Paediatrics Oct 97

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Primary Course in Nutritional Environmental
Medicine
Paediatrics
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Paediatrics

• Nutritional Status of Children
• Behaviour Learning Disorders
• Lead
• Autism
• Children in general nutritional practice

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Pediatrics 2005115736-743 www.pediatrics.org/cg
i/content/ full/115/3/736
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Pediatrics 2005115736-743

• 37 studies of dairy or unsupplemented dietary Ca
  intake
• 27 studies found no relationship between dairy or
  dietary Ca intake and measures of bone health
• Remaining 9 studies the effect on bone health
  are small
• 3 studies were confounded by Vit D intake from
  fortified milk
• 6 found positive relationships in some measures
  but not others
• 1 found an effect of increasing dietary Ca intake
  on BMD when habitual Ca intake was lt 400 mg/day

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Pediatrics 2005115736-743

• Physical activity
• Primary modifiable stimulus for increased bone
  growth
• Calcium
• Intake, turnover, absorption and excretion rates
  determine the availability of Ca for bone growth
  and development
• Absorption is modulated by
• food source
• Form of Ca salt
• Presence of phytates or oxalates
• Vitamin D status

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Pediatrics 2005115736-743

• Calcium
• Urinary losses modified by
• Potential renal acid load of the diet
• Total dietary protein
• Dietary sodium content
• Dietary potassium content
• Caffeine intake
• Smoking

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Pediatrics 2005115736-743

• Calcium supplements
• 9 of 10 RC trials ( 300-1000 mg daily )
• 1-6 increase in BMD
• But effect is transient ( not more than 2 years )
• Effect did not persist into late adolescence

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Pediatrics 2005115736-743

• Adult reference
• Weinsier RL, Krumdieck CL. Dairy foods and bone
  health examination of the evidence.
  AmJClinNutr.200072681-689
• Metanalysis, 57 papers
• body of evidence appears inadequate to support
  recommendation for daily intake of dairy foods to
  promote bone health in the general US population

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PEDIATRICS Vol. 107 No. 4 April 2001, p. e53

• Hypovitaminosis D in Healthy Schoolchildren
• Received Aug 2, 2000 accepted Nov 2, 2000.
• Ghada El-Hajj Fuleihan, Mona Nabulsi , Mahmoud
  Choucair, Mariana Salamoun, Carmen Hajj
  Shahine, Aline Kizirian, and Raja Tannous
• From the  Department of Internal Medicine,
  Endocrine Division, Calcium Metabolism and
  Osteoporosis Program and the Departments of
   Pediatrics and  Food Technology and Nutrition,
  American University of Beirut, Beirut, Lebanon.
• Background.  Vitamin D is essential for skeletal
  growth, but there are currently no guidelines for
  vitamin D supplementation after infancy. This
  study investigates vitamin D insufficiency in
  healthy children.
• Methods.  Children ages 10 to 16 years from
  3 private schools in Beirut, Lebanon, with
  differing socioeconomic status (SES) were
  studied 169 in the spring of 1999 and 177 in the
  following fall 83 students participated in both
  study phases. They had a physical examination,
  answered a dietary questionnaire, and blood was
  drawn for calciotropic hormones and indices of
  bone turnover.
• Results.  Overall, 52 of the students were
  vitamin D-insufficient the proportion of
  insufficiency was 65 in the winter and 40 at
  the end of the summer. During both seasons, girls
  had lower vitamin D levels than did boys those
  who followed the dress code of covered head,
  arms, and legs had the lowest levels. Students in
  the mid-SES school had lower 25-hydroxyvitamin D
  (25-OHD) levels than did the ones from the
  high-SES school. After adjusting for confounders,
  gender, SES, and body mass index remained the
  significant predictors of vitamin D levels in
  both seasons (R2  0.53, for spring and 0.28 for
  fall). There was a significant inverse
  correlation between 25-OHD levels and parathyroid
  hormone levels that was best fitted by a
  curvilinear model (R2  0.19).
• Conclusion.  Even in a sunny country,
  hypovitaminosis D is common in schoolchildren,
  more so in the winter. Girls, especially those
  with a lower SES, are at particular risk. The
  inverse changes in parathyroid hormone suggest
  that insufficient vitamin D levels may
  deleteriously affect skeletal metabolism in
  healthy adolescents. Vitamin D insufficiency may
  be prevalent in many other countries where
  supplementation of milk with vitamin D is not
  mandatory. Our results call to a reconsideration
  of vitamin D supplementation in high-risk
  adolescents to further optimize skeletal health.
  vitamin D insufficiency, bone metabolism,
  nutrition, gender, socioeconomic status. .

