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

Original Article

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1. Robert H. Lustig^1,*,
2. Kathleen Mulligan^2,3,
3. Susan M. Noworolski⁴,
4. Viva W. Tai²,
5. Michael J. Wen²,
6. Ayca Erkin-Cakmak¹,
7. Alejandro Gugliucci³ and
8. Jean-Marc Schwarz⁵

Article first published online: 26 OCT 2015

DOI: 10.1002/oby.21371

© 2015 The Obesity Society

Issue

Obesity

Early View (Online Version of Record published before inclusion in an issue)

Additional Information(Show All)

How to CiteAuthor InformationPublication HistoryFunding Information

1. Funding agencies: NIH (R01DK089216), UCSF CTSI (NCATS-UL1-TR00004), and Touro University.
2. Disclosure: The authors declared no conflict of interest.
3. 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.

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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.