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Zheng Y, Rostami Haji Abadi M, Gough J, Johnston JJD, Nour M, Kontulainen S. Higher Body Fat in Children and Adolescents With Type 1 Diabetes-A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:911061. [PMID: 35813369 PMCID: PMC9263393 DOI: 10.3389/fped.2022.911061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Yuwen Zheng
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jonathan Gough
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Munier Nour
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Flokas ME, Zeymo A, Mete M, Anhalt H, Rother KI, Gourgari E. Overweight and obese children with optimal control in the T1D Exchange Registry: How are they different from lean children with optimal control? J Diabetes Complications 2020; 34:107513. [PMID: 32007420 PMCID: PMC7524582 DOI: 10.1016/j.jdiacomp.2019.107513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/17/2019] [Indexed: 01/08/2023]
Abstract
AIMS Increased adiposity is a risk factor for suboptimal diabetes control and cardiovascular disease (CVD) complications. Our goal was to identify modifiable behavioral characteristics of overweight and obese pediatric patients with type 1 diabetes mellitus (T1DM) who achieve optimal glycemic control and to evaluate their CVD risk compared to lean patients. Our hypothesis was that optimally controlled obese and overweight participants require more total daily insulin and are at higher CVD risk compared to optimally controlled lean participants. METHODS We analyzed a cohort of 9263 participants with T1DM aged <21 years in the T1D Exchange Registry. Optimal diabetes control was defined as HbA1c ≤ 7.5% (58 mmol/mol). We compared factors that influence glycemic control in lean, overweight and obese participants with optimal vs. suboptimal control, using logistic regression. RESULTS Age, race, overweight status, continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) use were important variables influencing glycemic control. In the optimally controlled cohort, 27% of participants were overweight or obese versus 30% in the suboptimally controlled cohort (P < 0.001). Overweight and obese participants with optimal control were not significantly different from lean participants in terms of CSII use, total daily insulin dosage per kg of bodyweight, glucose checks per day, boluses with bedtime snack, use of CGM, but had higher LDL cholesterol and triglycerides, and lower HDL cholesterol (P < 0.05). CONCLUSIONS There were no differences in modifiable behavioral characteristics between the obese, overweight and lean optimally controlled participants. However, predictors of cardiovascular disease were higher in the overweight and obese group.
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Affiliation(s)
- Myrto Eleni Flokas
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States of America
| | - Alexander Zeymo
- Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, MD, United States of America
| | - Mihriye Mete
- Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, MD, United States of America
| | - Henry Anhalt
- Medical Affairs, Science 37, Playa Vista, CA, United States of America
| | - Kristina I Rother
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington, DC, United States of America; National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States of America.
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Billow A, Anjana RM, Ngai M, Amutha A, Pradeepa R, Jebarani S, Unnikrishnan R, Michael E, Mohan V. Prevalence and clinical profile of metabolic syndrome among type 1 diabetes mellitus patients in southern India. J Diabetes Complications 2015; 29:659-64. [PMID: 25899474 DOI: 10.1016/j.jdiacomp.2015.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 01/08/2023]
Abstract
AIM To assess the prevalence of metabolic syndrome (MetS) among patients with type 1 diabetes mellitus(T1DM) and to look at prevalence of diabetes complications in T1DM with and without MetS. METHODS We studied 451 T1DM patients attending a tertiary diabetes centre in Chennai, South India. T1DM was diagnosed based on absence of beta cell reserve and requirement of insulin from the time of diagnosis. Data on clinical and biochemical characteristics as well as complications details to study the prevalence were also extracted from electronic records. T1DM patients were divided into those with and without MetS[diagnosed according to the harmonizing the metabolic syndrome criteria(IDF/NHLBI/AHA/WHF/IAS/IASO)]. RESULTS The overall prevalence of MetS among T1DM was 22.2%(100/451). Patients with MetS were older, had longer diabetes duration, acanthosis nigricans, and increased serum cholesterol. In the unadjusted logistic regression analysis, retinopathy, nephropathy and neuropathy were associated with MetS. However after adjustment for age, gender, diabetes duration, HbA1C and BMI significant association was seen only between MetS and retinopathy [odds ratio (OR) 2.82, 95% CI 1.18-6.74, p = 0.020] and nephropathy [OR 4.92, 95% CI 2.59-9.33, p < 0.001]. CONCLUSION Prevalence of MetS is high among Asian Indian T1DM patients, and its presence is associated with increased risk of diabetic retinopathy and nephropathy.