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Fruit And Vegetable Intake

• Study from the National Cancer Institute
• Krebs-Smith et al. Fruit and Vegetable Intake of
  Children and Adolescents in the US Arch Pediatr
  Adolesc Med/Vol 150, Jan 1996

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Fruit And Vegetable Intake

• Diets that are abundant in fruits and
  vegetables are associated with a decreased risk
  of cancer of the colon, breast, lung, oral
  cavity, larynx, esophagus, stomach, bladder,
  cervix, and pancreas
• Childhood patterns are important determinants of
  adult risk of certain diet-related cancers
• The habit of eating lots of fruits and
  vegetables beginning during childhood is a
  significant positive predictor of fruit and
  vegetable intake among adults

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Fruit And Vegetable Intake

• The studys results were that
• nearly 1/4 of all vegetables consumed by children
  and adolescents were french fries
• intake of all fruits and dark green/or deep
  yellow vegetables were very low compared with
  recommendations

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Nutrition IntakePrehistoric - TodayDietl,H.
Ohlenschlaeger,G Handbuch der Orthomolekularen
Medizin 94
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CV risk in children

• Porkka KV, et al. The cardiovascular risk in
  young Finns study. Atherosclerosis.
  199410563-69
• Increased TFAs increases risk for CV disease
• Process starts in childhood
• Changes in intima thickness and lumen diameter,
  age 1 - 15

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Trans Fatty AcidsDecsi, et al. Ann Nutr Metab
39,36-41 (1995)

• present in hydrogenated vegetable oils
• 4-6 was considered to be safe
• but increase in LDL cholesterol
• impairment of EFA metabolism
• LCP are essential for normal growth, therefore
  inhibition of LCP synthesis in childhood is of
  serious concern

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Children and Nutrition

• Pollitt E. Does breakfast make a difference in
  school? J Am Diet Assoc. 1995951134-1139
• Nutritious breakfast may prevent nutrient
  deficiencies
• Omission of breakfast alters speed and accuracy
  of information retrieval

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Children and Sugar

• Wender EH, Solanto MV. Effects of sugar on
  aggressive and inattentive behaviour in children
  with ADD wit hyperactivity and normal children.
  Pediatrics. 199188(5)960-966.
• High sugar meal or placebo diet
• more aggressive after sugar-rich-meal

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Brain and Glucose

• Energy for neuronal function
• Neurotransmitter production and secretion
• Electro-physiological brain function
• Simple COH have different effect on
  neurochemistry than complex COH
• White JW, Wolraich M. Effect of sugar on
  behaviour and mental performance. Am
  J Clin Nutr. 199562(suppl)242-249

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Xenobiotics and Behaviour

• well known lead studies
• others
• Manganese, Aluminium, Cadmium
• Oxidation in CNS and dopamine depletion
• Development of brain free radical scavenging
  system and lipid peroxidation under the influence
  of gestational and lactational cadmium exposure.
  Human Exp Toxicol. 199514428-433

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Oils aint oils

• Pediatric dietary lipid guidelines a policy
  analysis. J Am Col Nutr.199514(5)411-418
• Total dietary fat not a problem
• Type of fat
• Increase in Omega 3 FAs

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Brain and EFAs

• CNS and retina of eye are rich in
  n-3-FAs partic. in DHA
• precursor alpha-linolenic acid
• breast milk has high concentration
• formulas very low
• Macrides M, Neumann et al. Fatty acid composition
  of brain, retina and erythrocytes in breast- and
  formula-fed infants. Am J
  Clin Nutr. 199460189-194

