Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome
Funding agencies: NIH (R01DK089216), UCSF CTSI (NCATS‐UL1‐TR00004), and Touro University.
Disclosure: Dr. Lustig reports author fees from Hudson Street Press. He is also a volunteer advisor to Action on Sugar and the unpaid Board President and Founder of Institute for Responsible Nutrition.
Author contributions: All authors had access to the study data and are responsible for the conclusions. Study concept and design: Lustig, Schwarz, Mulligan; acquisition, analysis, or interpretation of data: all authors; drafting of the manuscript: Lustig; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: Erkin‐Cakmak, Mulligan; obtained funding: Lustig, Schwarz, Noworolski, Gugliucci, Mulligan; administrative, technical, or material support: Lustig, Schwarz, Mulligan, Gugliucci, Tai, Wen; study supervision: Lustig, Schwarz, Mulligan.
This article was published online on 26 October 2015. An error in the Disclosure footnote was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected 14 December 2015.
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.
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