Submitted to: Journal of Clinical Endocrinology and Metabolism
Publication Type: Peer reviewed journal
Publication Acceptance Date: 8/5/2002
Publication Date: 11/1/2002
Citation: Sunehag AL, Toffolo G, Treuth MS, Butte NF, Cobelli C, Bier DM, Haymond MW. Effects of dietary macronutrient content on glucose metabolism in children. J Clin Endocrinol Metab. 2002 87:5168-5178. Interpretive Summary: We conclude that, healthy, non-obese children adapt to large changes in the dietary carbohydrate and that by appropriate changes in their substrate oxidation rates. Our results demonstrate that at least in the short term, dramatic changes in dietary fat and carbohydrate intakes, irrespective of dietary fructose content, would not adversely affect glucose and lipid metabolism in healthy, non-obese children. In fact, in the adolescents, the high carbohydrate diet resulted in increased insulin sensitivity, thus, facilitating insulin mediated glucose uptake. Therefore, issues other than dietary macronutrient distribution must be considered as the major risk factors for carbohydrate intolerance and insulin resistance
Technical Abstract: Effects of carbohydrate, fat and fructose intake on substrate and hormone concentrations, glucose production, gluconeogenesis and insulin sensitivity were determined in healthy, non-obese pre-pubertal children (n=12) and adolescents (n=24) using a crossover design. In one group, subjects were studied following 7 d of isocaloric, isonitogenous diets providing either 60% carbohydrate and 25% fat (HCHO/LF) or 30% carbohydrate and 55% fat (LCHO/HF), and in a second group (12 adolescents) HCHO/LF diets containing either 40 or 10% fructose was employed. All subjects adapted to changes in carbohydrate and fat intakes primarily by appropriately adjusting their substrate oxidation rates to match the intakes with only minor changes in parameters of glucose metabolism. Changing from a LCHO/HF to HCHO/LF diet resulted in increased insulin sensitivity (stable labeled IVGTT) in adolescents (from 3.2 ± 0.7 to 5.0 ± 1.4 x 10-4 (min-1/mU mL-1) (Mean ± SE) but not in pre-pubertal children (9.4 ± 2.5 to 9.9 ± 1.5 (min-1/mU mL-1), while b-cell sensitivity was unaffected in both groups. Insulin sensitivity was higher in pre-pubertal children than in adolescents (p<0.05). The dietary fructose content did not affect any measured parameter. We conclude that in the short term, dramatic changes in fat and carbohydrate intakes (regardless of fructose content) did not adversely affect glucose and lipid metabolism in healthy non-obese children. In the adolescents, the high carbohydrate diet resulted in increased insulin sensitivity, thus, facilitating insulin mediated glucose uptake.