Summary:
This study used national data from the United States to examine nutritional deficiencies and nutrition therapy and counselling among children and adolescents receiving glucagon-like peptide-1 receptor agonists (GLP-1s). GLP-1s are increasingly used to manage obesity and type 2 diabetes in young people, but their effects on appetite and food intake may increase the risk of inadequate nutrient intake. This is particularly relevant during childhood and adolescence, when adequate energy, protein, iron, calcium and vitamin D are needed for growth, bone development and muscle acquisition. The study looked at data from more than 100 million patients between 2017 and 2022, identifying 2,031 GLP-1 users aged 10-17 years who had no previous diagnosis of nutritional deficiency. Participants were followed for up to one year after starting treatment to identify newly diagnosed nutritional deficiencies and assess the use and timing of nutrition therapy and counselling. Within one year of starting treatment, 16.9% of participants received a diagnosis of at least one nutritional deficiency. Vitamin D deficiency was the most common diagnosis, followed by nutritional anaemia and iron-deficiency anaemia. Nutrition care appeared to be relatively uncommon. Only 23.3% of participants had a nutrition related session within 180 days of starting a GLP-1R, with the first visit occurring an average of 149 days after treatment initiation. Overall, the findings indicate that nutritional deficiencies may occur in young people receiving GLP-1 medications, while nutrition support is not routinely provided early in treatment. The study suggests that incorporating nutrition support and ongoing monitoring may help identify nutritional risks while supporting healthy growth and development.
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Abstract:
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to treat childhood obesity, prediabetes, and type 2 diabetes. We examined nutritional deficiency incidence and nutrition therapy/counseling (NT/C) utilization among pediatric GLP-1RA users. Methods: We analyzed Inovalon administrative claims data from 2017 to 2022 covering over 100 million patients to identify 2,031 GLP-1RA users aged 10–17 years who met continuous enrollment criteria and had no prior diagnosis of nutritional deficiency. Nutritional deficiencies were identified using the International Classification of Diseases, 10th edition codes for up to 1 year following GLP-1RA initiation. NT/C visits, time to first NT/C visit, and differences in nutritional deficiency diagnoses by NT/C consultation were assessed. Results are reported as proportions and means, with group comparisons using chi-square tests. Results: The mean age was 15 (±1.8) years, 61.5% were female, and 62.6% had obesity. Liraglutide (78.6%), dulaglutide (10.4%), and semaglutide (9.1%) were the most prescribed GLP-1RA drugs. Within 1 year, 16.88% of patients were diagnosed with at least one nutritional deficiency or deficiency-related complication, most frequently vitamin D deficiency (12.4%), followed by nutritional anemia (1.55%), and iron-deficiency anemia (1.44%). Only 23.3% had NT/C visit within 180 days (mean time to first visit: 149 days). Patients with NT/C consultations had higher rates of nutritional deficiencies and deficiency-related complications than those without (23.2% vs. 14.8%, p < 0.01). Conclusions: Nutritional deficiencies are a meaningful and under-recognized risk among pediatric patients receiving GLP-1RA therapy. Current care patterns suggest missed opportunities for proactive and preventative nutrition support. Integration of NT/C care into pediatric GLP-1RA treatment may support healthy growth and long-term outcomes.
Article Publication Date: 17/09/2026
DOI: 10.1177/21532176261486979
