Review Suggests Adolescents With T1D Limit High Fat Intake

Children and adolescents with type 1 diabetes (T1D) should avoid a high fat intake and be encouraged to adhere to a healthy and balanced diet—a decision that may help reduce cardiovascular risk and inflammation, according to a review published in Nutrients.

Although clinical manifestations of cardiovascular diseases (CVDs) typically appear in adulthood, “vascular damage might start early in T1D and evidence of subclinical CVD can be detected in adolescence,” researchers wrote.

In addition, as youth with diabetes or prediabetes are at an increased risk of hypertension, dyslipidemia, and other metabolic disorders in adulthood, “the prevention and early detection of cardiovascular risk factors are mandatory in young [patients] with T1D, as assessed in the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines,” they explained.

Glycemic control is the most important CV risk factor in patients with T1D and is affected by diet composition. To better understand the relationships among lipid intake, glycemic control, CVD, inflammation, and modifications of microbiota among youths with T1D, investigators conducted a review of relevant guidelines and past research.

Guidelines from both the ADA and ISPAD aim to improve glycemic control and lower CV risk in those with diabetes. However, studies reveal a low adherence to these recommendations among children and adolescents with T1D. Of particular concern to researchers was intake of high total fat and saturated fatty acid (SFA).

Investigations found an association between low adherence to recommendations and poorer glycemic control, therefore increasing the risk of potential CVD and related complications. However, following a regular meal pattern was associated with superior glycemic outcomes, authors found.

“Nutritional variations seen in youth with T1D tend to follow the changes in the eating habits of the general population and, in particular, of their peers, who frequently do not meet the recommendations either,” researchers wrote, adding food intake is frequently misreported and underreported by this cohort of patients.

Previous studies have showed meals with high fat or protein content lead to a delayed and prolonged increase in postprandial glycemia, while an additive effect was seen when consuming high-fat and high-protein meals together.

Because of this, authors recommended adapting meal insulin dose to counterbalance delayed hyperglycemia resulting from high-protein and high-fat meals. “Considering the wide inter-individual differences in insulin dose demand for fat and protein, it is therefore important to individualize the treatment,” they said.

Mixed results have been reported when it comes to the role of fat intake on glycated hemoglobin (A1C). Some studies found no association between total fat intake and glycemic control, whereas others showed the consumption is linked with A1C levels.

For example, 1 cross-sectional study including over 100 children and adolescents with T1D showed A1C levels “were positively correlated with lipid intake and SFA and negatively correlated with monounsaturated fatty acid (MUFA) intake. Interestingly, when increasing the SFA intake of 1% of total energy, the risk of having [A1C] >7.5% increases by 53%.”

Although more prospective studies are needed to clarify this relationship, published data indicate higher A1C levels have been frequently reported among patients with a high fat, high protein intake. Contrasting data have been reported for unsaturated fatty acids, researchers explained.

Relatively few studies have been conducted on the association between dietary intake and CVD risk among youth with T1D. One analysis carried out among 136 youth with T1D led researchers to conclude that a lower intake of polyunsaturated fatty acids (PUFA) may reduce CVD risk in this population. Overall, “in people with T1D, higher amounts of total fat intake has been associated with an increased risk of CVD, while the relationship between different fatty acid intake seems to be less consistent and results are mixed.”

Future investigations are warranted to better understand the role of different fatty acids on CV risk among adolescents and children with T1D.

Inflammation is more pronounced in individuals with T1D and is correlated with CVD, and different inflammatory markers have been shown to predict CVD in those with T1D. These include soluble interleukin-2 receptor, C-reactive protein, plasma fibrinogen, and white blood cell levels, among others. According to authors, following a healthy diet may be beneficial for lowering inflammation, underscoring the importance of meeting current dietary recommendations.

Furthermore, gut microbiota composition has been hypothesized to play a role in T1D pathogenesis.

Once case-controlled study included 16 children with T1D and 16 controls revealed “marked differences in the fecal microbial composition, including a decreased number of Actinobacteria and Firmicutes with significantly increased Bacteroidetes, thus leading to a lower Firmicutes to Bacteroidetes ratio in children with T1D, compared to healthy controls,” authors wrote.

Few data exist on the effects of high–fatty acid diets in gut microbiota alterations and most come from animal models. While published data do show that high-SFA diets can have harmful effects on gut microbiota, studies have also indicated some potential benefits of probiotics in those at risk of developing T1D. Further research is needed in this area.

“A high-fat intake is associated with a pro-inflammatory post-prandial response through different mechanisms, including gut microbiota changes. These processes promote an increase of the cardiovascular risk that is already associated with diabetes,” authors concluded.

“On the basis of this evidence, it is useful to promote a higher adherence to the dietary recommendations proposed by ISPAD and ADA to all children and adolescents with T1D, avoiding the intake of a high-fat diet.”

Reference

Garonzi C, Forsander G, Maffeis C. Impact of fat intake on blood glucose control and cardiovascular risk factors in children and adolescents with type 1 diabetes. Nutrients. 2021;13(8):2625. doi:10.3390/nu13082625