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Objective: To estimate the percentage of children with low, moderate and high caries risk; and to determine the predictors of caries risk amongst 11-12 year old Pakistani school children. Methods: Subjects' caries risk was assessed using the Cariogram programme. The survey was done among school children in Bhakkar district of Punjab, Pakistan. Caries and plaque level were assessed using the DMFT and Sillnes and Loe indices respectively, while diet content and frequency were assessed using a three-day diet diary. Results: A total of 226 children participated in this study, giving a response rate of 75%. Most subjects (39.8%) were in the low risk category with DMFT score of 0. The overall mean DMFT score was 1.49 (±0.63). Linear and multiple regressions were performed to evaluate the predictability of caries risk. Previous experience of dental caries was found to be the most relevant predictor of caries risk (40%). Conclusion: The levels of caries risk amongst Pakistani 11-12 year old school children were generally low. Past caries experience was the most significant factor in predicting future caries lesion in this sample population. [ABSTRACT FROM AUTHOR]

Background: Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. Methods: We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/ specialized ingredients versus home-available ingredients. We used all available outcome data to conduct randomeffects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. Results: Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactosecontaining liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-tomoderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet. Conclusions: Among children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited. [ABSTRACT FROM AUTHOR]

Moderate childhood wasting is defined as having a weight-for-height Z-score (WHZ) < -2, but ≥ -3. These children are typically given fortified corn/soy blended flour ICSB), but this intervention has shown limited effectiveness. Fortified spreads (FS) can be used as supplementary foods instead; they are energy-dense, lipid-based pastes with added powdered micronutrierits. In this randomized clinical effectiveness trial, the recovery rates were compared among children with moderate wasting who received either milk/peanut FS, soy/peanut FS, or CSB. Children received isoenergetic quantities of food, 314 kJ·kg-1·d-1, for up to 8 wk with biweekly follow-up. The primary outcome was recovery, defined as having a WHZ > -2. Time-event analysis was used to compare the recovery rate. A total of 1362 children were enrolled in the study. Children receiving soy/peanut FS had a similar recovery rate to those receiving milk! peanut ES and children in either FS group were more likely to recover than those receiving CSB (80% in both ES groups vs. 72% in the CSB group; P< 0.01). The rate of weight gain in the first 2 wk was greater among children receiving milk! peanut FS (2.6 g·kg-1·d-1, n = 465) or children receiving soy/peanut ES 12.4 g·kg-1·d-1, n = 4501 than among children receiving CSB (2.0 g·kg-1· d-1, n = 447; P < 0.051. Rates of length gain did not differ among the 3 groups. A total of 8% of children in each feeding group developed edema, indicative of severe malnutrition, while receiving supplemental feeding. We conclude that ES are superior supplementary foods to CSB for moderately wasted Malawian children. [ABSTRACT FROM AUTHOR]

We provide a critical appraisal of the literature on the effects of dietary prevention of atopic disease in children. In our view, currently available studies suffer from lack of blinding which is a major problem if the primary end point is subjective (such as the diagnosis of eczema). In addition, long-term follow-up suggests that atopic symptoms are delayed rather than truly prevented, and that only the mildest cases are prevented (or delayed). Although it has been reported that cow's milk allergy is truly prevented by dietary interventions in early life, this has never been demonstrated by double-blind placebo-controlled food challenges. No studies to date have shown effects of hypoallergenic formulae on objective markers of atopic sensitization, such as specific IgE levels. Finally, there is no universally accepted pathophysiological mechanism which could explain the usefulness of hypoallergenic formulae in allergy prevention. In conclusion, we feel that the currently available evidence on the allergy preventive effects of hypoallergenic formulae is insufficient to justify blanket advice being given to ‘high risk’ families. Such advice gives parents the hope that they can actually prevent allergy in their children which may not be justified. A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effects of synbiotic therapy in patients with short bowel syndrome (SBS). Four pediatric patients with SBS, who were receiving synbiotics therapy including Bifidobacterium breve, Lactobacillus casei and galactooligosaccharides, were enrolled in this study. We evaluated changes in immunonutritional parameters before and after receiving synbiotics therapy. Four normal, healthy, age-matched children were enrolled as controls. Fecal samples from patients and controls were collected and analyzed for fecal bacterial flora and organic acid (OA) contents. Levels of short chain fatty acids (SCFA) such as butyrate, propionate, and acetate increased in one patient, and SCFA/total OA levels increased in three patients. Serum lymphocyte counts and concentrations of pre-albumin increased after beginning synbiotics therapy, reaching a statistically significant level at the ninth month compared to the pre-treatment level. There was an increasing trend in height and weight gain velocity during the study compared with the pre-treatment period. The patients' fecal bacterial flora improved as a result of synbiotics therapy. Synbiotics therapy may be very effective at improving the intestinal flora and systemic immunonutritional status of patients with SBS. [ABSTRACT FROM AUTHOR]

