Are Children With Type 1 Diabetes Consuming a Healthful Diet? A Review of the Current Evidence and Strategies for Dietary Change

Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS, 6100 Executive Blvd., Room 7B13R, MSC 7500, Bethesda, MD 20892-7510, USA.
The Diabetes Educator (Impact Factor: 1.79). 01/2009; 35(1):97-107. DOI: 10.1177/0145721708326699
Source: PubMed


The purpose of this study is to review the literature on usual dietary intake in children with type 1 diabetes (T1D) and to discuss approaches to promote dietary change with potential efficacy.
Search strategies included a MEDLINE search for English-language articles that estimated usual dietary intake in children with T1D and a screening of the reference lists from original studies. The keywords used were diet, dietary intake, nutrition, type 1 diabetes, children, adolescents, and youth. Studies were included if they were observational, contained a sample of children with T1D, and estimated usual dietary intake.
Nine studies fulfilled the criteria (6 US, 3 European). Of the 4 studies with a control group, 3 reported that both total fat and saturated fat intake were higher in the children with T1D. Six studies examined the percent of total calories from saturated fat; mean intake ranged from 11 to 15%, exceeding ADA recommendations (< 7%). Fruit, vegetable, and fiber intakes were low among children with T1D. No prior studies have addressed dietary change in this population. The behavior-change literature suggests that nutrition education alone is unlikely to be adequate, but that incorporation of behavioral approaches offers potential efficacy in promoting healthful dietary change.
Children with T1D are not meeting dietary guidelines, and in some areas their diets are less healthful than children without diabetes. As these dietary behaviors may affect the risk of long-term complications, the incorporation of behavioral approaches promoting healthy eating into routine clinical practice is warranted.

