Dietary Recommendations for Children and Adolescents with Diabetes: An Implementation Paper

Abstract

General Recommendations: 1. Children with diabetes mellitus have the same basic nutritional requirements as other children. 2. Dietary recommendations should be based on good eating habits for the whole family. Radical changes in diet involving unusual foods or eating patterns for the child with diabetes alone are not appropriate. 3. Energy requirements of children vary widely and the energy content of the diet should be based on what the child usually eats. The diet should be reviewed regularly to meet the changing needs of growth and physical exercise without obesity. 4. The insulin regimen should, as far as is possible, be chosen to fit the child's daily lifestyle and preferred eating habits. Insulin type, dose, and frequency should be reviewed with the diet as the child develops. 5. Regular distribution of meals and snacks throughout the day remains the most important way to avoid extremes of hyperglycaemia and hypoglycaemia. This distribution should be based on an exchange system, using handy measures and taking into account food and meal type, the particular insulin regimen and the child's exercise patterns and usual eating habits. Currently this exchange system is based on carbohydrate foods but in the future the energy and fat contents will need further consideration. 6. Most special 'diabetic foods' are unnecessary. Low calorie sweeteners, as used in low calorie fruit squashes and fizzy drinks, are useful. 7. Children with diabetes from specific ethnic minority groups, or on vegan diets or living in deprived circumstances require special dietary attention for their diabetes. Those with coexisting chronic disorders such as cystic fibrosis or coeliac disease, should receive dietary advice from professionals with specialist knowledge. 8. Translating the principles of diabetic dietary management into a varied diet, arranged readily by the parents and eaten by the child, is demanding. It can best be met by a skilled dietitian working in close co-operation with child, parents, diabetes specialist nurse and doctor. Infancy 9. The diet should not differ from that of infants without diabetes. Breast feeding should be encouraged or a standard infant formula-feed used. Solids may be introduced from 3-6 months, but breast milk or a modified infant formula is encouraged as part of the increasingly mixed diet to at least the end of the first year. 10. Diabetes is rare in infancy so expert advice should be sought from dietitians experienced in paediatric diabetes. Under fives: 11.(ABSTRACT TRUNCATED AT 400 WORDS)

Two year prospective dietary survey of newly diagnosed children with diabetes aged less than 6 years

“…3 Recent Nordic nutrition recommendations7 for children aged 1 to 3 years recommend a fat intake 30–35% of total energy, after which the amount recommended for adults (30%) could be gradually reached. In our study, the mean proportion of fat of total energy increased slightly with the duration of diabetes, but was always below the UK recommendation.…”

Sweets, snacking habits, and skipping meals in children and adolescents on intensive insulin treatment

“…Nutritional management is considered an essential component of diabetes treatment, and diabetic subjects have long been advised to have a regular meal pattern and not skip meals to easier control blood glucose level (1). The non‐diabetic Western population seems to increasingly move away from regular meal patterns, and the prevalence of skipping meals is greater among healthy children and adolescents than among adults (2–4).…”

Dietary Intake of Austrian Diabetic Children 10 to 14 Years of Age

“…Nutritional education strategies should concentrate on increasing the intake of complex CHOs and reducing fat, and especially cholesterol, in the diet of the entire population, at a national level. Qualitative, rather than quantitative, advice may be more promising and successful in the dietary management of children with diabetes (4,26).…”

“…Diet therapy is considered an integral part of diabetes management. The current dietary recommendations for people with diabetes mellitus are well established (1‐4). A diet restricted in fats and proteins and abundant in complex carbohydrates (CHOs) and fibers is recommended because of the potential relationship between fat intake and macrovascular diseases and between protein intake and renal complications (5‐7).…”