title: Multiple indicators of poor diet quality in children and adolescents with type 1 diabetes are associated with higher body mass index percentile but not glycemic control.
abstract: BACKGROUND
  Diet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied.
  
  
  OBJECTIVE
  To evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile.
  
  
  METHODS
  In this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index.
  
  
  METHODS
  Children and adolescents with type 1 diabetes ≥ 1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data.
  
  
  METHODS
  Associations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression.
  
  
  RESULTS
  Participants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4 ± 11.0 (range = 26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P = 0.04) and whole-grain (P = 0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P = 0.01) and whole-grain (P = 0.04) intake and NRF 9.3 score (P = 0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses.
  
  
  CONCLUSIONS
  Data demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7510, USA. nanselt@mail.nih.gov
authors.forename: Tonja R
authors.initials: TR
authors.lastname: Nansel
authors.forename: Denise L
authors.initials: DL
authors.lastname: Haynie
authors.forename: Leah M
authors.initials: LM
authors.lastname: Lipsky
authors.forename: Lori M B
authors.initials: LM
authors.lastname: Laffel
authors.forename: Sanjeev N
authors.initials: SN
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D001900:Boston; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy*; D015930:Diet Records; D003927:Diet, Diabetic / Q000592:standards*; D002523:Edible Grain; D005260:Female; D005638:Fruit; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D016014:Linear Models; D008297:Male; D015596:Nutrition Assessment; D018673:Nutrition Policy; D010349:Patient Compliance; D014675:Vegetables
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin