Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 25:2023:7102890.
doi: 10.1155/2023/7102890. eCollection 2023.

Macronutrient Intake in Children and Adolescents with Type 1 Diabetes and Its Association with Glycemic Outcomes

Emma L Fisher  1 , Natasha A Weaver  2 , Alexandra L Marlow  2   3 , Bruce R King  1   2   3 , Carmel E Smart  1   2   3
Affiliations

Macronutrient Intake in Children and Adolescents with Type 1 Diabetes and Its Association with Glycemic Outcomes

Emma L Fisher et al. Pediatr Diabetes. .

Abstract

Aims: This study aimed to identify the quantity and range of protein, fat, and carbohydrate consumed in meals and snacks in children with Type 1 diabetes (T1D), and to explore associations between the variability in fat and protein intakes with the glycemic outcomes.

Methods: This was a cross-sectional dietary study of children 6-18 years attending pediatric diabetes service in Australia. Three-day weighed food records were analyzed for the macronutrient intake. Impacts of dietary intake on glycemic outcomes were explored.

Results: Forty-eight children (63% male) aged 11.7 ± 2.9 (mean ± SD) with HbA1c 6.7 ± 1.1% (mmol/mol), BMI Z-score 0.51 ± 0.83, and daily insulin dose 0.99 units/kg completed 3-day weighed food records. Mean intakes at breakfast were 47-g carbohydrate, 15-g protein, and 12-g fat. Lunch: 49-g carbohydrate, 19-g protein, and 19-g fat. Dinner: 57-g carbohydrate, 33-g protein, and 26-g fat. Fifty-five percent (n = 80) of the dinner meals met criteria for a high-fat, high-protein (HFHP) meal. In a subset (n = 16) of participants, exploratory analysis indicated a trend of reduced %TIR (58%) in the 8 hr following HFHP dinner, compared to %TIR (74%) following non-HFHP dinner (p=0.05). Seventy-eight percent of the participants aged 12-18 years intake at dinner varied by more than 20-g fat or more than 25-g protein. There was no association between the variability in fat and protein intake at dinner with HbA1c. Saturated fat contributed to 14.7% (±3.0) of participants energy intake.

Conclusions: Children with T1D frequently consume quantities of fat and protein at dinner that have been shown to cause delayed postprandial hyperglycemia. HFHP dinners were associated with the reduced %TIR over 8 hr, presenting an opportunity for insulin-dose adjustments. Future research that explores the meal dietary variability with postprandial glycemia in this population is needed. Excessive intake of the saturated fat highlights the need for dietary interventions to reduce CVD risk. This trial is registered with ACTRN12622000002785.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Scatter plot of HbA1c by total daily carbohydrate intake.
Figure 2
Figure 2
Comparison of 8-hr postprandial %TIR by dinner meal type (non HFHP vs. HFHP).
Figure 3
Figure 3
Scatter plot of percent of daily energy intake at dinner by BMI Z-score.
See this image and copyright information in PMC

References

    1. Rabasa-Lhoret R., Garon J., Langelier H., Poisson D., Chiasson J. L. Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal–bolus (ultralente–regular) insulin regimen. Diabetes Care . 1999;22(5):667–673. doi: 10.2337/diacare.22.5.667. - DOI - PubMed
    1. Smart C. E. M., Evans M., O’Connell S. M., et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care . 2013;36(12):3897–3902. doi: 10.2337/dc13-1195. - DOI - PMC - PubMed
    1. Bell K. J., Smart C. E., Steil G. M., Brand-Miller J. C., King B., Wolpert H. A. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care . 2015;38(6):1008–1015. doi: 10.2337/dc15-0100. - DOI - PubMed
    1. Paterson M., Bell K. J., O’Connell S. M., Smart C. E., Shafat A., King B. The role of dietary protein and fat in glycaemic control in type 1 diabetes: implications for intensive diabetes management. Current Diabetes Reports . 2015;15(9) doi: 10.1007/s11892-015-0630-5.61 - DOI - PMC - PubMed
    1. Ketema E. B., Kibret K. T. Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis. Archives of Public Health . 2015;73(1) doi: 10.1186/s13690-015-0088-6.43 - DOI - PMC - PubMed

LinkOut - more resources