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Brain and EFAs

• n-3 FAs
• ALA, EPA and DHA
• brain and visual development
• balance immune and inflammatory reactions
• balance effect of linoleic acid
• corn, safflower, sunflower, soy oils

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Essential Fatty Acids

• Overt Signs of Deficiency
• Dry Skin
• Dry, lusterless, unmanageable or brittle hair
• Dandruff
• Dry, patchy skin
• Brittle nails
• excessive or firm cerumen

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EFA - Suspect Signs of Deficiency

• Cold Sensitivity
• Allergies
• Autoimmune Disease
• Seborrhoeic Dermatitis
• Psoriasis
• Acne
• Aging Spots or Vitiligo
• Osteoarthritis
• Arthralgias
• Hypertension
• Hyperlipidaemia
• CV Disease
• Endocrinopathies
• Mental Disorders
• Cancer
• Diabetes
• Alcohol Intolerance

• Vertigo
• Migraine
• Hiatal Hernia
• Gastritis
• Irritable Bowel
• Peptic Ulcer
• Diverticulosis
• Ulcerative Colitis
• Chronic Recurring Infections
• Myalgias
• Neuralgias
• Tinnitus
• PMS
• Menopausal Symptoms
• Bursitis
• Glaucoma
• Prostatitis

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Behaviour, Learning and Omega-3
FAsStevens,Laura, et al.,
Physiology
and Behavior, 199659(4-5)915-920

• 96 boys, age 6-12
• inverse relationship b/w Omega-3 FAs
  concentration and
• behaviour, learning and health problems

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Nutrient deficiency in low fat diet

• Nicklas TA, Webber LS, et al. Nutrient adequacy
  of low fat diets for children.
  Bogalusa Heart Study. Pediatrics.199289221-2
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• B6 Pyridoxine 8 lower
• B12 Cyanocobalamin 34 lower
• E tocopheroal 32 lower
• B1 Thiamine 18 lower
• B2 Riboflavin 20 lower
• B3 Niacin 23 lower

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Nutrient Intake and FatnessMoore et al. Am J
Epidemiol 139 (11) S56(1994)

• 131 children (Framingham Children Study)
• Saturated Fats and Sucrose were strongest
  predictors of body fatness for girls
• Total Fat and COH strongest for boys
• nutrient composition more important than total
  caloric intake

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Diet and IQ

• Schoenthaler,S., Nature,July 25,1991352292
  Discussion in Lancet
• Double-blind placebo controlled
• 615 school children in 4 schools
• RDA supplementation over 10 weeks
• significant gain in non-verbal intelligence
• 803 schools 1.1 Mio schoolschildren
• Diet policies, only nutrient dense meals to be
  served at school
• 16 improvement in scholastic achievement

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Fruit Juice

• Fruit Juice Consumption, Growth and Development
  Nutrition Week, March 18, 19947
• Study of 14-27 month old children with 20-30
  ounces of juice 25-60 of daily calories
• When intake of fruit juice was reduced, children
  had more caloric intake and gained weight

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ADD

• ATTENTION DEFICIT DISORDER
• 1. HYPERACTIVITY
• ( ADD with hyperactivity )
• 2. LEARNING DISABILITY
• (ADD without hyperactivity )

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ADD with Hyperactivity

• Signs of
• inattention
• impulsiveness
• hyperactivity
• inappropriate for mental and
  chronological age

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ADD with Hyperactivity

• Main discussion point in NEM
• food additives
• food sensitivities
• sugar

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ADD with Hyperactivity

• Incidence 3 - 20
• boys girls 9 1
• Onset 3 years

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ADD with Hyperactivity

• Characteristics
• Hyperactivity
• Perceptual motor impairment
• General coordination deficit
• Emotional lability
• Disorders of attention
• Impulsiveness
• Disorders of memory and thinking
• Specific learning disability
• Disorders of speech and hearing
• Equivocal neurological signs and
• EEG irregularities

