**5. Fat**

The proportion of fat content in total energy intake should be approximately 35% in young children, and 25-30% in older children.

improve insulin sensitivity; decreases blood glucose and triglyceride levels and arterial blood pressure as well. The Mediterranean diet, with increased use of olive oil-rich omega-9 fatty acids, reduces LDL cholesterol without affecting HDL cholesterol. Its intake improves insulin sensitivity, blood glucose and triglyceride levels and blood pressure. These mecha‐ nisms explain the reduction in coronary heart disease in Mediterranean countries. Monoun‐ saturated fatty acids are more resistant to lipid peroxidation than the polyunsaturated fatty

Nutritional Management in Type 1 Diabetes Mellitus

http://dx.doi.org/10.5772/52465

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Trans-isomers of polyunsaturated fatty acids formed during the hydrogenation process may have potentially harmful effects. These trans-isomers are formed during solidification of vegetable oils. They are found in margarine and pastries, and intake of these foods increases LDL cholesterol and lowers HDL cholesterol. Therefore, in the UK and some European countries the intake of these trans-isomers in the amounts more than 5 g / day is not recom‐ mended. A consideration was given on intake of long chain omega-3 fatty acids. Epidemio‐ logical research studies have shown that prolonged use of concentrated fish oil may have an anti-atherogenic effect thanks to the high omega-3 acid contents (A. Simopoulos, 1991).

The existing nutritional recommendations of the European Association for the Study of Dia‐ betes (EASD) and American Diabetes Association (ADA) on dietary composition promote greater flexibility in the proportions of energy derived from carbohydrate and from mono‐ unsaturated fat (MUFA). MUFA are promoted as the main source of dietary fat because of their lower susceptibility of lipid peroxidation and consequent lower atherogenic potential

In diabetes, cholesterol intake is limited to a maximum of 300 mg daily, in order to slow down the development of atherosclerotic process. This means that cholesterol-rich foods (brain, egg yolk) should be avoided, and lean meat (veal, beef, chicken) or fish should be

Proteins are an essential nutrient, necessary for normal growth and development in child‐ hood. Adequate protein ingestion is critical in normal muscle development. Proteins are an

The recommended intake is 15% of total caloric daily intake in older children and 20% in younger. The intake of proteins per kilogram of body weight should be higher in infants, children and adolescents in comparison to adults in order to support growth and develop‐ ment. The daily requirements are about 1.5g/kg for preschool children for and somewhat less -1g/kg for the children in school age –e.g., until the period of rapid growth during pub‐

In diabetes variation in dietary protein may influence metabolic control by altering gluco‐ neogenic substrate availability as well as insulin and contra-regulatory hormone secretion

acids and less involved in the pathogenesis of atherosclerosis.

used instead; instead of whole milk a milk containing 2.8% fat.

erty, when the requirements increase again. (Stepanović R. et al 1991)

( Kratz M., et al. 2002).

**6. Proteins**

essential source of nitrogen.

(Nuttall FQ., 1983).

The vegetable fats have clearly advantage over animal ones. Intake decreases during child‐ hood from approximately 2 g/kg/day in early infancy to 1 g/kg/day for a ten year old and to 0.8–0.9 g/kg/day in late adolescence. (Kauffman FR, 2005). Substituting butter with margar‐ ine, vegetable oil for animal oil, and lean cuts of meat, poultry, and fish for fatty meats, such as bacon, is advisable. These simple measures reduce serum low-density lipoprotein choles‐ terol, a predisposing factor to atherosclerotic disease.

