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| ID | Type | Description | Link |
|---|---|---|---|
| R61AT009333 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Center for Complementary and Integrative Health (NCCIH) | NIH |
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Type 2 diabetes mellitus (T2DM) is the most expensive chronic disease in the U.S.
Lifestyle modification is central to T2DM management, but long-term adherence to dietary recommendations is difficult. A key challenge is the difficulty of coping with cravings for high carbohydrate or sugar-laden foods in an environment where these foods are tempting and widely available. One mechanism by which mindfulness may increase long-term dietary adherence is by better equipping individuals with skills to experience food cravings and difficult emotions without eating in response. Such approaches seek to strengthen abilities to be non-judgmentally aware of, tolerate, and respond skillfully to food cravings and difficult emotions without reacting impulsively or maladaptively. The investigators hypothesize that improved ability to manage food cravings and emotional eating is a key mechanism through which mindfulness-enhancements can improve dietary adherence. The study will test a mindfulness-based intervention (MBI) for improving dietary adherence. Although the particular diet employed is not the focus of this study, the study will use a diet with about 10% of calories from carbohydrate as: (1) it induces a low level of ketone production, which will be used as a biomarker for dietary adherence; (2) prior studies suggest it improves metabolic parameters in T2DM, including glycemic control.
The study will use ecological momentary assessment (EMA) methods to measure eating in response to difficult emotions and/or food cravings. In the R61 phase, the team will ensure this measure is appropriate for further testing and assess the impact of the MBI components on our hypothesized behavioral mechanisms in N=60 persons with T2DM. The study plans 3 waves of 20 persons each with 12 weekly sessions. All participants will attend an in-person group course providing education on basic behavioral strategies for diet and physical activity. Participants will be randomized to receive this education alone (Ed) or this same material with added MBI components (Ed+MBI). The team will also pilot test two levels of intensity of maintenance phase intervention (monthly group meetings alone or supplemented by individualized attention) to prepare them for R33 testing. the investigators plan an R33 phase trial in which 120 persons with T2DM will be randomized (using a 1:2 ratio) to Ed or Ed+MBI conditions and followed for 12 months, including a 9-month maintenance phase. The study will test the robustness of the effect of MBI components on our proposed behavioral mechanisms, and on dietary adherence, as well as preliminary effect sizes on weight and glycemic control. The study will use an innovative adaptive intervention design to optimize maintenance phase intensity, which the investigators believe may be key to augment the MBI effects. The R33 phase will be registered and reported in a separate clinicaltrials.gov record.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diet Education | Active Comparator | All participants will receive instruction in the carbohydrate-restricted diet (CR).The study diet has approximately 10% of kcal coming from carbohydrate, typically 50 grams/day or fewer, not including fiber. Participants will be encouraged to eat a normal amount of protein, typically about 80-100 grams/day (about 20-25% of calories), and the rest of their calories from fat. Foods that are encouraged include green leafy and other non-starchy vegetables, nuts, seeds, oils (especially olive oil), fish, poultry, tofu, and avocados. Other foods consistent with the diet include berries (in modest amounts), meats, eggs, and cheese. Key foods to minimize include any sugar-sweetened foods or beverages, bread, pasta, potatoes, highly processed packaged foods, and other starchy foods. |
|
| Diet Education + Mindfulness | Experimental | In addition to the carbohydrate-restricted diet described above, the Ed+MBI group will receive mindfulness training consisting of two integrated components: 1) use of a mindful eating app at home to learn and practice mindfulness skills for food-cravings and eating, and 2) in-person group-based meetings to discuss and troubleshoot how the mindfulness practices are working. Key mindfulness content includes helping people improve their relationship with food and control food cravings and using mindful eating approaches including paying attention, noticing habit loops, understanding brain science and food/sugar addiction, disrupting emotional and stress eating, cultivating acceptance and curiosity, lovingkindness, detaching from thoughts, using healthy restraint, and maintaining motivation. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Carbohydrate-restricted diet | Behavioral | Education for carbohydrate-restricted diet |
|
