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Nutrition Managing in Pediatric Diabetes: Aspects and Challenges

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (31 October 2023) | Viewed by 46612

Special Issue Editors


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Guest Editor
1. Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2. Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children’s Hospital, Department of Pediatrics, Gothenburg, Sweden
Interests: pediatric endocrinology; insulin resistance; diabetes; metabolic diseases; lipid metabolism

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Guest Editor
Diabetes Centre of the A’ Department of Paediatrics of P&A Kyriakou Children’s Hospital, Athens, Greece
Interests: pediatric diabetes obesity; hypertension; health care; endocrinology

Special Issue Information

Dear Colleagues,

Nutrition is the fundamental bottom-line for survival and good nutrition is the prerequisite for a healthy life. However, the opinion on what food choices are to prefer in pediatric diabetes have been discussed for decades.

Before insulin treatment was available 100 years ago, the natural advice from the medical staff was to avoid carbohydrates and eat fat and some protein to avoid rise in blood glucose. No matter how well this hint was followed the tragic outcome was unpreventable.

Since insulin treatment was available it became obvious that other factors also were of importance to avoid short-and long-term complications to the disease. The individual lifestyle regarding eating habits and physical activity as well as psychological and social wellbeing have been shown to be of utmost importance.

In modern time, nutrition is discussed lively especially in social media and proponents of different kinds of extraordinary food choices can have great impact on the opinion of the general public. Although research methodology in nutrition is a challenge, science has to defend the position as the most reliable platform for the important issue of healthy food choices.

In this special edition of Nutrients we are aiming for highlightening research areas in the frontline of today´s understanding regarding nutrition in pediatric diabetes. The ultimate goal is preventing complications to the disease and promoting a high quality of life for the children with diabetes.

Prof. Dr. Gun Forsander
Dr. Andriani Vazeou
Guest Editor

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Keywords

  • Pediatric diabetes
  • carbohydrates
  • fat
  • protein
  • micronutrients
  • obesity
  • physical activity
  • lipids
  • individualized nutrional guideline
  • micribiome
  • minority groups

Published Papers (14 papers)

