Effects of semaglutide, a GLP-1 receptor agonist, on food preferences in Japanese subjects with type 2 diabetes and visceral fat accumulation

Abstract

Obesity and type 2 diabetes mellitus (T2DM) are growing global health burdens, with dietary patterns, particularly high intake of carbohydrate- and fat-rich foods, contributing to disease progression. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), is effective for both lowering blood glucose and reducing weight; however, its effects on food preferences for specific macronutrients remain unclear. In this retrospective observational study, we enrolled 32 obese subjects with T2DM who were hospitalized for glycemic control, including 20 who started semaglutide treatment (the Sema group) and 12 who did not receive GLP-1RA therapy. Eating behaviors were assessed using the Dietary Behavior Questionnaire from the Japan Society for the Study of Obesity (JASSO-DBQ), and food preferences for carbohydrates, fat, protein, and dietary fiber were quantitatively evaluated using the Japan Food Preference Questionnaire (JFPQ). Thirteen subjects in the Sema group and eight in the Non-GLP-1 group completed 6-months of follow-up. The Sema group showed significant decreases in HbA1c levels (–1.1%) and body weight (–5.7 kg), with fat loss exceeding skeletal muscle loss. Significant decreases were observed in eating behavior scores for “Eating Motives,” “Way of Eating,” and “Dietary Content.” Notably, semaglutide significantly reduced preferences for sweet and non-sweet carbohydrates and non-sweet fats, without changing protein or dietary fiber preferences. In particular, significant reductions were observed in preferences for Japanese staple foods (e.g., white rice and udon/soba) and high-fat snacks. The Non-GLP-1 group showed no significant changes in food preferences for any of the nutrient categories. In summary, semaglutide treatment in obese subjects with T2DM facilitated weight loss, in part by altering food preferences, which potentially contributed to its metabolic benefits.