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of Eating in Response to Cravings (Primary Mechanistic Outcome) | Percent of ecological momentary assessment (EMA) opportunities in which participants reported eating in response to food cravings over a 3 day period. EMA measures were delivered to cell phones 3 times each day. The final EMA measure each day included a second question about whether there were any instances of craving related eating not already reported earlier during the day. Thus there was an opportunity to report eating in response to cravings on 4 different EMA questions each day, a total of 12 potential measures over 3 days. The percent here uses the number of EMA responses received as the denominator. | change from baseline to 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Impulsivity as Measured by Delayed Discounting Score | The 5-trial adaptation of the Delayed Discounting (DD; Koffarnus & Bickel, 2014) is a decision-making exercise where individuals choose between a smaller, immediate reward and a larger, delayed reward. The task measures an individual's "discount rate," or how much they devalue a future reward compared to an immediate one, which is a a key aspect of impulsivity and self-control. Respondents choose between $100 delivered after a delay, or $50 available immediately. To derive estimates of discount rate, we used Mazur's hyperbolic discounting model (V=A/ (1+kD)18, wherein V is the discounted value of the delayed option, A is its objective amount, D is its delay, and k indexes the discount rate. We calculated values of k for each participant as the inverse of the indifference delay (1/ED50). We log transformed these values prior to analysis. Higher values of K indicate greater discounting, which reflects greater impulsivity. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rick Hecht, MD | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UCSF Osher Center for Integrative Medicine | San Francisco | California | 94143 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31467583 | Derived | Mason AE, Saslow LR, Moran PJ, Kim S, Abousleiman H, Richler R, Schleicher S, Goldman VM, Hartman A, Leung C, Hartogensis W, Hecht FM. Lipid findings from the Diabetes Education to Lower Insulin, Sugars, and Hunger (DELISH) Study. Nutr Metab (Lond). 2019 Aug 27;16:58. doi: 10.1186/s12986-019-0383-2. eCollection 2019. | |
| 30545813 | Derived | Mason AE, Saslow L, Moran PJ, Kim S, Wali PK, Abousleiman H, Hartman A, Richler R, Schleicher S, Hartogensis W, Epel ES, Hecht F. Examining the Effects of Mindful Eating Training on Adherence to a Carbohydrate-Restricted Diet in Patients With Type 2 Diabetes (the DELISH Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2019 Feb 20;8(2):e11002. doi: 10.2196/11002. |
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Recruitment conducted 12/2016-9/2018 via several sources including: flyers posted in and outreach to providers in UCSF clinics (e.g., Diabetes Clinic, General Internal Medicine Clinic); letters mailed to potentially eligible participants in the UCSF system who had previously consented to be contacted about research studies for which they may be eligible; flyers posted in the community as on social media including Facebook, Nextdoor, and Craigslist. First participant was consented 2/17/2017.
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| ID | Title | Description |
|---|---|---|
| FG000 | Diet Education | All participants will receive instruction in the carbohydrate-restricted diet (CR).The study diet has approximately 10% of kcal coming from carbohydrate, typically 50 grams/day or fewer, not including fiber. Participants will be encouraged to eat a normal amount of protein, typically about 80-100 grams/day (about 20-25% of calories), and the rest of their calories from fat. Foods that are encouraged include green leafy and other non-starchy vegetables, nuts, seeds, oils (especially olive oil), fish, poultry, tofu, and avocados. Other foods consistent with the diet include berries (in modest amounts), meats, eggs, and cheese. Key foods to minimize include any sugar-sweetened foods or beverages, bread, pasta, potatoes, highly processed packaged foods, and other starchy foods. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet |
| FG001 | Diet Education + Mindfulness | In addition to the carbohydrate-restricted diet described above, the Ed+MBI group will receive mindfulness training consisting of two integrated components: 1) use of a mindful eating app at home to learn and practice mindfulness skills for food-cravings and eating, and 2) in-person group-based meetings to discuss and troubleshoot how the mindfulness practices are working. Key mindfulness content includes helping people improve their relationship with food and control food cravings and using mindful eating approaches including paying attention, noticing habit loops, understanding brain science and food/sugar addiction, disrupting emotional and stress eating, cultivating acceptance and curiosity, lovingkindness, detaching from thoughts, using healthy restraint, and maintaining motivation. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet Mindfulness: Mindful eating app-use and instruction |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Diet Education | All participants will receive instruction in the carbohydrate-restricted diet (CR).The study diet has approximately 10% of kcal coming from carbohydrate, typically 50 grams/day or fewer, not including fiber. Participants will be encouraged to eat a normal amount of protein, typically about 80-100 grams/day (about 20-25% of calories), and the rest of their calories from fat. Foods that are encouraged include green leafy and other non-starchy vegetables, nuts, seeds, oils (especially olive oil), fish, poultry, tofu, and avocados. Other foods consistent with the diet include berries (in modest amounts), meats, eggs, and cheese. Key foods to minimize include any sugar-sweetened foods or beverages, bread, pasta, potatoes, highly processed packaged foods, and other starchy foods. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Frequency of Eating in Response to Cravings (Primary Mechanistic Outcome) | Percent of ecological momentary assessment (EMA) opportunities in which participants reported eating in response to food cravings over a 3 day period. EMA measures were delivered to cell phones 3 times each day. The final EMA measure each day included a second question about whether there were any instances of craving related eating not already reported earlier during the day. Thus there was an opportunity to report eating in response to cravings on 4 different EMA questions each day, a total of 12 potential measures over 3 days. The percent here uses the number of EMA responses received as the denominator. | Posted | Mean | 95% Confidence Interval | % of EMAs with craving related eating | change from baseline to 6 months |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Diet Education | All participants will receive instruction in the carbohydrate-restricted diet (CR).The study diet has approximately 10% of kcal coming from carbohydrate, typically 50 grams/day or fewer, not including fiber. Participants will be encouraged to eat a normal amount of protein, typically about 80-100 grams/day (about 20-25% of calories), and the rest of their calories from fat. Foods that are encouraged include green leafy and other non-starchy vegetables, nuts, seeds, oils (especially olive oil), fish, poultry, tofu, and avocados. Other foods consistent with the diet include berries (in modest amounts), meats, eggs, and cheese. Key foods to minimize include any sugar-sweetened foods or beverages, bread, pasta, potatoes, highly processed packaged foods, and other starchy foods. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hypoglycemia | Metabolism and nutrition disorders | CTCAE (Unspecified) | Systematic Assessment |
We completed planned enrollment and did not have early termination. The trial was the initial part of a potentially two-step grant. This pilot phase was aimed at testing the trial design and assessing if there was evidence of effects on food cravings, a mechanistic goal. It was not powered to assess changes in clinical outcomes.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Frederick Hecht, MD | University of California, San Francisco | (415) 353-9743 | rick.hecht@ucsf.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 6, 2017 | Nov 18, 2025 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jul 24, 2017 | Nov 18, 2025 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D050528 | Diet, Carbohydrate-Restricted |
| D064866 | Mindfulness |
| ID | Term |
|---|---|
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D004032 | Diet |
| D009747 |
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Blood tests at LabCorp and 24-hour dietary recall interviews are done by research assistants blinded to treatment assignment.
| Mindfulness | Behavioral | Mindful eating app-use and instruction |
|
| change from baseline to 6 months |
| Emotion-related Eating (Secondary Mechanistic Outcome) | Change in emotion-related eating as measured by the Coping subscale of the Palatable Eating Motives Scale (PEMS). The Coping subscale is comprised of 4 items rated on a scale from 1 (almost never/never) to 5 (almost always/always), with possible scores ranging from 4-20. Higher scores reflect worse coping/greater emotional eating. Thus, decreases over time reflect improved coping/decreased emotional eating. | change from baseline to 6 months |
| Stress-related Eating (Secondary Mechanistic Outcome) | Change in stress-related eating as measured by two questions about stress-related eating from the MIDUS study. Possible scores range from 2-8. Higher scores reflect worse outcomes/greater eating in response to stress. Thus, decreases over time reflect improved outcomes/decreased stress-related eating. | change from baseline to 6 months |
| Glycemic Control, Using HbA1c | Change in hemoglobin A1c (HbA1c) from baseline to 6 months by study arm | change from baseline to 6 months |
