Bone mass and dietary intake in children and adolescents with type 1 diabetes mellitus.

OBJECTIVES: To evaluate the bone mineral density (BMD) in children/adolescents with type 1 diabetes mellitus (T1DM) and its association with the nutritional intake, metabolic control, and physical activity level of this population. METHODS: Study including 34 patients with T1DM and 17 controls. Assessments included the participants disease history, intake of macronutrient, calcium, phosphorus and magnesium, physical activity level, total body and lumbar spine BMD and serum levels of glycated hemoglobin, vitamin D, calcium, phosphorus, magnesium, osteocalcin and C-terminal telopeptide. RESULTS: Total body and lumbar spine BMD z-scores were normal in all but two participants in the T1DM group. The T1DM group had significantly lower total body BMD z-score values (p < 0.001) and levels of osteocalcin, C-terminal telopeptide, calcium, phosphorus, and magnesium. Intake of macronutrients and calcium was inadequate in both groups. Participants in the T1DM group were more sedentary (88%) and had inadequate metabolic control (91%) and low vitamin D levels (82%). Bone mass in the T1DM group was influenced by body mass index (BMI), pubertal stage, disease duration, calcium intake, and physical activity level. CONCLUSIONS: Bone mass in patients with T1DM was adequate but lower than controls and was influenced by BMI, pubertal stage, disease duration, calcium consumption, and physical activity level.

Influence of food consumption in the glycemic profile of children and adolescents with type 1 diabetes Mellitus / Influência do consumo alimentar no perfil glicêmico de crianças e adolescentes com diabetes Mellitus tipo 1

ABSTRACT Objective To review the dietary intake of children and adolescents with type 1 diabetes Mellitus and its association with the glycemic profile. Methods Longitudinal observational study. Dietary intake was measured using a three-day dietary record and the glycemic profile with a continuous glucose monitoring (range between 70 and 180mg/dL) and serum glycated hemoglobin levels (ideal <7.5%). Anthropometric data, insulin therapy, and carbohydrate counting were collected. Results The sample included 34 individuals with type 1 diabetes Mellitus aged 13.6±2.1 years. The majority of the population was eutrophic (76.4%). The entire sample used the basal-bolus insulin regimen, with mean insulin dose of 1.0±0.2U/kg/day; for 44.1% of the sample the carbohydrate counting method was used. Macronutrients intake was adequate in only 8.8% of the individuals, the highest frequency of inadequacy was related to carbohydrates (p=0.07). Inadequate glycemic control with hyperglycemia episodes and high mean glycated hemoglobin (9.7%) was observed in all individuals (61.3±18.5%). Carbohydrate counting was responsible for maintaining the percentage of time that the patient had interstitial blood glucose values within the range >40% (p<0.001) and maintaining the percentage of time in hyperglycemia <50% (p<0.001). Conclusion The majority of individuals were eutrophic, but presented inadequate dietary intake and glycemic control. The method of counting carbohydrates positively influenced the glycemic profile.

RESUMO Objetivo Analisar o consumo alimentar de crianças e de adolescentes com diabetes Mellitus tipo 1 e sua associação com o perfil glicêmico. Métodos Estudo observacional longitudinal. O consumo alimentar foi mensurado por meio de um registro alimentar de três dias, e o perfil glicêmico com um monitor contínuo de glicemia (alvo entre 70 e 180mg/dL) e de níveis séricos de hemoglobina glicada (ideal <7,5%). Foram coletados dados antropométricos, terapia insulínica e contagem de carboidratos. Resultados A amostra foi formada por 34 indivíduos com diabetes Mellitus tipo 1 com idade de 13,6±2,1 anos. A maior parte da população era eutrófica (76,4%). Toda a amostra utilizava o esquema de insulina basal-bolus, com dose média de 1,0±0,2U/kg/dia, e 44,1% realizava o método de contagem de carboidratos. O consumo dos macronutrientes estava adequado em apenas 8,8% dos indivíduos, sendo a maior frequência de inadequação nos carboidratos (p=0,07). Foram observados controle glicêmico inadequado com episódios de hiperglicemia em todos os indivíduos (61,3±18,5%) e média elevada de hemoglobina glicada (9,7%). A realização da contagem de carboidratos foi responsável por manter o percentual de tempo em que o paciente obteve valores de glicemia intersticial dentro do alvo >40% (p<0,001) e por manter o percentual de tempo em hiperglicemia <50% (p<0,001). Conclusão A maior parte dos indivíduos era eutrófica, porém apresentava consumo alimentar e controle glicêmico inadequados. O método de contagem de carboidratos influenciou positivamente o perfil glicêmico.

