Document Type

Dissertation - Open Access

Award Date


Degree Name

Doctor of Philosophy (PhD)

Department / School

Health and Consumer Sciences

First Advisor

Lacey A. McCormack


Child growth, a sensitive metric of overall health, results from the intricate interplay of nature and nurture. While the importance of nutrition in child growth is well established, growth trajectories exhibit substantial individual variability, influenced by sex and age, and often characterized by nonlinear patterns. Inadequate nutrition or disease can hinder growth, with potential for recovery upon proper nutrition or acute disease resolution. However, chronic disease or persistent malnutrition may lead to permanent growth perturbation. Notably, before the advent of insulin, chronic stunting and wasting were hallmarks of Type 1 diabetes mellitus (T1DM), though the specific impacts under modern standard of care remain incompletely understood. The three primary macronutrients—protein, carbohydrate, and fat—contribute to growth by supplying calories for total energy. Among healthy children, the roles of each macronutrient in physical growth are well-defined. Dietary protein uniquely supports linear and somatic growth through its dual energy-yielding and nitrogen-obtaining properties. Fatty acids from dietary fat are essential for neurological growth and development. Conversely, any direct role of dietary carbohydrate in growth beyond energy provision is minimal. Whether these macronutrient roles are altered in the presence of T1DM remains unclear. Additionally, recommendations for macronutrient distribution in children, as defined by the Acceptable Macronutrient Distribution Range (AMDR), were primarily extrapolated from adults and not tailored for diseased populations. This dissertation first provides context by examining the relationship between macronutrient intake and height growth in healthy children. Subsequent chapters explore growth and nutrition in children with T1DM undergoing standard insulin therapy. Longitudinal descriptive analyses, utilizing nonlinear mixed effects modeling, revealed that these children may experience earlier puberty onset and achieve taller final adult heights compared to their non-T1DM peers. Nutritional Geometry (NG) was applied to uncover disease-, sex-, and age-specific relationships between macronutrient distribution and physical height growth. Findings suggest a significant positive main effect association between fat intake and maximal height in boys, but not girls. However, no relationships with z-height were observed in boys or girls, suggesting macronutrient distribution is unrelated to normal growth in this population. The findings underscore NG's potential to inform disease-specific AMDR recommendations for optimal child growth.


South Dakota State University



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In Copyright