- Title
- Nutritional management in children and adolescents with diabetes
- Creator
- Smart, Carmel E.; International Society for Pediatric and Adolescent Diabetes,; Annan, Francesca; Bruno, Luciana P. C.; Higgins, Laurie A.; Acerini, Carlo L.
- Relation
- Pediatric Diabetes Vol. 15 , Issue S20, p. 135-153
- Publisher Link
- http://dx.doi.org/10.1111/pedi.12175
- Publisher
- Wiley-Blackwell Publishing
- Resource Type
- journal article
- Date
- 2014
- Description
- ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Executive summary and Recommendations: Nutrition therapy is recommended for all children and adolescents with type 1 diabetes. Implementation of an individualized meal plan with appropriate insulin adjustments can improve glycemic control (A). ; Dietary recommendations are based on healthy eating principles suitable for all children and families with the aim of improving diabetes outcomes and reducing cardiovascular risk (E). ; Nutritional advice should be adapted to cultural, ethnic, and family traditions, as well as the cognitive and psychosocial needs of the individual child (E). ; A specialist pediatric dietician with experience in childhood diabetes should be part of the interdisciplinary team and should be available as soon as possible at diagnosis to develop a lasting trusting relationship (E). ; Energy intake and essential nutrients should aim to maintain ideal body weight, optimal growth, health and development and help to prevent acute and chronic complications. Growth monitoring is an essential part of diabetes management (C). ; The optimal macronutrient distribution varies depending on an individualized assessment of the young person. As a guide, carbohydrate should approximate 50–55% of energy, fat <35% of energy (saturated fat <10%), and protein 15–20% of energy (C). ; Matching of insulin dose to carbohydrate intake on intensive insulin regimens allows greater flexibility in carbohydrate intake and meal times, with potential for improvements in glycemic control and quality of life (B). However, regularity in meal times and eating routines are still important for optimal glycemic outcomes (C). ; There are several methods of quantifying carbohydrate (CHO) intake (gram increments, 10–12 g CHO portions and 15 g CHO exchanges). There is no strong research evidence to suggest that one particular method is superior to another (E). ; Fixed insulin regimens require consistency in carbohydrate amount and timing to improve glycemic control and reduce the risk of hypoglycemia (C). ; The use of the glycemic index (GI) provides additional benefit to glycemic control over that observed when total carbohydrate is considered alone (B). ; Dietary fat and protein may impact postprandial glycemia (A). Randomized controlled trials of methods to manage hyperglycemia after meals high in fat and protein are required (E). ; Prevention of overweight and obesity in pediatric type 1 diabetes is a key strategy of care and should involve a family based approach (B). ; Weight loss or failure to gain appropriate weight may be a sign of illness (infections, celiac disease, and hyperthyroidism), insulin omission or disordered eating (C). ; Nutritional advice should be provided on how to cope successfully with physical activity, exercise, and competitive sports (E). ; Nutritional management of type 2 diabetes requires a family and community approach to address the fundamental problems of excessive weight gain, lack of physical activity, and the increased risk of cardiovascular disease (E). ; There is a need for more research and evaluation of dietetic management in childhood diabetes (E).
- Subject
- consensus; diabetes; guidelines; nutrition
- Identifier
- http://hdl.handle.net/1959.13/1302306
- Identifier
- uon:20448
- Identifier
- ISSN:1399-5448
- Language
- eng
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