Uncontrolled type I diabetes is associated with elevated plasma lipids, but adequate insulin therapy usually restores lipid levels to normal. People with type I diabetes who are treated with insulin generally have plasma cholesterol, VLDL cholesterol and triglyceride concen‐ trations similar to those of the general population of the same age and sex (Kern P, 1987). Although not all studies agree, it appears that blood glucose control may directly influence the levels of several plasma lipid components. Qualitative abnormalities such as changes in a density of lipoprotein composition may exist even when the usual clinical measurements of plasma lipids are normal (Dunn FL, 1992). Evidence that dietary fat and the development of atherosclerosis are linked is controversial and there is little sign that a reduction in dietary fat would reduce atherosclerotic disease. Epidemiological studies from Japan are often quot‐ ed and in other populations a fall in cardiovascular morbidity has coincided with alterations in eating habits. (Nattras M., 1996) The dietary contents of polyunsaturated / saturated fatty acids should optimally correspond to 1.2: 1.0 ratios.

The primary goal regarding management of dietary fat is to decrease the intake of total fat, saturated fat, and trans-fatty acids (Franz MJ et al, 2002). Monounsaturated fatty acids (MU‐ FA) and polyunsaturated fatty acids (PUFA) can be used as substitutes to keep lipid intake within recommended ranges or to improve the lipid profile.

Polyunsaturated fatty acids increase the production of lipid peroxides; some experimental studies considered their influence on occurrence of certain malignancies. They are rich in omega-6 fatty acids from sunflower oil and corn; moderate intake of these fatty acids lowers LDL cholesterol, while high intake lowers HDL cholesterol. Omega-3 fatty acids are found in deep sea blue fish (herring, mackerel, tuna and salmon). Their utilization from fish meat is more effective than the utilization from pharmacological supplements. The recommended intake of fish oil is 1.5-2.0 g / day. Omega-3 fatty acids moderately lower total cholesterol, significantly reduce triglyceride levels and reduce platelet aggregation, blood pressure and cardiovascular risk. However, they may increase hepatic glucose production, thus increas‐ ing blood glucose and hemoglobin A1-c levels. Therefore, in patients with impaired carbo‐ hydrate metabolism, the use of fish oil is not recommended; instead, blue sea fish meals should be taken 2-3 times a week.

Monounsaturated fatty acids are found in olive oil, walnuts and sesame. Studies have shown that application of these fatty acids for one month reduces insulin requirements and improve insulin sensitivity; decreases blood glucose and triglyceride levels and arterial blood pressure as well. The Mediterranean diet, with increased use of olive oil-rich omega-9 fatty acids, reduces LDL cholesterol without affecting HDL cholesterol. Its intake improves insulin sensitivity, blood glucose and triglyceride levels and blood pressure. These mecha‐ nisms explain the reduction in coronary heart disease in Mediterranean countries. Monoun‐ saturated fatty acids are more resistant to lipid peroxidation than the polyunsaturated fatty acids and less involved in the pathogenesis of atherosclerosis.

Trans-isomers of polyunsaturated fatty acids formed during the hydrogenation process may have potentially harmful effects. These trans-isomers are formed during solidification of vegetable oils. They are found in margarine and pastries, and intake of these foods increases LDL cholesterol and lowers HDL cholesterol. Therefore, in the UK and some European countries the intake of these trans-isomers in the amounts more than 5 g / day is not recom‐ mended. A consideration was given on intake of long chain omega-3 fatty acids. Epidemio‐ logical research studies have shown that prolonged use of concentrated fish oil may have an anti-atherogenic effect thanks to the high omega-3 acid contents (A. Simopoulos, 1991).

The existing nutritional recommendations of the European Association for the Study of Dia‐ betes (EASD) and American Diabetes Association (ADA) on dietary composition promote greater flexibility in the proportions of energy derived from carbohydrate and from mono‐ unsaturated fat (MUFA). MUFA are promoted as the main source of dietary fat because of their lower susceptibility of lipid peroxidation and consequent lower atherogenic potential ( Kratz M., et al. 2002).

In diabetes, cholesterol intake is limited to a maximum of 300 mg daily, in order to slow down the development of atherosclerotic process. This means that cholesterol-rich foods (brain, egg yolk) should be avoided, and lean meat (veal, beef, chicken) or fish should be used instead; instead of whole milk a milk containing 2.8% fat.
