Dietary recommendations for children and adolescents with diabetes: an implementation paper. British Diabetic Association's Professional Advisory Committee

Sweets, snacking habits, and skipping meals in children and adolescents on intensive insulin treatment

AIM

To examine the association between skipping meals and snacking events and dietary and clinical characteristics in children and adolescents using modern insulin treatment.

METHODS

Dietary intake was recorded for 4 d in food diaries in 655 young diabetic patients. Number of meals and snacking events was recorded in a separated questionnaire, while clinical data were obtained from case record forms. Skipping meals refer to consuming a main meal (e.g., breakfast) five times a week or less.

RESULTS

Modern insulin treatment may favor a more flexible lifestyle. This study shows that there are fewer young diabetic patients who skip meals than non-diabetic controls (p < 0.001) even when using modern intensified insulin treatment. However, skipping meals among young diabetic patients was associated with negative characteristics such as having suboptimal hemoglobin A1c (HbA1c) (OR 4.7, p = 0.02), higher low-density lipoprotein (LDL) cholesterol levels (OR 4.0, p < 0.001), watching more TV (OR 3.6, p < 0.001), being overweight (OR 2.8, p = 0.03), as well as having a higher intake of added sugar (OR 2.1, p = 0.01) and lower intake of fiber (OR 0.2, p = 0.04) compared with those not skipping meals. Having more than two snacking events during the day was associated with higher HbA1c, higher intake of added sugar and sweets, and spending more hours in front of the TV or personal computer.

CONCLUSIONS

In general, fewer children and adolescents with type 1 diabetes skip meals compared with healthy peers. Those who skip meals and have more snacking events have poorer glycemic control and less healthy dietary and leisure habits.

Two year prospective dietary survey of newly diagnosed children with diabetes aged less than 6 years

The food consumption of 38 children newly diagnosed with diabetes aged < 6 years at diagnosis was assessed by 5 day food records. During the 2 year follow up, the proportion of the total energy intake made up of protein decreased from 20% to 18%, that of carbohydrates from 54% to 52%, and that of fat increased from 26% to 30%. The energy intake from sucrose (3%) did not change. In addition, There was a small decrease in the intake of fibre and several vitamins and minerals. One year after diagnosis, the diet of diabetic children was compared with that of 66 age, sex, and social status matched control children. More energy was derived from protein (19% v 15%) and carbohydrates (53% v 50%), and less from fat (28% v 35%), especially from saturated fatty acids (11% v 15%), and sucrose (3% v 16%) in the diet of children with diabetes compared with that of control children. The higher intakes of several vitamins and minerals reflected the higher nutrient density of the diet of children with diabetes. Therefore, the diet of young children with diabetes met the dietary recommendations for subjects with diabetes. Only the protein content of the diet was higher than necessary.

School based screening for hypothyroidism in Down's syndrome by dried blood spot TSH measurement

OBJECTIVE

To determine the feasibility of annual hypothyroid screening of children with Down's syndrome by measuring thyroid stimulating hormone (TSH) on dried blood spots at school, and to describe the outcome in positive children.

DESIGN

Establishment of a register of school children with Down's syndrome, and procedures for obtaining permission from parents, annual capillary blood samples, TSH measurement, and clinical assessment of children with TSH values > 10 mU/litre.

SUBJECTS

All school age children with Down's syndrome within Lanarkshire and Glasgow Health Boards during 1996-7 and 1997-8.

RESULTS

200 of 214 school children with Down's syndrome were screened. Four of the unscreened children were receiving thyroxine treatment, and only 5 remained unscreened by default. 15 of the 200 children had capillary TSH > 10 mU/litre, and all but 1 had evidence of Hashimoto's thyroiditis. Seven of the 15 children started thyroxine treatment immediately, 6 with a pronounced rise in venous TSH and subnormal free thyroxine (fT4), and one with mildly raised TSH and normal fT4 but symptoms suggesting hypothyroidism. Eight children with mildly raised venous TSH and normal fT4 were left untreated; 1 year after testing positive, fT4 remained > 9 pmol/litre in all cases, but 4 children were started on thyroxine because of a rise in TSH. TSH fell in 3 of the 4 remaining children and there was a marginal rise in 1; all remain untreated. The prevalence of thyroid disease in this population is >/= 8.9%.

CONCLUSION

Dried blood spot TSH measurement is effective for detecting hypothyroidism in Down's syndrome and capillary sampling is easily performed at school. The existing programme could be extended to the whole of Scotland within a few years.

Dietary intake of Austrian diabetic children 10 to 14 years of age

BACKGROUND

The dietary intake of 63 children with insulin-dependent diabetes mellitus (IDDM; age 10 to 14 years) was weighed by dietitians for 2 days during a summer camp for youth with diabetes. Data were analyzed for the content of macronutrients with the help of a computer database program.

METHODS

The dietary intake of children with diabetes was compared with that of healthy Austrian school children and with the current nutritional recommendations for children with IDDM.

RESULTS

The mean intake of carbohydrate did not meet the recommended level, whereas sucrose, fiber, and protein intake approximated the recommendations. The total consumption of fat and cholesterol, however, exceeded the recommended values. The nutritional intake of Austrian children with IDDM was similar to that of healthy children of the same age and thus reflected regional dietary habits.

CONCLUSION

Dietary educational measures on a national basis are needed to change harmful local eating patterns.