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Food Additives

• up to 5000 are used
• 13 - 15 gms per day consumption
• Feingold hypothesis
• 40 - 50 of hyperactive children are sensitive
  to
• food colours, flavours, preservatives and
  naturally occuring salicylates phenolic
  compounds

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Feingold - Food Additives

• 1973 presentation to the American Medical
  Association
• Connor - greatest critical researcher

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Feingold - Connor

• Type of placebo - chocolate cookie
• other studies show
• 33 - 59 reactions to chocolate
• Inadaequacy of challenge dose
• study dose 13 mg
• compared to 150 mg (FDA data)
• other studies ( 75, 100 and 150 mg )
• significant impairment of learning performance
  in 85 of tested children

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Feingold - Connor

• Length of dose interval
• Type of testing - cytotoxic test
• Continuous bias of research
• Nutrition Foundation funded most of the negative
  studies

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Feingold - Connor

• Supportive studies in AUS
• Rowe et al Artificial food colourings and
  hyperkinesis
• Aust Paediatrics J 15202, 1979
• Rowe Food additives.
• Aust Paediatrics J 20171-4, 1984
• Cook,P The Feingold dietary treatment of
  thehyperkinetic
• syndrome. Med J Austr 285-90, 1976
• Salzmann Allergy testing, psychological
  assessment and
• dietary treatment of the hyperkinetic child
  syndrome
• Med J Austr 2248-251, 1976
• Weiss et al Behavioural response to artificial
  food colours
• Science 2071487-9, 1980

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Food Sensitivities

• Common
• Cows milk
• Peanuts
• Wheat
• Orange
• Chocolate

• Corn
• Yeast
• Soy
• Tomatoes
• Grapes

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Food Sensitivities

• Testing
• Elimination-challenge
• IgE
• IgG 4
• Electro-dermal
• Kinesiology
• Cytotoxic
• Alcat
• Intestinal Permeability

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ADD and EFAsStevens et al. Am J Clin Nutr 62
(4), 761-768 (1995)

• 53 boys with ADHD, 43 controls
• significantly lower conc. of EFAs
• many symptoms of EFA deficiency

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Learning DisabilityADD - without hyperactivity
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Learning Disability

• OTITIS MEDIA
• children with moderate to severe hearing loss
  have
• impaired speech and language
  development
• lowered general intelligence scores
• learning difficulties

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Otitis Media

• Etzel,R.,Pediatrics, August 199290(2)228-232
• PassiveSmoking and Middle Ear Effusion Among
  Children in Day Care
• 8 of cases of Otitis Media with effusion due to
  passive smoking
• 17,6 of days with OM with effusion due to
  passive smoking
• U.S. 5 Mio office visits for children under age
  3
• per year. 1 - 2 billion spent on OM per year

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Learning Disability

• NUTRIENT DEFICIENCY
• any nutrient deficiency can result in
  impaired CNS function

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Iron Deficiency

• Webb,TE. J.Spec.Education 1974
• Pollet, AJClinNutr 1986
• Behaviour, Learning Disability

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Learning Disabilities

• HEAVY METALS
• particularly lead
• many studies. Lancet 1972 - until today
• Recent studies in Sydney and NSW

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Learning Disability

• BEHAVIOURAL OPTOMETRIST

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ADD and Literature

• Weiss,G. NEJM, Nov 15,1990323(20)1413-1414
• Hyperactivity in Childhood
• Editorial review regarding Zametkins article.
• Study supports view of metabolic dysfunction, but
  probably not single cause
• Others are lead exposure, poverty and stressful
  family
• Stimulants have been used with some success, but
  their widespread use and long term efficiency is
  questionned.

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ADD and Lead

• Lead Toxicity May Underlie Behavioral, Learning
  Disorder,Family Practice News,
• Dec.15-31,199121(24)37.
• D. Herbert Needleman,
• Annual Meeting of the American Academy of Child
  and Adolescent Psychiatry
• Any child with behavioral disorder or learning
  disability should be tested for lead exposure
  immediately..

