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

Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
The Journal of pediatrics (Impact Factor: 3.79). 02/2012; 161(2):320-7.e1. DOI: 10.1016/j.jpeds.2012.01.041
Source: PubMed

ABSTRACT To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a standard portion-controlled (PC) diet in obese children.
Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of a low-CHO (LC), reduced glycemic load (RGL), or standard PC diet, along with weekly dietary counseling and biweekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline and 3, 6, and 12 months. Analyses applied intention-to-treat longitudinal mixed models.
Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (P<.0001), although LC diet adherence was persistently lower (P<.0002). At 3 months, body mass index z score was lower in all diet groups (LC, -0.27 ± 0.04; RGL, -0.20 ± 0.04; PC, -0.21 ± 0.04; P<.0001) and was maintained at 6 months, with similar results for waist circumference and percent body fat. At 12 months, participants in all diet groups had lower body mass index z scores than at baseline (LC, -0.21 ± 0.04; RGL, -0.28 ± 0.04; PC, -0.31 ± 0.04; P<.0001), and lower percent body fat, but no reductions in waist circumference were maintained. All diets demonstrated some improved clinical measures.
Diets with modified CHO intake were as effective as a PC diet for weight management in obese children. However, the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow, particularly in the long term.

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    • "Reduction in carbohydrate intake is taken to the extreme in the Atkins diet, which restricts adult subjects to less than 25 gm/day of ingested carbohydrate. Adult evaluations of the diet have been disappointing long term, 153,154 and there is currently a single study regarding the effect of the modified carbohydrate diet on obesity in children or adolescents that demonstrated short-term efficacy yet difficulties in adherence.155 However, it should be noted that the ketogenic diet used for seizure control is similar in composition to the Atkins diet. "
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    Annals of the New York Academy of Sciences 01/2013; 1281(1). DOI:10.1111/nyas.12030 · 4.38 Impact Factor
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    American journal of preventive medicine 11/2012; 43(5):565-8. DOI:10.1016/j.amepre.2012.07.024 · 4.53 Impact Factor
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    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. This trial was registered at as NCT01068197.
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