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Reduced Carbohydrate Diet to Improve Metabolic Outcomes and Decrease Adiposity in Obese Peripubertal African American Girls

Casazza, Krista*; Cardel, Michelle*; Dulin-Keita, Akilah*; Hanks, Lynae J.*; Gower, Barbara A.*; Newton, Anna L.*; Wallace, Stephenie

Journal of Pediatric Gastroenterology & Nutrition: March 2012 - Volume 54 - Issue 3 - p 336–342
doi: 10.1097/MPG.0b013e31823df207
Original Articles: Hepatology and Nutrition

Objective: Obesity prevalence among African American (AA) girls is higher than that in other groups. Because typical energy-restriction obesity treatment strategies have had limited success, alterations in macronutrient composition may effectively improve metabolic outcomes in this population and affect future body composition trajectories. The objective was to evaluate the efficacy of a moderately restricted carbohydrate (CHO) versus a standard CHO diet on weight/fat loss and metabolic parameters in overweight/obese AA girls ages 9 to 14 years.

Methods: A total of 26 AA girls (ranging from 92nd body mass index percentile and above) were assigned to either a reduced- (SPEC: 42% energy from CHO, n = 12) or a standard- (STAN: 55% of energy from CHO, n = 14) CHO diet (protein held constant) for 16 weeks. All of the meals were provided and clinically tailored to meet the estimated energy requirements (resting energy expenditure × 1.2 in eucaloric phase and resting energy expenditure × 1.2 − 1000 kcal in energy deficit phase). The first 5 weeks encompassed a eucaloric phase evaluating metabolic changes in the absence of weight change. The subsequent 11 weeks were hypocaloric (1000 kcal/day deficit) to promote weight/fat loss. Meal tests were performed during the eucaloric phase for metabolic analyses. Dual-energy x-ray absorptiometry was used to evaluate body composition.

Results: Both groups experienced reductions in weight/adiposity, but the difference did not reach significance. The solid meal test indicated improved glucose/insulin homeostasis on the SPEC diet up to 3 hours postingestion. In addition, significantly lower triglycerides (P < 0.001) were observed on the SPEC diet.

Conclusions: Dietary CHO reduction favorably influences metabolic parameters but did not result in greater weight/fat loss relative to a standard diet in obese AA girls. Future research is needed to determine long-term effectiveness of a reduced CHO diet on glucose and insulin homeostasis and how it may apply to weight maintenance/fat loss during development alone and/or in combination with additional weight loss/metabolic improvement strategies.

*Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL

Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.

Address correspondence and reprint requests to Krista Casazza, PhD, RD, Department of Nutrition Sciences, Webb 415, 1530 3rd Ave S, University of Alabama at Birmingham, Birmingham, AL 35294-3360 (e-mail:

Received 10 September, 2010

Accepted 10 October, 2011

The present study was funded by grant NIH K99 DK083333, Thrasher Research Fund, University of Alabama Center for Women's Reproductive Health P/F Grant, CA-47888, NIH P60DK079626, P30 DK056336.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN