Dietary sodium intake relates to vascular health in children with type 1 diabetes

Abstract

Background and Objective Children with type 1 diabetes (T1D) have vascular dysfunction and frequently struggle to adhere to dietary recommendations. Limited data exist for the vascular consequences of poor diet quality in children. We aimed to evaluate the association between dietary components and vascular function in children with T1D. Methods Cross‐sectional study including 90 children (13.6 [3.5] years, 41 boys) with T1D. They had evaluation of dietary micro and macronutrients (Australian Child and Adolescent Eating Survey), vascular endothelial and smooth muscle function (flow‐mediated dilatation and glyceryl trinitrate mediated dilatation [GTN], respectively), clinical and biochemical variables. Results Children had a sodium intake of 3.013 (0.76) (mean [SD]) g/day. Vascular smooth muscle dysfunction, as measured by GTN, related to higher daily sodium intake (r = −0.31, P = .003), independent of the inverse relationships between GTN and total energy (r = −0.30, P = .005) and fat intake (r = −0.28, P = .007). Multiregression model showed that an increase in 1 g of daily sodium intake was independently associated with a deterioration of 3 percentage units in GTN (95% CI −4.3, −0.9; P = .003). There was an association between sodium intake and systolic blood pressure after adjustment for age and gender (regression coefficient 2.4; 95% CI 0.5, 4.3; P = .01). Conclusions High dietary sodium intake in children with T1D is common and relates to vascular dysfunction, independently of other dietary intake, blood pressure, and glycemic control.

Australian children with type 1 diabetes consume high sodium and high saturated fat diets: Comparison with national and international guidelines

“…Similarly, the SEARCH for Diabetes in Youth Study found that children with T1D consumed sodium above the recommended levels . As we have shown that excess sodium intake in this age group relates to vascular dysfunction independent of other dietary intake, blood pressure and glycaemic control, this is of significant concern . Unhealthy diets during adolescence have been related to hypertension, metabolic syndrome and higher carotid intima media thickness in young adulthood …”

Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)

“…Identified studies were meta‐analyses (n = 1), RCTs (n = 3), prospective cohort studies (n = 4), retrospective case–control studies (n = 1), cross‐sectional studies (n = 27), case–control studies (n = 1), post hoc analyses of RCTs (n = 2), and quasi‐experimental studies (n = 3). Three studies assessed morbidity outcomes, two studies assessed outcomes related to symptoms/quality of life/functional status, 31 studies assessed clinically relevant surrogate outcomes, including 26 that assessed blood pressure outcomes, and six studies assessed physiologic outcomes . Of these studies, only three studies met the minimum methodological criteria for detailed critical appraisal (Table ).…”

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

“…High-dietary sodium intake in children with type 1 diabetes is common and relates to vascular dysfunction. 56…”

“…Children with diabetes should limit their sodium intake to at least that of recommendations for the general population. High‐dietary sodium intake in children with type 1 diabetes is common and relates to vascular dysfunction …”