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Kalaitzopoulou I, Theodoridis X, Kotzakioulafi E, Evripidou K, Chourdakis M. The Effectiveness of a Low Glycemic Index/Load Diet on Cardiometabolic, Glucometabolic, and Anthropometric Indices in Children with Overweight or Obesity: A Systematic Review and Meta-Analysis. Children (Basel) 2023; 10:1481. [PMID: 37761441 PMCID: PMC10528374 DOI: 10.3390/children10091481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
(1) Background: This systematic review and meta-analysis aims to evaluate the impact of a low glycemic index (LGI) and low glycemic load (LGL) diet on children with overweight and obesity, analyzing any changes in anthropometric, cardiometabolic, and glucometabolic parameters. (2) Methods: Three electronic databases (PubMed, Scopus, CENTRAL), as well as clinical trial registries and reference lists of the included studies, were searched for eligible randomized control trials (RCTs). Two independent reviewers performed the screening of the studies, data extraction, and risk of bias assessment. Mean difference (MD) and 95% confidence intervals (CI) using a random effects model were calculated for each outcome. (3) Results: Eleven RCTs (n = 634) examining the effect of LGI diet versus control were identified. The synthesized data provided from the RCTs indicate no difference between intervention and control groups regarding primary outcomes (body weight (MD: -0.14; 95% CI -1.93 to 1.64, 5 trials), body mass index (BMI) (MD: -0.31; 95% CI -0.85 to 0.23, 6 trials), BMI z-score (MD: -0.03; 95% CI -0.09 to 0.02, 5 trials), and waist circumference (MD: -0.52; 95% CI -2.35 to 1.31, 5 trials)) and other measures of cardiometabolic and glucometabolic parameters. The majority of trials were classified as "some concerns". (4) Conclusions: LGI and LGL diets do not seem to be associated with changes in adiposity, cardiometabolic or glucometabolic markers in children with overweight or obesity. Further research comparing the LGI diet to a high glycemic index diet, with proper methodological standards, is required to clarify the benefits of a LGI diet in this population.
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Affiliation(s)
- Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.K.); (X.T.); (E.K.); (K.E.)
| | - Xenophon Theodoridis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.K.); (X.T.); (E.K.); (K.E.)
| | - Evangelia Kotzakioulafi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.K.); (X.T.); (E.K.); (K.E.)
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, “AHEPA” Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Kleo Evripidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.K.); (X.T.); (E.K.); (K.E.)
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (I.K.); (X.T.); (E.K.); (K.E.)
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Herouvi D, Paltoglou G, Soldatou A, Kalpia C, Karanasios S, Karavanaki K. Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents. Children (Basel) 2023; 10:1230. [PMID: 37508727 PMCID: PMC10378563 DOI: 10.3390/children10071230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Obesity is a multifactorial chronic impairment that further decreases quality of life and life expectancy. Worldwide, childhood obesity has become a pandemic health issue causing several comorbidities that frequently present already in childhood, including cardiovascular (hypertension, dyslipidemia), metabolic (Type 2 diabetes mellitus, fatty liver disease, metabolic syndrome), respiratory, gastrointestinal and musculoskeletal disorders. In addition, obese children frequently experience stress and psychosocial symptoms, including mood disorders, anxiety, prejudice and low self-esteem. Given that cardiovascular risk factors and pediatric obesity have the tendency to pertain into adulthood, obesity management, including weight control and physical activity, should start before the late teens and certainly before the first signs of atherosclerosis can be detected. This review aims to concisely present options for childhood obesity management, including lifestyle modification strategies and pharmacological treatment, as well as the respective treatment indications for the general practitioner.
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Affiliation(s)
- Despina Herouvi
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - George Paltoglou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Christina Kalpia
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Spyridon Karanasios
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, University of Athens, "P&A Kyriakou" Children's Hospital, 11527 Athens, Greece
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Ludwig DS, Holst JJ. Childhood Obesity at the Crossroads of Science and Social Justice. JAMA 2023:2804576. [PMID: 37126323 DOI: 10.1001/jama.2023.7592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This Viewpoint considers the best approaches for treating obesity in youth and argues that better funding is needed for new dietary treatments and reimbursement for behavioral interventions.
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Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jens J Holst
- Department of Biomedical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Vinoy S, Goletzke J, Rakhshandehroo M, Schweitzer L, Flourakis M, Körner A, Alexy U, van Schothorst EM, Ceriello A, Zakrzewski-Fruer JK, Buyken A. Health relevance of lowering postprandial glycaemia in the paediatric population through diet': results from a multistakeholder workshop. Eur J Nutr 2023; 62:1093-1107. [PMID: 36534178 PMCID: PMC10030539 DOI: 10.1007/s00394-022-03047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Abstract
To summarize current knowledge and gaps regarding the role of postprandial glycaemic response in the paediatric population, a workshop was organized in June 2021 by the European branch of the International Life Science Institute (ILSI). This virtual event comprised of talks given by experts followed by in-depth discussions in breakout sessions with workshop participants. The main pre-specified topics addressed by the workshop organizing committee to the invited speakers and the workshop participants were: (1) the role of glycaemic responses for paediatric health, based on mechanistic insights from animal and human data, and long-term evidence from observational and intervention studies in paediatric populations, and (2) changes in metabolism and changes in dietary needs from infancy to adolescence. Each talk as well as the discussions were summarised, including the main identified research gaps. The workshop led to the consensus on the crucial role on health of postprandial glycaemic response in paediatric population. However, a lack of scientific data has been identified regarding detailed glucose and insulin profiles in response to foods commonly consumed by paediatric populations, as well as a lack of long-term evidence including the need for suitable predictors during childhood and adolescence to anticipate health effects during adulthood.
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Affiliation(s)
- Sophie Vinoy
- Mondelēz International, Nutrition Research, Clamart, France
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Hodder RK, O'Brien KM, Lorien S, Wolfenden L, Moore TH, Hall A, Yoong SL, Summerbell C. Interventions to prevent obesity in school-aged children 6-18 years: An update of a Cochrane systematic review and meta-analysis including studies from 2015-2021. EClinicalMedicine 2022; 54:101635. [PMID: 36281235 PMCID: PMC9581512 DOI: 10.1016/j.eclinm.2022.101635] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised. METHODS An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect. FINDINGS Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness. INTERPRETATION This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning. FUNDING This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).
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Affiliation(s)
- Rebecca K. Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
- Corresponding author at: C/- Hunter New England Population Health, Locked Bag 10, Wallsend NSW 2287 Australia.
| | - Kate M. O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sasha Lorien
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Theresa H.M. Moore
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Whitefriars, Lewins Mean, Bristol, BS1 2NT, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, United Kingdom
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, 29 Kookaburra Drive, New Lambton Heights, NSW 2305, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Burwood, VIC 3125, Australia
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Stockton Road, Durham DH1 3LE, United Kingdom
- Fuse, The NIHR Centre for Translational Research in Public Health, United Kingdom
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Ong YY, Huang JY, Michael N, Sadananthan SA, Yuan WL, Chen LW, Karnani N, Velan SS, Fortier MV, Tan KH, Gluckman PD, Yap F, Chong YS, Godfrey KM, Chong MFF, Chan SY, Lee YS, Tint MT, Eriksson JG. Cardiometabolic Profile of Different Body Composition Phenotypes in Children. J Clin Endocrinol Metab 2021; 106:e2015-e2024. [PMID: 33524127 PMCID: PMC7610678 DOI: 10.1210/clinem/dgab003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Cardiometabolic profiles of different body composition phenotypes are poorly characterized in young children, where it is well established that high adiposity is unfavorable, but the role of lean mass is unclear. OBJECTIVE We hypothesized that higher lean mass attenuates cardiometabolic risk in children with high fat mass. METHODS In 6-year-old children (n = 377) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) prospective birth cohort, whole-body composition was measured by quantitative magnetic resonance, a novel validated technology. Based on fat mass index (FMI) and lean mass index (LMI), 4 body composition phenotypes were derived: low FMI-low LMI (LF-LL), low FMI-high LMI (LF-HL), high FMI-low LMI (HF-LL), high FMI-high LMI (HF-HL). MAIN OUTCOME MEASURES Body mass index (BMI) z-score, fasting plasma glucose, insulin resistance, metabolic syndrome risk score, fatty liver index, and blood pressure. RESULTS Compared with the LF-HL group, children in both high FMI groups had increased BMI z-score (HF-HL: 1.43 units 95% CI [1.11,1.76]; HF-LL: 0.61 units [0.25,0.96]) and metabolic syndrome risk score (HF-HL: 1.64 [0.77,2.50]; HF-LL: 1.28 [0.34,2.21]). The HF-HL group also had increased fatty liver index (1.15 [0.54,1.77]). Girls in HF-HL group had lower fasting plasma glucose (-0.29 mmol/L [-0.55,-0.04]) and diastolic blood pressure (-3.22 mmHg [-6.03,-0.41]) than girls in the HF-LL group. No similar associations were observed in boys. CONCLUSION In a multi-ethnic Asian cohort, lean mass seemed to protect against some cardiometabolic risk markers linked with adiposity, but only in girls. The FMI seemed more important than lean mass index in relation to cardiometabolic profiles of young children.
