title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trail Registry ACTRN12608000416392 . Registered 25 August 2008.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. sarah.garnett@health.nsw.gov.au.|Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. sarah.garnett@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. sarah.garnett@health.nsw.gov.au.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. megan.gow@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. megan.gow@health.nsw.gov.au.
authors.forename: Megan
authors.initials: M
authors.lastname: Gow
authors.affiliation: The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. mandy.ho@health.nsw.gov.au.
authors.forename: Mandy
authors.initials: M
authors.lastname: Ho
authors.affiliation: Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. louise.baur@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. louise.baur@health.nsw.gov.au.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Baur
authors.affiliation: CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide, BC South Australia, 5000, Australia. Manny.Noakes@csiro.au.
authors.forename: Manny
authors.initials: M
authors.lastname: Noakes
authors.affiliation: Department of Paediatrics, Campbelltown Hospital, PO Box 149, Campbelltown, NSW, 2560, Australia. helen.woodhead@SESIAHS.health.nsw.gov.au.|Department of Diabetes and Endocrinology, Sydney Children's Hospital Network, Randwick, Sydney, NSW, 2031, Australia. helen.woodhead@SESIAHS.health.nsw.gov.au.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Woodhead
authors.affiliation: The Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. carolyn.broderick@health.nsw.gov.au.|The School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia. carolyn.broderick@health.nsw.gov.au.
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Broderick
authors.affiliation: Nutrition and Dietetics and Weight Management Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. kerryn.chisholm@health.nsw.gov.au.
authors.forename: Kerryn
authors.initials: K
authors.lastname: Chisholm
authors.affiliation: Department of Nuclear Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. julie.briody@health.nsw.gov.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Briody
authors.affiliation: Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. sukanya.de@health.nsw.gov.au.
authors.forename: Sukanya
authors.initials: S
authors.lastname: De
authors.affiliation: Academic Department of Adolescent Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, 2066, Australia. kate.steinbeck@health.nsw.gov.au.
authors.forename: Katherine
authors.initials: K
authors.lastname: Steinbeck
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. shubha.srinivasan@health.nsw.gov.au.
authors.forename: Shubha
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. geoffrey.ambler@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. geoffrey.ambler@health.nsw.gov.au.
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ambler
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. chris.cowell@health.nsw.gov.au.|Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. chris.cowell@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. chris.cowell@health.nsw.gov.au.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Cowell
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D003131:Combined Modality Therapy; D050528:Diet, Carbohydrate-Restricted; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D050177:Overweight / Q000178:diet therapy / Q000378:metabolism; D010349:Patient Compliance; D063766:Pediatric Obesity / Q000178:diet therapy / Q000378:metabolism; D011236:Prediabetic State / Q000178:diet therapy* / Q000378:metabolism
chemical_list: D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D007004:Hypoglycemic Agents; D008055:Lipids; D008687:Metformin