.77 mm Hg vs -5.18 mm Hg; P = .046), greater improvement in glycated hemoglobin (-0.35% vs -0.14%; P = .034), and greater improvement in weight (-19.14 lb vs -10.34 lb; P = .0003). The addition of extra support did not have a statistically significant effect on outcomes.ConclusionsFor adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity, the VLC diet resulted in greater improvements in systolic blood pressure, glycemic control, and weight over a 4-month period compared with the DASH diet. These findings suggest that larger trials with longer follow-up are warranted to determine whether the VLC diet might be more beneficial for disease management than the DASH diet for these high-risk adults.© 2023 Annals of Family Medicine, Inc.

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