As GLP-1 medications become more common for treating obesity and type 2 diabetes in children and teens, researchers are paying closer attention to whether young patients are getting enough nutrition while taking them.
A new study of 2,031 U.S. children and adolescents ages 10 to 17 found that 16.8% were diagnosed with at least one nutritional deficiency or related complication within a year of starting a GLP-1 medication. Vitamin D deficiency was the most common, diagnosed in 12.4% of patients. But the study did not include a comparison group of similar children who were not taking GLP-1 drugs, so it cannot show that the medications caused those deficiencies.
The study, published in Childhood Obesity, was funded by Abbott. Five of the six authors are Abbott employees, including researchers from Abbott Nutrition and Abbott Medical Devices. The remaining author reported relationships with several pharmaceutical and health technology companies but received no compensation from Abbott for this study. Those ties are important context because the paper recommends greater nutrition support for children taking GLP-1 medications.
Researchers used insurance claims from 2017 through 2022 to identify children who had started a GLP-1 medication and had no recorded nutritional deficiency during the previous six months.
The average participant was 15 years old. About 63% had obesity and 67% had type 2 diabetes. Nearly 79% were prescribed liraglutide, while about 10% used dulaglutide and 9% used semaglutide. Because most of the data came from before semaglutide became widely used in adolescents, the findings may not fully reflect how GLP-1 medications are prescribed today.
Within six months of starting treatment, 10.2% of patients had been diagnosed with a nutritional deficiency or related problem. By one year, that had risen to 16.8%. Vitamin D deficiency made up most of those diagnoses. Smaller numbers of patients were diagnosed with anemia, iron-deficiency anemia, dehydration or muscle loss.
Those numbers need to be interpreted carefully.
The study relied on insurance claims, not routine blood tests or detailed information about what children were eating. That means researchers could see when a deficiency was diagnosed, but they could not tell whether a child had already been low in a nutrient before starting treatment.
Some deficiencies may also have gone undiagnosed if children were never tested.
That is especially important for vitamin D, because low vitamin D levels are already common among adolescents with obesity. This study cannot tell us how much of the 12.4% rate was related to GLP-1 treatment and how much reflected risk that was already there.
The study also found that nutrition support was not common early in treatment.
Only 5.8% of patients had a nutrition counseling visit within 30 days of starting a GLP-1 medication. That rose to 23.3% by six months and 38.3% by one year. Among children who did receive nutrition care, the first visit happened an average of about five months after treatment began.
“As appropriate pediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development,” said senior author Justin Ryder of Ann & Robert H. Lurie Children’s Hospital of Chicago.
Children and teens need enough calories, protein, vitamins and minerals to support growth and development. Because GLP-1 medications can reduce appetite and food intake, researchers have raised concerns that some young people may have trouble meeting those needs.
But this study did not measure food intake, weight loss, growth or bone health. It also did not track blood levels of nutrients over time.
One finding could be easy to misread: nutritional deficiencies were diagnosed more often among children who received nutrition counseling than among those who did not.
That does not mean nutrition counseling caused the problem.
Children may have been referred to a dietitian because a deficiency had already been found. Nutrition visits may also have led to more testing and more diagnoses. The study could not determine which came first.
“We hope that our study findings bring much needed recognition to the importance of proactive nutritional management when GLP-1s are prescribed to children, as opposed to waiting until a nutritional deficiency is diagnosed,” Ryder said.
The findings add real-world data to growing concerns about nutrition during GLP-1 treatment in young people. They show that nutritional deficiencies are being diagnosed in a meaningful share of pediatric patients, while nutrition counseling often does not happen until months after treatment begins.
What the study does not establish is whether the medications themselves are responsible.
Future research will need to compare children taking GLP-1 medications with similar children who are not taking them and directly measure diet, nutrient levels and growth over time.
The study was funded by Abbott. Five authors were Abbott employees. Justin Ryder reported support from Boehringer Ingelheim Pharmaceuticals, participation as a clinical trial investigator for Eli Lilly and Recordati, and advisory roles with Calorify and Ciloa.bio.