| Fasting Glucose | Change in plasma fasting glucose from baseline to 6 months by study arm | change from baseline to 6 months |
| HOMA-2IR Index of Insulin Resistance (Secondary Clinical Outcome) | Insulin resistance estimated from the Homeostatic model assessment (HOMA) model 2 index of insulin resistance. The basic formula is: (glucose × insulin) / 22.5, where glucose is measured in mmol/L and insulin in mU/L. The computer assisted re-calibration in model 2 addresses variations in the glucose resistance of the peripheral tissue and liver, increases in the insulin secretion curve for glucose > 180 mg/dL, and contribution of circulating pro-insulin. Higher values indicate more insulin resistance (worse outcome). The Oxford University HOMA-2IR calculator was used (https://process.innovation.ox.ac.uk/software/p/2112/homa2-calculator/1). HOMA index values < 2.0 are generally considered normal and indicate adequate sensitivity of cells to insulin. HOMA index values between 2.0 and 2.5 may indicate borderline changes in insulin sensitivity. HOMA index values > 2.5 clearly indicate insulin resistance. | change from baseline to 6 months |
| Weight Change(Secondary Clinical Outcome) | kilograms | change from baseline to 6 months |
| Adherence to Diet as Measured by Fingerstick Blood Ketones | Adherence to diet as measured by average proportion of fingerstick blood ketones at or above 0.3 mmol/L at 24 weeks. | 6 months |
| Diet Adherence by Mean Grams of Non-fiber Carbohydrate Consumed Per Day | Diet Adherence Between Intervention Arms as Measured by Mean Grams of Non-fiber Carbohydrate Consumed Per Day From 24- Hour Diet Recall | change from baseline to 6 months |
| Perceived Stress | Perceived Stress Scale (PPS-10) total score. Scores can range from 0 to 40 with higher scores indicated greater perceived stress. | change from baseline to 6 months |
| BG001 | Diet Education + Mindfulness | In addition to the carbohydrate-restricted diet described above, the Ed+MBI group will receive mindfulness training consisting of two integrated components: 1) use of a mindful eating app at home to learn and practice mindfulness skills for food-cravings and eating, and 2) in-person group-based meetings to discuss and troubleshoot how the mindfulness practices are working. Key mindfulness content includes helping people improve their relationship with food and control food cravings and using mindful eating approaches including paying attention, noticing habit loops, understanding brain science and food/sugar addiction, disrupting emotional and stress eating, cultivating acceptance and curiosity, lovingkindness, detaching from thoughts, using healthy restraint, and maintaining motivation. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet Mindfulness: Mindful eating app-use and instruction |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Education | Number | participants |
|
| OG001 | Diet Education + Mindfulness | In addition to the carbohydrate-restricted diet described above, the Ed+MBI group will receive mindfulness training consisting of two integrated components: 1) use of a mindful eating app at home to learn and practice mindfulness skills for food-cravings and eating, and 2) in-person group-based meetings to discuss and troubleshoot how the mindfulness practices are working. Key mindfulness content includes helping people improve their relationship with food and control food cravings and using mindful eating approaches including paying attention, noticing habit loops, understanding brain science and food/sugar addiction, disrupting emotional and stress eating, cultivating acceptance and curiosity, lovingkindness, detaching from thoughts, using healthy restraint, and maintaining motivation. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet Mindfulness: Mindful eating app-use and instruction |
|
|
| Secondary | Change in Impulsivity as Measured by Delayed Discounting Score | The 5-trial adaptation of the Delayed Discounting (DD; Koffarnus & Bickel, 2014) is a decision-making exercise where individuals choose between a smaller, immediate reward and a larger, delayed reward. The task measures an individual's "discount rate," or how much they devalue a future reward compared to an immediate one, which is a a key aspect of impulsivity and self-control. Respondents choose between $100 delivered after a delay, or $50 available immediately. To derive estimates of discount rate, we used Mazur's hyperbolic discounting model (V=A/ (1+kD)18, wherein V is the discounted value of the delayed option, A is its objective amount, D is its delay, and k indexes the discount rate. We calculated values of k for each participant as the inverse of the indifference delay (1/ED50). We log transformed these values prior to analysis. Higher values of K indicate greater discounting, which reflects greater impulsivity. | Intent to treat; note 2 participants in each arm had impulsivity data excluded due to nonsystematic Delayed Discounting data at baseline | Posted | Geometric Mean | 95% Confidence Interval | % change | change from baseline to 6 months |
|
|
|
