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 Pediatrics

Chris T Cowell³  Geoffrey R Ambler³  Shubha Srinivasan⁶  Katherine Steinbeck⁷  Sukanya De⁵  Julie Briody⁸  Kerryn Chisholm⁴  Carolyn R Broderick⁹  Helen J Woodhead²  Manny Noakes¹  Louise A Baur³  Mandy Ho³  Megan Gow³  Sarah P Garnett³ 

[1] CSIRO Food and Nutritional Sciences, Adelaide 5000, BC South Australia, Australia;Department of Diabetes and Endocrinology, Sydney Children’s Hospital Network, Randwick, Sydney 2031, NSW, Australia;The Children’s Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, Sydney 2145, NSW, Australia;Nutrition and Dietetics and Weight Management Services, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney 2145, NSW, Australia;Kids Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney 2145, NSW, Australia;Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney 2145, NSW, Australia;Academic Department of Adolescent Medicine, Sydney Medical School, University of Sydney, Sydney 2066, NSW, Australia;Department of Nuclear Medicine, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney 2145, NSW, Australia;The School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney 2052, NSW, Australia

关键词: Pre-diabetes;    Adolescents;    Macronutrient intake;    Body composition;    Insulin sensitivity;   

Others  :  1113328
DOI  :  10.1186/s12887-014-0289-0

 received in 2014-08-05, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

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 webcite. Registered 25 August 2008.

