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Very little is known about the use of nutritional supplements in children with Tourette syndrome. The current study aimed to address the frequency of nutritional supplements and the use of special diets in children with Tourette syndrome and typically developing children. Additional data also sought to address the motivations behind using them, their cost and perceived benefits. A total of 76 responses from an anonymous online survey (Tourette syndrome = 42; typically developing = 34) were completed and analyzed. Fifty-six per cent of children with Tourette syndrome compared to 15% of typically developing children were currently taking nutritional supplements, with the majority take two or more. Thirty-five per cent of the Tourette syndrome compared to 6% typically developing were currently or had previously adopted a special diet. Supplements most used for children with TS included probiotics, omega-3, multivitamins and magnesium. For children with TS, supplementation often began around the age of eight, for a duration on average of 35 months. The average cost was £32.44 a month compared to £8.25 for typically developing children. Seventy-five per cent of supplement users in the Tourette syndrome group noted improvement, mainly in motor and vocal tics, sleep quality and anxiety reduction. Most caregivers learned of supplements through the Internet. In almost 42% of the Tourette syndrome group, their pediatrician was unaware of the supplement use and this rose to 65% for special diets. Given the popularity of nutritional supplements, more research on the effectiveness and safety of such interventions is crucial.

Western diets are characterized by a high dietary acid load (DAL), which has been associated with adverse clinical outcomes, including type-2-diabetes and metabolic syndrome. Effective dietary strategies to lower DAL are urgently warranted. Plant-based diets (PBD), including vegetarian and vegan diets, are an effective measure to reduce DAL. Notably, not every individual wishes to adopt a PBD. Instead, many people rely on special diets promising comparable health benefits. The effects of those diets on DAL have rarely been investigated. Using data from the National Health and Nutrition Examination Surveys, we aimed to quantify DAL and nutrient intake in the most popular special diets in the United States, including weight-loss, low fat, low salt, low sugar, and diabetic diets. Our analysis included 3552 individuals on a special diet. The most popular diets were the weight-loss diet (n = 1886 individuals) and the diabetic diet (n = 728). Energy intake was below 2000 kcal/d for all diets; however, there were no statistically significant intergroup differences. DAL scores were positive for all special diets (>9 mEq/d), suggesting acidifying properties. Acid load scores of special diets did not differ significantly and were comparable to a standard Western diet. None of the examined diets was associated with alkaline properties.

Objectives: To evaluate the prevalence of special diet adoption in juvenile idiopathic arthritis (JIA) and parental perceptions of efficacy. Design: An online survey was distributed over a...

Musicians are prone to performance injuries due to the nature of musical practice, and classical pianists are among the groups at high risk for playing-related musculoskeletal disorders (PRMDs). With the growing number of classical pianists in Malaysia, this study aimed to investigate the proportion of PRMDs occurring among classical piano students in tertiary institutions in Malaysia. Associations between gender, practice habits, diet, sports involvement, and PRMD were investigated. A survey was conducted among classical piano students (n=192) at tertiary institutions of Kuala Lumpur and Selangor. Results showed that 35.8% (n=68) students reported having PRMD. The shoulder was the most commonly affected body site, followed by the arm, finger, and wrist. Pain, fatigue, and stiffness were the most cited symptoms by those who suffered from a PRMD. Chi-square analysis showed a significant relationship between the occurrence of PRMD and practice hours (p=0.031), the habit of taking breaks during practice (p=0.045), physical cool-down exercises (p=0.037), and special diet (p=0.007). Multivariate logistic regression analyses confirmed the independent correlation between PRMDs and the lack of taking a break during practice, physical cool-down exercises, and special diet. Because PRMDs are reported at various severity levels, this study should increase awareness of PRMD among classical piano students and encourage injury prevention in musicians in the future to ensure long-lasting music careers.

Background: Special diets are frequently used by the public but reasons for use and characteristics of users remain unclear.AIM: To determine prevalence of the use of special diets, the individual characteristics associated with their use and reasons for use. Methods: The secondary analysis used data from the 2012 National Health Interview Survey (NHIS), a cross-sectional household interview survey of a nationally representative sample of non-hospitalized US adult populations ( n = 34,525). The dependent variables in this secondary analysis were the use of a special diet (vegetarian, macrobiotic, Atkins, Pritikin, and Ornish) ever and during the past 12 months. Independent variables included sociodemographic, clinical and behavioral variables. Prevalence of special diet use and reasons for use were analyzed descriptively. Associations between independent and dependent variables were analyzed using Chi-square tests and logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: Lifetime and 12-month prevalence of using special diets were 7.5% (weighted n = 17.7 million) and 2.9% (weighted n = 6.9 million), respectively. Individuals using special diets in the past 12 months were more likely female (OR = 1.45; 95% CI = 1.21-1.74), not married (OR = 0.76; 95% CI = 0.63-0.91), college-educated (OR = 1.98; 95% CI = 1.25-3.11) and depressed (OR = 1.50; 95% CI = 1.14-1.98). They more likely also used herbal products (OR = 2.35; 95%CI = 1.84-2.99), non-vitamin (OR = 1.82; 95% CI = 1.45-2.27) and vitamin supplements (OR = 1.57; 95% CI = 1.24-1.99). Diets were mainly used to improve overall health (76.7%) or for general wellness/prevention (70.4%). Conclusions: Special diets are mainly used for unspecific health reasons by those who are females, have a college degree or with depression, and commonly used in conjunction with herbs and dietary supplements. Refereed/Peer-reviewed

