Dietary patterns are associated with various vascular health markers and complications in type 1 diabetes

Postprandial glucose metabolism in children and adolescents with type 1 diabetes mellitus: potential targets for improvement

The main goal of therapeutic management of type 1 Diabetes Mellitus (T1DM) is to maintain optimal glycemic control to prevent acute and long-term diabetes complications and to enable a good quality of life. Postprandial glycemia makes a substantial contribution to overall glycemic control and variability in diabetes and, despite technological advancements in insulin treatments, optimal postprandial glycemia is difficult to achieve. Several factors influence postprandial blood glucose levels in children and adolescents with T1DM, including nutritional habits and adjustment of insulin doses according to meal composition. Additionally, hormone secretion, enteroendocrine axis dysfunction, altered gastrointestinal digestion and absorption, and physical activity play important roles. Meal-time routines, intake of appropriate ratios of macronutrients, and correct adjustment of the insulin dose for the meal composition have positive impacts on postprandial glycemic variability and long-term cardiometabolic health of the individual with T1DM. Further knowledge in the field is necessary for management of all these factors to be part of routine pediatric diabetes education and clinical practice. Thus, the aim of this report is to review the main factors that influence postprandial blood glucose levels and metabolism, focusing on macronutrients and other nutritional and lifestyle factors, to suggest potential targets for improving postprandial glycemia in the management of children and adolescents with T1DM.

Associations of major dietary patterns with cardiometabolic risk factors among Iranian patients with type 1 diabetes

Objective

To examine the associations between dietary patterns and cardiometabolic risk factors among type 1 diabetic (T1D) patients.

Methods

This cross-sectional study was conducted on 229 Iranian T1D patients. Data on dietary intakes were collected using a 168-item food frequency questionnaire. To identify major dietary patterns, we merged data on the 168 food items to obtain 23 food groups. Then, we constructed major dietary patterns using factor analysis with varimax rotation. We used binary logistic regression to assess the association between dietary patterns and cardiometabolic risk factors, in which potential confounders were adjusted.

Results

Four dietary patterns were identified: Western, unhealthy, traditional, and semi-healthy patterns. After adjusting for confounders including demographic variables, physical activity, energy intake, and medical history, participants in the highest tertile of the Western dietary pattern had 2.53 (95 % CI: 1.03-6.22) and 3.37 (95 % CI: 1.18-9.63) times more odds of elevated HbA1c and low estimated glucose disposal rate (eGDR), respectively, compared with those in the lowest tertile. Such the positive association was also seen for elevated fasting blood glucose (FBG). Moreover, individuals in the top tertile of unhealthy diet had more odds of elevated LDL-c and abdominal obesity than those in the lowest tertile. Regarding the semi-healthy diet, higher adherence was associated with 51 % lower odds of elevated FBG (OR: 0.49, 95 % CI: 0.24-0.99). For other outcomes, no significant association was found.

Conclusion

We found that T1D patients may take benefit from adherence to a semi-healthy diet with a low amount of unhealthy and Western-related foods.

Sex differences in cardiovascular risk factors of children and adolescents with type 1 diabetes mellitus: A role for diet?

BACKGROUND AND AIMS

Cardiovascular disease is the leading cause of morbidity and mortality in individuals with type 1 diabetes mellitus (T1DM). Cardiovascular risk is higher in women with diabetes than in men. With this study, we wanted to determine whether female children and adolescents with T1DM are more prone to cardiovascular risk factors (CVRFs) and an atherogenic diet than boys.

METHODS AND RESULTS

For this cross-sectional study, anthropometric, clinical, biochemical, and dietary intake data of 314 children with diabetes (3-18 years; 178 boys) were analysed according to age and sex. Linear and binary logistic regression was performed to test independent associations between sex, dietary intake, and CVRFs. Low-density lipoprotein -cholesterol (LDL-c), triglyceride (TG), fibre, monounsaturated fatty acid levels (all p < 0.01), and lipid (p = 0.022) intake were higher in the girls than in the boys. Multiple regression analysis showed that LDL was associated with sex, glycated haemoglobin (HbA1c), and lipid intake percentage (R (Kannel, 1979) [2] = 0.130; p = 0.0004) independent of age, pubertal stage, body mass index (BMI), duration of diabetes, energy, and fibre intake. Logistic regression analysis showed that high LDL-c levels were present more often in girls [odds ratio, OR; confidence interval, CI = 2.569 (1.178-5.604); p = 0.018] who had a higher dietary lipid intake percentage [OR (CI) = 1.089 (1.011-1.173); p = 0.025].