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Research

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11 pages, 651 KiB  
Article
Postprandial Glucose Variability Following Typical Meals in Youth Living with Type 1 Diabetes
by Susana R. Patton, Simon Bergford, Jennifer L. Sherr, Robin L. Gal, Peter Calhoun, Mark A. Clements, Michael C. Riddell and Corby K. Martin
Nutrients 2024, 16(1), 162; https://doi.org/10.3390/nu16010162 - 04 Jan 2024
Viewed by 1389
Abstract
We explored the association between macronutrient intake and postprandial glucose variability in a large sample of youth living with T1D and consuming free-living meals. In the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) Study, youth took photographs before and after their meals on [...] Read more.
We explored the association between macronutrient intake and postprandial glucose variability in a large sample of youth living with T1D and consuming free-living meals. In the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) Study, youth took photographs before and after their meals on 3 days during a 10 day observation period. We used the remote food photograph method to obtain the macronutrient content of youth’s meals. We also collected physical activity, continuous glucose monitoring, and insulin use data. We measured glycemic variability using standard deviation (SD) and coefficient of variation (CV) of glucose for up to 3 h after meals. Our sample included 208 youth with T1D (mean age: 14 ± 2 years, mean HbA1c: 54 ± 14.2 mmol/mol [7.1 ± 1.3%]; 40% female). We observed greater postprandial glycemic variability (SD and CV) following meals with more carbohydrates. In contrast, we observed less postprandial variability following meals with more fat (SD and CV) and protein (SD only) after adjusting for carbohydrates. Insulin modality, exercise after meals, and exercise intensity did not influence associations between macronutrients and postprandial glycemic variability. To reduce postprandial glycemic variability in youth with T1D, clinicians should encourage diversified macronutrient meal content, with a goal to approximate dietary guidelines for suggested carbohydrate intake. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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14 pages, 1071 KiB  
Article
Glycemic Control, Basal/Bolus Distribution, BMI and Meal Management in Children and Adolescents with Type 1 Diabetes and Advanced Hybrid Closed Loop
by Barbara Piccini, Matteo Felicioni, Benedetta Pessina, Mattia Bertini, Emilio Casalini, Chiara Ceccotti, Silvia Farina, Marta Ferrari, Lorenzo Lenzi, Francesca Monzali and Sonia Toni
Nutrients 2023, 15(23), 4875; https://doi.org/10.3390/nu15234875 - 22 Nov 2023
Viewed by 867
Abstract
Evidence about the impact of advanced hybrid closed loop (AHCL) on body mass index (BMI) and eating habits in children with type 1 diabetes (T1D) is lacking. This real-world study aimed at evaluating glycemic control, BMI, meals and basal/bolus distribution in young subjects [...] Read more.
Evidence about the impact of advanced hybrid closed loop (AHCL) on body mass index (BMI) and eating habits in children with type 1 diabetes (T1D) is lacking. This real-world study aimed at evaluating glycemic control, BMI, meals and basal/bolus distribution in young subjects with T1D treated by AHCL. Glycemic metrics, HbA1c, basal/bolus distribution, meals/day, BMI, total daily dose (TDD), and carbohydrates/kg (CHO/kg) have been evaluated in 83 subjects, aged 13 ± 4.5 years, in manual mode, 3 and 6 months after auto-mode. Time in range (TIR) increased after 3 months, exceeding the target of 70% and was maintained at 6 months. While coefficient of variation (CV) did not change, the glucose management indicator (GMI) decreased in auto-mode (6.7 ± 0.3 vs. 7.1 ± 0.5%; p < 0.001), as well as HbA1c. Basal proportion decreased in favor of boluses (38.3 ± 7.3 vs. 43.6 ± 10.9%; p < 0.001). Meals increased at 3 and 6 months (4.4 ± 1.2 vs. 5.0 ± 1.5, p 0.002 and 5.1 ± 1.7, p < 0.001), as well as TDD/kg, without changes in BMI and CHO consumed. No differences in meal composition have arisen from food diaries. In conclusion, AHCL ensured the achievement and maintenance of target TIR in young T1D subjects. The number of meals, TDD, and insulin bolus proportion increased over time, but BMI remained stable. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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9 pages, 473 KiB  
Article
Carbohydrate Counting, Empowerment and Glycemic Outcomes in Adolescents and Young Adults with Long Duration of Type 1 Diabetes
by Elisabeth Jelleryd, Anna Lena Brorsson, Carmel E. Smart, Ulrika Käck and Anna Lindholm Olinder
Nutrients 2023, 15(22), 4825; https://doi.org/10.3390/nu15224825 - 18 Nov 2023
Viewed by 1086
Abstract
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim [...] Read more.
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10–28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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14 pages, 1570 KiB  
Article
An Overview of Diet and Physical Activity for Healthy Weight in Adolescents and Young Adults with Type 1 Diabetes: Lessons Learned from the ACT1ON Consortium
by Franziska K. Bishop, Ananta Addala, Karen D. Corbin, Franklin R. Muntis, Richard E. Pratley, Michael C. Riddell, Elizabeth J. Mayer-Davis, David M. Maahs and Dessi P. Zaharieva
Nutrients 2023, 15(11), 2500; https://doi.org/10.3390/nu15112500 - 27 May 2023
Viewed by 2273
Abstract
The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to [...] Read more.
The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON). Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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11 pages, 498 KiB  
Article
Experiences and Attitudes of Parents Reducing Carbohydrate Intake in the Management of Their Child’s Type 1 Diabetes: A Qualitative Study
by Amelia J. Harray, Alison G. Roberts, Naomi E. Crosby, Charlene Shoneye and Keely Bebbington
Nutrients 2023, 15(7), 1666; https://doi.org/10.3390/nu15071666 - 29 Mar 2023
Cited by 1 | Viewed by 3498
Abstract
Reducing carbohydrate (CHO) intake is being used as an approach to manage type 1 diabetes (T1D) in children. This study aimed to investigate the experiences and attitudes of parents of children with T1D who are reducing CHO intake to help manage blood glucose [...] Read more.
Reducing carbohydrate (CHO) intake is being used as an approach to manage type 1 diabetes (T1D) in children. This study aimed to investigate the experiences and attitudes of parents of children with T1D who are reducing CHO intake to help manage blood glucose levels (BGLs). Semi-structured interviews were conducted with the parents of children with T1D for >1 year who reported implementing a low CHO approach to manage BGLs. Data were analysed using a constant comparative analysis approach. Participants (n = 14) were parents of children (6.6 ± 2.0 years) with T1D in Western Australia. All parents reported different methods of CHO restriction and all perceived that benefits outweighed challenges. Parents reported feeling less worried, had improved sleep and felt their child was safer when using a low CHO approach due to more stable BGLs. Reported challenges included: increased cost and time spent preparing food; perceived judgement from others; and child dissatisfaction with restricted food choices. Parents reported accessing information and support through social media networks. Parents reported a desire for more research into this approach. Understanding the promoters and barriers for this dietary approach may inform strategies to better engage and support families with approaches that align with current evidence while considering their concerns around safety and hyperglycaemia. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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12 pages, 291 KiB  
Article
Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus
by Sriwan Thongpaeng, Preeyarat Sorncharoen, Lukana Preechasuk and Jeerunda Santiprabhob
Nutrients 2022, 14(23), 5169; https://doi.org/10.3390/nu14235169 - 05 Dec 2022
Cited by 2 | Viewed by 2187
Abstract
Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth [...] Read more.
Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297–700) vs. 328 (167–447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13–48) vs. 34 (14–77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
12 pages, 595 KiB  
Article
Compliance to a Gluten-Free Diet in Swedish Children with Type 1 Diabetes and Celiac Disease
by Hanna Söderström, Julia Rehn, Matti Cervin, Cathrine Ahlstermark, Mara Cerqueiro Bybrant and Annelie Carlsson
Nutrients 2021, 13(12), 4444; https://doi.org/10.3390/nu13124444 - 13 Dec 2021
Cited by 7 | Viewed by 2659
Abstract
Children with type 1 diabetes (T1D) are at increased risk of celiac disease (CD). The replacement of insulin in T1D, and the exclusion of gluten in CD, are lifelong, burdensome treatments. Compliance to a gluten-free diet (GFD) in children with CD is reported [...] Read more.
Children with type 1 diabetes (T1D) are at increased risk of celiac disease (CD). The replacement of insulin in T1D, and the exclusion of gluten in CD, are lifelong, burdensome treatments. Compliance to a gluten-free diet (GFD) in children with CD is reported to be high, while compliance in children with both diseases has scarcely been studied. To examine compliance to a GFD in children with both T1D and CD, we analyzed tissue transglutaminase IgA-antibodies (tTGA). Moreover, associations between compliance and age, sex, glycemic control, ketoacidosis (DKA), body mass index (BMI), and time of CD diagnosis were investigated. Of the 743 children diagnosed with T1D in southern Sweden between 2005 and 2012, 9% were also diagnosed with CD. Of these, 68% showed good compliance to a GFD, 18% showed intermediate compliance, and 14% were classified as non-compliant. Higher age, poorer HbA1c, and more DKAs were significantly (p < 0.05) associated with poorer compliance. In conclusion, we found that compliance to a GFD in children with T1D and CD is likely be lower than in children with CD only. Our results indicate that children with both T1D and CD could need intensified dietary support and that older children and children with poor metabolic control are especially vulnerable subgroups. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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8 pages, 505 KiB  
Article
Screening Practices for Disordered Eating in Paediatric Type 1 Diabetes Clinics
by Emma Hanley Burden, Melissa Hart, Kirrilly Pursey, Peter P. Howley, Tenele A. Smith and Carmel E. Smart
Nutrients 2021, 13(11), 4187; https://doi.org/10.3390/nu13114187 - 22 Nov 2021
Cited by 2 | Viewed by 2688
Abstract
Background: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of [...] Read more.
Background: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of screening tools for the identification of disordered eating. Methods: A 24-item survey covering five content domains: clinic characteristics, identification of disordered eating, screening tool use, training and competence, and pathways for referral, was sent to Australasian clinics caring for ≥150 children and adolescents with T1D. Results: Of 13 eligible clinics, 10 participated. Two reported rates of disordered eating of >20%, while eight reported rates < 5%. All clinics used the routine clinical interview as the primary method of screening for disordered eating. Only one used screening tools; these were not diabetes-specific or routinely used. Barriers to use of screening tools included shortage of time and lack of staff confidence around use (n = 7, 70%). Enablers included staff training in disordered eating. Conclusions: Screening tools for disordered eating are not utilised by most Australasian paediatric T1D clinics. Overall, low reported rates of disordered eating suggest that it may be undetected, potentially missing an opportunity for early intervention. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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11 pages, 1296 KiB  
Article
Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes
by Emily Bell, Sabrina Binkowski, Elaine Sanderson, Barbara Keating, Grant Smith, Amelia J. Harray and Elizabeth A. Davis
Nutrients 2021, 13(11), 4154; https://doi.org/10.3390/nu13114154 - 19 Nov 2021
Cited by 2 | Viewed by 2048
Abstract
The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- [...] Read more.
The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8–15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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11 pages, 1066 KiB  
Article
Effect of Nutritional Habits on the Glycemic Response to Different Carbohydrate Diet in Children with Type 1 Diabetes Mellitus
by Agnieszka Lejk, Jędrzej Chrzanowski, Adrianna Cieślak, Wojciech Fendler and Małgorzata Myśliwiec
Nutrients 2021, 13(11), 3815; https://doi.org/10.3390/nu13113815 - 27 Oct 2021
Cited by 5 | Viewed by 3198
Abstract
Unhealthy eating habits are associated with obesity, metabolic syndrome, and increased insulin resistance in young patients with type 1 diabetes mellitus (T1DM), and may impact the possible benefit from dietary interventions on glycaemic control. This study determines how nutritional patterns influence the quality [...] Read more.
Unhealthy eating habits are associated with obesity, metabolic syndrome, and increased insulin resistance in young patients with type 1 diabetes mellitus (T1DM), and may impact the possible benefit from dietary interventions on glycaemic control. This study determines how nutritional patterns influence the quality of dietary intervention with a 30% or 50% carbohydrate diet in terms of glycaemic control measured with continuous glucose monitoring (CGM). Eating habits were obtained with a frequency-of-consumption questionnaire (FFQ-6) before the diet assessment. Altogether, we collected CGM and FFQ-6 data from 30 children (16 boys and 14 girls aged 10–17 years) with T1DM subjected to two consecutive 3-day nutritional plans. From these, 23 patients met the CGM data quality criteria for further analysis. Furthermore, high accuracy achieved in training (95.65%) and V-fold cross-validation (81.67%) suggest a significant impact of food habits in response to introduced nutritional changes. Patients who consumed more vegetables or grains (>4 times per day), more wheat products (>once per day), fewer fats (<1.5 times per day), and ranked fruit juice as the most common selection in the drinks category achieved glycaemic control more often after the introduction of a 30% carbohydrate diet, as opposed to those with different dietary patterns, whose glycaemic control was negatively impacted after switching to this diet. Additionally, the 50% carbohydrate diet was safe for all patients in the context of glycaemic control. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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Review

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13 pages, 685 KiB  
Review
Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes?
by Angelica Cristello Sarteau and Elizabeth Mayer-Davis
Nutrients 2022, 14(4), 824; https://doi.org/10.3390/nu14040824 - 16 Feb 2022
Viewed by 2649
Abstract
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during [...] Read more.
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during this life stage. Nutrition is fundamental to T1D management. We reviewed the evidence base of eating strategies tested to date to improve glycemic levels among youth with T1D in order to identify promising directions for future research. No eating strategy tested among youth with T1D since the advent of flexible insulin regimens—including widely promoted carbohydrate counting and low glycemic index strategies—is robustly supported by the existing evidence base, which is characterized by few prospective studies, small study sample sizes, and lack of replication of results due to marked differences in study design or eating strategy tested. Further, focus on macronutrients or food groups without consideration of food intake distribution throughout the day or day-to-day consistency may partially underlie the lack of glycemic benefits observed in studies to date. Increased attention paid to these factors by future observational and experimental studies may facilitate identification of behavioral targets that increase glycemic predictability and management among youth with T1D. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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21 pages, 1362 KiB  
Review
‘Old Is Gold’: How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management
by Sheryl Salis, Anju Virmani, Leena Priyambada, Meena Mohan, Kajal Hansda and Carine de Beaufort
Nutrients 2021, 13(12), 4427; https://doi.org/10.3390/nu13124427 - 10 Dec 2021
Cited by 5 | Viewed by 9537
Abstract
Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families [...] Read more.
Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families struggle to find ways to provide nutritious, yet attractive, food with a low glycemic index (GI). India is one of the oldest continuous civilizations with a rich and diverse cultural and culinary heritage. Traditional dietary practices, including the centuries-old ‘Thali’ (meaning plate) concept, emphasize combinations (grains, lentils, vegetables, dairy, spices, prebiotics and probiotics, and fats) of local, seasonal, and predominantly plant-based ingredients. These practices ensure that all of the necessary food groups are provided and fit well with current evidence-based recommendations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 Guidelines. Techniques for the preparation, cooking, and preservation of food further impact the GI and nutrient availability. These practices benefit nutrient density, diet diversity, and palatability and thus improve adherence to meal plans and glycemic control. This narrative review describes the ancient wisdom, food composition, and culinary practices from across India which are still valuable today. These may be of benefit worldwide to improve glycemic control as well as quality of life, especially in PwD. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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18 pages, 688 KiB  
Review
Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes
by Chiara Garonzi, Gun Forsander and Claudio Maffeis
Nutrients 2021, 13(8), 2625; https://doi.org/10.3390/nu13082625 - 29 Jul 2021
Cited by 17 | Viewed by 4236
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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15 pages, 579 KiB  
Review
Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review
by Monika Grabia, Renata Markiewicz-Żukowska and Katarzyna Socha
Nutrients 2021, 13(6), 1782; https://doi.org/10.3390/nu13061782 - 23 May 2021
Cited by 14 | Viewed by 5968
Abstract
Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The [...] Read more.
Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The purpose of this systematic review is to provide a concise and critical overview of the prevalence of MetS in children and adolescents with T1DM and, ultimately, to discuss prevention and treatment options. The study was conducted in accordance with PRISMA guidelines. This review shows that, apart from the growing percentage of overweight and obese children and adolescents with T1DM (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2 to 29.9%, depending on the criteria used) is one of the most important phenomena of our time. One of the methods of prevention and treatment is a combined approach: changing eating habits and lifestyle, but there are also reports about the beneficial effects of the gut microflora. Full article
(This article belongs to the Special Issue Nutrition Managing in Pediatric Diabetes: Aspects and Challenges)
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