4. Discussion
T1DM, TIDM, LCD, metabolic syndrome, Nutritional deficiencies, diabetes
TRACE ELEMENT DEFICIENCY, AIDS, EVENTS, MAGNESIUM DEFICIENCY, NUTRITIONAL DEFICIENCIES, METABOLIC SYNDROME, DIABETES
In this novel study of youth with TIDM who followed LCD for six months, decreases were found in median intakes of several macronutrients and micronutrients. Median blood levels of several nutrients decreased. These changes were in parallel to an improved median HbA1c level and lower median values of CRP, BMI z-score, and waist circumference.The proportion of calories from ultra-processed food decreased during the intervention, because adherence to the LCD required more frequent cooking and less consumption of prepared food. Our findings are in concordance with a randomized trial among adults without diabetes [The decrease by 70% in carbohydrate intake shows good compliance of our participants throughout the study period. We believe that the workshops with food preparation and imparting knowledge, together with the careful supervision and frequent in-person meetings and phone calls contributed to the good adherence and compliance in our study.The decrease in carbohydrate intake was associated with reduced intakes of fibers and fructose. Low fiber intake was consistently demonstrated in several studies that investigated LCD [Decreased carbohydrate intake requires the substitution of another macronutrient, hence the fear that increased fat consumption could impair the lipid profile. However, among our participants, the fat intake did not change significantly after conversion to LCD due to calories decrease. Lipid profiles were not significantly elevated; these findings are in line with a 12-week crossover randomized study comparing high-carbohydrate diet versus LCD in 14 participants with T1DM [The reported FFQ showed significantly lower median intakes at the end of the intervention compared to baseline, according to percentages of recommended daily allowance of several minerals and vitamins (iron, calcium, phosphorus, vitamin B1). These findings are in agreement with a systematic review that showed deficient intakes of magnesium, calcium, iron, iodine, thiamine, and folate in healthy adults who followed a carbohydrate-restricted diet [Median intake levels of the trace elements iron and calcium were lower after the LCD than at baseline. Notably, a systematic review and case series described a lower intake of iron after conversion to LCD [In the present study, median serum zinc values were within the normal range both at baseline and at the end of the intervention in spite of a downward trend. Data on the effect of dietary zinc intake on its serum level remain inconclusive. This decrease in daily consumption may be due to the lack of legumes and grains in LCD. Zinc is an essential trace element found in food, playing a role in many antioxidative defense and metabolic processes, such as insulin processing, storage, secretion and action [Data indicated a decrease in copper intake. Copper is a vital mineral that aids in the production of neurotransmitters, connective tissue, neuropeptides, and energy [According to the FFQ, magnesium intake was significantly lower in our participants after the LCD; four participants had deficient magnesium plasma levels. Magnesium is an essential cation that is found in legumes, nuts, and vegetables. Of note, magnesium deficiency is the most prevalent trace element deficiency in individuals with T1DM [A 30% decrease in selenium intake was observed in our cohort despite instructed supplementation with Brazil nuts. Selenium is an essential trace element known to influence various physiological processes, including energy homeostasis, through its redox functions. It is used to synthesize selenoproteins, which is a family of proteins with mainly antioxidant roles [Our data demonstrated improved parameters of the metabolic syndrome such as weight, BMI z-score, waist circumference, and CRP, as well as improved glycemic control, among adolescents with T1DM following a 6-month LCD intervention. The high CRP levels observed at baseline corroborate a study of children with T1DM who had higher levels of CRP than a control group; elevated CRP has been linked to coronary events [For people with T1DM who follow LCD, we advise long-term and periodic monitoring of the nutrients whose intakes and blood levels decreased during the six months of our intervention. Nutritional deficiencies after LCD emphasize the need to provide nutritional substitutes that could fill the nutritional gaps [Our study has some limitations. As with all dietary recall studies, FFQ interviews are subject to recall bias. However, this recall method is considered more reliable than a single-day recall [