A Carbohydrate Beverage Reduces Monocytes Expressing TLR4 in Children with Overweight or Obesity

Background: Childhood obesity is increasing, with about one-third of children overweight or obese. Obesity is characterized by a state of chronic low-grade inflammation that is related to cardiometabolic comorbidities. Inflammatory monocytes, which are classified into 3 different groups - classical, intermediate, and nonclassical monocytes, with Toll-like receptor 4 (TLR4⁺) expression indicating a proinflammatory state - underlie several obesity-associated morbidities. Objectives: This study aimed to assess the responses of monocyte populations to beverages of differing macronutrient composition in children with healthy weight (HW) or overweight/obesity (OW/OB). Methods: Ten HW children (5th to 84.9th percentile; mean age 12.29 ± 2.5 y) and 7 children with OW/OB (85th to 99.99th percentile; mean age 11.96 ± 3.8 y) completed the study. Adiposity was determined via DXA. Using a double-blinded, randomized, crossover design, participants consumed either a high-carbohydrate (CHO; 210 kcal; 0 g fat/56 g carbohydrates/0 g protein) or a whole-egg-based high-protein/fat (EGG; 210 kcal; 15 g fat/0 g carbohydrates/18 g protein) beverage. Venous blood was collected at baseline and 2 h postprandially for evaluation of metabolic and inflammatory responses. Repeated measures ANOVA and Pearson correlations were conducted. Results: Consuming the CHO beverage significantly reduced the primary outcome: TLR4⁺ expression on classical monocytes in children with OW/OB only (25.60% decrease from baseline in OW/OB compared with 1.61% increase in HW). Children with OW/OB had significantly less percentages of TLR4⁺ nonclassical monocytes than HW (47.66% lower after CHO). Insulin and glucose (secondary outcomes), were significantly higher after the CHO condition compared with baseline (230.61% and 9.93% increase, respectively). Changes in glucose were significantly and negatively related to changes in monocyte populations in the CHO condition. Conclusions: These data suggest that high-carbohydrate beverages alter monocyte populations in the blood in children with OW/OB, which is related to glucose metabolism. These findings have implications for nutritional recommendations in children with overweight/obesity. National Clinical Trial registry trial number: NCT03597542.