Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy.
Pediatr Diabetes. 2020 Sep;21(6):960-968. doi: 10.1111/pedi.13053. Epub 2020 Jun 12.
Diet plays a key role in the treatment of type 1 diabetes (T1D). Dietary habits changed rapidly in the last decades and few data are available on recent dietary changes in children and adolescents with T1D.
To test the hypothesis that diet composition changed in a 10-year period in children and adolescents with T1D.
Two hundred and twenty-nine T1D subjects (M/F:121/108) aged 6 to 16 years were recruited: 114 (group A) enrolled in 2009, not using CGM and/or CSII, and 115 (group B) enrolled in 2019. Anthropometric biochemical (HbA1c, lipid profile), diet, and insulin therapy parameters were compared between the two groups. Multivariate logistic regression analysis was performed with HbA1c as dependent variable (HbA1c > 58 mmol/mol = 1) and nutritional variables and technology use as independent ones.
Energy intake of group A was not statistically different from that of group B. Group B had a significantly (P < 0.001) higher protein and lipids intake and lower total carbohydrate and fiber intake than group A. HbA1c was significantly (P < 0.01) lower in group B than in group A. Logistic regression analysis showed that MUFA (OR 0.83, 95%CI:0.693-0.998), fiber intake (OR 0.82, 95%CI:0.699-0.0969), and technology use (OR 0.15, 95%CI:0.031-0.685), adjusted for age, gender, BMI, energy intake and diabetes duration, were associated with a HbA1c higher than 58 mmol/mol) (R = 0.27, P < 0.05).
In a 10-year period, diet composition of children and adolescents with T1D changed and glucometabolic control improved. Fiber and MUFA intake showed a positive effect on HbA1c, independent from technology use, supporting the importance of educating children with T1D and families to maintain healthy eating habits.
饮食在 1 型糖尿病（T1D）的治疗中起着关键作用。过去几十年饮食习惯发生了快速变化，而关于 T1D 儿童和青少年近期饮食变化的数据却很少。
验证关于 T1D 儿童和青少年饮食组成在 10 年内发生变化的假设。
共招募了 229 名 6 至 16 岁的 T1D 患者（男/女：121/108）：114 名（A 组）于 2009 年入组，未使用 CGMS 和/或 CSII，115 名（B 组）于 2019 年入组。比较两组之间的人体测量、生化（HbA1c、血脂谱）、饮食和胰岛素治疗参数。以 HbA1c 为因变量（HbA1c＞58mmol/mol=1），将营养变量和技术使用作为自变量进行多变量逻辑回归分析。
A 组的能量摄入与 B 组无统计学差异。B 组的蛋白质和脂质摄入量显著（P＜0.001）高于 A 组，总碳水化合物和纤维摄入量显著（P＜0.001）低于 A 组。B 组的 HbA1c 显著（P＜0.01）低于 A 组。逻辑回归分析显示，MUFA（OR 0.83，95%CI：0.693-0.998）、纤维摄入量（OR 0.82，95%CI：0.699-0.0969）和技术使用（OR 0.15，95%CI：0.031-0.685），调整年龄、性别、BMI、能量摄入和糖尿病病程后，与 HbA1c 高于 58mmol/mol（R=0.27，P＜0.05）相关。
在 10 年内，T1D 儿童和青少年的饮食结构发生了变化，血糖代谢控制得到了改善。纤维和 MUFA 的摄入对 HbA1c 有积极影响，独立于技术的使用，这支持了对 T1D 儿童及其家庭进行健康教育以保持健康饮食习惯的重要性。