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Available from: Tonja Nansel,
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    • "Diet and physical activity (PA) are fundamental aspects of care in type 1 diabetes, but scant data exist on diet and PA behaviors of adolescents with type 1 diabetes, especially compared to non-diabetic (non-DM) controls [1]. The nutrition guidelines for children with type 1 diabetes are similar to those for the general population with a focus on healthful eating to provide energy intake and nutrients to ensure normal growth and development [2-4]. "
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    ABSTRACT: Diet and physical activity (PA) are fundamental aspects of care in type 1 diabetes, but scant longitudinal data exist on these behaviors in adolescents with type 1 diabetes, especially compared to non-diabetic controls. Data in 211 adolescents with type 1 diabetes (baseline age = 15.3 ± 2.2 years, diabetes duration = 8.8 ± 3.1 years, A1c = 9.0 ± 1.5%, 51% male) and 67 non-diabetic (age = 14.9 ± 1.7 years, 52% male) controls were collected at baseline (V1) and again at 2-year follow-up (V2) (mean follow up = 2.2 ± 0.4 years). Diet data (meals/day, snacks/day, and weekly consumption of breakfast, fruit, vegetables and fried foods), and PA were collected using interviewer administered questionnaires. T-tests and chi-squared tests were used for comparisons. Both adolescents with type 1 diabetes and non-diabetic controls reported increased vegetable (2.8 v. 3.6 and 3.1 v. 3.8 times weekly, respectively, p < 0.0001) and fruit (2.9 v. 3.8, both groups, p < 0.0001) intake (times per week) and increased PA (hours/day; 1.8 v. 2.2, p = 0.005 and 1.5 v. 1.9, p = 0.008, respectively) from V1 to V2. Adolescents with type 1 diabetes reported eating breakfast (3.3 v. 3.8 weekly, p = 0.0002) but also fried foods (1.9 v. 2.3, p = 0.0005) weekly more often from V1 to V2. Adolescents with and without type 1 diabetes met PA recommendations of 60 minutes or more of moderate-to-hard PA daily at both V1 (74% v. 70%, respectively, p = 0.58) and V2 (70% v. 78%, respectively, p = 0.78). Over 2 years, adolescents with and without type 1 diabetes had a healthier diet with increased fruit and vegetable intake and increased PA. However, neither group met the guidelines of daily breakfast, fruit and vegetable intake. Some diet and PA improvements were seen in adolescents with type 1 diabetes over a 2-year period. Therefore, adolescence could be a beneficial time to target diet and lifestyle interventions to take advantage of this time period when behaviors are being modified.
    International Journal of Pediatric Endocrinology 08/2014; 2014(1):17. DOI:10.1186/1687-9856-2014-17
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    • "Despite attention to diet as part of the diabetes management regimen, diet quality of youth with type 1 diabetes is similarly poor to that of the general youth population [10-13], or possibly worse, as children with type 1 diabetes consume a greater proportion of saturated fat [14,15]. The dramatic increase in obesity prevalence in youth with type 1 diabetes [16,17] and the high prevalence of cardiovascular risk factors among these youth [18,19] suggests the need for evaluating factors contributing to diet quality in this population. "
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    ABSTRACT: Constructs based on Social Cognitive Theory have shown utility in understanding dietary behavior; however, little research has examined these relations in youth and parents concurrently. Unique demands of dietary management among families of youth with type 1 diabetes (T1D) suggest the importance of investigation in this population. The purpose of this study was to develop and evaluate youth and parent measures of self-efficacy, outcome expectations, and barriers for healthful eating, and parent modeling of healthful eating, in a sample of youth with type 1 diabetes and their parents. Youth (n=252) ages 8--18 years with diabetes duration >=1 year and parents completed self-report measures of healthful eating attitudes including self-efficacy, perceived barriers, positive and negative outcome expectations; youth reported parent modeling of healthful eating. Youth dietary intake from 3-day diet records was used to calculate the Healthy Eating Index 2005 and the Nutrient Rich Foods 9.3 index, measures of overall diet quality. The relations among parent and youth healthful eating attitudes, parent modeling, and youth diet quality were examined using structural equation modeling. Internal consistency and test-retest reliability of the measures were acceptable. The structural equation model demonstrated acceptable fit (CFI/TLI=0.94/0.94; RMSEA=0.03), and items loaded the hypothesized factors. Parent modeling beta^=.27,p=.02 and attitudes toward healthful eating (latent variable comprised of self-efficacy, barriers, outcome expectations) beta^=.16,p=.04 had direct effects on youth diet quality. Parent modeling had a direct effect on youth attitudes beta^=.49,p<.001; parent attitudes had an indirect effect on youth attitudes through parent modeling beta^=.12,p,<.001. Youth attitudes were not associated with youth diet quality. Overall, the model accounted for 20% of the variance in child diet quality. Parent diet-related behaviors demonstrated an impact on youth attitudes and diet quality, suggesting the importance of family-based clinical and public health efforts to improve diet.
    International Journal of Behavioral Nutrition and Physical Activity 11/2013; 10(1):125. DOI:10.1186/1479-5868-10-125 · 4.11 Impact Factor
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    • "We found positive relationships between fruit and whole grain intakes with preference and availability of corresponding food groups, comparable to research in the general youth population (Bere & Klepp, 2004; Brug et al., 2008; Cullen et al., 2003; McClain et al., 2009; Neumark-Sztainer, Wall, Perry, & Story, 2003; Rasmussen et al., 2006; Resnicow et al., 1997). The observed lack of association between intakes and home availability of fats/sweets replicates limited previous research in the general adolescent population (Befort et al., 2006), although this finding is in contrast with previous research documenting the direct influence of the school food environment on adolescent food choice (Kubik, Lytle, Hannan, Perry, & Story, 2003; Rovner & Nansel, 2009). Our finding regarding a lack of a significant association of vegetable intake with vegetable preference and availability conflicts with prior research in the general population (McClain et al., 2009; Rasmussen et al., 2006). "
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    ABSTRACT: The objective of this study was to examine associations of food preferences and availability with dietary intake in youth with type 1 diabetes, for whom dietary intake and quality are essential to disease management. Youth (n=252, age 13.2±2.8 y, diabetes duration 6.3±3.4 y) reported preferences and parents reported household availability for 61 food items categorized as fruit, vegetables, whole grains, refined grains and fats/sweets. Youth energy-adjusted daily servings of food groups, Healthy Eating Index-2005 and Nutrient Rich Foods 9.3 scores were calculated from 3-day diet records. Associations of dietary intake and quality variables with preference and availability of all food groups were evaluated by linear regressions adjusted for sociodemographic characteristics. Fruit and whole grain intake were positively related to corresponding preference and availability; whole grain intake and refined grain availability were inversely related. Vegetable, refined grain and fats/sweets intake were unrelated to preference and availability. Diet quality measures were related positively to fruit preference and whole grain availability and inversely to refined grains availability. Findings indicate associations of dietary intake with food preference and availability vary by food group in youth with type 1 diabetes. Measures of overall dietary quality were more consistently associated with food group availability than preferences.
    Appetite 05/2012; 59(2):218-23. DOI:10.1016/j.appet.2012.05.005 · 2.69 Impact Factor
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