Showing posts with label food. Show all posts
Showing posts with label food. Show all posts

Monday, March 23, 2015

Let Them Eat Cake: Gluten Free Diets In Response To Celiac Disease

By: Joann Schulte  DO, MPH; Editorial Board Member

Public Health Image Library (PHIL)

     Gluten-free dining and groceries are a growth industry these days.   Multiple restaurants, both of   Some charge a higher price for gluten-free items that can include everything from pizza to Mongolian beef to the flourless chocolate cake.  Such items have to be prepared carefully so there’s no cross-contamination in the kitchen from wheat or barley. There’s even a class-action lawsuit that’s been filed in California, claiming that the extra charges and higher prices are a violation of the Americans with Disabilities Act the gourmet type and the chain variety, spout their gluten-free menus.
      The availability of such diets and grocery choices is good news for patients with celiac disease (CD), including the children who are often diagnosed after prolonged complaints of abdominal pain, diarrhea, failure to thrive and nutritional deficiencies.  About 1% of the US population is estimated to have celiac disease, and new research published this month in Pediatrics documents risk factors associated with the disease among a birth cohort followed in six clinical centers located in four countries. 
     Agardh et al. (doi:10.1542/peds.2014-3675) followed a group of 6,706 children who were positive for HLA-DR3-DQ2 and/or DR4-DQ8.  Those HLA types have been associated with a higher risk of celiac disease.  The children were screened annually for tissue transglutaminase antibodies (tTGA) and screened for symptoms via questionnaires.  Those questionnaires include an assessment of abdominal discomfort, anemia, chronic constipation, loose stools, vomiting and poor growth.  The researchers also collected information about children’s height, weight and body mass index. The researchers found a 5% incidence of CD among children with HLA types linked to the disorder.
      Among the screened children, 914 developed persistent positive tTGA, 406 underwent intestinal biopsies and 304 were diagnosed with CD.  The researchers compared their pediatric subjects with age-matched children who were tTGA negative.  The children who were persistently positive were more likely to have symptoms at ages 2 and 3 years and to have higher levels of tTGA at seroconversion.  The levels of tTGA correlated with the severity of mucosal lesions in both symptomatic and asymptomatic children.
      In a related commentary, Dr. Richard Noel (doi:10.1542/peds.2015-0209) suggests that the study offers a tiered approach to CD diagnosis.  The 2-tiered approach of early genetic screening for genetic susceptibility and later screening for the celiac antibodies has been proposed.   Currently an individual physician must undertake the testing.  The study suggests a possible case-finding strategy in a disease that may be more easily managed given the attention it is getting both from medicine and the food industry.

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Wednesday, February 4, 2015

How Sweet It Should Not Be! Sugar and Sodium Content in Complementary Infant and Toddler Foods and Drinks.

By: Lewis First, MD, MS; Editor-in-Chief  
       We are certainly aware of the need to check food labels on the foods we eat so as to maximize our nutritional content (hopefully) and avoid foods that are high calorie due to unhealthy added sugars and often too much salt. But what about the foods our infants and toddlers eat?  Are parents checking the labels on those products?  Should they be? 
Cogswell et al. (doi: 10.1542/peds.2014-3251) provide us with some important food for thought this week in a study they have done categorizing more than 1000 of the most common infant and toddler foods and beverages that are on the shelves of most grocery stores to determine just how many of these contain added sugars and salts in excess of the Food and Drug Administration’s referenced amounts.  The results may surprise you—and the information in this study is well worth sharing with your patients.  At the very least it makes them aware of the need to read food labels even on the starter foods of our youngest patients. 
          What are the risks for infants and toddlers who do experience early exposure to complementary foods rich in added sugar and salt?  Drs. Susan and Robert Baker weigh in with a commentary (doi:10.1542/peds.2014-4028) that puts the study’s results in context and suggests we work with parents even more to advocate for healthier nutritional content of complementary foods and beverages even in those first few years of life. 
There’s lots of helpful data to digest in this study and accompanying commentary—so read both and then share what you are doing to foster healthy eating in your infant and toddler patients by commenting via a response to this blog, an e-letter or by posting on our Facebook or Twitter sites.

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Friday, January 30, 2015

Fast Foods that List the Amount of Exercise Needed to Burn Off the Calories: A Strategy for Healthier Eating?

By: Lewis First, MD, MS; Editor-in-Chief 

    More and more we find foods in restaurants and especially fast food restaurants listing the calories for the various items we wish to order. But what if the listing also included how much exercise is needed to burn off those calories?  Would it make a parent order even healthier options for their child? 
     Drs. Viera and Antonelli (doi: 10.1542/peds.2014-2902) conducted an intriguing national survey of 1000 parents who were randomized to receive one of four theoretical fast food menus that included a menu group with (1) no labels, (2) only calories, (3) calories plus minutes of exercise to burn off those calories and (4) calories plus miles needed to walk to burn off the calories.  
      Knowing the information on the menu, parents were then asked to order for their child as well as comment on whether putting nutritional as well as exercise information on the posted food item would promote their child to exercise more?The results do show caloric and exercise labels do make a difference—but as to which type of label works best, they all are better than just listing the food without labels but substantive differences of one type of label versus another do not seem to show statistically significant differences.  
      As to how many parents felt the label would help them promote exercise in their children, you’ll have to exercise your eyes and read the full study to glean the take-home lessons learned from this fast-food study and then digest the findings with your patients.

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Friday, January 23, 2015

Pizza Intake Over 8 Years in Children and Adolescents: Slicing Up the Nutritional Risks

By: Lewis First, MD, MS; Editor-in-Chief 
     If you ask children and teens what one of their favorite foods might be, a safe bet would likely be pizza.  So how does a child or adolescent’s pizza consumption affect their caloric and nutrient intake—and better yet, has the consumption pattern changed over the past decade or so?  
     Powell et al. (doi:10.1542/peds.2014-1844) looked at four different annual sets of dietary recall data from 2003 to 2010 for children and teens from the National Health and Nutrition Examination Survey and while controlling for various confounders, estimated the role that pizza consumption played on total caloric intake and amount of salt, saturated fat and sodium taken in daily.  Although caloric intake from pizza decreased over the study period, the prevalence of having pizza in the diet  was unchanged and in turn was associated with overall higher net total energy intake in terms of calories as well as with increased intake of saturated fat and sodium and sadly—this was seen across all sociodemographic categories studied.  
      The authors cook up even tastier pieces of information about the associated nutritional risks of eating pizza that await your perusal. Does this mean an end to pizza as a favorite meal for many of us?   No----but perhaps we could go with less “portion distortion” (i.e. smaller slices) and some healthier ingredients than currently occur with this popular dish.   
     Any ideas for a healthier pizza?  Share them with us by responding to this blog, sending an e-letter or commenting on our Facebook or Twitter sites.

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