Low‐carbohydrate interventions for adolescent obesity: Nutritional adequacy and guidance for clinical practice

Abstract

SummaryLow‐carbohydrate dietary patterns are re‐emerging as a popular method of weight reduction. However, their nutritional adequacy to meet the needs of growing adolescents should be considered. This study aimed to design theoretical low‐carbohydrate meal plans for clinical use in the management of adolescent obesity and assess nutritional adequacy. Meal plans were created for three levels of carbohydrate restriction (≤30, ≤50 and ≤120 g/day) without energy, protein or total fat restriction. Nutrient analysis was conducted using the FoodWorks Australia Ltd software (databases: AUSNUT 2013, AusBrands 2017, AusFoods 2017, NUTTAB 2010, New Zealand FOODfiles 2016), and compared with Australian Nutrient Reference Values for male and female adolescents aged 14 to 18 years. All low‐carbohydrate meal plans met the Recommended Dietary Intake, Adequate Intake or Estimated Average Requirements for most micronutrients at an energy intake of 6.3 to 7.2 MJ/day (1510‐1730 kcal/day). The proportion of energy from saturated fat exceeded recommendations across all models (11.3%‐17.1%). Dietary manipulation was required to minimize saturated fat and reach micronutrient adequacy, particularly for calcium in males and females, and iron for females. In practice, this may be challenging considering individual lifestyle and preferences. Therefore, the use of low‐carbohydrate diets with adolescents should be monitored by a trained professional to ensure nutritional adequacy.

Novel dietary interventions for adolescents with obesity: A narrative review

“…Theoretical meal plans for a modified carbohydrate/higher protein diet, IER utilising 3 days/week of VLED, 37 and low carbohydrate approaches at three levels of carbohydrate restriction (<30 g/day; <50 g/day; <120 g/day), 33 have shown that achieving nutritional adequacy is possible. That said, achieving energy restriction and nutritional adequacy relies on the inclusion of nutrient dense foods, such as vegetables (particularly for low carbohydrate and IER approaches), dairy foods and animal‐based protein choices.…”

“…Theoretical meal plans support nutritional adequacy, 33 however have not been tested in practice. Limited evidence of psychosocial outcomes in adolescents.…”

“…Challenges: Careful meal planning to meet micronutrient requirements 33 ; adherence may be affected by limited food choices 13 …”

Low carbohydrate diets in eating disorders and type 1 diabetes

“…Coconut flour and seaweed are also commonly used low carbohydrate alternatives. As with any restrictive diet, low carbohydrate diets can impact nutrient intake including thiamine, iron, calcium and fibre intakes (Jebeile et al, 2020 (Feinman et al, 2015). Studies in people with T1D who are not following a low carbohydrate diet show they eat approximately 43%-45% energy from carbohydrate, which is slightly less than the general population (Gilbertson et al, 2018;Helgeson et al, 2006).…”

“…References utilised: Eisler et al, (2000), Food and Agricultural Organisation of the United Nations (2020), Gallagher et al (2019), Hart et al (2011), Hay et al (2014, Jebeile et al (2020), Leow et al (2018, Ozier & Henry (2011), Reiter & Graves (2010, Smart et al (2018), and Waterhous and Jacob (2011). Ozier & Henry, 2011;Reiter & Graves, 2010;Royal College of Psychiatrists, 2005;Smart et al, 2018;Waterhous & Jacob, 2011).…”