Obesity Clinical Trial
Official title:
Metabolic Impact of Fructose Restriction in Obese Children
The sugar fructose has been implicated not just as a cause of obesity, but as a cause of the metabolic diseases that go along with obesity, termed "metabolic syndrome". Obese children with metabolic disease will be studied before and after 10 days of a fructose restricted diet. The question is whether their co-morbidities will improve, even if weight remains constant.
Recent studies suggest that specific types of macronutrients in the diet may have selective
effects on nutrient absorption, insulin sensitivity, and lipid metabolism. Elucidation of the
metabolic impact of specific dietary components may well result in improved efficacy of
lifestyle approaches to reduce obesity and metabolic diseases. Despite similar fructose
consumption, the phenotype of co-morbidities is different between African Americans and
Latinos. Latino and Caucasian children manifest worsened dyslipidemia and non-alcoholic fatty
liver disease (NAFLD), while African American children manifest worsened insulin resistance
and hypertension. We have also documented in adults that a reduction in de novo lipogenesis
(DNL; production of new lipids) in the liver and liver fat content, and improvement in
hepatic insulin sensitivity were achieved by substitution of complex carbohydrate for
fructose; but these changes appeared less dramatic in African American compared to Latino or
Caucasian subjects. These divergent findings suggest ethnic and race-specific differences of
fructose metabolism and disposition.
To determine whether fructose is a contributor to metabolic co-morbidity in children, we will
conduct a convenience cohort within-subject intervention with repeated measures, stratified
by racial/ethnic group (Latinos vs. African Americans vs. Caucasians). The intervention will
consist of restricting fructose ingestion only to naturally-occurring fructose in fruits and
vegetables (approximately 15 gm/day for 10 days), by substituting complex carbohydrate for
excess dietary fructose, while maintaining neutral energy balance. We anticipate fructose
restriction to differentially improve co-morbidities in different racial/ethnic groups.
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