AAP cautions against low-carbohydrate diets for children at risk for diabetes

In an October 2023 issue of Pediatrics, The American Academy of Pediatrics (AAP) warned against children and adolescents at risk for developing diabetes using low-carbohydrate diets, as overly restrictive patters could affect their health.

The report highlights that physicians and families focus on reducing the consumption of nutrient-poor snacks and sugary beverages in children.

According to the AAP, it is recommended that 45% to 65% of total daily calories come from carbohydrates. Very low-carbohydrate diets allow for 20 to 50 grams per day and ketogenic diets typically allow less than 20 grams per day.

There are concerns for children and teenagers using these diet restrictions related to nutritional deficiencies, growth deceleration, poor bone health, and disordered eating behaviors.

Neither the American Diabetes Association, nor the International Society for Pediatric and Adolescent Diabetes have endorsed the generalized use of low-carbohydrate diets in growing children and adolescents with type 1 diabetes (T1D), according to the report.

“We often see celebrities and weight loss programs endorsing carbohydrate restriction through low carb or ketogenic diets, but evidence is limited on the physical, metabolic and psychological effects of these dietary plans for children and teens,” said Tamara Hannon, MD, FAAP, co-author of the report, written by the Committee on Nutrition.

“This statement is not about restrictive diets–it is about providing evidence to clinicians so they can support parents and families in making informed decisions. Be sure to bring your questions to your pediatrician, who knows you best and can help provide guidance on a healthy dietary plan.”

A multidisciplinary team should monitor children or adolescents who follow a very low-carbohydrate diet or a ketogenic diet. Further, the AAP recommends the following:

Those aged 4 to 18 years should get 10% to 30% of their total energy intake as protein. An additional 25% to 35% should come from fat and less than 10% should come from saturated fats. The remaining 45% to 65% of energy requirements should be provided by carbohydrates, and no more than 10% of calories per day coming from added sugars.

Most carbohydrate calories should come from vegetables, fruits, legumes, whole grains, and dairy products. For families of children with T1D, prediabetes or type 2 diabetes (T2D), can be counseled to follow a healthy dietary pattern strategy.

Further, these children should strive for 60 minutes of moderate to vigorous aerobic activity each day.

In addition to their general pediatrician, pediatric patients with diabetes should be followed by a multidisciplinary, diabetes care team. Communication should be open-ended across all disciplines so that support and dietary recommendations can be reinforced broadly.

Those who have socioeconomic disadvantages “are at an increased risk for prediabetes and type 2 diabetes and face barriers to following Dietary Guidelines for Americans and restricting processed foods. Pediatricians can advocate for policies to strengthen federal nutrition programs and encourage families who qualify to participate in them,” the report states.

For more recommendations and the full report from the AAP, click here.

Reference:

American Academy of Pediatrics issues policy on low-carbohydrate diets for children and adolescents with or at risk of diabetes. The American Academy of Pediatrics. September 18, 2023. Accessed December 1, 2023. https://www.aap.org/en/news-room/news-releases/aap/2023/american-academy-of-pediatrics-issues-policy-on-low-carbohydrate-diets-for-children-and-adolescents-with-or-at-risk-of-diabetes/#:~:text=The%20American%20Academy%20of%20Pediatrics,patterns%20may%20affect%20their%20health