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Effects of Dietary Macronutrient Content on Glucose Metabolism in Children

Children’s Nutrition Research Center (A.L.S., M.S.T., N.F.B., D.M.B., M.W.H.), United States Department of Agriculture/Agricultural Research Service, Houston, Texas 77030; and Department of Electronics and Informatics (G.T., C.C.), University of Padua, 35131 Padua, Italy

Address all correspondence and requests for reprints to: Agneta L. Sunehag, M.D., Ph.D., Children’s Nutrition Research Center, 1100 Bates Street, Houston, Texas 77030. E-mail: asunehag{at}bcm.tmc.edu.

Abstract

Effects of carbohydrate, fat, and fructose intake on substrate and hormone concentrations, glucose production, gluconeogenesis, and insulin sensitivity were determined in healthy, nonobese prepubertal children (n = 12) and adolescents (n = 24) using a cross-over design. In one group (12 prepubertal children and 12 adolescents), subjects were studied after 7 d of isocaloric, isonitrogenous diets providing either 60% carbohydrate and 25% fat [high carbohydrate (H_CHO)/low fat (L_F)] or 30% carbohydrate and 55% fat [low carbohydrate (L_CHO)/high fat (H_F)], and in a second group (12 adolescents) H_CHO/L_F diets containing either 40% or 10% fructose was used.

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 L_CHO/H_F to H_CHO/L_F diet resulted in increased insulin sensitivity (stable labeled iv glucose tolerance test) in adolescents [from 3.2 ± 0.7 x 10^-4 to 5.0 ± 1.4 x 10^-4 (min^-1)/(µU·ml^-1) (mean ± SE)] but not in prepubertal children [9.4 ± 2.5 x 10^-4 to 9.9 ± 1.5 x 10^-4 (min^-1)/(µU·ml^-1)], whereas ß-cell sensitivity was unaffected in both groups. Insulin sensitivity was higher in prepubertal 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 nonobese children. In the adolescents, the high carbohydrate diet resulted in increased insulin sensitivity, thus facilitating insulin-mediated glucose uptake.

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