Vitamin D and ω-3 Supplementations in Mediterranean Diet During the 1st Year of Overt Type 1 Diabetes: A Cohort Study

Abstract

Vitamin D and omega 3 fatty acid (ω-3) co-supplementation potentially improves type 1 diabetes (T1D) by attenuating autoimmunity and counteracting inflammation. This cohort study, preliminary to a randomized control trial (RCT), is aimed at evaluating, in a series of T1D children assuming Mediterranean diet and an intake of cholecalciferol of 1000U/day from T1D onset, if ω-3 co-supplementation preserves the residual endogen insulin secretion (REIS). Therefore, the cohort of 22 “new onsets” of 2017 received ω-3 (eicosapentenoic acid (EPA) plus docosahexaenoic acid (DHA), 60 mg/kg/day), and were compared retrospectively vs. the 37 “previous onsets” without ω-3 supplementation. Glicosilated hemoglobin (HbA1c%), the daily insulin demand (IU/Kg/day) and IDAA1c, a composite index (calculated as IU/Kg/day × 4 + HbA1c%), as surrogates of REIS, were evaluated at recruitment (T0) and 12 months later (T12). In the ω-3 supplemented group, dietary intakes were evaluated at T0 and T12. As an outcome, a decreased insulin demand (p < 0.01), particularly as pre-meal boluses (p < 0.01), and IDAA1c (p < 0.01), were found in the ω-3 supplemented group, while HbA1c% was not significantly different. Diet analysis in the ω-3 supplemented group, at T12 vs. T0, highlighted that the intake of arachidonic acid (AA) decreased (p < 0.01). At T0, the AA intake was inversely correlated with HbA1c% (p < 0.05; r;. 0.411). In conclusion, the results suggest that vitamin D plus ω-3 co-supplementation as well as AA reduction in the Mediterranean diet display benefits for T1D children at onset and deserve further investigation.

Metabolic and Metabolomic Insights Regarding the Omega-3 PUFAs Intake in Type 1 Diabetes Mellitus

“…The human diet is complex, and different nutrients could have synergistic or antagonistic effects. For example, vitamin D intake reduces the risk of T1DM in children ( Hyppönen et al, 2001 ), but also co-administration vitamin D and ω-3 PUFAs display benefits for T1DM in the same age group ( Cadario et al, 2018 ; Cadario et al, 2019 ). In order to truly determine the protective actions of ω-3 PUFAs in T1DM, their effects in the presence and absence of other nutrients, especially those with which they often associate, should be assessed in larger cohort studies, also following the metabolomics (lipidomics, in particular) changes that occur and monitoring the levels pro-/anti-inflammatory molecules and pro-/anti-oxidant balance.…”

Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus

“…Eine Kohortenstudie basierend auf 59 Kindern mit neu manifestiertem T1Dm, die die Effekte einer 12-monatigen Co-Supplementation von n-3-PUFAs und Vitamin D untersucht, ergab eine Verbesserung von Surrogatparametern der endogenen Insulinsekretion in der Gruppe der cosupplementierten Kinder vs. der nur mit Vitamin D supplementierten Kinder bei einer Reduktion der nutritiven Zufuhr von Arachidonsäure vor dem Hintergrund einer mediterranen Ernährung [101].…”

Prediction and Prevention of Type 1 Diabetes

“…This could explain the reported controversial results. A recent study shows that the integration of vitamin D with ω-3 co-supplementation and arachidonic acid reduction in the Mediterranean diet have benefits for T1D children at onset (40 (41). Although these results add relevant information on the risk of T1D, other components still need to be evaluated.…”

“…This could explain the reported controversial results. A recent study shows that the integration of vitamin D with ω-3 co-supplementation and arachidonic acid reduction in the Mediterranean diet have benefits for T1D children at onset ( 40 ). On the other hand, in the Type 1 Diabetes Prediction and Prevention Study (DIPP), Mäkinen et al compared the 25(OH)D umbilical cord serum concentration of 764 children born between 1994 and 2004 who participated in DIPP in Finland.…”