Substantial evidence now exists that the origins of atherosclerosis begin in childhood. Therapeutic efforts early in life may delay formation of advanced atherosclerotic lesions and enhance early opportunities for lifelong acquisition of heart healthy eating habits. Diet therapy is the cornerstone of clinical management of children with hypercholesterolemia. The National Cholesterol Education Program targets lowering elevated LDL-cholesterol as the primary aim of diet therapy. Recommended dietary modifications for children with elevated LDL-cholesterol include lowering total fat to 30% or less of calories, saturated fat to less than 10% of calories, cholesterol to less than 300 mg/d, and consuming enough calories to achieve or maintain desirable body weight. For children with severe hypercholesterolemia (persistent LDL-cholesterol >130 mg/dl), a further reduction in saturated fat and cholesterol are advised. Parents play a powerful role in promoting adoption of heart healthy eating habits at home. Feeding strategies parents can use to promote acceptance of low fat foods include increasing the availability and accessibility and exposure to these foods, modeling healthy food habits, and presenting healthy foods to their child in a relaxed non-pressured manner. Adherence to a low fat diet can safely lower LDL-cholesterol levels and provide optimal calories and nutrients to support normal growth and development in childhood and adolescence. [Copyright &y& Elsevier]

Objectives. The purpose of this study was to identity factors that enhance the recovery due to supplementary feeding in wasted children. Methods. Recovery rates were obtained in mild to moderately wasted 6- to 48-month-old rural Guatemalan children living in four villages. Children in two villages received a high protein-energy supplement (supplemented children), while children in the other villages received a low protein-energy supplement (nonsupplemented children). The difference in recovery rates between the groups was the attributable benefit. The net supplementation amounted to 11% of the recommended energy intake and its associated nutrients. Results. Attributable supplement benefits were achieved in younger children (6 to 24 months old) and increased with decreasing weight for length, longer duration of supplementation, and duration of diarrhea, but not with chronicity of wasting. Conclusions. Supplementation's effectiveness can be improved in similar populations by programs targeted according to these findings. [ABSTRACT FROM AUTHOR]

Background: The severity of atopic dermatitis (AD) has been reported to be reduced by dietary eliminations in a subset of patients with AD. Aims: To assess the reduction of the severity of atopic dermatitis in infants and children after eliminations of certain dietary items. Materials and Methods: The study group comprised of 100 children with atopic dermatitis. Their severity of itching, surface area of involvement, and SCORAD index were measured. Patients who did not have any systemic disease or were not on systemic corticosteroids were included in the study. Selected patients were advised to strictly adhere to a diet excluding milk and milk products, all kinds of nuts and nut-containing foods, egg and egg-containing foods, seafish and prawns, brinjal and soyabean for a period of 3 weeks. Instead of these avoided items, the food items to be included freely to maintain proper nutrition were dal and dal products, rohu fish, chicken, and fruits. All the preintervention parameters were measured again after 3 weeks. Results: There was a statistically significant reduction in severity scores after dietary elimination alone. Conclusion: Dietary elimination helped to alleviate symptoms and signs in a subset of infants and children with AD. [ABSTRACT FROM AUTHOR]

About two-thirds of 90 clinics treating phenylketonuria (PKU) now recommend indefinite continuation of a low phenylalanine diet as compared to 1978 when fewer than one-fourth had this policy. The percentage of children maintained on diet has increased markedly for six to eight year-olds. Greater conservatism in clinic diet recommendations likely reflects reports of adverse consequences following diet discontinuation and negative individual clinic experiences. [ABSTRACT FROM AUTHOR]

On 29 March 1744, Thomasin Grace, a 13-year-old girl, was the first inpatient admitted to the Northampton General Infirmary (later the Northampton General Hospital). Inpatient hospital diets, then and now, are mainstays of effective patient treatment. In the mid-18th century there were four prescribed diets at Northampton: 'full', 'milk', 'dry' and 'low'. Previous opinions concerning these four diets were unfavourable, but had not been based upon an individual dietetic assessment. Thomasin would most likely have been given the milk diet, but use of the full diet cannot be excluded. 'Grace Everyman' is Thomasin's modern equivalent. Under current NHS guidelines Thomasin would be considered a paediatric patient, but in 1744 she would have been considered as an adult. This study undertakes a full dietetic analysis of all the prescribed diets available for Thomasin in 1744 and compares this against random choices for Grace from the 2009 inpatient menu from the paediatric (Paddington) ward, and the adult ward inpatient menu at the Northampton General Hospital. The results show that, for Thomasin, the 1744 milk and full diets met the current advised nutritional requirements for adequate dietary intake. However, for Grace, the present 2009 Paddington and adult ward menu, although generally meeting nutritional requirements, could, if Grace or her carer consistently chose poorly during a prolonged inpatient stay, lead to inadequate nutrition. This challenges assumptions that hospital diets were historically inadequate, and that choice in present day equates with satisfactory nutritional intake. [ABSTRACT FROM AUTHOR]

Presents an abstract of an article entitled `Nutrient Absorption and Weight Gain in Persistent Diarrhea: Comparison of Traditional Rice-Lentil/Yogurt/Milk Diet With Soy Formula,' by Z.A. Bhutta, A.M. Molla et al from the 1994 issue of the `Journal of Pediatric Gastroenterology and Nutrition.'