Adherence to Mediterranean Diet Is Associated With Better Glycemic Control in Children With Type 1 Diabetes: A Cross-Sectional Study

Abstract

Type 1 diabetes (T1D) is a chronic condition, with increased morbidity and mortality, due to a higher rate of cardiovascular disease among other factors. Cardiovascular risk increases with the worse glycemic profile. Nutrition has a deep impact on diabetes control. Adherence to the Mediterranean diet (MD) has been shown to decrease cardiovascular risk in children and adults with obesity and adults with type 2 diabetes, but its impact on T1D children has been scarcely analyzed. We hypothesized that the degree of adherence to MD could relate to the increased time in range in children with T1D.Patients and MethodsCross-sectional analysis involving two university hospitals. We measured the adherence to MD with the Mediterranean Diet Quality Index for children and teenagers (KIDMED) questionnaire, which is a validated tool for this purpose. A score of <5 indicates poor adherence to MD, while a good adherence is indicated by a score of >7. Demographic and clinical data were registered on the same day that the questionnaire was taken, with informed consent. Additionally, the patients' ambulatory glucose profiles (AGPs), were registered from the participants' glucose monitors (continuous or flash devices), and daily insulin needs were recorded from patients' insulin pumps (n=28). Other cardiovascular risk factors such as lipid profile, vitamin D levels, and other biochemical parameters were registered from a blood test, performed 2 weeks before recruitment, as part of the patients' annual screening.ResultsNinety-seven patients (44 girls), with an average age of 11.4 years (± 3.01), were included. Seventy-one of them were on multiple daily injection regimens, and all had either continuous or flash glucose monitoring. Fifty-three had HbA1c levels of <7.5%, while only 21 had a time in range (TIR) of >70%. Contingency analysis showed that the odds of having HbA1c <7.5% increase in children with KIDMED score of >7 (O.R. 2.38; ICR 1.05–5.41; p = 0.036). Moreover, the KIDMED score and the HbA1c levels were negatively correlated (R: −0.245; p-value: 0.001), while the KIDMED score and TIR showed a positive correlation (R: 0.200; p-value: 0.009).ConclusionsOur data suggest that adherence to MD may contribute to better glycemic control in children. This should be taken into account at the time of nutritional education on T1D patients and their families.

Proportion of vitamin D deficiency in children/adolescents with type 1 diabetes: A systematic review and meta-analysis

“…Measurement of the circulating form of vitamin D that best describes total body stores, namely, 25-hydroxyvitamin D, can be unreliable despite many sophisticated methodologies that have been proposed and implemented [10]. Likewise, evidence from clinical studies showing a bene cial role of vitamin D in different disease states has been controversial and at times speculative [11].…”

“…Measurement of the circulating form of vitamin D that best describes total body stores, namely, 25-hydroxyvitamin D, can be unreliable despite many sophisticated methodologies that have been proposed and implemented [10]. Likewise, evidence from clinical studies showing a bene cial role of vitamin D in different disease states has been controversial and at times speculative [11].The effects of vitamin D on T1D remain a controversial topic.Vitamin D de ciency has been shown to be commonplace in patients with T1D [12]. Vitamin D, also called calciferol, is one of the essential fat-soluble vitamins that has a considerable role in the growth and strength of bones by controlling calcium and phosphorus homeostasis [13].…”

Adherence to an energy‐restricted Mediterranean diet is associated with the presence and burden of carotid atherosclerosis in people with type 1 diabetes

“…The results should be interpreted with caution as four studies were included and only two were RCTs. Two cross‐sectional studies 14,15 also found an association between adherence to the Mediterranean diet and better glycaemic control in children and adolescents with T1D. Another study conducted in youth with T1D 16 showed the benefit of a number of dietary habits typical of the Mediterranean diet (consumption of dairy products at breakfast, extra virgin olive oil or fish) with lower HbA1c and blood pressure.…”

“…Adherence to the erMEDd was assessed with the validated 17-item questionnaire (PP-17, [Table S1]) used in the intervention group of the ongoing PREDIMED-Plus clinical trial. 19,20 The questionnaire has a maximum score of 17 points (maximum adherence) and, based on the literature, 28 is classified according to approximate tertiles: low (≤7), medium (8)(9)(10) and high (11)(12)(13)(14)(15)(16)(17).The questionnaire was selfadministered on the same day the carotid ultrasound was performed. Compared to the energy-unrestricted 14-item questionnaire used in the PREDIMED study, 12 in addition to assessing the degree of adherence to the Mediterranean diet, the PP-17 emphasises the restriction of certain foods (e.g., refined grains or processed red meat) to reduce the total energy intake.…”

“…In primary and secondary prevention RCTs, increased adherence to the Mediterranean dietary pattern has been shown to significantly reduce major cardiovascular events 11–13 . In people with T1D, greater adherence to the Mediterranean diet has been associated with improved glycaemic control 14,15 and various metabolic parameters 16 . However, little information is available on the relationship of the Mediterranean diet with atherosclerosis and CVD 17,18 .…”