Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome

Abstract

Objective: Dietary fructose is implicated in metabolic syndrome, but intervention studies are confounded by positive caloric balance, changes in adiposity, or artifactually high amounts. This study determined whether isocaloric substitution of starch for sugar would improve metabolic parameters in Latino (n = 27) and African-American (n = 16) children with obesity and metabolic syndrome.

Methods: Participants consumed a diet for 9 days to deliver comparable percentages of protein, fat, and carbohydrate as their self-reported diet; however, dietary sugar was reduced from 28% to 10% and substituted with starch. Participants recorded daily weights, with calories adjusted for weight maintenance. Participants underwent dual-energy X-ray absorptiometry and oral glucose tolerance testing on Days 0 and 10. Biochemical analyses were controlled for weight change by repeated measures ANCOVA.

Results: Reductions in diastolic blood pressure (-5 mmHg; P = 0.002), lactate (-0.3 mmol/L; P < 0.001), triglyceride, and LDL-cholesterol (-46% and -0.3 mmol/L; P < 0.001) were noted. Glucose tolerance and hyperinsulinemia improved (P < 0.001). Weight reduced by 0.9 ± 0.2 kg (P < 0.001) and fat-free mass by 0.6 kg (P = 0.04). Post hoc sensitivity analysis demonstrates that results in the subcohort that did not lose weight (n = 10) were directionally consistent.

Conclusions: Isocaloric fructose restriction improved surrogate metabolic parameters in children with obesity and metabolic syndrome irrespective of weight change.

Figure 1

Change in weight from baseline in the 43 participants over the 10 days of study. Individual weight change curves are in light gray, while mean±SEM for the entire cohort are in black.

Figure 2

a) Glucose, and b) insulin responses (Mean±SEM) to OGTT on Day 0 and 10 for all 43 participants. c) Glucose, and d) insulin responses to OGTT on Day 0 and 10 for the ten participants in the post-hoc sensitivity analysis who gained weight during the study interval. * p<0.05 paired t-test (Day 10 vs. Day 0) at each individual time point ** p<0.01 paired t-test (Day 10 vs. Day 0) at each individual time point