Aim: Information about the prevalence of special diets in preschool children is limited. The aim of this study was to measure the prevalence of all special diets among preschool children in a Swedish municipality. Methods: This was a population-based cross-sectional survey of all 3276 preschool children aged one to five years in the municipality of Karlskrona, Sweden. The questionnaire assessed the number of children at each preschool, how many were on special diets, their dietary requirements, age, sex, whether they had a medical certificate and whether the special diet had a perceived medical cause. Results: We obtained data for 3221 (98%) of the children, and 19% had special diets, including 12% on nonmedical diets and 6.3% on medical diets. The five most common diets were avoiding pork (7.8%), a vegetarian diet (4.8%), and avoiding cows' milk (3.5%), hens' eggs (1.2%) and lactose (1.1%). Gluten avoidance was more common in girls than boys (0.8% versus 0.2%, p = 0.032). Half (47%) of the children on special medical diets lacked a medical certificate. Conclusion: Special diets were common in preschool children in south-east Sweden, and the causes were mainly nonmedical. Mandatory medical certificates for medically based special diets might reduce unnecessary dietary restrictions. (Less)

The alternative food network (AFN) refers to connections between consumers, producers, and sellers of organic, local/regional, “sustainably grown,” and other artisanal and niche food not produced by the conventional system (Goodman & Goodman, 2007). Alternative foods are often viewed as the “right” consumption choice while conventional counterparts are positioned as ethically “wrong.” A moral positioning of food, avoidance of certain food groups, and anxiety elicited by food consumption choices bears similarities to disordered eating behaviors (Hesse-Biber, Leavy, Quinn, & Zoino, 2006), including a newly proposed eating syndrome, orthorexia nervosa (ON; Vandereycken, 2011; Zamora, Bonaechea, Sanchez, & Rial, 2005). This study examines the relationship among engagement in the AFN, disordered eating behaviors, and special diets. We hypothesized that individuals with higher AFN engagement would be more likely report disordered eating behaviors as well as to follow a special diet. Adult men and women (N = 284) completed a series of measures assessing engagement in the AFN and eating behaviors. We found that individuals with higher AFN engagement were more likely to report ON tendencies but not significantly likely to engage in other disordered eating behaviors. Individuals following a special diet were significantly more engaged in the AFN, more likely to report ON tendencies, and more likely to self-report an eating disorder. Our findings suggest that the most engaged consumers participate in the AFN for the purported benefits reaped by society and the environment and not to moderate their consumption or mask disordered eating behaviors. Future research should prospectively explore associations between AFN engagement, ON and disordered eating behaviors, and special diets as well as consider the utility of incorporating AFN engagement into existing disordered eating prevention programs.

Heat stress results in a multitude of biological and physiological responses which can become lethal if not properly managed. It has been shown that heat stress causes significant adverse effects in both human and animals. Different approaches have been proposed to mitigate the adverse effects caused by heat stress, among which are special diet and probiotics. We characterized the effect of the yeast fermentate EpiCor (EH) on the prevention of heat stress-related complications in rats. We found that increasing the body temperature of animals from 37.1±0.2 to 40.6±0.2°C by exposure to heat (45°C for 25min) resulted in significant morphological changes in the intestine. Villi height and total mucosal thickness decreased in heat-stressed rats pre-treated with PBS in comparison with control animals not exposed to the heat. Oral treatment of rats with EH before heat stress prevented the traumatic effects of heat on the intestine. Changes in intestinal morphology of heat-stressed rats, pre-treated with PBS resulted in significant elevation of lipopolysaccharides (LPS) level in the serum of these animals. Pre-treatment with EH was effective in the prevention of LPS release into the bloodstream of heat-stressed rats. Our study revealed that elevation of body temperature also resulted in a significant increase of the concentration of vesicles released by erythrocytes in rats, pre-treated with PBS. This is an indication of a pathological impact of heat on the erythrocyte structure. Treatment of rats with EH completely protected their erythrocytes from this heat-induced pathology. Finally, exposure to heat stress conditions resulted in a significant increase of white blood cells in rats. In the group of animals pre-treated with EH before heat stress, the white blood cell count remained the same as in non-heated controls. These results showed the protective effect of the EH product in the prevention of complications, caused by heat stress.