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Affiliation(s)
- Yi Ying Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonathan Y. Huang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ling-Wei Chen
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - S. Sendhil Velan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore
| | - Marielle V. Fortier
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary F-F. Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G. Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
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Dorenbos E, Drummen M, Adam T, Rijks J, Winkens B, Martínez JA, Navas‐Carretero S, Stratton G, Swindell N, Stouthart P, Mackintosh K, Mcnarry M, Tremblay A, Fogelholm M, Raben A, Westerterp‐Plantenga M, Vreugdenhil A. Effect of a high protein/low glycaemic index diet on insulin resistance in adolescents with overweight/obesity-A PREVIEW randomized clinical trial. Pediatr Obes 2021; 16:e12702. [PMID: 32681547 PMCID: PMC7757177 DOI: 10.1111/ijpo.12702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pubertal insulin resistance (IR) is associated with increased risk of type 2 diabetes mellitus development in adolescents with overweight/obesity. OBJECTIVES The PREVIEW study was a randomized parallel trial assessing the change in IR, analyzed by Homeostatic Model Assessment of IR (HOMA-IR), at 2 years after randomization to a high protein vs a moderate protein diet in adolescents with overweight/obesity. It was hypothesized that a high protein/low glycaemic index diet would be superior in reducing IR compared to a medium protein/medium GI diet, in insulin resistant adolescents with overweight or obesity. METHODS Adolescents with overweight/obesity and IR from the Netherlands, United Kingdom and Spain were randomized into a moderate protein/moderate GI (15/55/30En% protein/carbohydrate/fat, GI ≥ 56) or high protein/low GI (25/45/30En% protein/carbohydrate/fat, GI < 50) diet. Anthropometric and cardiometabolic parameters, puberty, dietary intake and physical activity (PA) were measured and effects on HOMA-IR were analyzed. RESULTS 126 adolescents were included in this study (13.6 ± 2.2 years, BMI z-score 3.04 ± 0.66, HOMA-IR 3.48 ± 2.28, HP n = 68, MP n = 58). At 2 years, changes in protein intake were not significantly different between timepoints or intervention groups and no effects of the intervention on IR were observed. The retention rate was 39%, while no compliance to the diets was observed. CONCLUSIONS The PREVIEW study observed no effect of a high protein/low GI diet on IR in adolescents with overweight/obesity and IR because of lack of feasibility, due to insufficient retention and dietary compliance after 2 years.
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Affiliation(s)
- Elke Dorenbos
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Centre for Overweight Adolescent and Children's Healthcare (COACH)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Mathijs Drummen
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Tanja Adam
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Jesse Rijks
- Centre for Overweight Adolescent and Children's Healthcare (COACH)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Bjorn Winkens
- Department of Methodology and StatisticsCare and Public Health Research Institute (CAPHRI), Maastricht UniversityMaastrichtThe Netherlands
| | - J. Alfredo Martínez
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN)Universidad de NavarraPamplonaSpain,CIBERobn, Instituto de Salud Carlos IIIMadridSpain,IMDEA Research Institute on Food and Health SciencesMadridSpain
| | - Santiago Navas‐Carretero
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN)Universidad de NavarraPamplonaSpain,CIBERobn, Instituto de Salud Carlos IIIMadridSpain
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A‐STEM)Swansea UniversitySwanseaUK
| | - Nils Swindell
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A‐STEM)Swansea UniversitySwanseaUK
| | - Pauline Stouthart
- Centre for Overweight Adolescent and Children's Healthcare (COACH)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Kelly Mackintosh
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A‐STEM)Swansea UniversitySwanseaUK
| | - Melitta Mcnarry
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A‐STEM)Swansea UniversitySwanseaUK
| | | | - Mikael Fogelholm
- Department of Food and Nutrition, University of HelsinkiHelsinkiFinland
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenFrederiksbergDenmark
| | | | - Anita Vreugdenhil
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Centre for Overweight Adolescent and Children's Healthcare (COACH)Maastricht University Medical CentreMaastrichtThe Netherlands
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Alvarez-Pitti J, de Blas A, Lurbe E. Innovations in Infant Feeding: Future Challenges and Opportunities in Obesity and Cardiometabolic Disease. Nutrients 2020; 12:nu12113508. [PMID: 33202614 PMCID: PMC7697724 DOI: 10.3390/nu12113508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
The field of nutrition in early life, as an effective tool to prevent and treat chronic diseases, has attracted a large amount of interest over recent years. The vital roles of food products and nutrients on the body’s molecular mechanisms have been demonstrated. The knowledge of the mechanisms and the possibility of controlling them via what we eat has opened up the field of precision nutrition, which aims to set dietary strategies in order to improve health with the greatest effectiveness. However, this objective is achieved only if the genetic profile of individuals and their living conditions are also considered. The relevance of this topic is strengthened considering the importance of nutrition during childhood and the impact on the development of obesity. In fact, the prevalence of global childhood obesity has increased substantially from 1990 and has now reached epidemic proportions. The current narrative review presents recent research on precision nutrition and its role on the prevention and treatment of obesity during pediatric years, a novel and promising area of research.
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Affiliation(s)
- Julio Alvarez-Pitti
- Department of Pediatrics, Consorcio Hospital General, University of Valencia, 46014 Valencia, Spain; (A.d.B.); (E.L.)
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, 28029 Madrid, Spain
- INCLIVA Biomedical Research Institute, Hospital Clínico, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-96-1820772
| | - Ana de Blas
- Department of Pediatrics, Consorcio Hospital General, University of Valencia, 46014 Valencia, Spain; (A.d.B.); (E.L.)
| | - Empar Lurbe
- Department of Pediatrics, Consorcio Hospital General, University of Valencia, 46014 Valencia, Spain; (A.d.B.); (E.L.)
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, 28029 Madrid, Spain
- INCLIVA Biomedical Research Institute, Hospital Clínico, University of Valencia, 46010 Valencia, Spain
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Bellissimo N, Fansabedian T, Wong VC, Totosy de Zepetnek JO, Brett NR, Schwartz A, Cassin S, Suitor K, Rousseau D. Effect of Increasing the Dietary Protein Content of Breakfast on Subjective Appetite, Short-Term Food Intake and Diet-Induced Thermogenesis in Children. Nutrients 2020; 12:nu12103025. [PMID: 33023221 PMCID: PMC7601774 DOI: 10.3390/nu12103025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
Dietary protein affects energy balance by decreasing food intake (FI) and increasing energy expenditure through diet-induced thermogenesis (DIT) in adults. Our objective was to investigate the effects of increasing the dietary protein in an isocaloric breakfast on subjective appetite, FI, blood glucose, and DIT in 9-14 y children. Two randomized repeated measures designs were used. In experiment 1, 17 children (9 boys, 8 girls) consumed isocaloric meals (450 kcal) on four separate mornings containing: 7 g (control), 15 g (low protein, LP), 30 g (medium protein, MP) or 45 g (high protein, HP) of protein. Blood glucose and subjective appetite were measured at baseline and regular intervals for 4 h, and FI was measured at 4 h. In experiment 2, 9 children (6 boys, 3 girls) consumed the control or HP breakfast on two separate mornings, and both DIT and subjective appetite were determined over 5 h. In experiment 1, all dietary protein treatments suppressed subjective appetite compared to control (p < 0.001), and the HP breakfast suppressed FI compared with the LP breakfast and control (p < 0.05). In experiment 2, DIT was higher after HP than control (p < 0.05). In conclusion, increasing the dietary protein content of breakfast had favorable effects on satiety, FI, and DIT in children.
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Affiliation(s)
- Nick Bellissimo
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
- Correspondence: ; Tel.: +14-16-979-5000-x553026
| | - Tammy Fansabedian
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
| | - Vincent C.H. Wong
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
| | | | - Neil R. Brett
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
| | - Alexander Schwartz
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, Toronto, ON M5B-2K3, Canada;
| | - Katherine Suitor
- School of Nutrition, Ryerson University, Toronto, ON M5B-2K3, Canada; (T.F.); (V.C.H.W.); (N.R.B.); (A.S.); (K.S.)
| | - Dérick Rousseau
- Department of Chemistry & Biology, Ryerson University, Toronto, ON M5B-2K3, Canada;
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10
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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11
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Livesey G, Taylor R, Livesey HF, Buyken AE, Jenkins DJA, Augustin LSA, Sievenpiper JL, Barclay AW, Liu S, Wolever TMS, Willett WC, Brighenti F, Salas-Salvadó J, Björck I, Rizkalla SW, Riccardi G, Vecchia CL, Ceriello A, Trichopoulou A, Poli A, Astrup A, Kendall CWC, Ha MA, Baer-Sinnott S, Brand-Miller JC. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: Assessment of Causal Relations. Nutrients 2019; 11:nu11061436. [PMID: 31242690 PMCID: PMC6628270 DOI: 10.3390/nu11061436] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022] Open
Abstract
While dietary factors are important modifiable risk factors for type 2 diabetes (T2D), the causal role of carbohydrate quality in nutrition remains controversial. Dietary glycemic index (GI) and glycemic load (GL) have been examined in relation to the risk of T2D in multiple prospective cohort studies. Previous meta-analyses indicate significant relations but consideration of causality has been minimal. Here, the results of our recent meta-analyses of prospective cohort studies of 4 to 26-y follow-up are interpreted in the context of the nine Bradford-Hill criteria for causality, that is: (1) Strength of Association, (2) Consistency, (3) Specificity, (4) Temporality, (5) Biological Gradient, (6) Plausibility, (7) Experimental evidence, (8) Analogy, and (9) Coherence. These criteria necessitated referral to a body of literature wider than prospective cohort studies alone, especially in criteria 6 to 9. In this analysis, all nine of the Hill’s criteria were met for GI and GL indicating that we can be confident of a role for GI and GL as causal factors contributing to incident T2D. In addition, neither dietary fiber nor cereal fiber nor wholegrain were found to be reliable or effective surrogate measures of GI or GL. Finally, our cost–benefit analysis suggests food and nutrition advice favors lower GI or GL and would produce significant potential cost savings in national healthcare budgets. The high confidence in causal associations for incident T2D is sufficient to consider inclusion of GI and GL in food and nutrient-based recommendations.
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Affiliation(s)
- Geoffrey Livesey
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Richard Taylor
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Helen F Livesey
- Independent Nutrition Logic Ltd, 21 Bellrope Lane, Wymondham NR180QX, UK.
| | - Anette E Buyken
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany.
| | - David J A Jenkins
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Livia S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Epidemiology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Napoli, Italy.
| | - John L Sievenpiper
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Alan W Barclay
- Glycemic Index Foundation, 26 Arundel St, Glebe, Sydney NSW 2037, Australia.
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA.
| | - Thomas M S Wolever
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health and Harvard Medical School, Boston, MA 02115, USA.
| | - Furio Brighenti
- Department of Food and Drug, University of Parma, 43120 Parma, Italy.
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili (IISPV), Rovira i Virgili University, 43201 Reus, Spain.
- Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 27400 Madrid, Spain.
| | - Inger Björck
- Retired from Food for Health Science Centre, Antidiabetic Food Centre, Lund University, S-221 00 Lund, Sweden.
| | - Salwa W Rizkalla
- Institute of Cardiometabolism and Nutrition, ICAN, Pitié Salpêtrière Hospital, F75013 Paris, France.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, 80147 Naples, Italy.
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 201330 Milan, Italy.
| | - Antonio Ceriello
- IRCCS MultiMedica, Diabetes Department, Sesto San Giovanni, 20099 Milan, Italy.
| | | | - Andrea Poli
- Nutrition Foundation of Italy, Viale Tunisia 38, I-20124 Milan, Italy.
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports (NEXS) Faculty of Science, University of Copenhagen, 2200 Copenhagen, Denmark.
| | - Cyril W C Kendall
- Departments of Nutritional Science and Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON M5C 2T2, Canada.
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5B5, Canada.
| | - Marie-Ann Ha
- Spinney Nutrition, Shirwell, Barnstaple, Devon EX31 4JR, UK.
| | | | - Jennie C Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney NSW 2006, Australia.
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12
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Veldhorst MAB, Verbruggen SCAT, van Harskamp D, Vermes A, Schierbeek H, van Goudoever JB, van den Akker ELT. Effects of a high-protein intake on metabolic targets for weight loss in children with obesity: a randomized trial. Obes Sci Pract 2018; 4:347-356. [PMID: 30151229 PMCID: PMC6105699 DOI: 10.1002/osp4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of this research is to study effects of a 4-week high-protein (HP) diet on energy intake, resting energy expenditure (REE), protein turnover and body composition in children with obesity. METHODS In this randomized placebo-controlled single-blind crossover study, children with obesity (n = 14; mean age: 10.1 years ± 1.2 standard deviation; body mass index-standard deviation score [BMI-SDS]: 2.8 ± 0.5) received an ad libitum HP (+50 g protein per day) or normal-protein (NP) diet for 4 weeks with a washout period of ≥2 weeks. Energy intake, REE, protein turnover, weight, BMI-SDS and body composition were measured. RESULTS No differences were found in energy intake or REE between HP and NP. There was an increased urea production and phenylalanine hydroxylation after HP compared with NP (p < 0.05). There was an increased rise in fat-free mass after HP compared with NP (∆HP: 0.8 ± 0.8 kg vs. ∆NP: 0.1 ± 0.6 kg, p < 0.05). BMI and BMI-SDS increased during the study (BMI-SDS start: 2.8 ± 0.5, end: 2.9 ± 0.5, p < 0.05) without a difference between groups. CONCLUSIONS A 4-week HP diet with ad libitum food intake did not affect energy intake and energy expenditure in children with obesity. BMI increased, although that could be partly explained by an increase in fat-free mass.
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Affiliation(s)
- M. A. B. Veldhorst
- Department of Pediatric Endocrinology, Obesity Center CGGErasmus MC–Sophia Children's HospitalRotterdamThe Netherlands
- Department of PediatricsEmma Children's Hospital–Academic Medical CenterAmsterdamThe Netherlands
- Department of PediatricsVU University Medical CenterAmsterdamThe Netherlands
| | | | - D. van Harskamp
- Department of PediatricsEmma Children's Hospital–Academic Medical CenterAmsterdamThe Netherlands
| | - A. Vermes
- Hospital PharmacyErasmus MCRotterdamThe Netherlands
| | - H. Schierbeek
- Department of PediatricsEmma Children's Hospital–Academic Medical CenterAmsterdamThe Netherlands
| | - J. B. van Goudoever
- Department of PediatricsEmma Children's Hospital–Academic Medical CenterAmsterdamThe Netherlands
- Department of PediatricsVU University Medical CenterAmsterdamThe Netherlands
| | - E. L. T. van den Akker
- Department of Pediatric Endocrinology, Obesity Center CGGErasmus MC–Sophia Children's HospitalRotterdamThe Netherlands
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13
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Abstract
The increased prevalence of adolescent obesity and associated short-term and long-term complications emphasize the need for effective treatment. In this Review, we aim to describe the evidence for, and elements of, behaviour management and adjunctive therapies and highlight the opportunities and challenges presented by obesity management in adolescence. The broad principles of treatment include management of obesity-associated complications; a developmentally appropriate approach; long-term behaviour modification (dietary change, increased physical activity, decreased sedentary behaviours and improved sleep patterns); long-term weight maintenance strategies; and consideration of the use of pharmacotherapy, more intensive dietary therapies and bariatric surgery. Bariatric surgery should be considered in those with severe obesity and be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents. Adolescent obesity management strategies are more reliant on active participation than those for childhood obesity and should recognize the emerging autonomy of the patient. The challenges in adolescent obesity relate primarily to the often competing demands of developing autonomy and not yet having attained neurocognitive maturity.
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Affiliation(s)
- Katharine S Steinbeck
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie B Lister
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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14
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Dorenbos E, Drummen M, Rijks J, Adam T, Stouthart P, Alfredo Martínez J, Navas-Carretero S, Stratton G, Swindell N, Fogelholm M, Raben A, Westerterp-Plantenga M, Vreugdenhil A. PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study in children aged 10 to 17 years: Design, methods and baseline results. Diabetes Obes Metab 2018; 20:1096-1101. [PMID: 29322617 DOI: 10.1111/dom.13216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/22/2017] [Accepted: 01/05/2018] [Indexed: 01/19/2023]
Abstract
Insulin resistance (IR) in adolescence is associated with type 2 diabetes mellitus [T2DM]. The PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study assessed the effectiveness of a high-protein, low-glycaemic-index diet and a moderate-protein, moderate-glycaemic-index diet to decrease IR in insulin-resistant children who were overweight or obese. Inclusion criteria were age 10 to 17 years, homeostatic model assessment of IR (HOMA-IR) ≥2.0 and overweight/obesity. In 126 children (mean ± SD age 13.6 ± 2.2 years, body mass index [BMI] z-score 3.04 ± 0.66, HOMA-IR 3.48 ± 2.28) anthropometrics, fat mass percentage (FM%), metabolic characteristics, physical activity, food intake and sleep were measured. Baseline characteristics did not differ between the groups. IR was higher in pubertal children with morbid obesity than in prepubertal children with morbid obesity (5.41 ± 1.86 vs 3.23 ± 1.86; P = .007) and prepubertal and pubertal children with overweight/obesity (vs 3.61 ± 1.60, P = .004, and vs 3.40 ± 1.50, P < .001, respectively). IR was associated with sex, Tanner stage, BMI z-score and FM%. Fasting glucose concentrations were negatively associated with Baecke sport score (r = -0.223, P = .025) and positively with daytime sleepiness (r = 0.280, P = .016) independent of sex, Tanner stage, BMI z-score and FM%. In conclusion, IR was most severe in pubertal children with morbid obesity. The associations between fasting glucose concentration and Baecke sport score and sleepiness suggest these might be possible targets for diabetes prevention.
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Affiliation(s)
- Elke Dorenbos
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mathijs Drummen
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jesse Rijks
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tanja Adam
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Pauline Stouthart
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Alfredo Martínez
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN), Universidad de Navarra, Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Navas-Carretero
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research (CIN), Universidad de Navarra, Pamplona, Spain
- CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A-STEM), Swansea University, Swansea, UK
| | - Nils Swindell
- Research Centre in Applied Sports, Technology, Exercise and Medicine (A-STEM), Swansea University, Swansea, UK
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Margriet Westerterp-Plantenga
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Anita Vreugdenhil
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Maastricht University Medical Centre, Maastricht, The Netherlands
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15
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Silveira BKS, Oliveira TMS, Andrade PA, Hermsdorff HHM, Rosa COB, Franceschini SDCC. Dietary Pattern and Macronutrients Profile on the Variation of Inflammatory Biomarkers: Scientific Update. Cardiol Res Pract 2018; 2018:4762575. [PMID: 29725543 DOI: 10.1155/2018/4762575] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/30/2017] [Indexed: 01/18/2023] Open
Abstract
It is known that the dietary pattern and macronutrients profile may influence the expression and secretion of inflammatory biomarkers, and the low-grade inflammation is associated with the manifestation of noncommunicable chronic diseases. Therefore, this review aimed to present and discuss the role of dietary patterns and macronutrients on the variation of inflammatory markers related to NCD risk. Scientific evidences within the last five years based on clinical trials, case-controls, cohorts, and cross-sectional studies indicate that normocaloric, carbohydrate-moderated, low-glycemic index, protein-moderated, monounsaturated and polyunsaturated fatty acid-rich, omega-3, and low-saturated fat diets display positive effects on the inflammatory state, both in healthy individuals and in those with cardiovascular risk, although the second group seems to benefit more from changes in the dietary profile.
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Hazell TJ, Gallo S, Vanstone CA, Agellon S, Rodd C, Weiler HA. Vitamin D supplementation trial in infancy: body composition effects at 3 years of age in a prospective follow-up study from Montréal. Pediatr Obes 2017; 12:38-47. [PMID: 26843140 DOI: 10.1111/ijpo.12105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of vitamin D status on body composition is not well understood. OBJECTIVES Evaluate how vitamin D supplementation in infancy affects body composition at 3 years of age. METHODS Double-blind randomized trial of 132, 1-month-old healthy, breastfed infants randomly assigned to receive oral vitamin D3 supplements of 400, 800, 1200 or 1600 IU d-1 for 11 months. In the present analysis, 87 (66%) returned at 3 years of age. Body composition was measured using dual-energy x-ray absorptiometry and plasma 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography tandem mass spectrometry. RESULTS Anthropometry, body composition, diet, activity and demographics were similar across dosage groups at 3 years. Mean 25(OH)D concentration from 1 month to 3 years was higher (P < 0.001) in the 1200 IU group than 800 and 400 IU groups. Children with 25(OH)D concentrations above 75 nmol L-1 had lower fat mass (~450 g; P = 0.049). In multiple linear regression, mean 25(OH)D was associated with lean mass percent (β = 0.06; CI: 0.00, 0.12; P = 0.042), fat mass (β = -11.29; CI: -22.06, -0.52; P = 0.048) and body fat percent (β = -0.06; CI: -0.12, -0.01; P = 0.045). CONCLUSIONS Higher vitamin D status from infancy through to 3 years of age associates with leaner body composition.
