Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome.
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.
Department of Pediatrics, University of California, San Francisco, California, USA.
Robert H
RH
Lustig
Department of Medicine, University of California, San Francisco, California, USA.|Department of Research, College of Osteopathic Medicine, Touro University-California, Vallejo, California, USA.
Kathleen
K
Mulligan
Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
Susan M
SM
Noworolski
Department of Medicine, University of California, San Francisco, California, USA.
Viva W
VW
Tai
Department of Medicine, University of California, San Francisco, California, USA.
Michael J
MJ
Wen
Department of Pediatrics, University of California, San Francisco, California, USA.
Ayca
A
Erkin-Cakmak
Department of Research, College of Osteopathic Medicine, Touro University-California, Vallejo, California, USA.
Alejandro
A
Gugliucci
Basic Sciences, College of Osteopathic Medicine, Touro University-California, Vallejo, California, USA.
Jean-Marc
JM
Schwarz
D015502:Absorptiometry, Photon; D050154:Adiposity / Q000187:drug effects; D000293:Adolescent; D001741:Black or African American; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D004032:Diet / Q000379:methods*; D019422:Dietary Sucrose / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005632:Fructose / Q000008:administration & dosage*; D005951:Glucose Tolerance Test; D006630:Hispanic or Latino; D006801:Humans; D006946:Hyperinsulinism / Q000178:diet therapy / Q000209:etiology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000178:diet therapy* / Q000378:metabolism; D009765:Obesity / Q000150:complications / Q000178:diet therapy* / Q000378:metabolism; D013549:Sweetening Agents / Q000008:administration & dosage*; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D019422:Dietary Sucrose; D013549:Sweetening Agents; D014280:Triglycerides; D005632:Fructose; D019344:Lactic Acid