Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications

Abstract

Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of “double diabetes”. The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.

Adherence to the Mediterranean Diet Is Associated with Better Metabolic Features in Youths with Type 1 Diabetes

“…Furthermore, females in our cohort were more at risk similar to other reports [32,33,35]. In all these studies, several factors have been associated with this risk of overweight/obesity in T1D as increased functional growth hormone (GH) secretion, longer disease duration, intensive insulin therapy in relation to pubertal insulin-resistance or flexible eating patterns, high insulin doses that could inhibit protein catabolism and slow basal metabolism or frequent snacking to avoid hypoglycemia [36,37]. However, only a few authors focused on dietary risk factors and even fewer on the MedDiet.…”

Impact of an Abdominal Compression Bandage on the Completion of Colonoscopy for Obese Adults: A Prospective Randomized Controlled Trial

“…In the USA, the prevalence of overweight or obesity is approximately 35% in males and 40.4% in females, which may increase to 86% in adults by 2030 [ 22 , 23 ]. Furthermore, it has been shown that obesity is one of the most significant predisposing factors for numerous cancers and chronic diseases, such as CRC, hypertension, and diabetes [ 23 , 24 ]. Moreover, obesity is significantly associated with colorectal adenomas and CRC [ 2 , 4 ].…”

Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review

“…A positive relationship exists between a country's level of economic development as measured by GDP and obesity [40]. An elevated BMI and a sedentary lifestyle may exacerbate insulin resistance, which could lead to β-cells fatigue and triggering of an autoimmune response with resultant β-cell apoptosis [41,42]. There exists a complex relationship between environmental factors and genetic risk for T1D or type 2 diabetes which likely plays a role in autoimmunity pathogenesis and presentation of clinical disease.…”