CONCLUSIONS

Girls with diabetes have higher LDL-c levels associated with higher dietary lipid intake. Our findings suggest that young people with diabetes, especially girls, may benefit from early dietary interventions to reduce their cardiovascular risk.

Data driven patterns of nutrient intake and coronary artery disease risk in adults with type 1 diabetes

AIMS

Dietary intake provides a potential intervention target to reduce the high risk for coronary artery disease (CAD) in type 1 diabetes. This effort aimed to identify patterns of nutrient intake in young/middle-aged adults with type 1 diabetes and to examine associations between those patterns and development of CAD.

METHODS

Principal component analysis was used to derive nutrient intake patterns among 514 individuals with childhood-onset (<17 years old) type 1 diabetes aged 18+ years and free of CAD (defined as CAD death, myocardial infarction, revascularization, ischemia, or study physician diagnosed angina). Cox models were used to assess the association between nutrient patterns and CAD incidence over 30-years of follow-up.

RESULTS

Three nutrient principal components (PC) were identified: PC1 (high caffeine and saccharin intake), PC2 (high alcohol and caffeine, lower intake of essential nutrients) and PC3 (higher fiber/micronutrients, low alcohol). In unadjusted Cox models, only PC1 (negatively) and PC2 (positively) were associated with CAD risk. These associations were no longer significant after adjusting for diabetes duration.

CONCLUSIONS

Important dietary components underlying the three patterns identified may have been influenced by diabetes duration or age. Future research can continue to explore patterns of nutrient intake over time and CAD development in type 1 diabetes.

Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

Nutrition therapy is a cornerstone of type 1 diabetes (T1D) management. Glycemic control is affected by diet composition, which can contribute to the development of diabetes complications. However, the specific role of macronutrients is still debated, particularly fat intake. This review aims at assessing the relationship between fat intake and glycemic control, cardiovascular risk factors, inflammation, and microbiota, in children and adolescents with T1D. High fat meals are followed by delayed and prolonged hyperglycemia and higher glycated hemoglobin A1c levels have been frequently reported in individuals with T1D consuming high amounts of fat. High fat intake has also been associated with increased cardiovascular risk, which is higher in people with diabetes than in healthy subjects. Finally, high fat meals lead to postprandial pro-inflammatory responses through different mechanisms, including gut microbiota modifications. Different fatty acids were proposed to have a specific role in metabolic regulation, however, further investigation is still necessary. In conclusion, available evidence suggests that a high fat intake should be avoided by children and adolescents with T1D, who should be encouraged to adhere to a healthy and balanced diet, as suggested by ISPAD and ADA recommendations. This nutritional choice might be beneficial for reducing cardiovascular risk and inflammation.

Associations of dietary patterns and nutrients with coronary artery calcification and pericardial adiposity in a longitudinal study of adults with and without type 1 diabetes

PURPOSE

To examine the associations of dietary patterns and nutrients with coronary artery calcification (CAC) and pericardial adiposity (PAT) in adults with and without type 1 diabetes.

METHODS

We conducted a six-year longitudinal analysis of data from Coronary Artery Calcification in Type 1 Diabetes study [n = 1255; T1D: n = 563; non-DM: n = 692] collected at baseline, year 3 and year 6. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12 h overnight fast) biochemical analyses. CAC and PAT were measured using electron beam computed tomography. Dietary patterns were identified using factor analysis. Generalized estimating equations were used to examine associations of dietary patterns and nutrients with CAC and PAT in models adjusted for traditional cardiovascular risks.

RESULTS

The 'starchy veggies, meats and alcohol pattern' was associated with significantly increased risk of CAC presence in all adjusted models; an increasing trend was observed with CAC progression. Increasing intake of dietary proteins and total fats were also associated with higher risk of the presence and/or progression of CAC in adjusted models (all p < 0.05). PAT was positively associated with dietary total fats, and inversely associated with dietary intakes of saturated fats, omega-3 fats and fiber in models adjusted for age, sex, total calories, time, diabetes status, systolic blood pressure, serum lipids and physical activity.

CONCLUSION

Diets high in total fats and proteins, and in meats (processed and red) and alcohol may increase risks of CAC, while saturated fats, omega-3-fats and fiber may be protective against pericardial adiposity as a risk factor for coronary artery disease. ClinicalTrials.gov Identifier: NCT00005754.