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Affiliation(s)
- T J Hazell
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada
| | - S Gallo
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VI, USA
| | - C A Vanstone
- School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - S Agellon
- School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - C Rodd
- Winnipeg Children's Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - H A Weiler
- School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
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Fleischman A, Hourigan SE, Lyon HN, Landry MG, Reynolds J, Steltz SK, Robinson L, Keating S, Feldman HA, Antonelli RC, Ludwig DS, Ebbeling CB. Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting. Clin Obes 2016; 6:380-388. [PMID: 27863024 PMCID: PMC5523655 DOI: 10.1111/cob.12166] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/09/2016] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
Abstract
In an integrated care model, involving primary care providers (PCPs) and obesity specialists, telehealth may be useful for overcoming barriers to treating childhood obesity. We conducted a pilot study comparing body mass index (BMI) changes between two arms (i) PCP in-person clinic visits plus obesity specialist tele-visits ( PCP visits + specialist tele-visits) and (ii) PCP in-person clinic visits only ( PCP visits only), with ongoing tele-consultation between PCPs and obesity specialists for both arms. Patients (N = 40, 10-17 years, BMI ≥ 95th percentile) were randomized to Group 1 or 2. Both groups had PCP visits every 3 months for 12 months. Using a cross-over protocol, Group 1 had PCP visits + specialist tele-visits during the first 6 months and PCP visits only during the second 6 months, and Group 2 followed the opposite sequence. Each of 12 tele-visits was conducted by a dietitian or psychologist with a patient and parent. Retention rates were 90% at 6 months and 80% at 12 months. BMI (z-score) decreased more for Group 1 (started with PCP visits + specialist tele-visits) vs. Group 2 (started with PCP visits only) at 3 months (-0.11 vs. -0.05, P = 0.049) following frequent tele-visits. At 6 months (primary outcome), BMI was lower than baseline within Group 1 (-0.11, P = 0.0006) but not Group 2 (-0.06, P = 0.08); however, decrease in BMI at 6 months did not differ between groups. After crossover, BMI remained lower than baseline for Group 1 and dropped below baseline for Group 2. An integrated care model utilizing telehealth holds promise for treating children with obesity.
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Affiliation(s)
- Amy Fleischman
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Helen N. Lyon
- Wareham Pediatric Associates, Wareham, Massachusetts
| | - Melissa Gallagher Landry
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Sarah K. Steltz
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Lisa Robinson
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | | | | | | | - David S. Ludwig
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Cara B. Ebbeling
- New Balance Foundation Obesity Prevention Center, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
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Affiliation(s)
- Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1165 Copenhagen, Denmark.
| | - Jennie Brand-Miller
- Charles Perkins Centre Research and Education Hub, The University of Sydney, Sydney, NSW, Australia
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; St Michael's Hospital, Toronto, ON, Canada
| | | | - Walter C Willett
- Harvard School of Public Health and Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- George A Bray
- Pennington Biomedical Research Center/LSU, Baton Rouge, LA 70808, USA.
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, CIBEROBN, IdiSNA, Spain
| | - Donna H Ryan
- Pennington Biomedical Research Center/LSU, Baton Rouge, LA 70808, USA
| | - John P H Wilding
- Department of Medicine (Obesity), University of Liverpool, Liverpool, UK
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20
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Gow ML, Garnett SP, Baur LA, Lister NB. The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth. Nutrients 2016; 8:E486. [PMID: 27517953 DOI: 10.3390/nu8080486] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 01/05/2023] Open
Abstract
Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet.
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Visuthranukul C, Sirimongkol P, Prachansuwan A, Pruksananonda C, Chomtho S. Low-glycemic index diet may improve insulin sensitivity in obese children. Pediatr Res 2015; 78:567-73. [PMID: 26270573 DOI: 10.1038/pr.2015.142] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/08/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND A low-glycemic index (GI) diet may be beneficial for weight management due to its effect on insulin metabolism and satiety. METHODS Obese children aged 9-16 y were randomly assigned either a low-GI diet or a low-fat diet (control group) for 6 mo. Body composition changes were measured by dual-energy X-ray absorptiometry and bioelectrical impedance analysis. Insulin sensitivity was measured by fasting plasma glucose and insulin. RESULTS Fifty-two participants completed the study (mean age: 12.0 ± 2.0 y, 35 boys); both groups showed significantly decreased BMI z-score but similar changes in fat and fat-free mass. The low-GI group demonstrated a significant decline in fasting plasma insulin (22.2 ± 14.3 to 13.7 ± 10.9 mU/l; P = 0.004) and homeostatic model of assessment-insulin resistance (4.8 ± 3.3 to 2.9 ± 2.3; P = 0.007), whereas the control group did not. However, general linear model showed no significant difference in insulin resistance between groups after adjusting for baseline levels, suggesting that the greater reduction in insulin resistance in the low-GI group may be explained by higher baseline values. CONCLUSION Despite subtle effects on body composition, a low-GI diet may improve insulin sensitivity in obese children with high baseline insulin. A bigger study in obese children with insulin resistance could be worthwhile to confirm our findings.
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Baum JI, Gray M, Binns A. Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age. J Nutr 2015; 145:2229-35. [PMID: 26269241 DOI: 10.3945/jn.115.214551] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/21/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently 1 in every 3 children aged 2-19 y is overweight or obese. Breakfast is a key component of a healthy diet and has the potential to affect children's health. OBJECTIVE The objective of this study was to determine whether consumption of a protein-based breakfast (PRO) increases postprandial energy metabolism and substrate oxidation, reduces hunger, and reduces food intake at lunch compared with a carbohydrate-based breakfast (CHO) in normal weight (NW) vs. overweight/obese (OW) children. METHODS A randomized, crossover-design study was conducted in NW (n = 16; 33 ± 1 kg) and OW (n = 13; 46 ± 2 kg) children (10 ± 1 y). Participants were served either a PRO [344 kcal, 21% protein (18 g), 52% carbohydrate, and 27% fat] or CHO [327 kcal, 4% protein (3 g), 67% carbohydrate, and 29% fat]. Energy expenditure (EE), substrate oxidation, appetite, and blood glucose were measured over a 4 h period. Four hour postprandial participants were provided with access to a lunch buffet and food intake was recorded. RESULTS After breakfast, OW children in the PRO group had higher (P < 0.0001) EEs and fat oxidation over the 4 h period than did the NW children in the CHO and PRO groups. There was no difference in postprandial EE or carbohydrate oxidation between the CHO and PRO groups over the 4 h period; however, fat oxidation was 16% higher (P < 0.05) after the PRO than the CHO and postprandial carbohydrate oxidation at 4 h was 32% higher after the PRO than the CHO (P < 0.01), independent of weight group. All participants had decreased feelings of hunger (-14%; P < 0.01) and increased fullness (+32%; P < 0.05) after the PRO than the CHO. Finally, there was no difference in food intake within the NW and OW groups. CONCLUSION This study indicates that breakfast macronutrient composition affects postprandial responses in both NW and OW children. A PRO increases postprandial EE and fat oxidation, reduces hunger, and increases satiety when compared with a carbohydrate-based breakfast.
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Affiliation(s)
| | - Michelle Gray
- Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR
| | - Ashley Binns
- Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR
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23
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Augustin LSA, Kendall CWC, Jenkins DJA, Willett WC, Astrup A, Barclay AW, Björck I, Brand-Miller JC, Brighenti F, Buyken AE, Ceriello A, La Vecchia C, Livesey G, Liu S, Riccardi G, Rizkalla SW, Sievenpiper JL, Trichopoulou A, Wolever TMS, Baer-Sinnott S, Poli A. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015; 25:795-815. [PMID: 26160327 DOI: 10.1016/j.numecd.2015.05.005] [Citation(s) in RCA: 377] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.
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Affiliation(s)
- L S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
| | - C W C Kendall
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada; University of Saskatchewan, Saskatoon, Canada
| | - D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - W C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, USA
| | - A Astrup
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - A W Barclay
- Glycemic Index Foundation, Sydney, Australia
| | - I Björck
- Food for Health Science Centre, Lund University, Lund, Sweden
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - F Brighenti
- Department of Food Sciences, University of Parma, Parma, Italy
| | - A E Buyken
- Department of Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Ceriello
- Institut d' Investigación Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - G Livesey
- Independent Nutrition Logic, Wymondham, UK
| | - S Liu
- Department of Epidemiology and Medicine, Brown University, Providence, USA
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - S W Rizkalla
- Institute Cardiometabolism and Nutrition (ICAN), University Pierre et Marie Curie, Pitié Salpêtrière Hospital, Paris, France; National Institute of Health and Medical Research (INSERM), University Pierre et Marie Curie and Pitié Salpêtrière Hospital, Paris, France
| | - J L Sievenpiper
- Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - T M S Wolever
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | | | - A Poli
- Nutrition Foundation of Italy, Milan, Italy
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Schwingshackl L, Hobl LP, Hoffmann G. Effects of low glycaemic index/low glycaemic load vs. high glycaemic index/ high glycaemic load diets on overweight/obesity and associated risk factors in children and adolescents: a systematic review and meta-analysis. Nutr J 2015; 14:87. [PMID: 26489667 PMCID: PMC4618749 DOI: 10.1186/s12937-015-0077-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/19/2015] [Indexed: 01/12/2023] Open
Abstract
The objective of the present systematic review and meta-analysis was to synthesize the available literature data investigating the effects of low glycaemic index/low glycamic load dietary regimens on anthropometric parameters, blood lipid profiles, and indicators of glucose metabolism in children and adolescents. Literature search was performed using the electronic databases MEDLINE, EMBASE, and the Cochrane Central Register of trials with restrictions to randomized controlled trials, but no limitations concerning language and publication date. Parameters taken into account were: body weight, body mass index, z-score of body mass index, fat mass, fat-free mass, height, waist cicrumference, hip circumference, waist-to-hip ratio, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, diastolic and systolic blood pressure, fasting serum glucose, fasting serum insulin, HOMA-index, glycosylated haemoglobin, and C-reactive protein. Meta-analyses were performed for each parameter to assess pooled effect in terms of weighted mean differences between the post-intervention (or differences in means) of the low glycaemic index diets and the respective high glycaemic index counterparts. Data analysis was performed using the Review Manager 5.3. software. Nine studies enrolling 1.065 children or adolescents met the inclusion criteria. Compared to diets providing a high gylcaemic index, low glycaemic index protocols resulted in significantly more pronounced decreases in serum triglycerides [mean differences −15.14 mg/dl, 95 %-CI (−26.26, −4.00)] and HOMA-index [mean difference −0.70, 95 %-CI (−1.37, −0.04), fixed-effects model only]. Other parameters under investigation were not affected by either low or high glycaemic indices. The present systematic review and meta-analysis provides evidence of a beneficial effect of a low glycaemic index/load diet in children and adolescents being either overweight or obese. Regarding the limitations of this analysis, further studies adopting a homogenous design are necessary to assure the present findings. Since low glycaemic index/load regimens were not associated with a deterioration of the outcome parameters, these diets should not be categorically excluded when looking for alternatives to change lifestyle habits in this age group.
