Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre-diabetes; RESIST a randomised control trial

BMC Pediatr. 2014 Nov 25;14:289. doi: 10.1186/s12887-014-0289-0.


Background: A higher protein to carbohydrate ratio in the diet may potentiate weight loss, improve body composition and cardiometabolic risk, including glucose homeostasis in adults. The aim of this randomised control trial was to determine the efficacy of two structured lifestyle interventions, differing in dietary macronutrient content, on insulin sensitivity and body composition in adolescents. We hypothesised that a moderate-carbohydrate (40-45% of energy), increased-protein (25-30%) diet would be more effective than a high-carbohydrate diet (55-60%), moderate-protein (15%) diet in improving outcomes in obese, insulin resistant adolescents.

Methods: Obese 10-17 year olds with either pre-diabetes and/or clinical features of insulin resistance were recruited at two hospitals in Sydney, Australia. At baseline adolescents were prescribed metformin and randomised to one of two energy restricted diets. The intervention included regular contact with the dietician and a supervised physical activity program. Outcomes included insulin sensitivity index measured by an oral glucose tolerance test and body composition measured by dual-energy x-ray absorptiometry at 12 months.

Results: Of the 111 adolescents recruited, 85 (77%) completed the intervention. BMI expressed as a percentage of the 95th percentile decreased by 6.8% [95% CI: -8.8 to -4.9], ISI increased by 0.2 [95% CI: 0.06 to 0.39] and percent body fat decreased by 2.4% [95% CI: -3.4 to -1.3]. There were no significant differences in outcomes between diet groups at any time.

Conclusion: When treated with metformin and an exercise program, a structured, reduced energy diet, which is either high-carbohydrate or moderate-carbohydrate with increased-protein, can achieve clinically significant improvements in obese adolescents at risk of type 2 diabetes.

Trial registration: Australian New Zealand Clinical Trail Registry ACTRN12608000416392 . Registered 25 August 2008.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Pressure
  • Body Composition
  • Body Mass Index
  • Child
  • Combined Modality Therapy
  • Diet, Carbohydrate-Restricted
  • Dietary Carbohydrates / administration & dosage*
  • Dietary Proteins / administration & dosage*
  • Exercise Therapy
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin Resistance
  • Lipids / blood
  • Male
  • Metformin / therapeutic use
  • Overweight / diet therapy
  • Overweight / metabolism
  • Patient Compliance
  • Pediatric Obesity / diet therapy
  • Pediatric Obesity / metabolism
  • Prediabetic State / diet therapy*
  • Prediabetic State / metabolism


  • Dietary Carbohydrates
  • Dietary Proteins
  • Hypoglycemic Agents
  • Lipids
  • Metformin

Associated data

  • ANZCTR/ACTRN1260800041639