Healthy Dietary Pattern is Related to Blood Lipids in Patients with Type 1 Diabetes Mellitus: A Cross-sectional Study from a Developing Country

Background:

The association between dietary patterns and cardiovascular disease (CVD) risk factors has been investigated in very limited studies in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the relationship between the major dietary patterns and CVD risk factors in these patients.

Methods:

A cross-sectional study was performed on 169 females of 18--35 years who were diagnosed with T1DM attending Iranian Diabetes Association in Tehran. Anthropometric measures, blood glucose, and lipid levels of all participants were measured. Dietary data was collected using a food frequency questionnaire. Dietary patterns were determined by factor analysis. Using the analysis of covariance (ANCOVA), mean value of the biochemical factors across the tertiles of dietary patterns was compared.

Results:

Three major dietary patterns were identified: the grain, legume and nut (GLN), the fruits and vegetables (FV), and the high calorie foods, salty snacks, sweet and dessert (HSD). After adjustment for age, body mass index and energy intake, subjects who were in the highest tertile of FV pattern had significantly lower levels of LDL-c (P = 0.01), triglyceride (TG) (P = 0.02), and total cholesterol (P = 0.01). GLN and HSD patterns had no significant relationship with blood glucose and lipids.

Conclusions:

This study demonstrates that a dietary pattern rich in vegetables and fruits may be inversely associated with dyslipidemia in patients with T1DM. The results can be used for developing interventions that aim to promote healthy eating for the prevention of CVD in these patients.

Nutrition habits of children and adolescents with type 1 diabetes changed in a 10 years span

BACKGROUND

Diet plays a key role in the treatment of type 1 diabetes (T1D). Dietary habits changed rapidly in the last decades and few data are available on recent dietary changes in children and adolescents with T1D.

OBJECTIVE

To test the hypothesis that diet composition changed in a 10-year period in children and adolescents with T1D.

METHODS

Two hundred and twenty-nine T1D subjects (M/F:121/108) aged 6 to 16 years were recruited: 114 (group A) enrolled in 2009, not using CGM and/or CSII, and 115 (group B) enrolled in 2019. Anthropometric biochemical (HbA1c, lipid profile), diet, and insulin therapy parameters were compared between the two groups. Multivariate logistic regression analysis was performed with HbA1c as dependent variable (HbA1c > 58 mmol/mol = 1) and nutritional variables and technology use as independent ones.

RESULTS

Energy intake of group A was not statistically different from that of group B. Group B had a significantly (P < 0.001) higher protein and lipids intake and lower total carbohydrate and fiber intake than group A. HbA1c was significantly (P < 0.01) lower in group B than in group A. Logistic regression analysis showed that MUFA (OR 0.83, 95%CI:0.693-0.998), fiber intake (OR 0.82, 95%CI:0.699-0.0969), and technology use (OR 0.15, 95%CI:0.031-0.685), adjusted for age, gender, BMI, energy intake and diabetes duration, were associated with a HbA1c higher than 58 mmol/mol) (R² = 0.27, P < 0.05).

CONCLUSIONS

In a 10-year period, diet composition of children and adolescents with T1D changed and glucometabolic control improved. Fiber and MUFA intake showed a positive effect on HbA1c, independent from technology use, supporting the importance of educating children with T1D and families to maintain healthy eating habits.

Dietary patterns reflecting healthy food choices are associated with lower serum LPS activity

Gram-negative bacteria-derived lipopolysaccharides (LPS) are associated with various negative health effects. Whether diet is associated with LPS, is an understudied phenomenon. We investigated the association between diet and serum LPS activity in 668 individuals with type 1 diabetes in the FinnDiane Study. Serum LPS activity was determined using the Limulus Amoebocyte Lysate assay. Diet was assessed with a food frequency questionnaire (FFQ) section of a diet questionnaire and a food record. The food record was used to calculate energy, macronutrient, and fibre intake. In a multivariable model, energy, macronutrient, or fibre intake was not associated with the LPS activity. Using factor analysis, we identified seven dietary patterns from the FFQ data (“Sweet”, “Cheese”, “Fish”, “Healthy snack”, “Vegetable”, “Traditional”, and “Modern”). In a multivariable model, higher factor scores of the Fish, Healthy snack, and Modern patterns predicted lower LPS activity. The validity of the diet questionnaire was also investigated. The questionnaire showed reasonable relative validity against a 6-day food record. The two methods classified participants into the dietary patterns better than expected by chance. In conclusion, healthy dietary choices, such as consumption of fish, fresh vegetables, and fruits and berries may be associated with positive health outcomes by reducing systemic endotoxaemia.