- Title
- Risk factors for overweight and obesity in children and adolescents with type 1 diabetes
- Creator
- Marlow, Alexandra Louise
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- People with type 1 diabetes (T1D) are disproportionately affected by cardiovascular disease (CVD) related morbidity and mortality. Data suggests cardiometabolic risks associated with being overweight or obese may offset the protective effects of intensive insulin therapy (IIT) for cardiovascular health. Maintenance of a healthy body weight is essential to reduce the risk of CVD, but a small body of evidence suggests children and adolescents with T1D are at increased risk of overweight and obesity compared to population data. Moreover, the management of T1D is complex and may pose additional barriers to healthy lifestyle behaviours such as regular physical activity. The unique risk factors for overweight and obesity in children and adolescents with T1D remain poorly understood. The lack of guidelines for weight management in this group underscores a gap in knowledge regarding who is most at risk, at what age, and at what stage after T1D diagnosis risk increases. Furthermore, it is important to identify what risk factors are most important to target for successful weight management in this at-risk group. To address these evidence gaps, this thesis sought to identify the prevalence of overweight and obesity in children and adolescents with T1D compared to a reference population and to explore potential risk factors for overweight and obesity. The results of a short narrative review exploring overweight and obesity and mechanisms of weight gain in children and adolescents with T1D highlighted a clear trend for elevated body weight in international cohorts of young people with T1D. A propensity toward excessive weight gain in females with T1D increasing with age was identified, along with a high prevalence of CVD risk factors in adolescents with T1D. The review highlighted the possible roles of IIT and longer diabetes duration in the development of overweight and obesity, and potential barriers to weight management such as fear of hypoglycaemia and disordered eating behaviours. Furthermore, several gaps in current understanding of the mechanisms of excessive weight gain in children and adolescents with T1D were found regarding modifiable risk factors for overweight and obesity such as physical activity, sedentary behaviours, sleep and dietary factors. A retrospective cross-sectional study was undertaken to determine the prevalence of overweight and obesity across two major Australian paediatric and young adult diabetes clinics, and to compare rates of overweight and obesity to sex and age-matched reference populations. Results showed females with T1D are significantly more overweight or obese compared with girls and young women from age matched groups in the general population. Overweight increased with age and was associated with increased CVD risk factors. To investigate a potential relationship between IIT and overweight in adolescents with T1D, a retrospective cross-sectional study comparing BMI-SDS and glycaemic control before and after the implementation of IIT in adolescents with T1D was undertaken. This study found that despite a doubling in the number of adolescents achieving the recommended glycaemic target of <7.0% from 2004 to 2016 after the implementation of IIT across the paediatric T1D clinic, body weight remained stable, highlighting it is possible to achieve target glycaemic control on an intensified insulin regimen without excessive weight gain. A prospective cross-sectional study was undertaken to determine physical activity levels, sedentary behaviour, sleep and barriers to physical activity in adolescents with T1D, and examine possible associations between moderate-to-vigorous physical activity (MVPA), barriers to physical activity and overweight in this group. This study found Australian adolescents with T1D engage in insufficient amounts of MVPA, spend excessive amounts of time in sedentary behaviour and have inadequate sleep. MVPA was not associated with body mass index however, and there was no difference in amounts physical activity, sedentary behaviour or sleep across healthy weight and overweight or obese groups. Diabetes-specific barriers to physical activity were experienced by less than half of participants and these barriers were not reported to impact participation in MVPA. Finally, in a systematic review examining the associations between modifiable lifestyle risk factors and overweight and obesity in children and adolescents with T1D, higher fat, lower carbohydrate intake and disordered eating behaviours were associated with excess adiposity. There was a small amount of evidence to suggest higher frequency of skipping meals and less time in rapid eye movement sleep are associated with increased adiposity, and that higher fruit and wholegrain intake have a protective effect on body weight. Overall, this sequence of studies seeks to improve the understanding of high rates of overweight and obesity in young people with T1D. Clinical implications and specific recommendations are offered for practice and research to improve health outcomes for children living with T1D.
- Subject
- type 1 diabetes; children and adolescents; prevalence; risk factors; overweight and obesity; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1511596
- Identifier
- uon:56512
- Rights
- Copyright 2024 Alexandra Louise Marlow
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 360 KB | Adobe Acrobat PDF | View Details Download |