Effect of Restriction of Foods with High Fructose Corn Syrup Content on Metabolic Indices and Fatty Liver in Obese Children

Abstract

Objective: We examined the effect of restriction of foods with high fructose content in obese school children. Methods: In a clinical study, we selected 54 obese children 6 to 11 years old with high fructose consumption (>70 g/day) in order indicate dietary fructose restriction (<20 g/day) for 6 weeks. Anthropometry, liver ultrasound as well as glucose, insulin, lipids, leptin, IGFBP1, and RBP4 serum levels were collected. Results: The group of children had 80% adherence and reported decreased fructose consumption (110 ± 38.6 to 11.4 ± 12.0 g/day) and also a significant decrease in caloric (2,384 ± 568 to 1,757 ± 387 kcal/day) and carbohydrate consumption (302 ± 80.4 to 203 ± 56.0 g/day). The severity of steatosis improved significantly after fructose restriction (p < 0.000001). However, no changes in BMI, systolic blood pressure, or diastolic blood pressure were found. Only triglyceride levels decreased (1.44 ± 0.43 to 1.31 ± 0.38 mmol/l), High-densitiy lipoprotein cholesterol showed a marginal increase (1.45 ± 0.19 to 1.56 ± 0.44 mmol/l). Insulin resistance and RBP4 did not change. Conclusions: In school children, the restriction of high fructose foods with a decrease of caloric and carbohydrate intake at 6 weeks did not induce weight loss; however, triglyceride levels and hepatic steatosis decreased. Differences with other studies in regard to weight loss may be explained by adaptive changes on metabolic expenditure.

Dietary carbohydrates: role of quality and quantity in chronic disease

“…Reduction of fructose or sugar consumption in several clinical trials resulted in lower intrahepatic fat. 48 49 50 However, each of these studies has design limitations, such as lack of a control group and confounding by unintended weight loss. In a six month trial, people consuming sugar sweetened drinks had higher levels of liver and ectopic fat than those consuming drinks without added sugar, even though body weight did not differ by diet group.…”

Insulin-Like growth factor binding Protein-1, non-alcoholic fatty liver disease, and its relationship with fructose consumption in children with obesity

“…A previous study in children by our group showed that the restriction of high-fructose foods with a decrease in caloric and carbohydrate intake, at 6 weeks induced a decrease of TG levels and hepatic steatosis 48 . In the present study, the group of children without steatosis and the group with mild steatosis had similar fructose intake; besides, they had similar metabolic and anthropometric characteristics.…”

Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories

“…Two more recent studies demonstrate benefits of sugar restriction in children with obesity (162,163). In response to a 6-week dietary intervention consisting of advice to reduce fructose consumption from a usual intake > 70 to < 20 g d −1 , 54 children (age range: 6–11 years) exhibited significant decreases in liver fat and fasting TG, but no changes in body weight or BMI (162).…”

“…Two more recent studies demonstrate benefits of sugar restriction in children with obesity (162,163). In response to a 6-week dietary intervention consisting of advice to reduce fructose consumption from a usual intake > 70 to < 20 g d −1 , 54 children (age range: 6–11 years) exhibited significant decreases in liver fat and fasting TG, but no changes in body weight or BMI (162). A 6-month dietary intervention consisting of advice to reduce consumption of fructose and high glycaemic index foods resulted in lowered systolic blood pressure, alanine aminotransferase, apoB and HOMA-IR in 12 children (age range: 7–18 years) with non-alcoholic fatty liver disease (NAFLD) (163).…”

“…A 6-month dietary intervention consisting of advice to reduce consumption of fructose and high glycaemic index foods resulted in lowered systolic blood pressure, alanine aminotransferase, apoB and HOMA-IR in 12 children (age range: 7–18 years) with non-alcoholic fatty liver disease (NAFLD) (163). An important limitation of all three of these studies (159,162,163) is they did not include control groups. However, in a recent RCT, adults (mean BMI: 31 kg m −2 ), whose normal diets contained ~94 g of sugar per day from SSB, were randomized to receive and consume their usual quantity of beverage sweetened with sucrose ( n = 14) or with an NNS ( n = 13) for 12 weeks (164).…”