Nutritional Deficiencies, Complications, and Nutrition Therapy/Counseling in Pediatric Patients Using GLP-1 Receptor Agonists.

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.