Some track-and-field athletes implement special diets aiming to improve health and/or performance. An evidence-based approach to any diet is recommended to minimize the risks associated with unnecessary dietary restriction, which may potentially do more harm than good. Four prevalent diets are reviewed in this study: (a) gluten-free; (b) low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP); (c) vegetarian; and (d) fasting diets. Recently, gluten-free diets and low FODMAP diets have emerged as novel regimes thought to improve gastrointestinal health and reduce the risk of exercise-associated gastrointestinal symptoms. No direct beneficial outcomes have been associated with avoiding gluten for clinically healthy athletes. Indirectly, a gluten-free diet is associated with other dietary changes, particularly FODMAP reduction, which may improve adverse gastrointestinal symptoms. Vegetarian diets can optimally support athletic demands. However, attention is required to ensure adequate energy and intake of specific nutrients that are less abundant or less well absorbed from plant sources. Finally, fasting is a long-standing concept that is undertaken on a voluntary and obligatory basis. Despite limited supporting research, voluntary fasting is a popular alternative to conventional diets perceptually offering health and body composition benefits. Strict obligatory fasting guidelines likely require the implementation of tailored nutrition strategies to help athletes cope with athletic demands. Overall, a multitude of factors influence adherence to special diets. Even when adherence to a special diet is a necessity, education and advice from an accredited dietitian/nutritionist are recommended for track-and-field athletes to optimize nutrition for health and performance.

Tooth erosion is becoming an increasingly common dental problem among teenagers. The study aimed to determine risk factors for erosive lesions in young sports professionals. Participants were 155 students&mdash, 102 physically active and 53 controls. The method included dental examination (including Basic Erosive Wear Examination) and a questionnaire concerning sports activity, dietary and hygienic habits. The sporting activity significantly correlated with erosive lesions (RSpearman = 0.344). The regression model incorporating the kind of sports activity, special diet and (non-)drinking water was statistically significant (p = 0.922 for the Hosmer&ndash, Lemeshow test) and strong enough to predict erosive lesions in young athletes (AUC = 0.758). Water sports professionals were almost 14 times more likely to suffer from erosive lesions than control students. Drinking water as the main beverage decreased the odds by about 70%. The graphical interpretation of multidimensional correspondence analysis confirms the predictive value of these factors. The kind of sports activity adjusted by the main beverage and a special diet was the best variable to predict erosive lesions among teenagers. Early proper diagnosis with defined risk factors leads to better prevention and successful treatment.

The study was conducted to determine the levels of usage of complementary and integrative health (CIH) approaches and the symptoms experienced by Turkish patients with gastrointestinal cancer. A descriptive study was conducted on 81 patients with gastrointestinal cancer attending the medical oncology department of an oncology hospital. In the data collection stage, the patient description form that prepared by the researchers and the "Edmonton Symptom Assessment Scale" were used. Data were evaluated via Chi-square and student t test. It was determined that 55.6% of the patients with gastrointestinal cancer applied at least one CIH approaches, and these CIH approaches were praying (80.0%), herbal medicine (57.7%), a special diet (40.0%), therapeutic touch (15.6%), exercise (13.3%) and psychotherapy (4.4%). 68.8% of patients who used the CIH approach stated that they applied the CIH approaches in order to supplement the medical treatment, and 91.1% stated that they did not inform health employees about that they using the CIH approach. It was also found that the use of CIH approaches was not related to socio-demographic characteristics, disease characteristics and experienced symptoms. It is very important that patients with gastrointestinal cancer be questioned in terms of CIH approaches used.

Aims We provided 3 special diets to 40 preschool children with autism at lunchtime and detected improvements in diet-related issues in almost all of the children. The children fell into the following 3 groups: those who selected their diet based on: group1 = sensory factors; group2 = visual appearance of foods; and group3 = familiar foods. To identify effective support, we performed developmental and sensory assessments of each group retrospectively. Method There were 7 children in group1, 9 in group2, and 24 in group3. The duration of support was 1–3 years. We performed developmental assessments before and after the support period. Results We found improvement in diet-related issues in almost all children. Initially, the mean developmental age for language understanding differed among group1 (10.8 months), group2 (14.7 months), and group3 (16.6 months). Furthermore, with respect to basic ability in daily life, the mean developmental age in group1 (19.2 months) was lower than that in group3 (24.8 months). Finally, the mean developmental quotient in group3 (49.6) was higher than that in group1 (36.4) and group2 (40.8). No significant differences were observed in sensory assessment among the groups. Conclusions Developmental assessment can be useful for determining the type of support. Group1 support is suitable for children in the pre-language stage. Group2 support is suitable for children who can recognize shapes or understand instructions in simple language. Group3 support is suitable for children who can understand instructions in simple language and a daily routine.

