Medical nutrition therapy (MNT) for children with type 1 diabetes (T1D) emerged in the 1990’s 1,2
and is an essential component of disease management. The goals of MNT are to keep blood glucose levels near normal, to avoid both acute and long term diabetes-related complications and to support normal growth and development. 3
The American Diabetes Association’s (ADA) current nutrition recommendations focus on matching the insulin dose to the grams of carbohydrates consumed. 4
The coordination of carbohydrate intake and insulin administration is emphasized in order to achieve near-normal glycemia since tighter glycemic control reduces the risk of microvascular complications in individuals with diabetes. 5
Dietary management of T1D has changed dramatically in recent years. Modern therapies, including the insulin pump and flexible injection regimens, have resulted in less restrictive dietary regimens, allowing children with T1D to lead more normal lifestyles. 6,7
Therefore, the ADA now recommends individualized meal planning based on food preferences, culture, physical activity patterns, family eating patterns and schedules. 4
Thus, today most children with T1D are able to eat what they want and do not have to time meals carefully or limit certain foods. Although flexible insulin regimens have decreased restrictive timing and consistency of food consumption, they also may have made it easier for children with T1D to eat unhealthful foods. For example, according to current dietary management of diabetes, children do not have to limit the amount of refined sweets consumed as long as they are included in their daily carbohydrate allowance and their glycemic targets are achieved. In addition, use of processed foods may be appealing to facilitate ease of carbohydrate counting. Nevertheless, healthful dietary practices are particularly important for children with diabetes due to their increased risk of dyslipidemia and cardiovascular disease.
There is no research supporting differing nutrient needs for children with T1D compared to children without diabetes. 3
Therefore, children with T1D, like all children, should follow the 2005 Dietary Guidelines for Americans () and consume a diet that emphasizes fruits, vegetables, whole grains, and low-fat milk while limiting intake of less-nutrient-dense foods. 8
Total fat intake should be 30% to 35% of calories for children 2 to 3 years of age, and 25% to 35% of calories for children 4 to 18 years of age. In addition, the ADA recommends that saturated fat intake should be less than 7% of total calories. 4
A diet emphasizing a wide variety of healthful foods and not just one that limit sugars and other carbohydrates is now recommended for children with T1D.
2005 Dietary Guidelines for Americans dietary recommendations for children*
Children with T1D and their families may hold misconceptions about what constitutes a healthful diet for diabetes management. In a recent qualitative study of 140 youths with T1D ages 7 to 16 years age discordance was demonstrated between what the youths thought were generally healthful foods and what foods they thought were good for managing their diabetes. 9
Youths correctly described overall healthful eating practices primarily in terms of eating fruits, vegetables and low-fat foods. However, many youths reported that “free” foods high in total fat, cholesterol and saturated fat (such as cheese, bacon, steak) were good choices for their diabetes management since these foods do not contain carbohydrates. There is some evidence that such perceptions translate into actual dietary practices. The SEARCH for Diabetes in Youth study reported higher than recommended amounts of total fat and saturated fat in the diets of children with T1D 10
; however, this study did not have a healthy control group, so it is unknown whether this dietary pattern is representative of children in general or specific to those with T1D. Yet other smaller studies have found that children with T1D do consume more total fat and saturated fat compared to healthy children. 11,12
The purpose of this study is to review the literature on usual dietary intake in children with type 1 diabetes (T1D) and to discuss approaches to promote dietary change that have potential efficacy.