【 授权许可】

   
2014 Garnett et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Weickert MO: What dietary modification best improves insulin sensitivity and why? Clin Endocrino 2012, 77:508-512.
• [2]Abete I, Astrup A, Martinez JA, Thorsdottir I, Zulet MA: Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutr Rev 2010, 68:214-231.
• [3]Wycherley TP, Moran LJ, Clifton PM, Noakes M, Brinkworth GD: Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012, 96:1281-1298.
• [4]Due A, Toubro S, Skov AR, Astrup A: Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 2004, 28:1283-1290.
• [5]Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M: Protein, weight management, and satiety. Am J Clin Nutr 2008, 87:1558S-1561S.
• [6]Buyken AE, Mitchell P, Ceriello A, Brand-Miller J: Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective. Diabetologia 2010, 53:406-418.
• [7]Gow ML, Ho M, Burrows TL, Baur LA, Stewart L, Hutchesson MJ, Cowell CT, Collins CE, Garnett SP: Macronutrient distribution of the diet – impact on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev 2014, 72:453-470.
• [8]Gately PJ, King NA, Greatwood HC, Humphrey LC, Radley D, Cooke CB, Hill AJ: Does a high-protein diet improve weight loss in overweight and obese children? Obesity 2007, 15:1527-1534.
• [9]Duckworth LC, Gately PJ, Radley D, Cooke CB, King R, Hill AJ: RCT of a high-protein diet on hunger motivation and weight-loss in obese children: an extension and replication. Obesity 2009, 17:1808-1810.
• [10]Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P: Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord 2004, 28:514-519.
• [11]Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, Broderick CR, Burrell S, Chisholm K, Halim J, De S, Steinbeck K, Srinivasan S, Ambler GR, Kohn MR, Cowell CT: Optimal macronutrient content of the diet for adolescents with prediabetes; RESIST a randomised control trial. J Clin Endocrinol Metab 2013, 98:2116-2125.
• [12]Garnett SP, Baur LA, Noakes M, Steinbeck K, Woodhead HJ, Burrell S, Chisholm K, Broderick CR, Parker R, De S, Srinivasan S, Hopley L, Hendrie G, Ambler GR, Kohn MR, Cowell CT: Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers-RESIST. A randomised control trial investigating the effects of two different diets on insulin sensitivity in young people with insulin resistance and/or pre-diabetes. BMC Public Health 2010, 10:575. BioMed Central Full Text
• [13]Altman DG, Bland JM: Treatment allocation by minimisation. BMJ 2005, 330:843.
• [14]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320:240-1243.
• [15][http://www-users.york.ac.uk/~mb55/guide/minim.htm] webcite Evans S, Royston P, Day S: Minim: allocation by minimisation in clinical trials []
• [16]Diagnosis and classification of diabetes mellitus Diabetes Care 2008, 31(Suppl 1):S55-S60.
• [17][http:/ / www.health.gov.au/ internet/ main/ publishing.nsf/ Content/ health-pubhlth-strateg-phys-act-gui delines/ $File/ FS-YPeople-13-17-Years.PDF] webcite Australian Government, Department of Health and Ageing: Australian, National Children’s Nutrition and Physical Activity Survey 2008 []
• [18]Tanner JM, Whitehouse RH: Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976, 51:170-179.
• [19]Burke JPHD, Hazuda HP, Stern MP: A quantitative scale of acanthosis nigricans. Diabetes Care 1999, 22:1655-1659.
• [20]Matsuda M, DeFronzo RA: Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999, 22:1462-1470.
• [21]Norton K, Olds T: Anthropometrica. University of NSW Press, Sydney; 1996.
• [22][http://www.cdc.gov/growthcharts/] webcite Centres for Disease Control. 2000 CDC Growth Charts for the United States []
• [23]Flegal KM, Wei R, Ogden CL, Freedman DS, Johnson CL, Curtin LR: Characterizing extreme values of body mass index-for-age by using the 2000 centers for disease control and prevention growth charts. Am J Clin Nutr 2009, 90:1314-1320.
• [24]Kuczmarski RJ, Ogden CL, Guo SS: CDC growth charts for the United States: methods and development. Vital Health Stat 2000, 2002(11):1-190.
• [25]The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents Pediatrics 2004, 114(Suppl 2):555-576.
• [26]Fraser A, Longnecker MP, Lawlor DA: Prevalence of elevated alanine aminotransferase among US adolescents and associated factors: NHANES 1999–2004. Gastroenterology 2007, 133:1814-1820.
• [27]Wells JC, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, Kennedy K, Haroun D, Wilson C, Cole TJ, Fewtrell MS: Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am J Clin Nutr 2012, 96:1316-1326.
• [28]Papadaki A, Linardakis M, Larsen TM, Van Baak MA, Lindroos AK, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesova M, Holst C, Astrup A, Saris WH, Kafatos A: The effect of protein and glycemic index on children’s body composition: the DiOGenes randomized study. Pediatrics 2010, 126:e1143-e1152.
• [29]Damsgaard CT, Papadaki A, Jensen SM, Ritz C, Dalskov SM, Hlavaty P, Saris WH, Martinez JA, Handjieva-Darlenska T, Andersen MR, Stender S, Larsen TM, Astrup A, Molgaard 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, 143:810-817.
• [30]Quinn S, Baur L, Garnett S, Cowell C: Treatment of clinical insulin resistance in children: a systematic review. Obes Rev 2010, 11:722-730.
• [31]Park MH, Kinra S, Ward KJ, White B, Viner RM: Metformin for obesity in children and adolescents: a systematic review. Diabetes Care 2009, 32:1743-1745.
• [32]Kendall D, Vail A, Amin R, Barrett T, Dimitri P, Ivison F, Kibirige M, Mathew V, Matyka K, McGovern A, Stirling H, Tetlow L, Wales J, Wright N, Clayton P, Hall C: Metformin in obese children and adolescents: the MOCA trial. J Clin Endocrinol Metab 2013, 98:322-329.
• [33]Cook JS, Hoffman RP, Stene MA, Hansen JR: Effects of maturational stage on insulin sensitivity during puberty. J Clin Endocrinol Metab 1993, 77:725-730.
• [34]Ho M, Garnett SP, Baur LA, Burrows T, Stewart L, Neve M, Collins C: Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA Pediatr 2013, 167:759-768.
• [35]Steinbeck K, Baur L, Cowell C, Pietrobelli A: Clinical research in adolescents: challenges and opportunities using obesity as a model. Int J Obes 2008, 33:2-7.