Purpose We aimed to examine the experience of complementary and alternative medicine (CAM) use and its association with health-related quality of life (HRQOL) in lymphoma survivors in South Korea. Methods The participants were 869 lymphoma survivors from three hospitals in South Korea, all diagnosed with lymphoma at least 24 months prior to participation. Self-reported questionnaires were used to assess CAM use. The questionnaire addressed types of CAM used, sources of information about CAM, reason for CAM use, satisfaction with CAM use, discussion of CAM use with doctors, experience of side effects, costs of CAM use, and intentions to continue using CAM. HRQOL was measured with the EORTC QLQ-C30. Results Of the 869 participants, 42.2% had experience using CAM, and there were statistically significant differences among CAM users and non-users in terms of sex, religion, and time since diagnosis. A special diet (e.g., ginseng, chitosan, mixed cereals) was the most commonly used type of CAM, and most CAM users (82.1%) were satisfied with their CAM use. Most CAM users (77.5%) did not discuss the use of CAM with their doctors, and only 9.2% reported any side effects from CAM. CAM users showed significantly lower HRQOL scores than did non-users. Conclusion A significant number of lymphoma survivors in Korea have used CAM, and most CAM users are satisfied with their CAM use. Oncology nurses should be aware of the range of CAM use among patients and reflect their responses in their treatment and/or follow-up care.

Orthorexia nervosa (ON) may precede, ensue, or coexist with eating disorders (ED) and also affect eating behaviors. The aim of this study was to explore the dietary patterns (DPs) and other eating habits of people showing ON tendency, ED symptoms, and both ON tendency and ED symptoms, as well as those not showing either. The data for the study were collected from a sample of 1120 Polish college students through a cross-sectional survey in 2017. The questionnaire used in the survey included the ORTO-15, the Eating Disorder Screen for Primary Care (ESP), and the Food Frequency Questionnaire (FFQ-6), and the students were also asked questions about their eating habits and special diets. A factor analysis was conducted to identify the following five DPs: &ldquo, high-sugar products and refined products,&rdquo, &ldquo, meat and meat products,&rdquo, alcohol,&rdquo, high-fiber products and nuts,&rdquo, and &ldquo, dairy products and whole-meal bread.&rdquo, Univariate logistic regression analyses were carried out to verify the associations between the variables. Students in the &ldquo, ON and without ED&rdquo, group were found to exhibit more healthy eating habits than the students in the &ldquo, ED and without ON&rdquo, group. The use of a special diet in the past and currently increased the risk of displaying ON tendency and ED symptoms. Students in the &ldquo, ON and ED&rdquo, groups were characterized by less frequent consumption of high-sugar and refined products. Students who rarely consumed meat and related products were found to be less likely to display &ldquo, ON and ED.&rdquo, In conclusion, different eating habits shown by people with ON tendency and ED symptoms confirmed the difference between ON and ED. However, the simultaneous displaying of ON and ED leads to the overlapping of specificity of eating habits, which can make the diagnosis based only on the eating habits difficult. Thus, there is still a need for further research involving the use of more sensitive tools that can better identify ON tendency and ED symptoms, as well as DPs.

Dietary habits evolve over time, being influenced by many factors and complex interactions. This work aimed at evaluating the updated information on food group consumption in Italy.A total of 8944 (4768 women and 4176 men) participants aged18 years from all over Italy recruited in 2010-13 (Italian NutritionHEalth Survey, INHES) was analyzed. The recruitment was performed using computer-assisted-telephone-interviewing and one-day 24-h dietary recall retrieved from all participants. The updated, second version, of FoodEx2 food classification system was applied to extract data on food group consumption. The participation rate was 53%; 6.2% of the participants declared to follow a special diet, the most prevalent being hypo-caloric diets (55.7% of special diets). Men compared to women presented significantly higher intakes of "grains and grain-based products", "meat and meat products", "animal and vegetable fats and oils and primary derivatives" and "alcoholic beverages" (P for all0.001); moreover, men had lower intakes of "milk and dairy products", "water and water-based beverages" and "products for non-standard diets, food imitates and food supplements" (P for all0.001). Differences in food group intake among age groups, geographical regions and educational level groups were also identified (P for all0.05).Data on the consumption of more than 70 food groups and sub-groups were illustrated in different strata. The present analysis could be considered as an updated source of information for future nutrition research in Italy and in the EU.

