Glucose-independent association of adiposity and diet composition with cardiovascular risk in children and adolescents with type 1 diabetes

Aims: To test the hypothesis that diet composition, adiposity and glycometabolic control could independently contribute to an increase in the cardiovascular risk (CVR) for children/adolescents with type 1 diabetes (T1D). Methods: One hundred and eighty children/adolescents with T1D (age range 5–18 years) were enrolled. Diet (3-day weighed dietary record), physical (height, weight, waist circumference, bioelectrical impedance analysis) and biochemical (HbA1c, lipid profile) parameters were recorded. Regression models, using non-HDL cholesterol (a gross index of CVR) as the dependent variable and HbA1c (mmol/mol), fat mass (FM) %, lipid-to-carbohydrate intake ratio as independent ones, were calculated. Results: Non-HDL cholesterol was significantly associated with adiposity (FM%; r = 0.27, 95% CI 0.13–0.43), body fat distribution (waist-to-height ratio; r = 0.16, 95% CI 0.02–0.31), lipid intake [% of energy intake (EI)] (r = 0.25, 95% CI 0.11–0.41), carbohydrate intake (% EI; r = −0.24, 95% CI 0.10–0.40), lipid-to-carbohydrate intake ratio (r = 0.26, 95% CI 0.12–0.42) and blood glucose control (HbA1c; r = 0.24, 95% CI 0.10–0.40). A p value cutoff of 0.10 was used for covariates to be included in the regression analysis. Multiple regression analysis showed that adiposity (FM%), blood glucose control (HbA1c) and lipid-to-carbohydrate intake ratio independently contributed to explaining the inter-individual variability of non-HDL cholesterol (R2 = 0.163, p < 0.05). Conclusions: Adiposity and lipid-to-carbohydrate intake ratio affect non-HDL cholesterol, a gross index of CVR, regardless of HbA1c, in children and adolescents with T1D. Intervention to reduce CVR in T1D patients should focus not only on glycometabolic control but also on adiposity and diet composition.