The effects of carbohydrate-restricted (ketogenic) diets on metabolic parameters in children have been incompletely assessed.
To compare the efficacy and metabolic impact of ketogenic and hypocaloric diets in obese children and adolescents.
Fifty-eight obese subjects were placed on one of the two diets for 6 months.
Anthropometric measurements, body composition, oral glucose/insulin tolerance test, lipidemic profile, high molecular weight (HMW) adiponectin, whole-body insulin sensitivity index (WBISI), and homeostatic model assessment-insulin resistance (HOMA-IR) were determined before and after each diet.
Both groups significantly reduced their weight, fat mass, waist circumference, fasting insulin, and HOMA-IR (p = 0.009 for ketogenic and p = 0.014 for hypocaloric), but the differences were greater in the ketogenic group. Both groups increased WBISI significantly, but only the ketogenic group increased HMW adiponectin significantly (p = 0.025).
The ketogenic diet revealed more pronounced improvements in weight loss and metabolic parameters than the hypocaloric diet and may be a feasible and safe alternative for children's weight loss.
[Show abstract][Hide abstract] ABSTRACT: High-fat, low-carbohydrate ketogenic diets (KD) are used for weight loss and for treatment of refractory epilepsy. Recently, short-time studies in rodents have shown that besides their beneficial effect on body weight, KD lead to glucose intolerance and insulin resistance. However, the long-term effects on pancreatic endocrine cells are unknown. In this study we investigate the effects of long-term KD on glucose tolerance and beta and alpha cell mass in mice. Despite an initial weight loss, KD did not result in weight loss after 22 weeks. Plasma markers associated with dyslipidemia and inflammation (cholesterol, triglycerides, leptin, MCP-1, IL-1β and IL-6) were increased and KD-fed mice showed signs of hepatic steatosis after 22 weeks of diet. Long-term KD resulted in glucose intolerance that was associated with insufficient insulin secretion from beta cells. After 22 weeks insulin-stimulated glucose uptake was reduced. A reduction in beta cell mass was observed in KD-fed mice together with an increased number of smaller islets. Also alpha cell mass was markedly decreased, resulting in a lower alpha to beta cell ratio. Our data show that long-term KD causes dyslipidemia, a pro-inflammatory state, signs of hepatic steatosis, glucose intolerance and a reduction in beta and alpha cell mass, but no weight loss. This indicates that long-term high-fat, low-carbohydrate ketogenic diets lead to features that are also associated with the metabolic syndrome and an increased risk for type 2 diabetes in humans.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Background:
Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs.
This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics.
The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed.
Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes.
Stephanie K Tanamas, Michael E J Lean, Emilie Combet, Antonis Vlassopoulos, Paul Z Zimmet, Anna Peeters
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