The article discusses the potential role that restricting the amino acid valine from the diet of blood cancer patients, prior to a bone marrow transplant, could play in treating blood cancer, instead of using chemotherapy. The article references a study led by the scientist Hiromitsu Nakauchi in the journal "Nature." The role that valine plays in blood stem cells is discussed.

Special diet with restricted branched-chain-amino-acids used for treating maple syrup urine disease can lead to specific amino acid deficiencies.We report a neonate who developed skin lesions due to isoleucine deficiency while using specialised formula.Feeds were supplemented with expressed breast milk. This caused biochemical and clinical improvement with resolution of skin lesions.Breast milk is a valuable and necessary adjunct to specialized formula in maple syrup urine disease to prevent specific amino acid deficiency in the neonatal period.

Case reports have linked childhood nephrotic syndrome to food sensitivity, including gluten. We report our experience with 8 children (6 boys, 2 girls; age at implementation of special diet 2–14 years) with difficult-to-manage nephrotic syndrome who were placed on a gluten-free diet for 3.4 ± 4.3 years (range, 0.6–14 years) and who had clinical improvement enabling reduction or discontinuation in steroid dosage.

Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents.We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel.After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel.The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.

Introduction. Phenylketonuria is a genetic disorder of metabolism of amino acid phenylalanine, which results in the absence of phenylalanine hydroxylase, an enzyme that catalyzes the conversion of phenylalanine into tyrosine. It is an autosomal recessive disorder. Screening for phenylketonuria in Voivodina started in 2003. Screening data are shown in this paper. Treatment of phenylketonuria is based on a strict, life long, low protein diet with the controlled phenylalanine intake. Diet must start early, in the first weeks of life. The aim of the diet is to reduce natural protein intake and to cover protein needs by special phenylalanine free protein products. There is a big variety of formulas found available on the market for treatment of phenylketonuria. All of them are free of phenylalanine and very expensive. Discussion. Till May 2005 there was no refunding for these products in our country. According to the decision made by the Provincial Secretariat for Health, providing all children with protein supplement in their first year of life started at the Institute for Child and Youth Healthcare. In September 2007 the Republic Fund for Health Insurance started to refund protein supplement and low protein products for all children up to the age of 18 years. Conclusion. Besides all technical and organizational difficulties associated with this work, this paper also shows how, by good prevention of phenylketonuria complications, much more money can be saved than it has been invested, even in countries with low amounts of money allocated for this purpose (in absolute figures).

Because of the restricted intake of high-biologic-value protein, children with phenylketonuria (PKU) may have lower than normal plasma concentrations of copper, zinc, and selenium. The purpose of the present study was to investigate erythrocyte zinc levels and serum copper and selenium levels in children and adolescents with PKU by analyzing the relation between their diet and the laboratory profiles of these elements. The study was conducted in 32 children and adolescents with PKU, who were on a special diet. Dietary records and blood samples were collected from each subject. Erythrocyte zinc and serum selenium levels were below normal in 37.5% and 90.6% of the subjects, respectively. Plasma copper levels were normal. Metabolic formulas were the only source of 86.9% of the zinc, 65.6% of the copper, and 32.4% of the selenium. Despite this, there was no significant correlation between the zinc formula supply and erythrocyte zinc levels ( ρ = −0.143, P = .435) or the supply and serum levels for copper ( ρ = −0.117, P = .523) and selenium ( ρ = 0.113, P = .538). These results suggest that Brazilian patients with PKU present with low ingestion levels, low serum selenium levels, and low erythrocyte zinc levels.

There are no indications to prescribed special diets for postoperative patients. Low-sodium and low-fat or low-cholesterol diets are examples of restricted diets, especially in patients with heart disease and atherosclerosis. These restricted diets are unpalatable. Postoperative nausea, paralytic ileus, and vomiting caused by residual anesthetic effects and opioids used for pain control further contribute to the problem. Long-term adherence to these diets is necessary to derive benefits. Prescribing regular and palatable diets in the immediate postoperative period to meet protein and energy goals is important for wound healing and is commensurate with best clinical practices. In the following, we review the pertinent literature and offer clinical evidence that routine special diet orders for postoperative patients are not necessary.

