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Medical nutrition therapy is a cornerstone in type 1 diabetes management and is based on the principles of healthy eating. The recommendations presented are valid for all children and their families. A number of frequently asked questions will be addressed in this article. Although carbohydrates are the main nutrient that affects postprandial blood glucose in individuals with type 1 diabetes, intake of carbohydrates (type and amount), protein and fat content of the meal, and glycemic index affect the postprandial glycemic response. In recent years, the relative increase in studies about Ramadan fasting for individuals with type 1 diabetes has indicated that health professionals should be informed about this issue. The difficulties in nutritional management of preschool children should be solved with a professional approach. The increasing frequency of celiac disease in people with type 1 diabetes and an increasing interest in a gluten-free diet for non-celiac reasons (popular diet trends for weight loss or healthy eating) further complicate diabetes management. This review provides evidence-based approaches to frequently encountered problems on medical nutrition therapy in children and adolescents with type 1 diabetes. [ABSTRACT FROM AUTHOR]

The data regarding the application of motivational interviewing techniques (MITs) in the treatment of obese adolescents contain conflicting results. The case examined in this study belongs to a patient who was advised to diet and exercise and given medication for 5 years in the examination by a dietician and various outpatient clinics. However, the patient did not comply with the diet or use medication regularly, so weight gain continued. Laboratory tests showed the presence of insulin resistance and hepatosteatosis. The patient was sedentary, uncomfortable with their weight, and had limited family and peer relationships. The patient's BMI SDS was 3.7, with the physical examination showing the presence of acanthosis nigricans, striae, and mild kyphosis. MITs were conducted every 15 days for the first 3 months, and then once a month. At the end of the two-year follow-up, the patient's weight had decreased to 62 kg (BMI = 24.2 kg/m2, +1.15 SDS), and their family-peer relationships had improved. MITs are a treatment method healthcare teams should use for treating obesity in adolescents. MITs are also effective for the accompanying psychopathologies. Conducting frequent interviews in the early stages of obesity treatment may result in more positive findings. [ABSTRACT FROM AUTHOR]

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It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD. [ABSTRACT FROM AUTHOR]

Objective: Increased risk of unfavorable cardiovascular risk factors has been recognised in ageing patients with haemophilia (PwH), but needs further studies in younger patients. The purpose of this study was to assess obesity, hypertension (HT), metabolic variables, insulin resistance and metabolic syndrome in young PwH. Methods: Forty-eight haemophilia A and B patients and 35 age and sex matched healthy controls were included in the study. Anthropometric measurements, blood pressure (BP), fasting glucose and insulin levels, serum lipids and diet were evaluated. The metabolic syndrome was defined according to the criteria of the International Diabetes Federation for pediatric and adult age groups. Results: The mean age of PwH was 21±9 years (range, 6-40 years). Of those ≥18 years, 46% were were obese/overweight while there were no obese/overweight cases in the <18 year-old patients. Obesity was more prevalent in PwH with arthropathy (p=0.017). Seven percent of the PwH between 10 and 18 years-old and 25% of those ≥18 years had metabolic syndrome. There was no difference in metabolic syndrome frequency between PwH and controls >10 years-old (19.5% vs 10% respectively, p=0.34). Fifty percent of the PwH ≥18 years-old had elevated BP or HT. Fasting blood glucose levels of PwH were significantly higher compared to controls (p=0.02). Conclusion: Our study showed that obesity, HT and metabolic syndrome are frequent problems, especially in PwH with arthropathy. Early prevention and management of overweight, obesity and their sequelae must be addressed in clinical practice in order to maximize the overall health of the haemophilia population. [ABSTRACT FROM AUTHOR]