Dietary fat intake predicts 1-year change in body fat in adolescent girls with type 1 diabetes

Modifiable lifestyle risk factors for overweight and obesity in children and adolescents with type 1 diabetes: A systematic review

This review aims to identify and report epidemiological associations between modifiable lifestyle risk factors for overweight or obesity in children and adolescents with type 1 diabetes (T1D). A systematic literature search of medical databases from 1990 to 2023 was undertaken. Inclusion criteria were observational studies reporting on associations between dietary factors, disordered eating, physical activity, sedentary and sleep behaviours and measures of adiposity in children and adolescents (<18 years) with T1D. Thirty-seven studies met inclusion criteria. Studies were mostly cross-sectional (89 %), and 13 studies included adolescents up to 19 years which were included in this analysis. In adolescents with T1D, higher adiposity was positively associated with disordered eating behaviours (DEB) and a higher than recommended total fat and lower carbohydrate intake. A small amount of evidence suggested a positive association with skipping meals, and negative associations with diet quality and sleep stage. There were no published associations between overweight and physical activity, sedentary behaviours and eating disorders. Overall, the findings infer relationships between DEB, fat and carbohydrate intake and adiposity outcomes in people with T1D. Prospective studies are needed to determine causal relationships and to investigate sleep stages. High quality studies objectively measuring physical activity and include body composition outcomes are needed.

Higher Body Fat in Children and Adolescents With Type 1 Diabetes-A Systematic Review and Meta-Analysis

Aims

Higher prevalence of overweight and obesity in children and adolescents with type 1 diabetes (T1D) suggests alterations are required in body composition. However, differences in body composition between children with T1D and typically developing children (TDC) have not been synthesized using meta-analysis. Therefore, we conducted a systematic review and meta-analysis to compare body composition between children with T1D and TDC, and to explore the role of disease and non-disease related factors in potential body composition differences.

Methods

Studies were performed comparing dual-energy x-ray absorptiometry-acquired total body fat and lean mass, absolute (kg) and relative (%) values, between children with T1D and TDC. We reported mean differences with 95% confidence intervals (CI) from meta-analysis and relative between-group %-differences. We used meta-regression to explore the role of sex, age, height, body mass, body mass index, Hemoglobin A1c, age of onset, disease duration, and insulin dosage in the potential body composition differences between children with T1D and TDC, and subgroup analysis to explore the role of geographic regions (p < 0.05).

Results

We included 24 studies (1,017 children with T1D, 1,045 TDC) in the meta-analysis. Children with T1D had 1.2 kg more fat mass (kg) (95%CI 0.3 to 2.1; %-difference = 9.3%), 2.3% higher body fat % (0.3-4.4; 9.0%), but not in lean mass outcomes. Age of onset (β = -2.3, -3.5 to -1.0) and insulin dosage (18.0, 3.5-32.6) were negatively and positively associated with body fat % mean difference, respectively. Subgroup analysis suggested differences among geographic regions in body fat % (p < 0.05), with greater differences in body fat % from Europe and the Middle East.

Conclusion

This meta-analysis indicated 9% higher body fat in children with T1D. Earlier diabetes onset and higher daily insulin dosage were associated with body fat % difference between children with T1D and TDC. Children with T1D from Europe and the Middle East may be more likely to have higher body fat %. More attention in diabetes research and care toward body composition in children with T1D is needed to prevent the early development of higher body fat, and to minimize the cardiovascular disease risk and skeletal deficits associated with higher body fat.

Changes in Body Composition and Its Relationship to Performance in Elite Female Track and Field Athletes Transitioning to the Senior Division

Many elite female athletes struggle to maintain performance while transitioning from high school to university-level (senior) sports. This study explores factors of body composition that influenced performance in elite junior female track and field athletes transitioning to the senior division. Forty-two elite female track and field athletes, ranked among the top 100 in Japan, were enrolled in this study. Whole-body mode dual-energy X-ray absorptiometry scans were performed during the post-season of 2016 and 2017. Athletes’ performances were assessed using the International Association of Athletics Federation scoring system. Relationships between changes in performance and those in body composition were investigated. There were significant negative correlations between changes in performance and fat mass (FM), and percentage FM (FM%). This was seen in total body and lower extremities, and not in the trunk and upper extremities. In addition, there was a positive correlation between changes in performance and percentage lean mass (LM%). However, there were no correlations between changes in performance and LM and total mass. Elite female track and field athletes transitioning to senior division should decrease their FM and FM% and increase LM%, to sustain or improve performance. It is also more important to monitor changes in body composition than body mass.

Effects of residential summer camp on body mass index and body composition in type 1 diabetes

BACKGROUND

Body mass index (BMI) and fat mass may be higher in children with diabetes compared to healthy peers. It is not certain how diabetic children respond to exercise and diet interventions.