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Affiliation(s)
- Lukas Schwingshackl
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Althanstraße 14 (UZAII), A-1090, Vienna, Austria.
| | - Lisa Patricia Hobl
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Althanstraße 14 (UZAII), A-1090, Vienna, Austria.
| | - Georg Hoffmann
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Althanstraße 14 (UZAII), A-1090, Vienna, Austria.
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Kouřimská L, Jiráková Š, Adámková A. The effect of food with different glycaemic index on the blood glucose level. Potr S J F Sci 2015. [DOI: 10.5219/458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Blood glucose levels are affected by many factors including the type of foods consumed, processing technology and cooking method. Hormone insulin lowers blood glucose to its constant level, while glucagon, growth hormone, adrenalin and glucocorticoids have the opposite effect. High steepness of the blood glucose level rise after meals may be unfavourable for the organism. Sugars are transferred into the blood at different speeds according to the type of food. Therefore the aim of this study was to confirm experimentally the effect of food on blood glucose levels in men and women of different ages. Two types of low, medium and high-glycaemic index (GI) foods were given to 4 men and 4 women of different age (from 35 to 65 years). All volunteers were healthy, slightly overweight, and without any regular sporting activity. None of them had any idea about their daily carbohydrates consumption and what the term glycaemic index meant. The volunteers came to the GI determination fasted in the morning. Their rise in blood glucose level was monitored by glucometer before the meal and after 1 and 2 hours of the consumption of baked potatoes (GI 85), white bread bun (GI 70), boiled potatoes (GI 64), rye bread (GI 62), potato dumplings (GI 52) and white cooked spaghetti (GI 41). Fasting blood sugar levels of volunteers highly depended on their age (p <0.0001) and gender (p <0.0001). The blood glucose values increased with age and were higher in men than in women. Significant influence of food GI on blood glucose levels in both men and women in all the age categories was observed (p <0.0001). An interaction between age and gender was also statistically highly significant (p <0.0001). One hour after consuming food the blood glucose values were significantly different from the values of fasting (p = 0.0035). The differences of these values did not depend on the age (p = 0.0574) and sex (p = 0.8256) of volunteers, but there was a significant difference on the GI value of food (p <0.0001). Significant interactions were also found in case of sex*age (p = 0.0002), age*GI (p <0.0001) and age*sex*GI (p <0.0001). Medium correlation was found between the GI values of food and the rise of blood glucose levels after 1 h (r = 0.6468). After the consumption of high-GI foods the values of glycaemia did not returned to their fasting levels even after 2 hours. There was still significant difference (p = 0.0032), but the values after 2 h were also statistically different from those after 1 hour (p <0.0001). The response to a particular type of consumed food depended on age (p = 0.0018) and especially the GI of foods.
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Navas-Carretero S, Holst C, Saris WH, van Baak MA, Jebb SA, Kafatos A, Papadaki A, Pfeiffer AFH, Handjieva-Darlenska T, Hlavaty P, Stender S, Larsen TM, Astrup A, Martinez JA. The Impact of Gender and Protein Intake on the Success of Weight Maintenance and Associated Cardiovascular Risk Benefits, Independent of the Mode of Food Provision: The DiOGenes Randomized Trial. J Am Coll Nutr 2015; 35:20-30. [PMID: 25826291 DOI: 10.1080/07315724.2014.948642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Maintenance of weight loss and associated cardiovascular benefits after following energy-restricted diets is still a challenging field, and thorough investigation is needed. The present research aimed to determine the role of protein and gender in relation to two different intervention models related to food supply, in a weight maintenance trial. SUBJECTS AND METHODS The DiOGenes trial was a long-term, multicenter, randomized, dietary intervention study, conducted in eight European countries (Clinical Trials.gov, NCT00390637), focusing on assessing the effectiveness of weight maintenance over 6 months. This secondary analysis intended to evaluate the different benefits for weight maintenance and cardiometabolic markers of two dietary advice delivery models: "shop + instruction intervention" vs "instruction-alone intervention," which were further categorized for gender and macronutrient intake. RESULTS The weight maintenance intervention based on different macronutrient intake showed, independently of the advice delivery model, in both sexes that higher protein consumption was more effective for weight stability, showing better results in obese women (low protein: 1.65 kg in males and 0.73 Kg in females vs high protein: 1.45 kg in males and -0.93 Kg in females) . Measurements concerning cardiovascular risk markers from subjects on both structured models produced similar trends in the subsequent follow-up period, with a lower rebound in women for most of the markers analyzed. CONCLUSION The reported dietary benefits for weight sustainability should be ascribed to the macronutrient distribution (higher protein diets) rather than to the structured mode of delivery. Higher weight regain in males was noted, as well as a metabolic divergence attributable to the sex, with a better biochemical outcome in women.
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Affiliation(s)
- Santiago Navas-Carretero
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
| | - Claus Holst
- e University of Copenhagen , Copenhagen , DENMARK.,f Institute of Preventive Medicine, Copenhagen University Hospital , Copenhagen , DENMARK
| | - Wim H Saris
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Marleen A van Baak
- g NUTRIM, School for Nutrition, Toxicology and Metabolism, Department of Human Biology, Maastricht University Medical Centre , Maastricht , THE NETHERLANDS
| | - Susan A Jebb
- h The Medical Research Council, Human Nutrition Research, Elsie Widdowson Laboratory , Cambridge , UNITED KINGDOM
| | - Anthony Kafatos
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE
| | - Angeliki Papadaki
- i Department of Social Medicine, Preventive Medicine, and Nutrition Clinic , University of Crete , Heraklion , Crete , GREECE.,j Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol , Bristol , UNITED KINGDOM
| | - Andreas F H Pfeiffer
- k Department of Clinical Nutrition , German Institute of Human Nutrition Potsdam-Rehbrücke , Nuthetal , GERMANY.,l Department of Endocrinology, Diabetes, and Nutrition , Charité Universitätsmedizin Berlin , Berlin , GERMANY
| | - Teodora Handjieva-Darlenska
- m Department of Human Nutrition, Dietetics and Metabolic Diseases , National Transport Hospital , Sofia , BULGARIA
| | - Petr Hlavaty
- n Obesity Management Center, Institute of Endocrinology , Prague , CZECH REPUBLIC
| | - Steen Stender
- d Department of Clinical Biochemistry, Gentofte Hospital , University of Copenhagen , Copenhagen , DENMARK
| | - Thomas M Larsen
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - Arne Astrup
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,c Department of Human Nutrition, Faculty of Life Sciences , University of Copenhagen , Copenhagen , DENMARK
| | - J Alfredo Martinez
- a Department of Nutrition, Food Science and Physiology , University of Navarra , Pamplona , SPAIN.,b CIBERobn Physiopathology of Obesity and Nutrition , Madrid , SPAIN
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Olza J, Aguilera CM, Gil-Campos M, Leis R, Bueno G, Valle M, Cañete R, Tojo R, Moreno LA, Gil Á. A Continuous Metabolic Syndrome Score Is Associated with Specific Biomarkers of Inflammation and CVD Risk in Prepubertal Children. Ann Nutr Metab 2015; 66:72-9. [PMID: 25612676 DOI: 10.1159/000369981] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We aimed to evaluate the use of a continuous metabolic syndrome (MetS) score and to assess the associations of this score with risk biomarkers of inflammation, endothelial damage and cardiovascular disease (CVD) in prepubertal children. METHODS A total of 677 prepubertal children (295 obese, 146 overweight, and 236 normal-weight) were recruited. MetS traits, markers of inflammation, endothelial damage and CVD risk were measured, and a continuous MetS score was calculated, consisting of the sum/5 of the standardised scores of the MetS components. RESULTS The continuous MetS score was significantly associated with active plasminogen activator inhibitor-1 (r = 0.406, p < 0.001), adiponectin (r = -0.212, p < 0.001), resistin (r = 0.263, p < 0.001), C-reactive protein (r = 0.254, p < 0.001), tumour necrosis factor alpha (r = 0.120, p = 0.003), myeloperoxidase (r = 0.188, p < 0.001) and sE-selectin (r = 0.278, p < 0.001). Children in the normal-weight, overweight and obese groups with MetS totalled 0 (0%), 1 (0.7%) and 24 (8.7%), respectively, whereas the at-risk children identified using the continuous MetS score in each group totalled 2 (0.85%), 17 (11.6%) and 167 (56.6%), respectively. CONCLUSIONS The association of the continuous MetS score with specific risk biomarkers of inflammation, endothelial damage and CVD supports its use in the early identification of children at increased risk of metabolic dysfunction.
