AIMS: We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to a change in body weight, body composition, and muscle strength in children and young people with diabetes (CYPwD). METHODS: Thirty-five CYPwD were recruited into this randomized controlled cross-over study (20 female; age 14.5 ± 2.9 years). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were body weight and body mass index (BMI) standard deviation scores (SDS), body fat percentage assessed by bioimpedance and muscle strength assessed by jumping mechanography at the end of each dietary intervention. The Welch two-sample t-tests were used to determine the difference in outcomes. RESULTS: At the end of the LCD period, the participants had significantly lower body weight and BMI SDS than at the end of the RCD period (61.7 kg vs. 62.6 kg, P < 0.001, and 22.3 kg/m2 vs. 22.7 kg/m2, P < 0.001) and (0.84 SD vs. 0.94 SD, P < 0.001, and 0.81 SD vs. 0.91 SD, P < 0.001). The body fat percentage was lower at the end of the LCD period (24.5% vs. 25.3%, P = 0.001). Dynamic muscle functions did not differ significantly at the end of the intervention periods. CONCLUSIONS: We demonstrated that a short-term low-carbohydrate diet is able to decrease body weight, BMI, and decrease the percentage of body fat in CYPwD without negatively affecting their muscle function.

Department of Food Science Czech University of Life Sciences Prague Czechia

Department of Microbiology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Department of Pediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Department of Probability and Mathematical Statistics Faculty of Mathematics and Physics Charles University Prague Prague Czechia

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Zimmermann AT, Lanzinger S, Kummernes SJ, Lund-Blix NA, Holl RW, Frohlich-Reiterer E, et al. Treatment regimens and glycaemic outcomes in more than 100 000 children with type 1 diabetes (2013-22): a longitudinal analysis of data from paediatric diabetes registries. Lancet Diab Endocrinol. 2025;13:47–56.

Rawshani A, Sattar N, Franzen S, Rawshani A, Hattersley AT, Svensson AM, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392:477–86. PubMed PMC

Collaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

Maffeis C, Birkebaek NH, Konstantinova M, Schwandt A, Vazeou A, Casteels K, et al. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry. Pediatr Diab. 2018;19:1211–20.

Seckold R, Fisher E, de Bock M, King BR, Smart CE. The ups and downs of low-carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes. Diabet Med. 2019;36:326–34. PubMed

Ranjan A, Schmidt S, Damm-Frydenberg C, Steineck I, Clausen TR, Holst JJ, et al. Low-carbohydrate diet impairs the effect of glucagon in the treatment of insulin-induced mild hypoglycemia: a randomized crossover study. Diab Care. 2017;40:132–5.

de Bock M, Lobley K, Anderson D, Davis E, Donaghue K, Pappas M, et al. Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: an illustrative case series. Pediatr Diab. 2018;19:129–37.

Hart M, Pursey K, Smart C. Low carbohydrate diets in eating disorders and type 1 diabetes. Clin Child Psychol Psychiatry. 2021;26:643–55. PubMed

Caccavale LJ, Nansel TR, Quick V, Lipsky LM, Laffel LM, Mehta SN. Associations of disordered eating behavior with the family diabetes environment in adolescents with Type 1 diabetes. J Dev Behav Pediatr. 2015;36:8–13. PubMed PMC

Groleau V, Schall JI, Stallings VA, Bergqvist CA. Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy. Dev Med Child Neurol. 2014;56:898–904. PubMed PMC

Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diab. 2022;23:1297–321.

Neuman V, Plachy L, Drnkova L, Pruhova S, Kolouskova S, Obermannova B, et al. Low-carbohydrate diet in children and young people with type 1 diabetes: A randomized controlled trial with cross-over design. Diab Res Clin Pr. 2024;217:111844.

Neuman V, Plachy L, Pruhova S, Kolouskova S, Petruzelkova L, Obermannova B, et al. Low-carbohydrate diet among children with type 1 diabetes: a multi-center study. Nutrients. 2021;13. https://doi.org/10.3390/nu13113903 .