OBJECTIVE

To investigate the effect of summer camp on BMI and body composition in children with type 1 diabetes.

METHODS

Five hundred eighty-six children (5-19 years, 518 with type 1 diabetes, 68 without diabetes) were followed while attending camp. BMI z-scores (BMIz) and body composition (bioelectrical impedance analysis) were measured at the beginning and end of each 19-day session. Diet and activity were directly supervised, blood glucose closely monitored. A nested diabetic/non-diabetic sib pair analysis was also conducted. Changes in BMIz and percent fat mass (%FM) were the primary outcomes. Findings were confirmed by analysis of data from 612 campers (549 with diabetes) the following summer.

RESULTS

At entry, campers with diabetes had higher BMIz and %FM. They tended to gain BMIz (0.04 ± 0.01) whereas non-diabetic campers lost (-0.16 ± 0.11, P < .0001). BMIz increases were positively correlated with precamp hemoglobin A1c values. The differences in initial values and changes in BMIz remained when campers with diabetes were compared to their siblings. All experienced a similar reduction in %FM. Similar results were obtained the following summer.

CONCLUSIONS

Children with diabetes may, therefore, accrue more lean body tissue with increased exercise and a healthy diet than those without diabetes. This effect is greatest in those with initially poor metabolic control.

Changes in weight and BMI following the diagnosis of type 1 diabetes in children and adolescents

The aim of this study was to study weight and body mass index (BMI) before, at, and after diagnosis of type 1 diabetes (T1D) and to identify factors associated with weight gain. Studied retrospectively were 209 children <18 years with T1D followed for 6 years. Data collected included clinical and laboratory data before diagnosis, at diagnosis, and during 6 years of follow-up. Anthropometric parameters of patients were compared along follow-up and with those of their parents and siblings. Mean BMI-standard deviation score (SDS) was below average at diagnosis (-0.66 ± 1.27), had increased to 0.37 ± 0.93 at 3 months, and decreased to a nadir at 6 months in females and 12 months in males; between 1 and 3 years, there was a slight increase and between 3 and 6 years a further increase only in the females. BMI-SDS at 6 years was significantly higher than pre-diabetes BMI-SDS (0.35 ± 0.83 vs. -0.04 ± 1.23, p < 0.001). Patients' BMI-SDS at 6 years was similar to that of their parents and siblings, was higher in the females (0.53 ± 0.74 vs. 0.27 ± 0.82, p = 0.02) and in those keeping diabetes a secret (0.66 ± 0.82 vs. 0.33 ± 0.78, p = 0.027), and was not associated with age or pubertal stage at diagnosis, ethnicity, or metabolic control. A longer duration of insulin pump therapy was associated with a lower BMI-SDS (r = -0.2375, p < 0.025). BMI-SDS increased during the 6 years following diagnosis of T1D in pediatric patients, especially in the females, but remained in the normal range and was similar to that of other family members.

Nutritional education and carbohydrate counting in children with type 1 diabetes treated with continuous subcutaneous insulin infusion: the effects on dietary habits, body composition and glycometabolic control

Carbohydrate counting (CHC) in combination with nutritional education has been used to optimize the insulin dose in patients with type 1 diabetes (T1D). The aim of this study was to test the impact of CHC and nutritional education on changes in dietary habits, body composition and body fat distribution in children with T1D treated with insulin pumps (CSII). Twenty-five children with T1D and CSII were recruited and valuated at baseline and after 18 months of follow-up. They were trained in CHC and following standard nutrition education program (based on American Diabetes Association and International Society of Pediatric and Adolescent Diabetes guidelines); clinical, biochemical and nutritional variables were measured. In the total population, body composition, body fat distribution and biochemical variables did not change, at follow-up; HbA1c was significantly reduced (8.50 ± 0.77 vs 7.92 ± 0.74 %; p < 0.001) without changing insulin/kg/day requirement. In the sub-group of patients with a significant HbA1c reduction (ΔHbA1c ≥ 0.5 %, n = 12), the carbohydrate (CHO) intake was significantly higher at follow-up (53.0 ± 4.0 vs 57.6 ± 2.5 %; p < 0.01); on the contrary, fat (31.3 ± 3.6 vs 28.5 ± 1.6 %; p < 0.05) and protein intake (15.4 ± 1.8 vs 13.3 ± 1.6 %; p < 0.01) significantly decreased. Patients without a significant HbA1c reduction did not show any difference. CHC, in combination with nutritional education, does not affect dietary habits, body composition and body fat distribution in children with T1D treated with CSII. Moreover, the sub-group of subjects showing a significant improvement in glycometabolic control reported an increase in CHO intake and a reduction in fat and protein intake.