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Affiliation(s)
- Josune Olza
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
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Peirson L, Fitzpatrick-Lewis D, Morrison K, Ciliska D, Kenny M, Usman Ali M, Raina P. Prevention of overweight and obesity in children and youth: a systematic review and meta-analysis. CMAJ Open 2015; 3:E23-33. [PMID: 25844367 PMCID: PMC4382039 DOI: 10.9778/cmajo.20140053] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND One-third of Canadian children are overweight or obese. This problem carries considerable concern for negative impacts on current and future health. Promoting healthy growth and development is critical. This review synthesized evidence on the effectiveness of behavioural interventions for preventing overweight and obesity in children and adolescents. METHODS We updated the search of a previous Cochrane review. Five databases were searched up to August 2013. Randomized trials of primary care-relevant behavioural (diet, exercise and lifestyle) interventions for preventing overweight and obesity in healthy normal- or mixed-weight children or youth aged 0-18 years were included if 12-week postbaseline data were provided for body mass index (BMI), BMI z-score, or prevalence of overweight or obesity. Any study reporting harms was included. Meta-analyses were performed if possible. Features of interventions showing significant benefits were examined. RESULTS Ninety studies were included, all with mixed-weight populations. Compared with controls, interventions showed a small but significant effect on BMI and BMI z-score (standardized mean difference -0.07, 95% confidence interval [CI] -0.10 to -0.03, I (2) = 74%), a reduction in BMI (mean difference -0.09 kg/m(2), 95% CI -0.16 to -0.03, I (2) = 76%) and a reduced prevalence of overweight and obesity (risk ratio [RR]; RRintervention - RRcontrol 0.94, 95% CI 0.89 to 0.99, I (2) = 0%; number needed to treat 51, 95% CI 29 to 289). Little evidence was available on harms. There was variability across efficacious interventions, although many of the interventions were short-term, involved school-aged children and were delivered in educational settings. INTERPRETATION Behavioural prevention interventions are associated with small improvements in weight outcomes in mixed-weight populations of children and adolescents. No intervention strategy consistently produced benefits. REGISTRATION PROSPERO no. CRD42012002754.
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Affiliation(s)
- Leslea Peirson
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- School of Nursing, Master University, Hamilton, Ont
| | - Donna Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- School of Nursing, Master University, Hamilton, Ont
| | | | - Donna Ciliska
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- School of Nursing, Master University, Hamilton, Ont
| | - Meghan Kenny
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont
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Astrup A, Raben A, Geiker N. The role of higher protein diets in weight control and obesity-related comorbidities. Int J Obes (Lond) 2015; 39:721-6. [PMID: 25540980 DOI: 10.1038/ijo.2014.216] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/18/2014] [Accepted: 09/24/2014] [Indexed: 12/25/2022]
Abstract
The importance of the relative dietary content of protein, carbohydrate and the type of carbohydrate (that is, glycemic index (GI)) for weight control under ad libitum conditions has been controversial owing to the lack of large scale studies with high diet adherence. The Diet, Obesity and Genes (DioGenes) European multicentre trial examined the importance of a slight increase in dietary protein content, reduction in carbohydrate and the importance of choosing low (LGI) vs high GI (HGI) carbohydrates for weight control in 932 obese families. Only the adults underwent a diet of 800 kcal per day for 8 weeks, and after losing ~11kg they were randomized to one of five energy ad libitum diets for 6 months. The diets differed in protein content and GI. The high-protein (HP) diet groups consumed 5.4% points more energy from protein than the normal protein (NP) groups, and the LGI diet groups achieved 5.1% lower GI than the HGI groups. The effect of HP and LGI was additive on weight loss and maintenance, and the combination was successful in preventing weight regain and reducing drop-out rate among the adults after the 11kg weight loss. This diet also reduced body fatness and prevalence of overweight and obesity among their children and had consistent beneficial effects on blood pressure, blood lipids and inflammation in both parents and children. After 1 year, mainly the HP effects were maintained. Putative genes have been identified that suggest this diet to be particularly effective in 67% of the population. In conclusion, the DioGenes diet has shown to be effective for prevention of weight regain and for weight reduction in overweight children under ad libitum conditions. The less-restrictive dietary approach fits into a normal food culture, and has been translated into popular diet and cook books in several languages.
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Perez-Cornago A, van Baak MA, Saris WHM, Martínez JA, Astrup A. The Role of Protein and Carbohydrates for Long-Term Weight Control: Lessons from the Diogenes Trial. Curr Nutr Rep 2014. [DOI: 10.1007/s13668-014-0096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, Broderick CR, Chisholm K, Briody J, De S, Steinbeck K, Srinivasan S, Ambler GR, Cowell CT. 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. BMC Pediatr 2014; 14:289. [PMID: 25422027 PMCID: PMC4252020 DOI: 10.1186/s12887-014-0289-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/06/2014] [Indexed: 01/01/2023] Open
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. Conclusion 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. Trial registration Australian New Zealand Clinical Trail Registry ACTRN12608000416392. Registered 25 August 2008.
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Affiliation(s)
- Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Megan Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Mandy Ho
- The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Louise A Baur
- Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Manny Noakes
- CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide, BC South Australia, 5000, Australia.
| | - Helen J Woodhead
- Department of Paediatrics, Campbelltown Hospital, PO Box 149, Campbelltown, NSW, 2560, Australia. .,Department of Diabetes and Endocrinology, Sydney Children's Hospital Network, Randwick, Sydney, NSW, 2031, Australia.
| | - Carolyn R Broderick
- The Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Kerryn Chisholm
- Nutrition and Dietetics and Weight Management Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Sukanya De
- Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Katherine Steinbeck
- Academic Department of Adolescent Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, 2066, Australia.
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Chris T Cowell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
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Nicholl A, du Heaume M, Mori TA, Beilin LJ, Oddy WH, Bremner AP, O'sullivan TA. Higher breakfast glycaemic load is associated with increased metabolic syndrome risk, including lower HDL-cholesterol concentrations and increased TAG concentrations, in adolescent girls. Br J Nutr 2014; 112:1974-83. [DOI: 10.1017/s0007114514003092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Almost all previous studies examining the associations between glycaemic load (GL) and metabolic syndrome risk have used a daily GL value. The daily value does not distinguish between peaks of GL intake over the day, which may be more closely associated with the risk of the metabolic syndrome. The aim of the present study was to investigate the cross-sectional associations between daily and mealtime measures of GL and metabolic syndrome risk, including metabolic syndrome components, in adolescents. Adolescents participating in the 14-year follow-up of the Western Australian Pregnancy Cohort (Raine) Study completed 3 d food records and metabolic assessments. Breakfast GL, lunch GL, dinner GL and a score representing meal GL peaks over the day were determined in 516 adolescents. Logistic regression models were used to investigate whether GL variables were independent predictors of the metabolic syndrome in this population-based cohort (3·5 % prevalence of the metabolic syndrome). Breakfast GL was found to be predictive of the metabolic syndrome in girls (OR 1·15, 95 % CI 1·04, 1·27; P <0·01), but not in boys. Other meal GL values and daily GL were found to be not significant predictors of the metabolic syndrome. When breakfast GL was examined in relation to each of the components of the metabolic syndrome in girls, it was found to be negatively associated with fasting HDL-cholesterol concentrations (P= 0·037; β = − 0·004; 95 % CI − 0·008, − 0·002) and positively associated with fasting TAG concentrations (P= 0·008; exp(β) = 1·002; 95 % CI 1·001, 1·004). The results of the present study suggest that there may be an association between breakfast composition and metabolic syndrome components in adolescent girls. These findings support further investigation into including lower-GL foods as part of a healthy breakfast in adolescence, particularly for girls.
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Ladas EJ. Nutritional Counseling in Survivors of Childhood Cancer: An Essential Component of Survivorship Care. Children (Basel) 2014; 1:107-18. [PMID: 27417470 DOI: 10.3390/children1020107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022]
Abstract
There is a growing body of evidence suggesting that nutritional status during treatment for cancer has a significant impact on treatment-related toxicities and outcomes among children and adolescents with cancer. The effects of nutritional status appear to extend into survivorship with a large proportion of survivors at risk for a variety of nutrition-related morbidities. The influence of dietary intake on overall treatment outcomes and long-term morbidities is largely unknown. In adults, evidence suggests that greater adherence to cancer prevention dietary guidelines improves long-term health outcomes among survivors of cancer. Surveys describing dietary intake among survivors of childhood cancer have found that most survivors are not meeting the recommended guidelines for many dietary nutrients and this may have an unfavorable effect on nutrition-related outcomes. However, more research is needed in this area so that well-designed clinical trials may be developed and tested. This review presents an overview of the existing literature describing dietary intake among survivors of childhood cancer, the clinical implications of reported dietary behaviors among survivors, and identifies areas for future research.
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Abstract
Dietary restrictions required to manage individuals with inborn errors of metabolism (IEM) are essential for metabolic control, however may result in an increased risk to both short and long-term nutritional status. Dietary factors most likely to influence nutritional status include energy intake, protein quality and quantity, micronutrient intake and the frequency and extent to which the diet must be altered during periods of increased physical or metabolic stress. Patients on the most restrictive diets, including those with intakes consisting of low levels of natural protein or those with recurrent illness or frequent metabolic decompensation carry the most nutritional risk. Due to the difficulties in determining condition specific requirements, dietary intake recommendations and nutritional monitoring tools used in patients with IEM are the same as, or extrapolated from, those used in healthy populations. As a consequence, evidence is lacking for the safest dietary prescriptions required to manage these patients long term, as tolerance to dietary therapy is generally described in terms of metabolic stability rather than long term nutritional and health outcomes. As the most frequent therapeutic dietary manipulation in IEM is alteration in dietary protein, and as protein status is critically dependent on adequate energy provision, the use of a Protein to Energy ratio (P:E ratio) as an additional tool will better define the relationship between these critical components. This could accurately define dietary quality and ensure that not only an adequate, but also a safe and balanced intake is provided.
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Affiliation(s)
- Maureen Humphrey
- Metabolic Genetics, Victorian Clinical Genetic Services, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, Melbourne 3052, Australia; Department of Nutrition and Food Services, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Melbourne 3052, Australia; Be Active Sleep Eat (BASE) Facility, Department of Nutrition and Dietetics, Monash University, Faculty of Medicine, Nursing and Health Sciences, Level 1, 264 Ferntree Gully Road, VIC 3168, Melbourne, Australia.
| | - Helen Truby
- Be Active Sleep Eat (BASE) Facility, Department of Nutrition and Dietetics, Monash University, Faculty of Medicine, Nursing and Health Sciences, Level 1, 264 Ferntree Gully Road, VIC 3168, Melbourne, Australia.
| | - Avihu Boneh
- Metabolic Genetics, Victorian Clinical Genetic Services, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, Melbourne 3052, Australia; Be Active Sleep Eat (BASE) Facility, Department of Nutrition and Dietetics, Monash University, Faculty of Medicine, Nursing and Health Sciences, Level 1, 264 Ferntree Gully Road, VIC 3168, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Melbourne 3052, Australia.
