Associação entre padrão alimentar, estado nutricional e controle glicêmico de crianças e adolescentes com Diabetes Mellitus tipo 1

Abstract

Type 1 Diabetes Mellitus (DM1) is an autoimmune disease, resulting from the destruction of pancreatic β cells, causing complete deficiency in insulin production, more prevalent in childhood and adolescence and with an increasing incidence. Research suggests that children and adolescents with T1DM are following the same unhealthy eating practices that lead to obesity. Therefore, there is a need for investigations in order to assess the influence of diet quality on the nutritional status and metabolic control of children and adolescents with DM1. Objective: To evaluate the association between dietary patterns, nutritional status and glycemic control in children and adolescents with DM1. Methods: Cross-sectional study, carried out in a Reference Center for the treatment of Diabetes in Rio de Janeiro. The eligibility criteria was: age between 7 and 16 years old; diagnosis of DM1 for at least 1 year; and absence of other autoimmune diseases. Sociodemographic and outpatient follow-up data were obtained from the medical records. The assessment of food consumption was performed using a 24-hour Food Recall. To assess the nutritional status of children and adolescents, the Body Mass Index-for-Age (BMI-for-age) was used. Glycemic control was by glycated hemoglobin (HbA1c). Dietary patterns were created from factor analysis, with extraction by Principal Component Analysis and the distribution of individual adherence to each dietary pattern was classified into tertiles. Binomial statistical models were used for outcome estimates with dichotomous distributions and generalized linear models for outcomes estimates with continuous distribution. For both cases, the models were adjusted for the variables of gender, total calories consumed reported in a 24-hour recall, time of diagnosis, insulin dose and age, given that these may interfere with the results of the analyzed outcomes. Results: The sample of the present study had a total of 120 children and adolescents and 5 eating patterns were identified. The frequency of overweight was 31.7% (n= 38) and thinness in only 1.7% (n= 2), however, no statistically significant relationship was observed with the dietary patterns found. As for glycemic control, the average value of HbA1c was 8.13% (±1.3), highlighting that 64.2% (n= 77) had inadequate glycemic control and an increased risk of major complications was observed. HbA1c levels for individuals whose diet corresponds to dietary pattern 5, with a higher predominance of consumption of ultra-processed snacks. Conclusion: The results reinforce that the frequent consumption of ultra-processed foods can be detrimental to glycemic control and reinforce the importance of nutritional monitoring within the multidisciplinary care of patients with Type 1 Diabetes Mellitus.