Diet, physical, and biochemical characteristics of children and adolescents with type 1 diabetes: relationship between dietary fat and glucose control

BACKGROUND

Nutritional habits may significantly influence glycemic control and cardiovascular risk factors in youth with type 1 diabetes (T1D).

AIMS

To assess dietary intake, cardiovascular risk factors, and the association between diet composition and glycemic control in Italian youth with T1D.

METHODS

Subjects included 114 youth aged 6-16 yr with T1D receiving a routine treatment program with nutrition counseling and 448 controls. Cross-sectional measures included dietary intake, anthropometry, blood pressure, lipid profile, and, in children with diabetes, HbA1c.

RESULTS

In prepubertal children, BMI, subcutaneous skinfolds, the prevalence of overweight/obesity, and LDL cholesterol (LDL-CH) were significantly lower in patients than in controls, whereas HDL cholesterol (HDL-CH) was higher. Pubertal boys with T1D did not differ significantly from controls in either anthropometry or lipid profile. Pubertal girls with T1D had a higher BMI and higher triceps skinfolds than controls but not significantly different prevalence of overweight/obesity or lipid profile. Compared to controls, participants with T1D had a lower intake of lipids and simple carbohydrates, a higher ratio of unsaturated/saturated fats and fibre, and a dietary intake closer to the National Reference Dietary Intakes (RDIs). The odds of having an HbA1c higher than 7.5, adjusted for BMI, lipid, and fibre intake, increases by 53% for every 1% increase of energy intake from saturated fat in the diet and by 30% for every year of duration of diabetes.

CONCLUSIONS

Youth with T1D having regular nutritional counseling had a diet closer to RDIs than controls and not different cardiovascular risk factors. High saturated fatty acid intake was associated with poor blood glucose control.

Fatores socioeconômicos, demográficos, nutricionais e de atividade física no controle glicêmico de adolescentes portadores de diabetes melito tipo 1

OBJETIVO: Identificar a associação de condições socioeconômicas, demográficas, nutricionais e de atividade física sobre o controle glicêmico de adolescentes portadores de DM1. SUJEITOS E MÉTODOS: Estudo transversal com 71 adolescentes com diagnóstico clínico de diabetes tipo 1. Foram obtidos dados socioeconômicos, demográficos e antropométricos. O controle glicêmico foi classificado pelo índice de hemoglobina glicada (A1C). Foram aplicados quatro recordatórios de 24 horas de consumo alimentar e de atividade física. RESULTADOS: A A1C foi inadequada para a maioria dos adolescentes. A menor escolaridade do cuidador influenciou para o controle glicêmico inadequado. Pacientes com menor dose de insulina apresentaram melhor controle glicêmico. A alimentação observada foi hipoglicídica e hiperlipídica. A maioria dos pacientes era sedentária. CONCLUSÃO: Fatores relacionados à educação, à insulina e à alimentação influenciaram no controle glicêmico.

Rapid weight gain in children soon after diagnosis of type 1 diabetes: is there room for concern?

OBJECTIVE

To examine weight status in children at diagnosis (Dx) of type 1 diabetes and observe weight change post-Dx.

RESEARCH DESIGN AND METHODS

Data on 136 subjects (76 M/60 F) with type 1 diabetes diagnosed in 1998-2001 at Children's Hospital San Diego was obtained from Institutional Review Board (IRB)-approved database. All patients received two daily insulin injections (NPH/Regular) and were examined at least twice, up to 7 months post-Dx.

RESULTS

Average age at Dx (SD) was 9.02 yr (4.46)yr; 63.9% were Caucasian, 25% Mexican American (MA), 2.9% African American, 0.7% Asian, and 7.3% mixed. Diabetic ketoacidosis rate was more common in MA (44.1%) vs. Caucasians (20.9%) at Dx (p < 0.02). Average body mass index Z-score (BMI-Z) at Dx was -0.28 (39th percentile); 13.5% had BMI > or = 85th percentile, and 7.2% were obese. By 2 wk, and 15-41 d post-Dx, mean weight gain was 9% (5.9) and 12.8% (8), respectively. Mean A1C at Dx, 42-70 and 71-139 d later, was 11.4, 7.6, and 6.9%, respectively. Coinciding with improved glycemic control, by 10 wk, mean BMI-Z reached a plateau of 0.86 (80th percentile). On average, MA were heavier than Caucasians at Dx (p = 0.006), and remained heavier. By 71-139 d, 31.7% had BMI > or = 85th percentile and 15.9% were obese; 47.8% of 2- to 5-yr olds had BMI > or = 85th percentile vs. 22.6% nationally (p < 0.005) CONCLUSIONS: Despite the initial weight loss at Dx of type 1 diabetes, by 10-20 wk post-Dx, almost one third were overweight and obese, more so in MA. In light of the obesity epidemic, closer attention to overall caloric intake in children with new onset diabetes is prudent.