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Gow ML, Ho M, Burrows TL, Baur LA, Stewart L, Hutchesson MJ, Cowell CT, Collins CE, Garnett SP. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev 2014; 72:453-70. [PMID: 24920422 DOI: 10.1111/nure.12111] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The present systematic review examined the effectiveness of weight management interventions comparing diets with varying macronutrient distributions on BMI and cardiometabolic risk factors in overweight or obese children and adolescents. A systematic search of seven databases for the period 1975-2013 identified 14 eligible randomized or quasi-randomized controlled trials conducted with 6-18-year-old subjects. Seven trials compared a low-fat (≤ 33% energy or < 40 g/day) to an isocaloric (n = 2) or ad libitum (n = 5) low-carbohydrate diet (< 20% energy or < 60 g/day). Meta-analysis indicated a greater reduction in BMI in the low-carbohydrate group immediately after dietary intervention; however, the quality of the studies was limited and cardiometabolic benefits were inconsistent. Six trials compared increased-protein diets (19-30% energy) to isocaloric standard-protein diets (15-20% energy) and one compared an increased-fat diet (40% energy) to an isocaloric standard-fat diet (27% energy); there were no differences in outcomes in these studies. Current evidence suggests that improved weight status can be achieved in overweight or obese children and adolescents irrespective of the macronutrient distribution of a reduced-energy diet. Tailoring the macronutrient content to target specific cardiometabolic risk factors, such as a low-carbohydrate diet to treat insulin resistance, may be possible, but further research is needed before specific recommendations can be made.
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Affiliation(s)
- Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, New South Wales, Sydney, Australia; The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Kong APS, Choi KC, Chan RSM, Lok K, Ozaki R, Li AM, Ho CS, Chan MHM, Sea M, Henry CJ, Chan JCN, Woo J. A randomized controlled trial to investigate the impact of a low glycemic index (GI) diet on body mass index in obese adolescents. BMC Public Health 2014; 14:180. [PMID: 24552366 PMCID: PMC3937245 DOI: 10.1186/1471-2458-14-180] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/12/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The role of a low glycemic index (GI) diet in the management of adolescent obesity remains controversial. In this study, we aim to evaluate the impact of low GI diet versus a conventional Chinese diet on the body mass index (BMI) and other obesity indices of obese adolescents. METHODS Obese adolescents aged 15-18 years were identified from population-recruited, territory-wide surveys. Obesity was defined as BMI ≥95th percentile of Hong Kong local age- and sex-specific references. Eligible subjects were randomized to either an intervention with low GI diet (consisting of 45-50% carbohydrate, 30-35% fat and 15-20% protein) or conventional Chinese diet as control (consisting of 55-60% carbohydrate, 25-30% fat and 10-15% protein). We used random intercept mixed effects model to compare the differential changes across the time points from baseline to month 6 between the 2 groups. RESULTS 104 obese adolescents were recruited (52 in low GI group and 52 in control group; 43.3% boys). Mean age was 16.7 ± 1.0 years and 16.8 ±1.0 years in low GI and control group respectively. 58.7% subjects completed the study at 6 months (65.4% in low GI group and 51.9% in control group). After adjustment for age and sex, subjects in the low GI group had a significantly greater reduction in obesity indices including BMI, body weight and waist circumference (WC) compared to subjects in the control group (all p <0.05). After further adjustment for physical activity levels, WC was found to be significantly lower in the low GI group compared to the conventional group (p = 0.018). CONCLUSION Low GI diet in the context of a comprehensive lifestyle modification program may be an alternative to conventional diet in the management of obese adolescents. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Ref. No: NCT01278563.
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Affiliation(s)
| | - Kai Chow Choi
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, Shatin, N,T,, Hong Kong, SAR, China.
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Rouhani MH, Kelishadi R, Hashemipour M, Esmaillzadeh A, Azadbakht L. Glycemic index, glycemic load and childhood obesity: A systematic review. Adv Biomed Res 2014; 3:47. [PMID: 24627855 PMCID: PMC3949335 DOI: 10.4103/2277-9175.125757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/02/2012] [Indexed: 02/07/2023] Open
Abstract
Background: Several evidences have been reported so far in terms of the relationship between obesity and glycemic index and glycemic load in children. However, the number of review studies that have dealt with recent findings is quite low. The purpose of present study is to review the existing evidences in this regard. Materials and Methods: First of all, the phrases: “Glycaemic index”, “Glycaemic load”, “Glycemic index” OR “Glycemic load” accompanied by one of the words: “Adolescent”, “Young”, “Youth” “Children” OR “Child” were searched in texts of articles existing in ISI and PUBMED databases which were obtained out of 1001 articles. Among these, some articles, which reviewed the relationship of obesity with glycemic index and glycemic load, were selected. Finally, 20 articles were studied in current review study. Results: The majority of cross-sectional studies have found children's obesity directly linked with glycemic index and glycemic load; however, cohort studies found controversial results. Also, the intervention studies indicate the negative effect of glycemic index and glycemic load on obesity in children. Conclusion: Published evidences reported inconsistent results. It seems that existing studies are not sufficient and more studies are needed in this regard.
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Affiliation(s)
- Mohammad Hossein Rouhani
- Food Security Research Center, Isfahan University of Medical Sciences and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, and School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Department of Pediatrics, Child Growth and Development Research Center, and School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Pediatric Endocrinology and Metabolism Diseases, Endocrinology and Metabolism Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center, Isfahan University of Medical Sciences and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Ning Y, Yang S, Evans RK, Stern M, Sun S, Francis GL, Wickham EP. Changes in body anthropometry and composition in obese adolescents in a lifestyle intervention program. Eur J Nutr 2014; 53:1093-102. [DOI: 10.1007/s00394-013-0612-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022]
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Rouhani MH, Kelishadi R, Hashemipour M, Esmaillzadeh A, Azadbakht L. The effect of low glycemic index diet on body weight status and blood pressure in overweight adolescent girls: a randomized clinical trial. Nutr Res Pract 2013; 7:385-92. [PMID: 24133618 PMCID: PMC3796664 DOI: 10.4162/nrp.2013.7.5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/15/2013] [Accepted: 05/14/2013] [Indexed: 11/04/2022] Open
Abstract
Although several studies have assessed the influence of the glycemic index on body weight and blood pressure among adults, limited evidence exists for the pediatric age population. In the current study, we compared the effects of low glycemic index (LGI) diet to the healthy nutritional recommendation (HNR)-based diet on obesity and blood pressure among adolescent girls in pubertal ages. This 10-week parallel randomized clinical trial comprised of 50 overweight or obese and sexually mature girls less than 18 years of age years, who were randomly assigned to LGI or HNR-based diet. Macronutrient distribution was equivalently prescribed in both groups. Blood pressure, weight and waist circumference were measured at baseline and after intervention. Of the 50 participants, 41 subjects (include 82%) completed the study. The GI of the diet in the LGI group was 42.67 ± 0.067. A within-group analysis illustrated that in comparison to the baseline values, the body weight and body mass index (not waist circumference and blood pressure) decreased significantly after the intervention in both groups (P = 0.0001). The percent changes of the body weight status, waist circumference and blood pressure were compared between the two groups and the findings did not show any difference between the LGI diet consumers and those in the HNR group. In comparison to the HNR, LGI diet could not change the weight and blood pressure following a 10-week intervention. Further longitudinal studies with a long-term follow up should be conducted in this regard.
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Affiliation(s)
- Mohammad Hossein Rouhani
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, and School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Department of Pediatrics, Child Growth and Development Research Center, and School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Pediatric Endocrinology and Metabolism Diseases, Endocrinology and Metabolism Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran
| | - Leila Azadbakht
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, PO Box 81745, Isfahan, Iran
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Mcconnon A, Horgan GW, Lawton C, Stubbs J, Shepherd R, Astrup A, Handjieva-darlenska T, Kunešová M, Larsen TM, Lindroos AK, Martinez JA, Papadaki A, Pfeiffer AFH, van Baak MA, Raats MM. Experience and acceptability of diets of varying protein content and glycemic index in an obese cohort: results from the Diogenes trial. Eur J Clin Nutr 2013; 67:990-5. [DOI: 10.1038/ejcn.2013.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/11/2013] [Accepted: 03/13/2013] [Indexed: 02/01/2023]
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Damsgaard CT, Papadaki A, Jensen SM, Ritz C, Dalskov SM, Hlavaty P, Saris WHM, Martinez JA, Handjieva-Darlenska T, Andersen MR, Stender S, Larsen TM, Astrup A, Mølgaard C, Michaelsen KF. Higher protein diets consumed ad libitum improve cardiovascular risk markers in children of overweight parents from eight European countries. J Nutr 2013; 143:810-7. [PMID: 23596158 DOI: 10.3945/jn.112.173427] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary strategies to improve early cardiovascular markers in overweight children are needed. We investigated the effect of dietary protein and glycemic index (GI) on cardiovascular markers and metabolic syndrome (MetS) scores in 5- to 18-y-old children of overweight/obese parents from 8 European centers. Families were randomized to 1 of 5 diets consumed ad libitum: high protein (HP) or low protein (LP) combined with high GI (HGI) or low GI (LGI), or a control diet. At 6 centers, families received dietary instruction (instruction centers); at 2 centers, free foods were also provided (supermarket centers). Diet, anthropometry, blood pressure, and serum cardiovascular markers (lipid profile, glucose regulation, and inflammation) were measured in 253 children at baseline, 1 mo, and/or 6 mo. Protein intake was higher in the HP groups (19.9 ± 1.3% energy) than in the LP groups at 6 mo (16.8 ± 1.2% energy) (P = 0.001). The GI was 4.0 points lower (95% CI: 2.1, 6.1) in the LGI compared with the HGI groups (P < 0.001). In the supermarket centers, the HP and LP groups differed more in protein intake than did the groups in the instruction centers (P = 0.009), indicating better compliance. The HP diets evoked a 2.7-cm (95% CI: 0.9, 5.1) smaller waist circumference and a 0.25-mmol/L (95% CI: 0.09, 0.41) lower serum LDL cholesterol compared with the LP diets at 6 mo (P < 0.007). In a separate supermarket center analysis, the HP compared with LP diets reduced waist circumference (P = 0.004), blood pressure (P < 0.01), serum insulin (P = 0.013), and homeostasis model of assessment-insulin resistance (P = 0.016). In the instruction centers, the HP compared with the LP diets reduced LDL cholesterol (P = 0.004). No consistent effect of GI was seen and the MetS scores were not affected. In conclusion, increased protein intake improved cardiovascular markers in high-risk children, particularly in those undergoing most intensive intervention.