Levran N, Levek N, Gruber N, Afek A, Monsonego-Ornan E, Pinhas-Hamiel O. Low-carbohydrate diet proved effective and safe for youths with type 1 diabetes: A randomised trial. Acta Paediatr. 2025;114:417–27. PubMed

Harray AJ, Roberts AG, Crosby NE, Shoneye C, Bebbington K. Experiences and attitudes of parents reducing carbohydrate intake in the management of their child’s type 1 diabetes: a qualitative study. Nutrients. 2023;15. https://doi.org/10.3390/nu15071666 .

Turton JL, Brinkworth GD, Parker HM, Lim D, Lee K, Rush A, et al. Effects of a low-carbohydrate diet in adults with type 1 diabetes management: A single arm non-randomised clinical trial. PLoS One. 2023;18:e0288440. PubMed PMC

Wachsmuth NB, Aberer F, Haupt S, Schierbauer JR, Zimmer RT, Eckstein ML, et al. The impact of a high-carbohydrate/low fat vs. low-carbohydrate diet on performance and body composition in physically active adults: a cross-over controlled trial. Nutrients. 2022;14. https://doi.org/10.3390/nu14030423 .

Gram-Kampmann EM, Hansen CD, Hugger MB, Jensen JM, Brond JC, Hermann AP, et al. Effects of a 6-month, low-carbohydrate diet on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes: An open-label randomized controlled trial. Diab Obes Metab. 2022;24:693–703.

Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, et al. Management of type 1 diabetes with a very low-carbohydrate diet. Pediatrics. 2018;141. https://doi.org/10.1542/peds.2017-3349 .

Schulz KF, Altman DG, Moher D, Fergusson D. CONSORT 2010 changes and testing blindness in RCTs. Lancet. 2010;375:1144–6. PubMed

Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, et al. Skinfold equations for estimation of body fatness in children and youth. Hum Biol. 1988;60:709–23. PubMed

Kobzova J, Vignerova J, Blaha P, Krejcovsky L, Riedlova J. The 6th nationwide anthropological survey of children and adolescents in the Czech Republic in 2001. Cent Eur J Public Health. 2004;12:126–30. PubMed

Vanderwall C, Eickhoff J, Randall Clark R, Carrel AL. BMI z-score in obese children is a poor predictor of adiposity changes over time. BMC Pediatr. 2018;18:187. PubMed PMC

Veilleux LN, Rauch F. Reproducibility of jumping mechanography in healthy children and adults. J Musculoskelet Neuronal Interact. 2010;10:256–66. PubMed

Sumnik Z, Matyskova J, Hlavka Z, Durdilova L, Soucek O, Zemkova D. Reference data for jumping mechanography in healthy children and adolescents aged 6-18 years. J Musculoskelet Neuronal Interact. 2013;13:297–311. PubMed

Kawashima S, Sogi C, Kamimura M, Kikuchi A, Kanno J. Severe growth retardation during carbohydrate restriction in type 1 diabetes mellitus: A case report. Clin Pediatr Endocrinol. 2024;33:181–6. PubMed PMC

Schmidt S, Christensen MB, Serifovski N, Damm-Frydenberg C, Jensen JB, Floyel T, et al. Low versus high carbohydrate diet in type 1 diabetes: a 12-week randomized open-label crossover study. Diab Obes Metab. 2019;21:1680–8.

Maratova K, Soucek O, Matyskova J, Hlavka Z, Petruzelkova L, Obermannova B, et al. Muscle functions and bone strength are impaired in adolescents with type 1 diabetes. Bone. 2018;106:22–7. PubMed

Potter AW, Nindl LJ, Soto LD, Pazmino A, Looney DP, Tharion WJ, et al. High precision but systematic offset in a standing bioelectrical impedance analysis (BIA) compared with dual-energy X-ray absorptiometry (DXA). BMJ Nutr Prev Health. 2022;5:254–62. PubMed PMC

Buch A, Ben-Yehuda A, Rouach V, Maier AB, Greenman Y, Izkhakov E, et al. Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes. Nutr Diab. 2022;12:45.

Silva AM, Campa F, Stagi S, Gobbo LA, Buffa R, Toselli S, et al. The bioelectrical impedance analysis (BIA) international database: aims, scope, and call for data. Eur J Clin Nutr. 2023;77:1143–50. PubMed