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A reduced-glycemic load diet in the treatment of adolescent obesity.
Arch Pediatr Adolesc Med. 2003 Aug; 157(8):773-9.AP

Abstract

BACKGROUND

The incidence of type 2 diabetes increases markedly for obese children after puberty. However, the effect of dietary composition on body weight and diabetes risk factors has not been studied in adolescents.

OBJECTIVE

To compare the effects of an ad libitum, reduced-glycemic load (GL) diet with those of an energy-restricted, reduced-fat diet in obese adolescents.

DESIGN

Randomized control trial consisting of a 6-month intervention and a 6-month follow-up.

MAIN OUTCOME MEASURES

Body composition (body mass index [BMI; calculated as weight in kilograms divided by the square of height in meters] and fat mass) and insulin resistance (homeostasis model assessment) were measured at 0, 6, and 12 months. Seven-day food diaries were used as a process measure.

SUBJECTS

Sixteen obese adolescents aged 13 to 21 years. Intervention Experimental (reduced-GL) treatment emphasized selection of foods characterized by a low to moderate glycemic index, with 45% to 50% of energy from carbohydrates and 30% to 35% from fat. In contrast, conventional (reduced-fat) treatment emphasized selection of low-fat products, with 55% to 60% of energy from carbohydrates and 25% to 30% from fat.

RESULTS

Fourteen subjects completed the study (7 per group). The GL decreased significantly in the experimental group, and dietary fat decreased significantly in the conventional group (P<.05 for both). At 12 months, mean +/- SEM BMI (-1.3 +/- 0.7 vs 0.7 +/- 0.5; P =.02) and fat mass (-3.0 +/- 1.6 vs 1.8 +/- 1.0 kg; P =.01) had decreased more in the experimental compared with the conventional group, differences that were materially unchanged in an intention-to-treat model (n = 16) (BMI, P =.02; fat mass, P =.01). Insulin resistance as measured by means of homeostasis model assessment increased less in the experimental group during the intervention period (-0.4 +/- 0.9 vs 2.6 +/- 1.2; P =.02). In post hoc analyses, GL was a significant predictor of treatment response among both groups (R2 = 0.51; P =.006), whereas dietary fat was not (R2 = 0.14; P =.22).

CONCLUSIONS

An ad libitum reduced-GL diet appears to be a promising alternative to a conventional diet in obese adolescents. Large-scale randomized controlled trials are needed to further evaluate the effectiveness of reduced-GL and -glycemic index diets in the treatment of obesity and prevention of type 2 diabetes.

Links

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Authors+Show Affiliations

Ebbeling CB
Division of Endocrinology, Department of Medicine, Children's Hospital Boston, MA 02115, USA.
Leidig MM
No affiliation info available
Sinclair KB
No affiliation info available
Hangen JP
No affiliation info available
Ludwig DS
No affiliation info available

MeSH

AdolescentAdultBlood GlucoseBody CompositionBody Mass IndexBody WeightDiet, Fat-RestrictedDiet, ReducingDietary CarbohydratesDietary FatsFemaleHumansInsulin ResistanceLinear ModelsMaleObesityRegression AnalysisTreatment OutcomeWeight Loss

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12912783

Clinical Trial Links

Integrated Care for Pediatric Obesity Using Telehealth
A Cooking and Eating Study

Citation

Ebbeling, Cara B., et al. "A Reduced-glycemic Load Diet in the Treatment of Adolescent Obesity." Archives of Pediatrics & Adolescent Medicine, vol. 157, no. 8, 2003, pp. 773-9.
Ebbeling CB, Leidig MM, Sinclair KB, et al. A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med. 2003;157(8):773-9.
Ebbeling, C. B., Leidig, M. M., Sinclair, K. B., Hangen, J. P., & Ludwig, D. S. (2003). A reduced-glycemic load diet in the treatment of adolescent obesity. Archives of Pediatrics & Adolescent Medicine, 157(8), 773-9.
Ebbeling CB, et al. A Reduced-glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med. 2003;157(8):773-9. PubMed PMID: 12912783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A reduced-glycemic load diet in the treatment of adolescent obesity. AU - Ebbeling,Cara B, AU - Leidig,Michael M, AU - Sinclair,Kelly B, AU - Hangen,Jan P, AU - Ludwig,David S, PY - 2003/8/13/pubmed PY - 2003/9/5/medline PY - 2003/8/13/entrez SP - 773 EP - 9 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 157 IS - 8 N2 - BACKGROUND: The incidence of type 2 diabetes increases markedly for obese children after puberty. However, the effect of dietary composition on body weight and diabetes risk factors has not been studied in adolescents. OBJECTIVE: To compare the effects of an ad libitum, reduced-glycemic load (GL) diet with those of an energy-restricted, reduced-fat diet in obese adolescents. DESIGN: Randomized control trial consisting of a 6-month intervention and a 6-month follow-up. MAIN OUTCOME MEASURES: Body composition (body mass index [BMI; calculated as weight in kilograms divided by the square of height in meters] and fat mass) and insulin resistance (homeostasis model assessment) were measured at 0, 6, and 12 months. Seven-day food diaries were used as a process measure. SUBJECTS: Sixteen obese adolescents aged 13 to 21 years. Intervention Experimental (reduced-GL) treatment emphasized selection of foods characterized by a low to moderate glycemic index, with 45% to 50% of energy from carbohydrates and 30% to 35% from fat. In contrast, conventional (reduced-fat) treatment emphasized selection of low-fat products, with 55% to 60% of energy from carbohydrates and 25% to 30% from fat. RESULTS: Fourteen subjects completed the study (7 per group). The GL decreased significantly in the experimental group, and dietary fat decreased significantly in the conventional group (P<.05 for both). At 12 months, mean +/- SEM BMI (-1.3 +/- 0.7 vs 0.7 +/- 0.5; P =.02) and fat mass (-3.0 +/- 1.6 vs 1.8 +/- 1.0 kg; P =.01) had decreased more in the experimental compared with the conventional group, differences that were materially unchanged in an intention-to-treat model (n = 16) (BMI, P =.02; fat mass, P =.01). Insulin resistance as measured by means of homeostasis model assessment increased less in the experimental group during the intervention period (-0.4 +/- 0.9 vs 2.6 +/- 1.2; P =.02). In post hoc analyses, GL was a significant predictor of treatment response among both groups (R2 = 0.51; P =.006), whereas dietary fat was not (R2 = 0.14; P =.22). CONCLUSIONS: An ad libitum reduced-GL diet appears to be a promising alternative to a conventional diet in obese adolescents. Large-scale randomized controlled trials are needed to further evaluate the effectiveness of reduced-GL and -glycemic index diets in the treatment of obesity and prevention of type 2 diabetes. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/12912783/A_reduced_glycemic_load_diet_in_the_treatment_of_adolescent_obesity_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/vol/157/pg/773 DB - PRIME DP - Unbound Medicine ER -