Glutaric aciduria type I is an autosomal recessive disorder resulting from a deficiency of glutaryl-CoA dehydrogenase. This leads to an accumulation of glutaric and 3-hydroxyglutaric acids and secondary carnitine deficiency. The symptomatology is discussed, especially those resulting from lesions in the basal ganglia, and the encephalopathic episodes which are often precipitated by infections. The variability of the clinical presentation is stressed. The most serious complications are collections of fluid and blood in the middle fossae, the bleeding resulting from rupture of bridging veins. The prognosis does not seem to be related to the extent of the enzyme deficiency. The diagnosis is confirmed by identifying the abnormal acids in the urine and the deficiency of the enzyme in cultured fibroblasts. The differential diagnosis is reviewed: from other biochemical disorders and from other cerebral lesions. Treatment is by special diet and carnitine supplementation. The dystonia can prove difficult to treat, and surgery may be needed to remove the collections of fluid and blood. Glutaric aciduria type II is caused by a deficiency of either electron transport flavoprotein or of electron transport flavoprotein oxoreductase. The symptoms can be mild or severe. The former may only occur in times of stress, and the latter include congenital anomalies, especially of the kidneys and heart. The pathology of these are discussed. The demonstration of organic acids in the urine and the results of muscle and liver biopsies confirm the diagnosis, and treatment with a special diet and supplementation with carnitine and riboflavine is effective.

Objective: To study consumption of special diet (disease-related and non disease-related) among Finnish adolescents during 1979–2001. Methods: Self-administered questionnaires were mailed to nationally representative samples of 12- (except in 1979), 14-, 16-, and 18-year-olds in 1979, 1993, 1997, 1999 and 2001. Results: The total number of respondents was 33998. The response rate declined from 78% in 1979 to 70% in 2001. Consumption of special diet increased from 1979 to 2001: in 14- year-old girls from 4% to 24%, boys from 1% to 12%; 16-yearold girls from 5% to 29%, boys from 3% to 11%; and 18-year-old girls from 9% to 30%, boys from 3% to 16%. An increase was observed both in the consumption of disease-related diets (diabetic, lactose intolerance, allergies), and in non disease-related diets (weight reducing, sports and body-building, vegetarianism, other). Conclusions: Adherence to special diet is partly explained by an increased prevalence of certain diseases (lactose intolerance, allergies, diabetes). Increase in vegetarianisms and diets related to body weight or shape are most likely explained by fads, ideals created by media, and by growing ecological awareness.

Javier's* wrists and ankles were bound in iron bands and attached to a chain that circled his waist. He shuffled into my office wearing an orange jumpsuit and shoes without laces under the watchful eyes of 2 armed prison guards. Having treated Javier for myasthenia gravis for 15 years, I had grown accustomed to the shackles that were necessary when a convicted criminal serving a lifetime sentence in our state Department of Corrections is transported 100 miles to see me. But these visible reminders of his incarceration were relatively insignificant compared to the other constraints in my longstanding doctor-patient relationship with prisoner number 32267. The first time I examined Javier is etched vividly in my memory. He couldn't walk, his eyelids were drooping, and he couldn't smile or hold up his head without support. More ominously, his speech was slurred and his breathing was shallow. It only took me a few minutes to decide that I had to admit him to our intensive care unit to support his breathing, to prevent aspiration, and to do a few quick tests to confirm my suspicion of myasthenia gravis. I was amazed that Javier hadn't been sent to me sooner since his symptoms had been progressing over many months. As it turned out, the guards and prison doctors had concluded that he was malingering. Years earlier, Javier's spleen and part of his bowel had been removed following an accident. The surgery left him with digestive problems and chronic abdominal pain so Javier was constantly asking for a special diet and narcotics to alleviate his abdominal pain. The prison staff felt manipulated and grew increasingly deaf to his requests for medical care. Although their attitude seemed shocking at first, over time I begin to appreciate the complexities of prison culture and why staff …

The 40-day postpartum period is characterised in the Middle East and elsewhere by an observance of seclusion, congratulatory visiting, the reciprocal exchange of gifts and money, and a special diet. Based on primary data from in-depth interviews among the Negev Bedouin in Israel, health enhancing practices are reviewed. The data are a subset from a larger study carried out in this setting. Often postnatal checkups, family planning counselling, and immunization services may not be routinely available or used. It is argued that these health services could be provided at the end of the 40-day period for mother and child, as in a pilot study in Tunisia some years ago. Health service provision would thus build on the health enhancing practices of the 40-day period.

This study investigates the effect of socioeconomic and demographic variables, nutrition and health related factors, attitudes, and use of nutritional labels on consumers' choice for healthier food products. Seven equations are estimated representing different food types: luncheon meat, milk, cheese, ice cream, salad dressing, dessert, and meats. The results generally indicate that individuals who are less likely to choose a healthier alternative of a food product include: blacks, younger individuals, males, those with smaller households, smokers, those who take less exercise, those who are not on a special diet, those who are less aware about the linkage between diet and disease, those who put more importance on taste when food shopping, and those who less frequently use nutrition panels and labels that describe health benefits on food packages.

