FMC dynamics
±, weight loss, Fasting morning cortisol
At baseline, FMC levels were not statistically different across intervention groups (HDG =307 ± 91.5 nmol/L, MED=304.05 ± 81.4 nmol/L, Green-MED=301.1 ± 97.3 nmol/L; p=0.89). Following a 6-month intervention period (HDG=317.3 ± 126 nmol/L, MED=328.1 ± 107.5 nmol/L, Green-MED=313.5 ± 106.27 nmol/L) (Fasting morning cortisol changes across intervention and sex groups. 1. However, after 18-months(HDG=297.51 ± 85.81 nmol/L, MED=281.82 ± 76.6 nmol/L, Green-MED=273 ± 98.6 nmol/L), both the Med and Green-MED diets achieved significant reductions in FMC levels (mean FMC percentages and absolute change: MED=-1.6% ± 39% [-21.45 ± 92.7 nmol/L], Green-MED=-1.8% ± 45% [-26.67 ± 117.1 nmol/L]; p<0.05 vs. baseline for both; Median percentages change and IQR: MED=-7%[-25.86%, 12.8%], Green-MED=-10.47%[-29.12, 17.83]), while the HDG group showed a non-significant change in FMC (mean FMC percentages and absolute change:+4% ± 46.54% [-12 ± 104 nmol/L], p=0.28; Median percentages change and IQR: HDG=-3.9%[-27.46%,18.9%]). Additionally, after 18-months men (289 ± 86 nmol/L) experienced a significant change in FMC levels (1% ± 44.9% [-19.2 ± 107.9 nmol/L], p<0.01) whereas the women’s group (237.45 ± 83.9 nmol/L) displayed non-significant reduction (-6.9 ± 31.2% [-27.2 ± 80.93 nmol/L], p=0.08). The difference in FMC percentage change between the Green-MED and HDG groups at 18-months, was statistically significant (p=0.048, multivariable model adjusted for age, sex, and weight-loss from baseline). There were no significant differences between sex-based groups at each time point (multivariable model adjusted for age and weight-loss from baseline).To further examine the association between the 18-month change in FMC and various metabolic biomarkers, we performed three correlation models. In a univariate correlation model, 18-months FMC decrease was positively correlated with 18-month changes of glucose (r=0.19), ALT (r=0.17), Fetuin A (r=0.20), TSH (r=0.28), and testosterone (r=0.18) and HDLc (r=0.18), p<0.05 for all. After adjusting for age, sex, and intervention group, the same markers remained significantly correlated with the 18-month change in FMC (glucose=0.17, HDLc=0.19, ALT=0.16, Fetuin A= 0.2, TSH=0.28, testosterone=0.2). Additionally, after further adjustment for 18-month weight loss, the 18-month decrease in FMC levels was positively correlated with 18-month changes of glucose (r=0.18), HbA1c (r=0.15), ALT (r=0.2), hsCRP (r=0.16), Fetuin A (r=0.2), TSH (r=0.28), MRI-assessed IHF (r=0.19), testosterone (r=0.18) and HDLc (r=0.19), p<0.05 for all. Further associations are illustrated in Crude and adjusted correlations between 18-month biomarkers changes and 18-month fasting morning cortisol change. 1. Partial correlation analysis of Δvariable