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Affiliation(s)
- Amy Billow
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Michelle Ngai
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Anandakumar Amutha
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Saravanan Jebarani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India
| | - Edwin Michael
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India.
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Prevalencia de obesidad y de factores de riesgo cardiovascular en una población de pacientes pediátricos con diabetes tipo 1. An Pediatr (Barc) 2013; 78:382-8. [DOI: 10.1016/j.anpedi.2012.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/05/2012] [Accepted: 11/14/2012] [Indexed: 12/16/2022] Open
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Abd El Dayem SM, El-Shehaby AM, Abd El Gafar A, Fawzy A, Salama H. Bone density, body composition, and markers of bone remodeling in type 1 diabetic patients. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:387-93. [PMID: 21476826 DOI: 10.3109/00365513.2011.573574] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess bone mineral density (BMD), body composition by dual X-ray absorptiometry (DXA), and various biochemical markers of bone growth and resorption in a group of children with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS The study included 47 patients with T1DM and 30 age- and sex-matched controls. Anthropometric measurements, biochemical markers for bone formation, bone resorption and DXA were done for all patients and controls. RESULTS Of our diabetes patients, seven (16.7 %), three (7.3 %), and 17 (41.5%) met diagnostic criteria for osteopenia at the right femur, lumbar spine and total body, respectively. On the other hand, osteoporosis as defined by the WHO criteria was diagnosed in 21 patients (51.2%) at the total body by DXA. Lean body mass and lean fat ratio were lower, while, total fat mass, abdominal fat%, soft tissue fat mass%, and fat/lean ratio were higher in diabetics compared to controls. Also, our patients showed lower serum osteocalcin, osteoprotegerin, procollagen type 1, and higher urinary deoxypyridinoline. Pubertal (diabetics and controls) have higher BMD and BMC than prepubertal. CONCLUSION Diabetic patients had a low BMD after adjustment (Z score), low bone formation and high bone resorption markers. Diabetes control and increase in BMI leads to a decrease in the incidence of low bone mineral density. Diabetes causes an increase in body fat especially abdominal fat which leads to an increase in insulin resistance and decrease in lean mass.
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Dubé MC, Prud'homme D, Lemieux S, Lavoie C, Weisnagel SJ. Body composition indices in women with well-controlled type 1 diabetes. Diabetes Care 2008; 31:e48. [PMID: 18509135 DOI: 10.2337/dc07-2355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Denis Prud'homme
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Simone Lemieux
- Institute of Nutraceuticals and Functional Foods, Laval University, Quebec, Canada
| | - Carole Lavoie
- Department of Physical Activity Sciences, Université du Québec à Trois-Rivières, Quebec, Canada
- Faculty of Medicine, Department of Physiology and Endocrinology, Laval University, Quebec, Canada
| | - S. John Weisnagel
- Diabetes Research Unit, CRML, CRCHUL, Quebec, Canada
- Faculty of Medicine, Division of Kinesiology, Laval University, Quebec, Canada
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Czupryniak L, Strzelczyk J, Cypryk K, Pawlowski M, Szymanski D, Lewinski A, Loba J. Gastric bypass surgery in severely obese type 1 diabetic patients. Diabetes Care 2004; 27:2561-2. [PMID: 15451938 DOI: 10.2337/diacare.27.10.2561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Greenfield JR, Samaras K, Campbell LV, Chisholm DJ. Type 1 diabetes is not associated with increased central abdominal obesity. Diabetes Care 2003; 26:2703; author reply 2703-4. [PMID: 12941755 DOI: 10.2337/diacare.26.9.2703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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