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Lead

• CDC in 1991 reduced action level for lead
  poisoning from
• 25 ug/dl (set in 1975 ) to 10 ug/dl
• Report Preventing Lead Poisoning in Your
  Children.
• Office of Public Affairs, CDC, Atlanta, Georgia
  30333

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Lead

• Beck, Barbara, Fundamental and Applied
  Toxicology,1992181-16
• Symposium Overview An Update on Exposure and
  Effects of Lead
• Neurobehavioral effects
• Carcinogenicity

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More on Lead

• Journal of th American College of Nutrition,
  Oct199211(5)608/37
• Overview of Lead Toxicity Early in Life, Effects
  on Intellect loss, Hypertension.
• 10 of all children have been exposed to unsafe
  levels of lead
• 10-50 of children have increased lead levels
• In 1978 lead levels in babies teeth were
  correlated wit neurobehavioral function,
  inversely related to lead dentine levels

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Lead contd - JACN Oct 1992

• 11 years later significant association with
• lower class standing
• absenteeism
• lower verbal scores
• poor coordination
• longer reaction times
• Epidemiological and clinical studies
• hypertension, kidney dysfunction

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Lead - IntelligenceTong, Shilu, et al (Uni of
New England,Armidale)BMJ,19963121569-75

• 375 children born close to a lead smelter
• IQ inversely associated with antenatal and
  postnatal blood lead concentration

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Lead Poisoning and ZincCould Zinc help Protect
Children from Lead Poisoning?Schmitt, Nicholas,
Canadian Medical Association Journal, January 1,
1996154(1)13-14.

• High intake of lead results in neurological
  damage
• Zinc is a known metabolic antagonist of lead
• Zinc supplementation may be of benefit in
  children with risk of lead poisoning
• Children from low income family are deficient in
  Zinc
• Address Zinc deficiency and reduce lead exposure

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Lead and Vitamin CDawson,E.et al, J of the Am
Coll of Nut 199716(5)480/Abstract 42

• 75 adult males 20-35 years
• 0, 200, 1000 mg Vit C for 1 months
• mean blood lead levels
• Results
• no change in 0 or 200 mg Vit C
• in 1000 mg group
• reduction from 38 to 8 ug/dl in 1 week
• remained for the length of the study

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Lead levels and BehaviourNeedleman et al. JAMA
275(5), 363-369 (1995)

• 850 primary school aged boys
• follow up over 4 years
• lead exposure associated with
• sleep disturbances
• attention problems
• aggression
• delinquency
• anxiety/depression
• social problems
• negative effects of lead follow a developmental
  curve

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AUTISM
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AUTISM

• Syndrome of early childhood
• male female 4 1
• Profound failure to develop social
  relationships
• Language disorder with
• impaired understanding
• echolalia,pronominal reversal
• Rituals and compulsive phenomena
• General retardation in intellectual
  development ( most cases )

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AUTISM

• Organic defect in brain development
• as a result of
• abnormal SEROTONIN metabolism

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AUTISM

• Prognosis
• generally poor
• related to results of IQ testing
• in children lt 50, temporal lobe epilepsy

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Theory 1
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Theory 1
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Theory 2
increased
tryptohan
oxygenase
activity
reduces available tryptophan for serotonin
synthesis
inhibits tryptohan transport across the BBB
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Theory 2
increased
tryptohan
oxygenase
activity
reduces available tryptophan for serotonin
synthesis
inhibits tryptohan transport across the BBB
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Theory 3
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AUTISM

• Abnormal serotonin metabolites are seen in
  autistic children
• may significantly contribute to their mental
  dysfunction
• LSD and other hallucinogens are serotonin
  analogues
• Serotonin and its metabolites are produced in and
  absorbed from intestines ( ? leaky gut syndrome
  )
• Recent study on secretin

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Autism

• Amino Acid Metabolism
• Fatty Acid Metabolism
• Opiods from casein and gluten
• Other toxic metabolites