Associação entre o consumo alimentar e o nível de atividade física com o risco cardiometabólico em crianças e adolescentes portadores de diabetes mellitus tipo 1 / Association between food consumption and the level of physical activity, with the cardiometabolic risk in children and adolescents carried out of diabetes mellitus type 1

Introdução: O diabetes tipo 1 é uma doença crônica, caracterizada pela destruição das células beta pancreáticas que leva a uma deficiência de insulina. É a segunda doença crônica mais frequente da infância e sua incidência vem aumentando nas últimas décadas. O processo aterosclerótico é uma das complicações da doença, inicia-se na infância e sua extensão relaciona-se com o número e a gravidade dos fatores de risco cardiovascular encontrados. Objetivos: Investigar a influência do padrão da ingesta alimentar e do nível de exercício físico realizado por crianças e adolescentes portadores de diabetes mellitus tipo 1 com o risco cardiometabólico. Método: Estudo transversal de caráter descritivo, com crianças e adolescentes, idades entre 9 e 17 anos, portadores de diabetes mellitus tipo 1. Foram avaliados parâmetros antropométricos (peso corporal, altura, circunferência da cintura (CC), cálculos de índice de massa corporal (IMC), escore Z (E/I) e (IMC/I), aferição da pressão arterial, exames bioquímicos e determinação do estágio puberal, além de questionário para avaliação do nível de atividade física e um diário alimentar de 3 dias. Após dados obtidos, foi realizado a classificação dos pacientes, quanto portadores ou não de síndrome metabólica (SM). Resultados: A amostra compreendeu 31 pacientes (14 masculino e 17 feminino). Destes, 8 crianças e adolescentes apresentavam mais de 3 fatores de risco, sendo classificados como portadores de SM. O consumo alimentar foi considerado inadequado conforme o preconizado, em 90,32% dos avaliados. O consumo de calorias (p=0,039), proteínas (p=0,001) e colesterol (p=0,009) foi significativamente maior no sexo masculino. Tanto o grupo portador de SM como o sem SM apresentaram alimentação inadequada e sedentarismo instalado. Conclusão: Crianças e adolescentes com diabetes tipo 1 tendem a apresentar uma elevação no risco cardiovascular, devido aos fatores de risco presentes com frequência. Não se pode relacionar com a qualidade da alimentação e nível de atividade física.(AU)

Introduction: Type 1 diabetes is a chronic disease, characterized by the destruction of pancreatic beta cells that lead to insulin deficiency. It is the second most frequent chronic disease of childhood, and its incidence has been increasing in the last decades. The atherosclerotic process is one of the complications of the disease, which begins in childhood and its extension is related to the number and severity of the cardiovascular risk factors found. Objective: To investigate the influence of the dietary intake pattern and the level of physical exercise performed by children and adolescents with type 1 diabetes mellitus with cardiometabolic risk. Methods: Descriptive cross-sectional study with children and adolescents, ages 9 to 17 years, with type 1 diabetes mellitus. The study also evaluated anthropometric parameters (body weight, height, waist circumference (WC), body mass index (BMI), Z score (E / I) and (BMI / I), blood pressure measurement, biochemical tests and determination of the pubertal stage, and included a questionnaire to assess the level of physical activity and a food diary of 3 days. After the data were obtained, the classification of patients, whether or not with metabolic syndrome (MS), was performed. Results: The sample consisted of 31 patients (14 male and 17 female). Of these, 8 children and adolescents had more than 3 risk factors, being classified as having MS. Food intake was considered inadequate according to what was recommended in 90.32% of the patients evaluated. Calorie consumption (p=0.039), protein (p=0.001) and cholesterol (p=0.009) were significantly higher in males. Both the SM and non-SM groups presented inadequate diet and sedentary lifestyle. Conclusion: Children and adolescents with type 1 diabetes frequently tend to present an elevation in cardiovascular risk due to present risk factors. It can not be related to the quality of the diet and level of physical activity.(AU)