Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review

Gow, Megan L.; Ho, Mandy; Burrows, Tracy; Baur, Louise A.; Stewart, Laura; Hutchesson, Melinda J.; Cowell, Chris; Collins, Clare E.; Garnett, Sarah P.

doi:10.1111/nure.12111

Cited by 89 publications

(90 citation statements)

References 59 publications

(242 reference statements)

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“…Our 2014 systematic review with meta-analysis examined, for the first time, whether variations in dietary macronutrient content differentially affect changes in weight and cardio-metabolic risk factors in children and adolescents who are overweight or obese [12]. Overall, the review indicated improved weight status in children and adolescents undergoing obesity treatment, irrespective of the macronutrient distribution of a reduced-energy diet.…”

Section: Macronutrient Distribution Of the Diet And Weight Lossmentioning

confidence: 99%

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The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

et al. 2016

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Type 2 diabetes in children and adolescents has become a prominent clinical issue in recent decades. Increasing numbers of young people have risk factors for type 2 diabetes, particularly obesity, indicating the need for effective type 2 diabetes prevention strategies. The aim of this review was to identify specific dietary strategies that optimize improvements in risk factors for type 2 diabetes in youth and hence reduce the risk of type 2 diabetes development. Our review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high. However, in addition to weight loss, a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia. While further research is needed to confirm this finding, reduced carbohydrate diets may include a very low-carbohydrate diet, a very low-energy diet, a lower-glycemic-index diet, and/or an intermittent fasting diet. This array of dietary strategies provides a suite of intervention options for clinicians to recommend to young people at risk of type 2 diabetes. However, these findings are in contrast to current guidelines for the prevention of type 2 diabetes in adults which recommends a low-fat, high-carbohydrate diet.

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Section: Macronutrient Distribution Of the Diet And Weight Lossmentioning

confidence: 99%

“…While there may not be an impact on weight loss, findings from our 2014 systematic review did suggest the potential for the specific application of certain macronutrient distributions to target certain T2DM risk factors [12]. …”

Section: Macronutrient Distribution Of the Diet And Improvements Imentioning

confidence: 99%

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

et al. 2016

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“…Further, consumption of whole fruits, vegetables and dietary fiber is encouraged in addition to portion control education, enhancing food labeling, and encouraging eating regular meals to avoid grazing (47). A recent meta-analysis conducted by Gow et al (55) suggests that primary goal in dietary intervention programs should focus on reduced total energy intake based on the observation that a reduced energy diet, irrespective of the macronutrient distribution, was successful in improving weight status in overweight and obese children and adolescents. It is essential that dietary interventions and calorie reduction in children and adolescents are supervised by an experienced dietician in growing children's needs (47).…”

Section: Dietary Interventionmentioning

confidence: 99%

Metabolic syndrome in children and adolescents

2017

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Prevalence of metabolic syndrome in children and adolescents is increasing, in parallel with the increasing trends in obesity rates. Varying definitions of this syndrome have hindered the development of a consensus for the diagnostic criteria in the pediatric population. While pathogenesis of metabolic syndrome is not completely understood, insulin resistance and subsequent inflammation are thought to be among its main mechanistic underpinnings. Overweight and obesity are cardinal features, along with abnormal glucose metabolism, dyslipidemia, and hypertension. Other disorders associated with metabolic syndrome include fatty liver, polycystic ovarian syndrome (PCOS), and pro-inflammatory states. Prevention and management of this condition can be accomplished with lifestyle modifications, behavioral interventions, pharmacological and surgical interventions as needed.

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“…Indeed, higher-calorie fattier foods and higher-fat diets may produce and sustain as much or more weight loss than calorie-restricted or higher-carbohydrate diets (9,10,89-98) -particularly among those already having metabolic abnormalities (93,94,99) . Moreover, certain fattier/lower-carbohydrate diets may also be associated with favourable metabolic indicators (10,89,(91)(92)(93)(94)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109) , reduced adverse health events (69,102,110,111) and delayed mortality (110)(111)(112)(113) .…”

Section: More-nuanced Thinking About Obesity and Related Diseasesmentioning

confidence: 99%

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Lucan

DiNicolantonio

2014

Public Health Nutr.

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Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories -regardless of their sources -are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheetstargeting 'calories in' and/or 'calories out' -that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote caloriedirected messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases. KeywordsObesity Calories Carbohydrates Public health Chronic diseaseWith worldwide concerns about obesity and diseases related to it (e.g. diabetes and CVD), there is substantial interest in shifting populations to healthier weights and better health. More precisely, there is interest in reducing body fat since fat -particularly visceral or abdominal fat -may matter more than weight when it comes to health (1)(2)(3) . Nevertheless, much of the evidence regarding obesity and related diseases focuses on body weight, rather than body fat. In reviewing such evidence, therefore, the present paper will therefore also often use the imprecise term 'weight' as opposed to 'fat', pointing out when such imprecision might mislead thinking.One way such imprecision might mislead thinking is in supporting the notions that (i) 'a calorie is a calorie' † and (ii) intervening on calories is the best way to address obesity (i.e. the quantitative problem of excess pounds or kilograms on a scale as opposed to the qualitative problem † 'Calorie' -or more correctly kilocalorie (kcal), for which the word often imprecisely substitutes -is the main unit of energy used to discuss food and obesity-related issues in the USA. It is also the word used in common expressions l...

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Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review

Cited by 89 publications

References 59 publications

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth

Metabolic syndrome in children and adolescents

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

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