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AUTISM and Rx

• RECOMMENDATIONS ARE INCOMPLETE
• Specialised services and counselling
• Eliminate factors that play a role in aggrevating
  
• CNS dysfunction ( eg. food sensitivities )
• Milk, wheat, sugar 40 - 50 improvement
• Amino acid and Fatty Acid assessment
• Bowel detox

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AUTISM and Rx

• Suggested supplementation
• Ascorbate 1g
• B 6 50 mg
• Folic acid 500 mcg
• B 12 500 mcg
• Mg 100 mg
• Omega 3 and 6

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Milk and Tonsillitis

• Hodson,A., The Journal of The Royal Society of
  Medicine, Jan 19918458
• Milk allergy may be an etiological factor in
  tonsillitis
• Few children in countries without milk have ever
  tonsillitis
• If substitution of milk powder in those
  countries, significant increase in tonsillitis
  eg. WHO in Lybia

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Acute Otitis Media Antibiotics

• Browning,G., BMJ April 14,19903001005-1006
  Review Childhood OtalgiaAcute Otitis Media
  Antibiotics Not Necessary in Most Cases
• Child with ear pain - less than 50 chance of
  acute OM
• After initial myringotomy - 20-30 no pus, no
  bacteria
• No consistent data supporting antibiotic use in
  serous OM

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OM Antibiotics (Browning)

• 85 of children pain free after 24 hours
  irrespective of Antibiotics
• Evidence that ABs reduce incidence of
  mastoiditis is negligible
• Recommendation
• Antibiotics only if otalgia persists for longer
  than 24 hours

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OM Antibiotics (Browning)

• If policy were instituted in UK
• 1.84 Mio fewer prescriptions for antibiotics
• Saving of 6 Mio pounds per year
• In Scandinavian countries antibiotics are not
  routinely given and parents do not expect them

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Otitis Media

• Food Allergies Can Trigger Ear Infection
  Pediatric News, 199125(2)
• 78 of children with chronic ear infection were
  sensitive to different foods incl
• milk, wheat, peanuts, corn
• Elimination for 11 weeks - resolution in 88
• Reintroduction of those foods - 66 relapse
• Suggested mechanism Production of mucous and
  swelling of Eustachian tubes

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Eustachian Tube DysfunctionDerebery,M et al., Am
J of Otology,199718160-165

• underlying inhalant and food allergy
• most pts have at least 1 positive reaction to
  food by provocation or skin testing
• most have symptom improvement with dietary
  elimination
• wheat 70.7
• milk 51.5
• corn 60.9
• egg 51.7
• yeast 55.9
• soy 45.5

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Milk allergy and SoyJ of Pediatrics 1999
134614-22

• 14 of IgE cows milk allergic children have IgE
  allergy to soy
• safe to introduce under medical supervision
• Soy remains unsuitable for children with
  non-IgE-associated cows milk allergy involving
  enterocolitis in these non-atopic patients

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Vitamin C Antibiotics

• Vitamin C Enhances Antibiotic Therapy The
  Nutrition Report,April 199210(4)31
  
• Staph aureus strains lost resistance in 4/6
  strains after 6 hours
• Antibiotic levels effectivity increase by
  50-75 after Vit C exposure
• 23-93 Vitamin C was bacteriocidal

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Vit C Antibiotics contd

• Vitamin C may modify bacteria DNA
• Vitamin C shows no mutagenic or carcinogenic
  effects on normal cells
• Vitamin C inhibits bacterial resistance to Ab
  therapy

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Milk Intestinal Permeability

• Cows Milk Allergy, Sugar and Intestinal
  Permeability
  Troncone,R., Allergy 199449142-146
• 90 of infants who developed symptoms after
  challenge
• showed increase post-challenge intestinal
  permeability
• 4.5 in non-reactors

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Food Allergy and Atopic Disease
Annals of Allergy December 1993, 71495-502

• less than 20 are true allergy or
  hypersensitivity
• food allergy in at least 25 of infants with
  atopic eczema
• intestinal permeability may increase risk of food
  allergy
• breast milk may reduce atopy
• research should move beyond the obsession with
  IgE mediated type 1 reaction