Objective: To determine the incidence of postnatal depression of Malaysias women at 6 week postpartum and a survey of their sociocultural practices. Methods: A hundred and fifty-four women who were 6 weeks postpartum attending the postnatal clinic between May and July 1995 at Maternal and Child Health Clinic, Seremban, Malaysia. Maternal socio-demography, depression by Edinburgh Postnatal Depression Scale (EPDS), postnatal care and practices e.g. pantang larang (prohibited behaviour and practices), diet and partnering were evaluated. Results: Postnatal depression was 3.9%. Indians had the highest rate at 8.5% as compared to Malays (3.0%) and none in Chinese (p < 0.05). There were no demographic differences in the study groups. Average score of EPDS was 4.05 which ranged from 0 to 20. During the confinement 85.7% of women took special diet; 64.3% followed pantang larang and 78.8% had someone to look after them. The incidence of postnatal depression is low in Malaysia at 3.9%. Majority of Malaysian women still observed the traditional postnatal beliefs and practices.

Background Long-distance ocean voyages may have substantial impacts on seamen's health, possibly causing malnutrition and other illness. Measures can possibly be taken to prevent such problems from happening through preparing special diet and making special precautions prior or during the sailing if a detailed understanding can be gained about what specific health effects such voyages may have on the seamen. Methods We present a computational study on 200 seamen using 41 chemistry indicators measured on their blood samples collected before and after the sailing. Our computational study is done using a data classification approach with a support vector machine-based classifier in conjunction with feature selections using a recursive feature elimination procedure. Results Our analysis results suggest that among the 41 blood chemistry measures, nine are most likely to be affected during the sailing, which provide important clues about the specific effects of ocean voyage on seamen's health. Conclusions The identification of the nine blood chemistry measures provides important clues about the effects of long-distance voyage on seamen's health. These findings will prove to be useful to guide in improving the living and working environment, as well as food preparation on ships.

Hyperphagia is a frequent symptom in patients with Prader-Willi Syndrome (PWS) and results in marked obesity with the risk of metabolic and cardiovascular complications. Previously, we reported that our special diet for PWS patients is effective in the long run, if started early at about 2 years of age. Our objective in this study was to investigate if our special diet is also effective in PWS adolescents who are already overweight. We provided a strict, fat-reduced, and carbohydrate-modified diet, consisting of 10 kcal/cm height, to five adolescents (two female, three male) with PWS. Patients were prospectively followed at our center for 2-6 years. BMI, BMI-SDS, and Weight-for-Height Index were recorded over that period. The special diet was started at a mean age of 16 years (range: 14.1-18.9 years) and initial BMI was 41.3 kg/m2(range: 32.4-55.5 kg/m2), corresponding to BMI-SDS +3.6 (range: +2.8 to +4.5 SDS). Weight-for-Height Index was 243% (range: 190-339%). After 2 years of the diet, BMI decreased to 33 kg/m2(range: 26.7-38 kg/m2), as well as BMI-SDS +2.7 (range: 1.7-3.4 SDS) and Weight-for-Height Index to 191% (range: 157-232%); p < 0.01. The special diet was still effective in reducing weight after 4–6 years, with a mean BMI of 30.5 kg/m2(range: 24.6–34.5 kg/m2) and a mean BMI-SDS of +2.1 (range: 0.7–2.9). We conclude that in a period of 2–6 years, our strict, fat-reduced, and carbohydrate-modified diet, with 10 kcal/cm height, is effective even in adolescents with PWS who are already overweight.

Adiponectin is thought to exert anti-inflammatory actions. The aim of the present work was to evaluate the association of long-term adherence to the Mediterranean diet with adiponectin levels, in a sample of cardiovascular disease-free adults. In a random sub-sample of "ATTICA" study, 532 men and women, serum adiponectin was measured. Among several sociodemographic, clinical and biological factors, adherence to the Mediterranean diet was assessed by a special diet score (MedDietSCore) that incorporated the inherent characteristics of this traditional diet. Unadjusted analysis revealed that participants who were in the highest tertile of the diet score had an average 41% higher adiponectin levels, as compared to those who were in the lowest tertile (P