A preliminary case-control study on nutritional status, body composition, and glycemic control of Greek children and adolescents with type 1 diabetes

BACKGROUND

Because scientific data on the diet of diabetic Greek youngsters are scarce, diabetic experts use findings from international studies. However, because of diet variations between countries, this may result in problems in diabetes control. The aim of the present pilot study was to assess body composition, nutritional status, and diabetes control in Greek youngsters with type 1 diabetes mellitus (T1DM).

METHODS

Twenty-four children and adolescents with diabetes, aged 4-16 years, and the same number of age- and sex-matched controls participated in the study. Anthropometry included stature, weight, and body fat determined by bioelectrical impedance analysis. Body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and z-scores were calculated. Diabetes control was evaluated through glycosylated hemoglobin (HbA1c) and dietary intake was recorded for 3 days.

RESULTS

The FFMI, BMI z-score and weight-for-age z-score were lower in controls compared with diabetic youngsters (P ≤ 0.001, P ≤ 0.02, and P ≤ 0.01, respectively). Three diabetic participants were overweight (12.5%) and two controls were underweight (8.3%). The energy and nutrient intake was similar between the two groups, and all participants consumed a diet high in fats and proteins at the expense of carbohydrates. Dietary fat was highly correlated with BMI in both groups. The consumption of vitamin D was inadequate in the diabetic participants, but they had a higher intake of antioxidant vitamins, vitamin B(6) , and folate compared with the control group.

CONCLUSIONS

In conclusion, youngsters with T1DM failed to adhere to the macronutrient recommendations for diabetes, but dietary patterns were similar in both the diabetic and control groups. The control of diabetes was not associated with any nutrient or anthropometric variable.

Teaching children with diabetes about adequate dietary choices

Recent recommendations by the American Diabetes Association suggest that children with type 1 diabetes should follow the recommendations for age, sex and body size of the general population. In the case of being overweight or obese, weight-control strategies should be applied. Adherence to recommendations should be pursued by continuous nutritional education that should start at the onset of diabetes and maintained by means of nutritional counselling to the family. The second main target of nutritional intervention is to encourage a reproducible daily meal plan that can be maintained by acquiring good habits when making nutritional choices. Finally, children and parents should be taught how to count carbohydrates, which would help them manage exceptions in their daily meal plan. Specifically, nutritional recommendations for children with diabetes focus on limiting the intake of foods of animal origin (red meat, cheese, cold cuts), moderating fat intake and promoting the intake of foods that naturally contain fibre (mainly vegetables, legumes, fruit). There are two at-risk periods in the lives of children when nutritional education procedures as well as diabetes care in general are less likely to be effective: early years of life and adolescence. In the case of very young children, new behavioural-based intervention strategies to help parents improve mealtimes could be useful in teaching diabetic children to learn to follow a structured eating schedule, which is desirable for long-lasting efficacy in diabetes care. In adolescents, eating disorders and insulin misuse for weight control purposes are concrete and difficult problems to deal with. A good balance between eating for pleasure and maintaining one's health is a challenge for anyone. Appropriate nutritional education helps children with diabetes to find this balance and enjoy a better quality of life.

Body composition in young female adults with Type 1 diabetes mellitus. A prospective case-control study

AIMS

Overweight is common during late puberty in female patients with Type 1 diabetes. The aim of this study was to examine the change in body composition from late puberty to early adulthood in such female patients in comparison with age-matched control subjects.

METHODS

Eighteen females with Type 1 diabetes and 19 healthy female control subjects were recruited for a case-control study at the age of 16-19 years (baseline). Six years later, 16 of the diabetic females and 17 of the control subjects were re-examined (follow-up). Body composition was assessed by dual energy X-ray absorptiometry.

RESULTS

Body mass index (BMI) and fat mass index (total fat mass/height2) were significantly higher at baseline in the diabetic patients than in the control subjects (26.4 +/- 2.6 vs. 23.9 +/- 3.7 kg/m2, P < 0.05, and 10.0 +/- 2.4 vs. 8.0 +/- 2.8 kg/m2, P = 0.04, respectively). At follow-up, these parameters still tended to be higher in the diabetic group (27.8 +/- 4.9 vs. 24.6 +/- 5.7 kg/m2, P = 0.09, and 11.8 +/- 5.6 vs. 8.7 +/- 4.9 kg/m2, P = 0.05, respectively). BMI at baseline was strongly correlated to BMI at follow-up in both diabetic patients (r = 0.60; P < 0.05) and control subjects (r = 0.83; P < 0.01).

CONCLUSIONS

Increased fat mass in pubertal girls with Type 1 diabetes seems to persist in young adulthood. This study emphasizes the need for new strategies to prevent the development of overweight during puberty in diabetic girls.