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Pediatric Weight Management

PWM: Altered Macronutrient Diets (2006)

Altered Macronutrient Diets

Some dietary treatments for pediatric obesity include not only an alteration in daily energy intake, but utilize a strategy of modifying the macronutrient make-up of the diet as well. While we discuss the evidence with reference to the modification of single macronutrients (e.g., protein, carbohydrates, fats), the fact is that modifying one macronutrient often entailed the modification of another macronutrient. We analyzed separately the evidence on:

One of the most common dietary approaches is to reduce the amount of dietary fat in a child's or adolescent's diet. However, we did not consider this approach an altered macronutrient diet unless the amount of fat prescribed by the diet professional was less than the DRI for that macronutrient.

What counts as an “altered macronutrient” diet?

For the evidence analysis a diet was classified as being “altered macronutrient” if the prescribed macronutrient makeup fell outside the ranges set by the Institute of Medicine’s Dietary Reference Intakes*.

With respect to the macronutrient composition of a diet, the DRI’s indicate:

“Adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent from fat, and 10 to 35 percent from protein. Acceptable ranges for children are similar to those for adults, except that infants and younger children need a slightly higher proportion of fat (25 %-40%).”*

*Institute of Medicine, Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (available at