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Affiliation(s)
- Camilla T Damsgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
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Mirza NM, Palmer MG, Sinclair KB, McCarter R, He J, Ebbeling CB, Ludwig DS, Yanovski JA. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial. Am J Clin Nutr 2013; 97:276-85. [PMID: 23255569 PMCID: PMC3545680 DOI: 10.3945/ajcn.112.042630] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Hispanic children and adolescents, the prevalence of obesity and insulin resistance is considerably greater than in non-Hispanic white children. A low-glycemic load diet (LGD) has been proposed as an effective dietary intervention for pediatric obesity, but to our knowledge, no published study has examined the effects of an LGD in obese Hispanic children. OBJECTIVE We compared the effects of an LGD and a low-fat diet (LFD) on body composition and components of metabolic syndrome in obese Hispanic youth. DESIGN Obese Hispanic children (7-15 y of age) were randomly assigned to consume an LGD or an LFD in a 2-y intervention program. Body composition and laboratory assessments were obtained at baseline and 3, 12, and 24 mo after intervention. RESULTS In 113 children who were randomly assigned, 79% of both groups completed 3 mo of treatment; 58% of LGD and 55% of LFD subjects attended 24-mo follow-up. Compared with the LFD, the LGD decreased the glycemic load per kilocalories of reported food intakes in participants at 3 mo (P = 0.02). Both groups had a decreased BMI z score (P < 0.003), which was expressed as a standard z score relative to CDC age- and sex-specific norms, and improved waist circumference and systolic blood pressure (P < 0.05) at 3, 12, and 24 mo after intervention. However, there were no significant differences between groups for changes in BMI, insulin resistance, or components of metabolic syndrome (all P > 0.5). CONCLUSIONS We showed no evidence that an LGD and an LFD differ in efficacy for the reduction of BMI or aspects of metabolic syndrome in obese Hispanic youth. Both diets decreased the BMI z score when prescribed in the context of a culturally adapted, comprehensive weight-reduction program.
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Affiliation(s)
- Nazrat M Mirza
- Children's National Medical Center, Washington, DC 20010, USA.
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Huang JS, Barlow SE, Quiros-Tejeira RE, Scheimann A, Skelton J, Suskind D, Tsai P, Uko V, Warolin JP, Xanthakos SA; NASPGHAN Obesity Task Force. Childhood obesity for pediatric gastroenterologists. J Pediatr Gastroenterol Nutr 2013; 56:99-109. [PMID: 23282941 DOI: 10.1097/MPG.0b013e31826d3c62] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.
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Larsen LH, Angquist L, Vimaleswaran KS, Hager J, Viguerie N, Loos RJF, Handjieva-Darlenska T, Jebb SA, Kunesova M, Larsen TM, Martinez JA, Papadaki A, Pfeiffer AFH, van Baak MA, Sørensen TI, Holst C, Langin D, Astrup A, Saris WHM. Analyses of single nucleotide polymorphisms in selected nutrient-sensitive genes in weight-regain prevention: the DIOGENES study. Am J Clin Nutr 2012; 95:1254-60. [PMID: 22492381 DOI: 10.3945/ajcn.111.016543] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Differences in the interindividual response to dietary intervention could be modified by genetic variation in nutrient-sensitive genes. OBJECTIVE This study examined single nucleotide polymorphisms (SNPs) in presumed nutrient-sensitive candidate genes for obesity and obesity-related diseases for main and dietary interaction effects on weight, waist circumference, and fat mass regain over 6 mo. DESIGN In total, 742 participants who had lost ≥ 8% of their initial body weight were randomly assigned to follow 1 of 5 different ad libitum diets with different glycemic indexes and contents of dietary protein. The SNP main and SNP-diet interaction effects were analyzed by using linear regression models, corrected for multiple testing by using Bonferroni correction and evaluated by using quantile-quantile (Q-Q) plots. RESULTS After correction for multiple testing, none of the SNPs were significantly associated with weight, waist circumference, or fat mass regain. Q-Q plots showed that ALOX5AP rs4769873 showed a higher observed than predicted P value for the association with less waist circumference regain over 6 mo (-3.1 cm/allele; 95% CI: -4.6, -1.6; P/Bonferroni-corrected P = 0.000039/0.076), independently of diet. Additional associations were identified by using Q-Q plots for SNPs in ALOX5AP, TNF, and KCNJ11 for main effects; in LPL and TUB for glycemic index interaction effects on waist circumference regain; in GHRL, CCK, MLXIPL, and LEPR on weight; in PPARC1A, PCK2, ALOX5AP, PYY, and ADRB3 on waist circumference; and in PPARD, FABP1, PLAUR, and LPIN1 on fat mass regain for dietary protein interaction. CONCLUSION The observed effects of SNP-diet interactions on weight, waist, and fat mass regain suggest that genetic variation in nutrient-sensitive genes can modify the response to diet. This trial was registered at clinicaltrials.gov as NCT00390637.
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Affiliation(s)
- Lesli H Larsen
- Department of Human Nutrition, LIFE, University of Copenhagen, Copenhagen, Denmark.
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Balzer BW, Graham CL, Craig ME, Selvadurai H, Donaghue KC, Brand-Miller JC, Steinbeck KS. Low glycaemic index dietary interventions in youth with cystic fibrosis: a systematic review and discussion of the clinical implications. Nutrients 2012; 4:286-96. [PMID: 22606371 DOI: 10.3390/nu4040286] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/24/2022] Open
Abstract
A systematic review was conducted to assess what is known about the effect of low glycaemic index (GI) diets on glycaemic control, weight and quality of life in youth with cystic fibrosis (CF). Eligibility criteria were systematic reviews, randomised and non-randomised trials of low GI dietary interventions in CF. Outcomes examined were glycaemic control, quality of life, anthropometry and respiratory function. Reference lists were manually searched and experts in the field were consulted. Four studies met the eligibility criteria; two were excluded because they did not include data on any of the outcomes. The remaining two were studies that examined GI secondary to any other intervention: one used GI as a factor in enteral feeds and the other incorporated low GI dietary education into its treatment methodology. There is insufficient evidence to recommend use of low GI diets in CF. Since there is evidence to support use of low GI diets in type 1, type 2 and gestational diabetes, low GI diets should be tested as an intervention for CF. The potential risks and benefits of a low GI diet in CF are discussed.
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Abstract
PURPOSE OF REVIEW In recent years, many of the concerns surrounding the glycemic index have been addressed by methodological studies and clinical trials comparing diets carefully matched for other nutrients. These findings are reviewed together with new observational evidence for the role of the dietary glycemic index in the etiology of cardiovascular disease. RECENT FINDINGS The determination and classification of the glycemic index of a food product is now standardized by the International Standards Organization. Systematic studies using isoenergetic single and mixed meals have shown that glycemic index and/or glycemic load are stronger predictors of postprandial glycemia and insulinemia than carbohydrate content alone. In overweight individuals, a diet that combined modestly higher protein and lower glycemic index carbohydrates was the most effective diet for prevention of weight regain. New observational studies have reported increased risks of coronary heart disease associated with higher intakes of carbohydrates from high glycemic index foods. Epidemiological evidence has emerged linking dietary glycemic index to visceral fat and inflammatory disease mortality. SUMMARY There is growing recognition that replacing saturated fat with refined, high glycemic index carbohydrates increases postprandial glycemia and may be detrimental for weight control and predisposition to cardiovascular and inflammatory disease. In contrast, low glycemic index carbohydrates reduce risk.
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Affiliation(s)
- Jennie Brand-Miller
- School of Molecular Bioscience and Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, New South Wales, Australia.
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Lorenzen J, Frederiksen R, Hoppe C, Hvid R, Astrup A. The effect of milk proteins on appetite regulation and diet-induced thermogenesis. Eur J Clin Nutr 2012; 66:622-7. [PMID: 22274550 DOI: 10.1038/ejcn.2011.221] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES There is increasing evidence to support that a high-protein diet may promote weight loss and prevent weight (re)gain better than a low-protein diet, and that the effect is due to higher diet-induced thermogenesis (DIT) and increased satiety. However, data on the effect of different types of protein are limited. In the present study we compare the effect of whey, casein and milk on DIT and satiety. SUBJECTS/METHODS Seventeen slightly overweight (29 ± 4 kg/m(2)) male subjects completed the study. The study had a randomized, crossover design, where the effect on 4 h postprandial energy expenditure (EE), substrate oxidation and subjective appetite sensation of three isocaloric test meals containing either a whey drink, a casein drink or skim milk was examined. Energy intake (EI) at a subsequent ad libitum lunch was also measured. RESULTS There was no significant effect on subjective appetite sensation, but EI at lunch was lower after the milk test meal than after the casein (9%; P=0.0260) and the whey (9%; P=0.0258) test meals. Postprandial lipid oxidation was significantly higher after the casein test meal compared with the whey test meal (P=0.0147) when adjusted for baseline values. There was no significant difference in effect on EE, protein oxidation or carbohydrate oxidation. CONCLUSIONS Milk reduced subsequent EI more than isocaloric drinks containing only whey or casein. A small but significant increase in lipid oxidation was seen after casein compared with whey.
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Affiliation(s)
- J Lorenzen
- Department of Human Nutrition, Centre for Advanced Food Studies, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark.
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