| Secondary | Emotion-related Eating (Secondary Mechanistic Outcome) | Change in emotion-related eating as measured by the Coping subscale of the Palatable Eating Motives Scale (PEMS). The Coping subscale is comprised of 4 items rated on a scale from 1 (almost never/never) to 5 (almost always/always), with possible scores ranging from 4-20. Higher scores reflect worse coping/greater emotional eating. Thus, decreases over time reflect improved coping/decreased emotional eating. | Posted | Mean | 95% Confidence Interval | scores on a scale | change from baseline to 6 months |
|
|
|
| Secondary | Stress-related Eating (Secondary Mechanistic Outcome) | Change in stress-related eating as measured by two questions about stress-related eating from the MIDUS study. Possible scores range from 2-8. Higher scores reflect worse outcomes/greater eating in response to stress. Thus, decreases over time reflect improved outcomes/decreased stress-related eating. | Posted | Mean | 95% Confidence Interval | units on a scale | change from baseline to 6 months |
|
|
|
| Secondary | Glycemic Control, Using HbA1c | Change in hemoglobin A1c (HbA1c) from baseline to 6 months by study arm | Posted | Mean | 95% Confidence Interval | % of hemaglobin with glucose (HbA1C) | change from baseline to 6 months |
|
|
|
| Secondary | Fasting Glucose | Change in plasma fasting glucose from baseline to 6 months by study arm | Posted | Mean | 95% Confidence Interval | mg/dL | change from baseline to 6 months |
|
|
|
| Secondary | HOMA-2IR Index of Insulin Resistance (Secondary Clinical Outcome) | Insulin resistance estimated from the Homeostatic model assessment (HOMA) model 2 index of insulin resistance. The basic formula is: (glucose × insulin) / 22.5, where glucose is measured in mmol/L and insulin in mU/L. The computer assisted re-calibration in model 2 addresses variations in the glucose resistance of the peripheral tissue and liver, increases in the insulin secretion curve for glucose > 180 mg/dL, and contribution of circulating pro-insulin. Higher values indicate more insulin resistance (worse outcome). The Oxford University HOMA-2IR calculator was used (https://process.innovation.ox.ac.uk/software/p/2112/homa2-calculator/1). HOMA index values < 2.0 are generally considered normal and indicate adequate sensitivity of cells to insulin. HOMA index values between 2.0 and 2.5 may indicate borderline changes in insulin sensitivity. HOMA index values > 2.5 clearly indicate insulin resistance. | Posted | Mean | 95% Confidence Interval | units on a scale | change from baseline to 6 months |
|
|
|
| Secondary | Weight Change(Secondary Clinical Outcome) | kilograms | Posted | Mean | 95% Confidence Interval | kilograms | change from baseline to 6 months |
|
|
|
| Secondary | Adherence to Diet as Measured by Fingerstick Blood Ketones | Adherence to diet as measured by average proportion of fingerstick blood ketones at or above 0.3 mmol/L at 24 weeks. | Posted | Mean | 95% Confidence Interval | proportion of measurements >= 0.3 mmol/L | 6 months |
|
|
|
| Secondary | Diet Adherence by Mean Grams of Non-fiber Carbohydrate Consumed Per Day | Diet Adherence Between Intervention Arms as Measured by Mean Grams of Non-fiber Carbohydrate Consumed Per Day From 24- Hour Diet Recall | Posted | Mean | 95% Confidence Interval | grams | change from baseline to 6 months |
|
|
|
| Secondary | Perceived Stress | Perceived Stress Scale (PPS-10) total score. Scores can range from 0 to 40 with higher scores indicated greater perceived stress. | Posted | Mean | 95% Confidence Interval | score on a scale | change from baseline to 6 months |
|
|
|
| 0 |
| 28 |
| 0 |
| 28 |
| 12 |
| 28 |
| EG001 | Diet Education + Mindfulness | In addition to the carbohydrate-restricted diet described above, the Ed+MBI group will receive mindfulness training consisting of two integrated components: 1) use of a mindful eating app at home to learn and practice mindfulness skills for food-cravings and eating, and 2) in-person group-based meetings to discuss and troubleshoot how the mindfulness practices are working. Key mindfulness content includes helping people improve their relationship with food and control food cravings and using mindful eating approaches including paying attention, noticing habit loops, understanding brain science and food/sugar addiction, disrupting emotional and stress eating, cultivating acceptance and curiosity, lovingkindness, detaching from thoughts, using healthy restraint, and maintaining motivation. Carbohydrate-restricted diet: Education for carbohydrate-restricted diet Mindfulness: Mindful eating app-use and instruction | 0 | 30 | 0 | 30 | 11 | 30 |
| Hypertriglyceridemia | Cardiac disorders | CTCAE (Unspecified) | Systematic Assessment |
|
| other | General disorders | CTCAE (Unspecified) | Systematic Assessment |
|
Not provided
Not provided
| D004700 | Endocrine System Diseases |
| Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D015928 | Cognitive Behavioral Therapy |
| D001521 | Behavior Therapy |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |