Role of Carbohydrate Modification in Weight Management among Obese Children: A Randomized Clinical Trial

Abstract

Objective To compare the effectiveness and safety of carbohydrate-modified diets with a standard portion-controlled diet among obese children. Study design Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of low carbohydrate (LC), reduced glycemic load (RGL), or standard portion-controlled (PC) diet, along with weekly dietary counseling and bi-weekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline, 3, 6 and 12 months. Analyses applied intention-to-treat longitudinal mixed models. Results Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (p<0.0001), although LC diet adherence was persistently lower (p<0.0002). At 3 months BMI z-score was lower in all diet groups (LC: -0.27 ± 0.04; RGL: -0.20 ± 0.04; PC: -0.21 ± 0.04; p<0.0001) and maintained at 6 months, with similar results for waist circumference (WC) and percent body fat (%BF). At 12 months, participants in all diet groups had lower BMI z-scores than at baseline (LC: -0.21±0.04; RGL: -0.28±0.04; PC: -0.31±0.04; p<0.0001), and lower %BF, but no reductions in WC were maintained. All diets demonstrated some improved clinical measures. Conclusions Diets with modified carbohydrate intake were as effective as a PC diet for weight management in obese children. However, lower adherence to the LC diet suggests this regimen is more difficult for children to follow, particularly in the long-term.

Low-glycemic index diet may improve insulin sensitivity in obese children

“…Intensive intervention by 12 dietary behavioral therapy counseling sessions for 6 mo followed by two dietary counseling sessions for 6 mo afterward may have caused this reduction in FM, not observed in our study. Two other studies of low-GI diets have shown decreases in fat percentages that may be attributed to intensive intervention (9,10). A crossover study by Pal et al (14) of participants receiving a low-GI breakfast for 21 d and low-GI diet instruction for other meals demonstrated, similar to our study, a decreasing trend of fat percentage without statistical significance and higher satiety ratings before lunch during the low-GI study period.…”

“…However, the effectiveness of a low-GI diet in the treatment of pediatric obesity has not been well evaluated. There are few studies in obese children on BMI reduction (6)(7)(8) and fat mass reduction (9)(10)(11)(12), and some of these studies showed an improvement in insulin sensitivity (9,12); however, their sample sizes were quite small, and most of the studies were conducted in western countries and may not be applicable to Thai cuisine. In Thailand, the staple food is rice which has several varieties.…”

Combined dyslipidemia in childhood

“…[123][124][125][126] In adolescents, a low-carbohydrate diet with or without weight loss has been shown to significantly reduce TG levels. [127][128][129] These lifestyle change interventions have been shown to significantly reduce TG, non-HDL-C and TG/HDL-C ratio, and lead to an improvement in LDL subpopulation pattern. 130,131 There are no trials of CDO evaluating clinical cardiovascular events in response to lifestyle changes initiated in childhood.…”

“…This approach has been shown to be successful in addressing all the cardiometabolic risks in case series and in randomized trials, particularly when combined with cognitive behavioral therapy. 128,[142][143][144][145][146][147][148][149][150][151][152][153][154] Application of these simple recommendations with infrequent monitoring has been associated with weight loss and improvement in CDO and the other cardiometabolic risk factors in obese adolescents. However, there are no data to this time evaluating the lipid subpopulation or vascular response to lifestyle change in CD in adolescents and there are no studies of long-term lifestyle change.…”

Pädiatrische Ernährungsmedizin

“…Im Vergleich zu einer Reduktion der Portionsgrößen war der Effekt einer Kost mit niedrigem glykämischen Index (GI) zwar gleich hinsichtlich der Gewichtsabnahme, aber diese Low-GI-Diet war durch schlechtere Compliance gekennzeichnet [19,20]. Eine neuere Studie aus Australien weist allerdings auf die Bedeutung hin, die EEG-Symptome (EEG: Elektroenzephalografie) genau zu charakterisieren, um den Nutzen einer ketogenen Diät abzuschätzen [30].…”