Children with multiple food allergies have a higher risk of impaired growth and may have a higher risk of inadequate nutrient intake than children without food allergies. Until more research is available, we recommend monitoring of nutrition and growth of children with multiple food allergies to prevent possible nutrient deficiencies and to optimize growth.

A treatment program for adolescents with phenylketonuria (PKU), incorporating education, goal-setting, self-monitoring, contracts, and rewards, was evaluated by measuring knowledge of PKU, blood phenylalanine concentrations, and health locus of control (LOC) before and after participation in the program. Of the 16 subjects, seven subjects successfully completed the program by achieving behavioral goals. These subjects increased their knowledge of PKU and decreased their blood phenylalanine concentrations, but the nine nonsuccessful subjects did not. There was no significant change in LOC scores for either group. There was a significant relationship between baseline blood phenylalanine levels and success with the program. Therefore, this pilot study demonstrates that adolescents who have already achieved some measure of metabolic control can be expected to be most successful with this program and realize the greatest benefits from it in the form of increased knowledge of PKU and even better metabolic control.

Blood phenylalanine and the metabolites of phenylalanine can be dramatically lowered in pregnant PKU mothers. Special formulas and a strict protocol should be used to achieve diet control and adequate compliance. Levels of blood phenylalanine of 4 mg/dl and lower can be achieved and are preferable to higher levels. The problem of treatment postconception may lead to limited success, as in our case. In order to achieve optimal results, blood phenylalanine should be controlled at or before conception. Since it is difficult to return patients to diet who have been taken off phenylalanine restriction, diet therapy for PKU should not be discontinued at any age.

Background. Glycemic index (GI) and glycemic load (GL) are tools to estimate the postprandial glycemic response (PPG) to carbohydrate-containing foods. Currently, the American Diabetes Association recommends matching insulin dose to the carbohydrate content of food in individuals with type 1 diabetes mellitus (T1DM) without considering GI or GL. Objectives. The objective of this study was to determine the following: (1) the relationship between the PPG and the carbohydrate content, GI, and GL of a meal in adolescents with T1DM and (2) whether mean GL per meal is related to long-term glycemic control as measured by hemoglobin A1c (HbA1c). Methods. A retrospective analysis of three 24-hour recall interviews was performed for 87 adolescents aged 12 to 17 years. Average GL was calculated for each meal and each day and compared with 2 weeks of blood glucose data and HbA1c data using linear regression analysis. Results. A significant correlation was seen between GL and PPG only in those who dosed prior to eating. Inverse correlations were found between HbA1c, average GL per meal, and average reported carbohydrate intake. However, when the analysis was repeated in only those with an HbA1c below 8%, a positive correlation was found between average GL and HbA1c. Conclusion. GI/GL may be clinically useful in managing PPG in those who dose before eating. The inverse correlation between GL and HbA1c may be explained by underreporting of carbohydrate intake in adolescents with poor glycemic control. For those with a HbA1c below 8%, GL may be considered an advanced tool to optimize management.

Background. Food allergies are a growing problem among American children. There is currently no cure for food allergy. Food allergies are managed by strictly eliminating allergens from the diet, which may lead to poor nutrient intake and poor growth. The aim of this study was to retrospectively analyze changes in calcium intake and growth in children with multiple food allergies after medical nutrition therapy (MNT). Materials and Methods. A retrospective chart review was conducted on 50 patients with 2 or more food allergies. At least one of their food allergies was nutritionally significant: milk, soy, wheat, or egg. Weight and length/ height were recorded from the medical record from the initial allergist visit (visit 1), the initial dietitian visit (visit 2), and the follow-up dietitian visit (visit 3). Dietary intake was collected from the medical record from visits 2 and 3 and calcium intake was calculated based on these data. Results. Weight-for-age and weight-for-length or body mass index (BMI)-for-agez-scores decreased from visit 1 to visit 2 and increased from visit 2 to visit 3, but this was not statistically significant. The mean change in weight-for-length or BMI-for-age z-scores from visits 1 to 2 was significantly lower than the mean change in weight-for-length or BMI-for-age z-scores from visits 2 to 3. The average calcium intake of all patients at visit 2 was 163 ± 75% of goal calcium intake. Conclusions. Although more research is needed, our study supports the need for MNT for children with multiple food allergies. Children with multiple food allergies are at nutrition risk, and MNT may improve nutrient intake and growth for these children.