Metabolic adaptation to high-fat and high-carbohydrate diets in children and adolescents

Background: Difficulty adapting to high-fat (HF) and high-carbohydrate (HC) diets may predispose children to obesity and diabetes. Objective: We tested the hypothesis that children have metabolic flexibility to adapt to HF and HC diets. Design: In protocol 1, 12 children aged 6-9 y and 12 adolescents aged 13-16 y were randomly assigned in a crossover design to consume low-fat (LF), HC (25% and 60% of energy, respectively) or HF, low-carbohydrate (LC) (55% and 30% of energy, respectively) diets. In protocol 2, 12 adolescents aged 13-16 y were randomly assigned in a crossover design to consume an LF-HC diet with 11% or 40% of carbohydrate as fructose. Total energy expenditure, nonprotein respiratory quotients (NPRQs), and substrate utilization were measured by using 24-h calorimetry. Effects of sex, puberty, body fat (dual-energy X-ray absorptiometry), intraabdominal fat (magnetic resonance imaging), and fitness on substrate utilization were tested. Results: Substrate utilization was not affected by puberty, body fat, intraabdominal fat, or fitness. Total energy expenditure was not affected by diet. In protocol I, NPRQs and carbohydrate and fat utilization were significantly affected by diet (P = 0.001) and sex (P = 0.005). NPRQs and carbohydrate utilization increased with the LF-HC diet. NPRQs decreased and fat utilization increased with the HF-LC diet; changes in substrate utilization were less pronounced in females than in males. In protocol 2, 24-h NPRQs and 24-h substrate utilization were not significantly affected by fructose, although net carbohydrate and fat utilization were significantly lower and higher, respectively, with the high-fructose diet during fasting (P = 0.01) and in the subsequent feeding period (P = 0.05). Conclusion: Healthy, nonobese children and adolescents adapt appropriately to HF and HC diets.