Hormonal and metabolic effects of carbohydrate restriction in children with Prader-Willi syndrome.

Abstract

OBJECTIVE:

Macronutrient regulation of hyperphagia and adiposity in Prader-Willi syndrome (PWS) is poorly understood. We compared fasting and postprandial concentrations of hormones and metabolites in eight PWS children (age 9-18 years) fed, in random order, low carbohydrate, high-fat (LC, 15% carb; 65% fat; 20% protein) and low-fat, high carbohydrate (LF, 65% carb, 15% fat, 20% protein) diets matched for calories and protein.

METHODS:

Participants were randomized to consume either the LC or LF diet during a first hospital admission and the second diet during a subsequent admission. Blood samples were obtained after overnight fasting and 1 hour after a mixed meal.

RESULTS:

Relative to subjects consuming the LF diet, subjects consuming the LC diet had: lower postprandial insulin concentrations (P = 0.02); higher fasting GLP-1 AND GIP concentrations and increased postprandial GLP-1 (P < 0.02); reduced ratio of fasting ghrelin to GLP-1 (P = 0.0078); increased FFA and fatty acid oxidation, as assessed by concentrations of even-chain acylcarnitines (P < 0.001); lower fasting TG and TG/HDL ratio (P < 0.01); and higher concentrations of branch chain amino acids (P < 0.01). There were no changes in glucose, PYY, or adiponectin. CRP, AST and ALT were all higher (P < 0.01) on the LC diet.

CONCLUSIONS:

Increases in GLP-1 with low carbohydrate feeding and reductions in the ratio of ghrelin to GLP-1 might limit food intake and improve glycaemic control in PWS. Other potential benefits of carbohydrate restriction may include fat mobilization and oxidation and reductions in the TG/HDL ratio, a marker of insulin resistance. However, increases in CRP, AST and ALT necessitate longer-term studies of low carbohydrate efficacy and safety.

• Authors: Krystal A Irizarry, Diana R Mager, Lucila Triador, Michael J Muehlbauer, Andrea M Haqq, Michael Freemark
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 90 Issue 4 Pg. 553-561 (04 2019) ISSN: 1365-2265 [Electronic] England
• PMID: 30614551 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 John Wiley & Sons Ltd.

Chemical References

• Amino Acids
• Blood Glucose
• Insulin
• Peptide YY
• Glucagon-Like Peptide 1

Topics

• Adiposity (physiology)
• Adolescent
• Amino Acids (blood, metabolism)
• Blood Glucose (metabolism)
• Child
• Fasting (blood)
• Female
• Glucagon-Like Peptide 1
• Humans
• Insulin (blood, metabolism)
• Insulin Resistance
• Male
• Peptide YY (blood, metabolism)
• Prader-Willi Syndrome (blood, metabolism)