Diet of Adolescents With and Without Diabetes: Part 2

There have been drastic changes over the last 3 decades with regard to the dietary recommendations for people with diabetes. Before 1994, nutrition recommendations were set forth for all people with diabetes with little regard to the individual’s lifestyle. After 1994 and consistent with the 2002 American Diabetes Association (ADA) evidence-based guidelines, the emphasis shifted from a strict focus on dietary components to a focus on maintaining target blood glucose levels and a lipid profile and blood pressure that reduce the risk of chronic disease. The current ADA nutrition recommendations for children and adolescents with type 1 diabetes share these goals and also focus on adequate nutrient intake for growth and development. These recommendations are based on the requirements for nondiabetic children and adolescents that are collected in the Dietary Reference Intakes, which update and expand the recommended dietary allowances (RDAs).

Only a few studies have examined the diets of children with type 1 diabetes, and even fewer have compared those diets with children without diabetes. In terms of energy intake, two studies of children with type 1 diabetes found that energy intake was lower than recommended; one study found that children met the RDA, and a fourth study found that male subjects met the RDA but female subjects had energy levels below the RDA. Two studies compared the energy intake of children with diabetes with that of matched control subjects. One study found that the intake of children with diabetes fell below that of control subjects who met the RDA, and the other study, based solely on girls, found no difference between children with diabetes and control subjects in energy intake, with both groups reporting lower intake than predicted by energy expenditure.

Studies have also examined the components of dietary intake. Carbohydrates are an important consideration in the diets of children with type 1 diabetes, as they are the principal source of energy but require appropriate amounts of insulin to be utilized by the body. Four studies found that children met carbohydrate requirements, and one study found that children had a lower carbohydrate intake than recommended. In the two studies that included a comparison group, children with diabetes had a lower carbohydrate intake than age- and sex-matched control subjects.