Isocaloric Fructose Restriction and

Metabolic Improvement in Children

with Obesity and Metabolic Syndrome

Robert H. Lustig, Kathleen Mulligan,

Susan M. Noworolski, Viva W. Tai,
Michael J. Wen, Ayca Erkin-Cakmak,
Alejandro Gugliucci, and Jean-Marc
Schwarz
Whats the deal with fructose?
Liver is the primary location for fructose metabolism

Causes triglyceride accumulation

Fructose is substrate for de novo lipogenesis

Causes cellular dysfunction

Non-enzymatic fructation and ROS formation

Overeating

Ghrelin is not suppressed, so hunger remains

Nucleus accumbens stimulated

Study Objectives
Investigate whether isocaloric substitution of starch for sugar would
improve metabolic parameters in children with obesity and metabolic
syndrome

Isocaloric- means they did not change amount of overall calories.

** Important to show that the TYPE of nutrient drove the results, not energy intake.
Methods
Population Requirements:

8-18 years old

Latino or African American (43 total)

Higher risk populations for dyslipidemia, NAFLD, T2DM, HTN

Identify as high frequent sugar consumers

Must be obese (BMI) + one other parameter for metabolic syndrome

Could NOT have existing diabetes or be using medications which interfere with insulin

Baseline diet information: food frequency questionnaire (FFQ) + interview with

Methods
Participants Diet:

Followed for 9 days

Same percentages of protein, fat and carbohydrate as usual diet

Dietary sugar reduced from 28% to 10% and substituted with starch

4% of total calories

Daily weight: recorded by participants

Tests: Fasting blood specimens, DXA and OGTT on Day 0 and Day 10
Results

Table 1.
Results Peak
Insulin

Improved Reduction in
Glucose Hyperinsulinemia
Glucose Insulin
Tolerance AUC AUC
Fasting
Glucose Fasting
Insulin

Reduction in
Hyperinsulinemia
Results
Table 2.

Argues that fructose specifically causes adverse health effects regardless of its caloric value.
Discussion
Considerations with this study:

Reliance on participant accuracy can confound results i.e.) initial FFQ

No control subject described in the Materials and Methods

10 test subjects who did not experience weight loss

The 33 who did lose weight

Possibly due to protein and water content

Unintended caloric deficit

Four difficulties with establishing causality

Conclusion
Dietary sugar has a causal effect on diabetes and is supported by the findings in this
study.

Changes in public health policy including sugar intake and labeling are necessary in
order for greater improvements in diabetes prevalence to occur.

Dietary sugar and fructose put individuals at a greater risk of diabetes through
mechanisms independent of their caloric content/effects on weight.
Group Discussion