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Glucose-independent association of adiposity and diet composition with cardiovascular risk in children and adolescents with type 1 diabetes

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Abstract

Aims

To test the hypothesis that diet composition, adiposity and glycometabolic control could independently contribute to an increase in the cardiovascular risk (CVR) for children/adolescents with type 1 diabetes (T1D).

Methods

One hundred and eighty children/adolescents with T1D (age range 5–18 years) were enrolled. Diet (3-day weighed dietary record), physical (height, weight, waist circumference, bioelectrical impedance analysis) and biochemical (HbA1c, lipid profile) parameters were recorded. Regression models, using non-HDL cholesterol (a gross index of CVR) as the dependent variable and HbA1c (mmol/mol), fat mass (FM) %, lipid-to-carbohydrate intake ratio as independent ones, were calculated.

Results

Non-HDL cholesterol was significantly associated with adiposity (FM%; r = 0.27, 95% CI 0.13–0.43), body fat distribution (waist-to-height ratio; r = 0.16, 95% CI 0.02–0.31), lipid intake [% of energy intake (EI)] (r = 0.25, 95% CI 0.11–0.41), carbohydrate intake (% EI; r = −0.24, 95% CI 0.10–0.40), lipid-to-carbohydrate intake ratio (r = 0.26, 95% CI 0.12–0.42) and blood glucose control (HbA1c; r = 0.24, 95% CI 0.10–0.40). A p value cutoff of 0.10 was used for covariates to be included in the regression analysis. Multiple regression analysis showed that adiposity (FM%), blood glucose control (HbA1c) and lipid-to-carbohydrate intake ratio independently contributed to explaining the inter-individual variability of non-HDL cholesterol (R 2 = 0.163, p < 0.05).

Conclusions

Adiposity and lipid-to-carbohydrate intake ratio affect non-HDL cholesterol, a gross index of CVR, regardless of HbA1c, in children and adolescents with T1D. Intervention to reduce CVR in T1D patients should focus not only on glycometabolic control but also on adiposity and diet composition.

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Abbreviations

CVR:

Cardiovascular risk

BIA:

Bioelectrical impedance analysis

FM:

Fat mass

EI:

Energy intake

CVD:

Cardiovascular disease

MDI:

Multiple daily injection

CSII:

Continuous subcutaneous insulin infusion

BMI:

Body mass index

WC:

Waist circumference

WHtR:

Waist-to-height ratio

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

TG:

Triglycerides

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

ANOVA:

Analysis of variance

PAL:

Physical activity level

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Acknowledgements

The study was funded by the University of Verona, Department of Life and Reproduction Sciences (University Funds for Research FUR # 2013 MAFF). We kindly thank the patients and their families who participated in the study.

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Authors and Affiliations

  1. Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani, 1, 37126, Verona, Italy

    Claudio Maffeis, Elena Fornari, Anita Morandi, Claudia Piona, Francesca Tomasselli, Mara Tommasi & Marco Marigliano

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  1. Claudio Maffeis
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  2. Elena Fornari
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Correspondence to Marco Marigliano.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Informed consent was obtained from all patients for being included in the study.

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Maffeis, C., Fornari, E., Morandi, A. et al. Glucose-independent association of adiposity and diet composition with cardiovascular risk in children and adolescents with type 1 diabetes. Acta Diabetol 54, 599–605 (2017). https://doi.org/10.1007/s00592-017-0993-y

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