The Impact of a Low-Carbohydrate Diet on Micronutrient Intake and Status in Adolescents with Type 1 Diabetes

Abstract

Objective: The aim of this study was to evaluate the macronutrient and micronutrient intake and status in youth with type 1 diabetes mellitus (T1DM) following the consumption of a low-carbohydrate diet (LCD). Research Methods and Procedures: In a prospective intervention clinical trial, adolescents with T1DM using a continuous glucose monitoring device were enrolled. Following a cooking workshop, each participant received a personalized diet regime based on LCD (50–80 g carbohydrate/day). A Food Frequency Questionnaire was administered, and laboratory tests were taken before and 6 months following the intervention. Twenty participants were enrolled. Results: The median age was 17 years (15; 19), and the median diabetes duration was 10 years (8; 12). During the six-months intervention, carbohydrate intake decreased from 266 g (204; 316) to 87 g (68; 95) (p = 0.004). Energy intake, the energy percent from ultra-processed food, and fiber intake decreased (p = 0.001, p = 0.024, and p < 0.0001, respectively). These changes were accompanied by declines in BMI z-score (p = 0.019) and waist-circumference percentile (p = 0.007). Improvement was observed in the median HbA1c from 8.1% (7.5; 9.4) to 7.7% (6.9; 8.2) (p = 0.021). Significant declines below the DRI were shown in median intake levels of iron, calcium, vitamin B1, and folate. Conclusions: The LCD lowered ultra-processed food consumption, BMI z-scores and the indices of central obesity. However, LCDs require close nutritional monitoring due to the possibility of nutrient deficiencies.

The Mediterranean Diet for Adolescents with Type 1 Diabetes: A Prospective Interventional Study

“…Although the amount of carbohydrates in grams did not differ significantly before and after intervention, the proportion of carbohydrates in total calories was lower after the diet. This change might have contributed to the observed improvement in glycemic control, as seen in other studies [25]. The intensive nutritional monitoring program, conducted by a registered dietitian, might also have contributed to better glycemic control [26,27].…”

Effect of Isocaloric Meals on Postprandial Glycemic and Metabolic Markers in Type 1 Diabetes—A Randomized Crossover Trial

“…In our study, we found more favorable glycemic effects after the HP and HF meals, which reflect the macronutrient composition of low carbohydrate diets (LCDs). LCDs have been found to reduce HbA1c in people with T2D [ 31 ] and T1D [ 32 ] and decrease time spent in hypoglycemia and glycemic variability in people with T1D [ 33 ]. Moreover, the higher MUFA content of our HP and HF meals resembles Mediterranean-style diets, which have shown beneficial long-term effects on CVD risk factors in T2D [ 31 ].…”

The Influence of Body Fat and Lean Mass on HbA1c and Lipid Profile in Children and Adolescents with Type 1 Diabetes Mellitus

“…The increase in the proportion of body fat (especially visceral fat) and the reduction in lean mass is negatively related to glycemic and lipid metabolism, leading to worse glycemic control and the need for insulin dose increments in DM1 patients [ 10 , 11 , 12 ]. Changes in insulin sensitivity are due to the change in the secretory pattern of adipose tissue from lean to obese, where M2 macrophages can be replaced by M1, resulting in an increased gene expression and production of pro-inflammatory mediators that are released by adipose visceral tissue.…”

“…Although DM1 patients traditionally tend to be underweight, the increase in sedentary lifestyles and exacerbated consumption of foods high in sugar and fat has contributed to weight gain in this population. It is known that an increase in the proportion of fat, especially visceral fat, and a reduction in lean mass worsen glycemic control and plasma lipid levels [ 10 , 11 , 12 ]. In addition, the increase in visceral adipose tissue to the detriment of the reduction in lean mass has direct implications for installing a pro-inflammatory scenario and oxidative stress that will strongly contribute to the micro and macro-vascular complications [ 13 , 14 , 15 , 16 ].…”