The Impact of Obesity and Lifestyle Status on Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes (T1D)

Cardiovascular disease is more frequent in patients with T1D than the general population. The aim of the study was to examine the impact of obesity, diet and physical activity (PA) on common cardiovascular risk factors in youth with T1D. Cross-sectional analyses were performed using data from 96 T1D subjects [mean age 13.4 ± 2.7 years, (females 57%), median disease duration 5.3 (range 3.5-8.4) years]. Dietary intake was evaluated by a single 24-hour dietary recall and a food frequency questionnaire (FFQ). Diet quality was assessed with the KIDMED test. The ENERGY-child questionnaire was used for the assessment of PA. Systolic (SBP), diastolic (DBP) blood pressure, HbA1c levels and lipid profile were evaluated. The prevalence of overweight/obesity was 31%. Overweight/obese individuals were in higher SBP percentile, compared to those with normal weight (68.59 ± 26.58 vs. 51.77 ± 26.72, P = 0.006). In multiple regression analysis, higher BMI z-score, was associated with higher ηbA1c (standardized β = 0.334, P = 0.002, R² = 0.268) and higher triglycerides (standardized β = 0.224, P = 0.05, R² = 0.095). Most participants (80%) abstained from optimal Mediterranean Diet (MD). Lower KIDMED score was associated with higher ηbA1c (standardized β = - 0.432 P < 0.001, R² = 0.268). Partial correlation analyses after controlling for confounding factors revealed that BMI z-score was negatively correlated with low fat dairy portions/d (r = - 0.315, P < 0.05), HbA1c was positively correlated with high fat dairy portions/d (r = 0.305, P < 0.05) and SBP percentile was negatively correlated with total milk and yogurt portions/d (r = - 0.313, P < 0.05). Moreover, higher participation in sports (hours/week), was associated with lower DBP percentile (standardized β = - 0.283, P = 0.015, R² = 0.080). The maintenance of a healthy body weight and a physically active lifestyle, was accompanied by lower BP levels in the participants of this study. Greater adherence to MD was associated with lower HbA1c.