Short-term isocaloric fructose restriction lowers apoC-III levels and yields less atherogenic lipoprotein profiles in children with obesity and metabolic syndrome.

Dietary fructose may play a role in the pathogenesis of metabolic syndrome (MetS). In a recently published study of obese children with MetS, we showed that isocaloric fructose restriction reduced fasting triglyceride (TG) and LDL-cholesterol (LDL-C). In these ancillary analyses, we tested the hypothesis that these effects were also accompanied by improved quantitative and qualitative changes in LDL and HDL subclasses and their apolipoproteins; as well as change in VLDL, particularly apoC-III. Obese children with MetS (nxa0=xa037) consumed a diet that matched self-reported macronutrient composition for nine days, with the exception that dietary fructose was reduced from 11.7xa0±xa04.0% to 3.8xa0±xa00.5% of daily calories and substituted with glucose (in starch). Participants underwent fasting biochemical analyses on Days 0 and 10. HDL and LDL subclasses were analyzed using the Lipoprint HDL and LDL subfraction analysis systems from Quantimetrix. Significant reductions in apoB (78xa0±xa024 vs. 66xa0±xa024xa0mg/dl) apoC-III (8.7xa0±xa03.5 vs. 6.5xa0±xa02.6xa0mg/dl) and apoE (4.6xa0±xa02.3 vs. 3.6xa0±xa01.1xa0mg/dl), all pxa0<xa00.001) were observed. LDL size increased by 0.87xa0Å (pxa0=xa00.008). Small dense LDL was present in 25% of our cohort and decreased by 68% (pxa0=xa00.04). Small HDL decreased by 2.7% (pxa0<xa00.001) and large HDL increased by 2.4% (pxa0=xa00.04). The TG/HDL-C ratio decreased from 3.1xa0±xa02.5 to 2.4xa0±xa01.4 (pxa0=xa00.02). These changes in fasting lipid profiles correlated with changes in insulin sensitivity. Isocaloric fructose restriction for 9 days improved lipoprotein markers of CVD risk in children with obesity and MetS. The most dramatic reduction was seen for apoC-III, which has been associated with atherogenic hypertriglyceridemia.