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J Pediatr. 2004 Nov145(5)606-11.
                 Lymphoid nodular hyperplasia
and cow's milk hypersensitivity in children with
chronic constipation.Turunen S, Karttunen TJ,
Kokkonen J.Department of Pediatrics, University
Hospital Oulu, Finland.OBJECTIVE To
investigate the incidence of cow's milk allergy
as evidenced by milk challenge and the findings
of endoscopic and immunohistochemical
examinations in children with chronic and
refractory constipation. STUDY DESIGN
Thirty-five study subjects (mean age, 8.3 /- 3.3
years range, 3-15 years 17 girls) and 15
control subjects (mean age, 11.7 /- 3.2 years
range, 2-15 years 9 girls) were studied by
colonoscopy and a 4-week cow's milk elimination
and challenge. RESULTS Lymphoid nodular
hyperplasia was the most prominent endoscopic
finding in half of the subjects (46), mostly
occurring patchily in the transverse colon.
Histologic findings other than lymphoid
accumulation and mildly increased density of
eosinophils were few. During the milk elimination
and with supportive medication, 83 of subjects
remitted. Constipation and/or other
gastrointestinal or skin symptoms relapsed only
in one third (34) during the cow's milk
challenge, these having significantly higher
densities of intraepithelial gammadelta T cells
( P lt.001) in the biopsy samples of the terminal
ileum as compared with the control subjects.
CONCLUSIONS We were able to find formal evidence
for the presence of cow's milk allergy in
children with chronic constipation.
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Breast Feeding and Atopic Disease

• Saarinen,KajosaariBreastfeeding as prophylaxis
  against atopic diseaseProspective follow-up
  study until 17 years old.
  Lancet1995 3461065-69
• Breast feeding is prophylactic

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Breast Feeding and Atopic Disease

• Group Age substantial atopy
• 1 3 5 10 17 age 17
• lt1 month or no 23 36 46 43 65 54
• 1-6 months 23 24 27 31 36 23
• gt6 months 11 22 34 29 42 8
• CLINICAL HISTORY, SKIN-PRICK TEST,IGE,
  RAST, NASAL EOSINOPHILS

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Infantile Colic - Allergy?

• Hill et al.Royal Childrens Hospital, Melbourne
• A low allergen diet is a significant intervention
  in infantile colic Results of a community-based
  study.
• J Allergy Clin Immunol96,6 Part 1
• DBRPC trial ofcolicky infants over 1 week
• 38 bottle fed and 77 breast fed
• casein hydrolysate or cows milk
• Mothers diet oligo-antigenic diet
• free of additives, preservatives colours
• free of milk, egg, wheat and nuts

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Infantile Colic - Allergy?

• Significant higher rate of improvement
• 39 compared to 16

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Diarrhoea Good BacteriaBaker,B. Family
Practice News, Sept15,19971,2

• infant follow up after hospital admission for
  non-GIT conditions
• regular formula
• formula bifidobacteria Strep therm.
• 31 diarrhoea in infants with formula
• 7 diarrhoea in supplemental group

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Vit A Growth

• Vitamin A Deficiency in Nocturnal Growth
  Hormone Secretion in Short Children
  The
  Lancet, January 8,199434387-88
• Strong correlation between plasma Vit A and
  nocturnal GH secretion
• Supplementation with Vit A 3,000 ug for 3
  months increases nocturnal GH secretion

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Fluoride and MagnesiumMachoy-Mokrzynska,
Fluoride 28,175-177 (1995)

• Fluoride interferes with biological activity of
  Magnesium
• Magnesium competes with fluoride for absorption
  by the gut
• Mg deficiency leads to higher fluoride levels in
  bones
• Mg may protect against some of the possible
  ill-effects of fluoride

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Psyllium and Cholesterol

• Davidson MH et al. A J ClinNutr.19966396-102
• DB,Contr,cross-over study of 25 children
• 6 weeks treatment with 6.4 g Psyllium
• significant 7 reduction in LDL cholesterol