Pediatric Weight Management

PWM: Balanced Macronutrient: Adolescents (2006)

 American Dietetic Association Pediatric Weight Management Evidence Analysis Project

Balanced Macronutrient: Adolescents

A prescribed diet was considered to be macronutrient "balanced" if the macronutrient composition fell within DRI ranges:

“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 http://www.iom.edu/CMS/3788/4576/4340.aspx)

• Intervention
  In adolescents, what balanced macronutrient dietary interventions are effective in treating obesity?

  • Conclusion

    Using a reduced-calorie diet (over 1,200-DRI kcal per day) in the acute treatment phase of adolescent obesity is generally effective for short-term improvement in weight status. However, without continuing intervention, weight is regained.
    
    All the studies reviewed had treatment programs lasting less than one year (three weeks to nine months) and evidence on longer-term treatment trials was not available.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: Balanced Macronutrient Diet and Treating Obesity in Adolescents
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, and Ludwig DS. A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med 2003;157:773-779.
      • Maffiuletti NA, De Col A, Agosti F, Ottolini S, Moro D, Genchi M, Massarini M, Lafortuna CL, Sartorio A. Effect of a 3-week body mass reduction program on body composition, muscle function and motor performance in pubertal obese boys and girls. J Endocrinol Invest. 2004 Oct;27(9):813-20.
      • Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M, Roinsol D, Longueville E, Bellisle F, Serog P. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord. 2004 Apr;28(4):514-9.
      • Saelens B, Sallis J, Wilfley D, Patrick K, Cella J, and Buchta R. Behavioral Weight Control for Overweight Adolescents Initiated in Primary Care. Obesity Research 2002;10:22-32
      • Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr 2003; 142: 253-8.
      • Wadden, T., Stunkard, A., Rich, L., Rubin, C., Sweidel, G, McKinney, S. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics. 1990, 85(3): 345-352.
  • Search Plan and Results: Diet Therapy: Balanced Macronutrient 2005