title: Optimal macronutrient content of the diet for adolescents with prediabetes; RESIST a randomised control trial.
abstract: BACKGROUND
  Prediabetes and clinical insulin resistance in adolescents are rapidly emerging clinical problems with serious health outcomes.
  
  
  OBJECTIVE
  The objective of this study was to determine the efficacy of 2 structured lifestyle interventions, both differing in diet macronutrient composition, on insulin sensitivity.
  
  
  METHODS
  This study was a randomized controlled trial, known as Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers, in 2 hospitals in Sydney, Australia.
  
  
  METHODS
  Participants included overweight or obese 10- to 17-year-olds with either prediabetes and/or clinical features of insulin resistance.
  
  
  METHODS
  At baseline adolescents were prescribed metformin and randomized to a structured diet, which was either high carbohydrate or moderate carbohydrate with increased protein. The program commenced with a 3-month dietary intervention, with the addition of an exercise intervention in the next 3 months.
  
  
  RESULTS
  The outcomes included an insulin sensitivity, anthropometry, and cardiometabolic profile at 6 months.
  
  
  RESULTS
  One hundred eleven subjects (66 girls) were recruited and 98 subjects (58 girls) completed the 6-month intervention. After 3 months the mean insulin sensitivity index increased by 0.3 [95% confidence interval (CI) 0.2-0.4]. After 6 months the mean insulin (picomoles per liter) to glucose ratio (millimoles per liter) decreased by 7.2 [95%CI -12.0 to -2.3], body mass index, expressed as a percentage of the 95th centile, decreased by 9% (95% CI -3 to -15), but there was no significant change in the lipids. There were no significant differences in outcomes between the diet groups at any time point.
  
  
  CONCLUSIONS
  These results are in contrast with our hypothesis that adolescents randomized to the increased protein diet would have better outcomes. Further strategies are required to better address prediabetes and clinical features of insulin resistance in adolescents.
authors.affiliation: The Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia. sarah.garnett@health.nsw.edu.au
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
authors.forename: Megan
authors.initials: M
authors.lastname: Gow
authors.forename: Mandy
authors.initials: M
authors.lastname: Ho
authors.forename: Louise A
authors.initials: LA
authors.lastname: Baur
authors.forename: Manny
authors.initials: M
authors.lastname: Noakes
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Woodhead
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Broderick
authors.forename: Susie
authors.initials: S
authors.lastname: Burrell
authors.forename: Kerryn
authors.initials: K
authors.lastname: Chisholm
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Halim
authors.forename: Sukanya
authors.initials: S
authors.lastname: De
authors.forename: Katherine
authors.initials: K
authors.lastname: Steinbeck
authors.forename: Shubha
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ambler
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kohn
authors.forename: Chris T
authors.initials: CT
authors.lastname: Cowell
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003927:Diet, Diabetic / Q000379:methods*; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008019:Life Style; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008687:Metformin / Q000627:therapeutic use; D009517:New South Wales / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D010349:Patient Compliance; D010352:Patient Dropouts; D011236:Prediabetic State / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology; D012306:Risk; D015431:Weight Loss / Q000187:drug effects
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin