Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes

Round 1

Reviewer 1 Report

The submitted review paper presents an overview of the published evidence on the relationship between fat intake and glycemic control, cardiovascular risk, inflammation, and gut microbiota in children/adolescents with type 1 diabetes (T1D). Based on the presented evidence the authors conclude that a high fat intake should be avoided by these patients who should be further encouraged to follow the relevant recommendations by the International Society for Pediatric and Adolescent Diabetes and the American Diabetes Association, and so adhere to a healthy and balanced diet in order to maintain good glycemic control and reduce the cardiovascular risk and inflammation related to T1D.

The submitted manuscript has reviewed the relevant available literature and is up-to-date. A point that the authors should consider addressing is the lack of one or more summary tables which would help the reader to have a quick summary of the main relevant studies in this field. Therefore, the authors could consider adding in the “Conclusions” section a table summarizing the details/findings of key relevant studies (the format of this table could include first a column for the author/year/ref. number of the study; followed by columns for: study cohort/design; type of studied intervention/diet; key findings). This table could follow the sequence of the sections of this review and could include the key studies of each section, so that the reader may also refer to this table for a quick overview/summary of the most important relevant studies. In addition, the authors could consider adding another table in line 534 of the “Conclusions” section, which would summarize the most recent recommendations from the International Society for Pediatric and Adolescent Diabetes and the American Diabetes Association, as well as from any other relevant guidelines/recommendations

Other minor points which could be also addressed are the following:

1) The authors should do a final check for errors/typos; for example: in the abstract please correct “is a cornerstones” to “is a cornerstone” and “This review aim” to “This review aims”.

2) in lines 195-196, please rephrase the sentence: “Although different studies express the results in different ways, why it is difficult to obtain an adequate comparison,…”

3) Section “5.1. High-fat diets and inflammation” is lacking adequate citations, so please cite one or more relevant papers (preferably relevant recent reviews) for each of the points/sentences included in this section.

Author Response

First of all, we would thank you for the useful comments aimed at improving the manuscript. The responses to the queries raised are as follows:

QUERY: "A point that the authors should consider addressing is the lack of one or more summary tables which would help the reader to have a quick summary of the main relevant studies in this field. Therefore, the authors could consider adding in the “Conclusions” section a table summarizing the details/findings of key relevant studies (the format of this table could include first a column for the author/year/ref. number of the study; followed by columns for: study cohort/design; type of studied intervention/diet; key findings). This table could follow the sequence of the sections of this review and could include the key studies of each section, so that the reader may also refer to this table for a quick overview/summary of the most important relevant studies. In addition, the authors could consider adding another table in line 534 of the “Conclusions” section, which would summarize the most recent recommendations from the International Society for Pediatric and Adolescent Diabetes and the American Diabetes Association, as well as from any other relevant guidelines/recommendations." 

REPLY: Considering the suggested tables, we inserted them in the text (please see “Conclusions” section). Specifically, we add table 1 entitled: “Summary of the key relevant studies in individuals with T1D reported in this review”, in which we reported the main articles encountered by the reader through the text. Moreover, we added table 2 “Overview of the main ADA and ISPAD recommendations on nutrition management and macronutrients intake in children and adolescents with T1D”, in which we briefly summarized the mentioned recommendations of latest ADA and ISPAD guidelines.

Other responses:

1) "The authors should do a final check for errors/typos; for example: in the abstract please correct “is a cornerstones” to “is a cornerstone” and “This review aim” to “This review aims”."

REPLY: Thank you, we provided a careful check of the text and corrected the errors/typos.

2) "in lines 195-196, please rephrase the sentence: “Although different studies express the results in different ways, why it is difficult to obtain an adequate comparison,…”

REPLY: Thank you for the suggestion. We modified the sentence in lines 195-198 as follows: “An adequate comparison between the abovementioned studies is difficult to obtain, since they sometimes express results in different ways. However, it seems reasonable to assess that there is a relationship between lipid intake and glucose control in individuals with T1D.”

3)  "Section “5.1. High-fat diets and inflammation” is lacking adequate citations, so please cite one or more relevant papers (preferably relevant recent reviews) for each of the points/sentences included in this section."

REPLY: most concepts of paragraph 5.1 were summarized from reference n. 85 (Meessen et al., Human Postprandial Nutrient Metabolism and Low-Grade Inflammation: A Narrative Review. Nutrients, 2019). Thus, we added the following sentence at the beginning of the paragraph in order to try to clarify this issue: “The relationship between high-fat diets and inflammation has been recently reviewed, as well as detailed mechanisms [85].” Nevertheless, we added references n. 86 and 87 (Rogero et al., Obesity, Inflammation, Toll-like Receptor 4 and Fatty Acids. Nutrients 2018, 10 (4), 432; Erridge et al., High-Fat Meal Induces Low-Grade Endotoxemia: Evidence of a Novel Mechanism of Postprandial Inflammation. Am. J. Clin. Nutr. 2007, 86 (5), 1286–1292.)

Reviewer 2 Report

I like The review, it discussed very important issue  in vwide point od view.  No comments.

I have no comments to the paper, It is well written, subject is current and interesting. Authors have made a good research of the newest databases

Author Response

Thank you for your approval and your kind feedback.