Objective: The objective was to collect data related to individual dietary recommendations and restrictions for people with ostomies. Design: A descriptive survey was used that asked people about food choices/avoidances that occurred because of their ostomy. Subjects: Subjects were members of the United Ostomy Association who had an ostomy and were living at home. Methods: A 14-item questionnaire was mailed to the United Ostomy Association membership (approximately 40,000 current members) in their quarterly newsletter. Results: Six hundred and four questionnaires were returned. The most frequent reason for ostomy surgery among the respondents was colon cancer (71%; n = 424), and the most common type of ostomy was a colostomy. The majority of respondents (88.4%) stated that they were not following a special diet because of the ostomy; 11.8% (n = 69) stated that they had modified their diet. Of the people who had modified their diet, 55% stated that they were using the special diet indefinitely and were adhering to it very well. More than half of the participants had received dietary instructions, provided mainly by a WOC nurse, at the time of surgery. The foods avoided because of the ostomy included fresh fruits, nuts, coconut, and vegetables such as corn, popcorn, cabbage, beans, and onions. The major problems reported were blockage and increased gas. Conclusion: Many respondents reported problems with certain foods. Preoperative teaching and postoperative follow-up must include anticipatory guidance on food selection.

The authors of this descriptive study used Orem's Theory of Self-Care to assess perceived demand for or change in universal and health-deviation self-care activity and the degree of difficulty ascribed to meeting that demand. Perceived demand or change in self-care and difficulty in self-care were measured using the Self-Care Burden Scale ( Oberst, Hughes, Chang & McCubbin, 1991 ) and a structured interview. A convenience sample of 10 English or Spanish-speaking women with HIV infection utilizing a city hospital's outpatient immunodeficiency clinic were recruited. Of the health deviation selfcare items, home medical/nursing treatments, special diet, and obtaining resources were the most burdensome categories. Universal self-care tasks with the highest burden scores were caring for children, physical activity, and work

This is a report of a dietary analysis of meals offered in one large congregate feeding program and clients' consumption patterns as they relate to self-reported dietary restrictions. Most meals exceeded dietary guidelines for kilocalories, cholesterol, and proportion of energy from fat. Of 438 congregate meal clients 60 years of age and older who were surveyed at senior citizen centers and congregate meal sites, 30% reported following a "special diet." The most commonly mentioned dietary modifications were low sodium and/or low fat/low cholesterol. Clients who reported dietary restrictions also reported eating fewer congregate meals per week than did clients who denied dietary restrictions.

We diagnosed 21 patients with hereditary tyrosinemia in Norway; 14 of them had the diagnosis confirmed by enzyme studies. Five died in infancy before dietary treatment was introduced. Six developed hepatoma, between the ages of 3 ½- 20 years, three of them while on dietary treatment. Three died from causes other than hepatoma. Of the seven still alive at the time of writing, two received liver transplants, and one a kidney transplant, three are receiving dietary treatment and one is being managed without a special diet. Dietary treatment may be life-saving in acute cases. It improves the general condition in the chronic forms, improves tubular dysfunction and growth and may postpone develop ment of hepatoma. Liver transplantation is the only curative treatment, but difficulty remains in deciding the optimum time for transplantation; it should ideally be performed before hepatoma develops.

Thirteen young adult patients suffering from heterozygotic familial hypercholesterolaemia with tendinous xanthomatosis, previously treated with a suitable special diet, were studied to assess the effect of bezafibrate, given for 2 years at a dose of 800 mg/day, on plasma lipid and lipoprotein levels and on changes in size of the Achilles tendon xanthomas. Measurements were made before and at intervals during treatment, the tendinous xanthomas being measured by an echographic procedure to give data on antero-posterior and lateral diameters, thus enabling an Achilles tendon index to be defined. The results confirm the hypolipidaemic activity of bezafibrate, changes in the levels of total cholesterol, triglycerides, lipids and lipoproteins (LDL, VLDL and HDL) being similar in direction and magnitude to those reported previously. A significant regression in the size of the Achilles tendon xanthomas was observed in 11 of the 13 patients, and the regression in the Achilles tendon index correlated significantly with a favourable change in the ratio HDL/LDL + VLDL. It is suggested that, as a result of this objective observation, a favourable effect of bezafibrate treatment would possibly be seen on the anatomical atheromatous lesions which are usual in this type of hyperlipidaemia.

Absorption from a chemically defined liquid feed consisting of small peptides, oligosaccharides, and little fat (half medium-chain triglycerides) was compared with that from a feed of whole protein, polysaccharides, and long-chain triglycerides in 7 patients with less than 150 cm of jejunum ending in a stoma. Comparisons of absorption from three solid food diets varying in their fiber and fat content but containing equal amounts of nitrogen and minerals were also made in 4 of the patients. There were no consistent differences between the two liquid or three solid-food diets in percentage of calorie, nitrogen, or fat absorption. The absolute loss of fat depended on the fat intake, but larger losses did not appear detrimental. A liquid diet consisting of peptides, oligosaccharides, and medium-chain triglycerides is not more beneficial than a polymeric diet in patients with a high jejunostomy. A liberal attitude is appropriate toward the fat and fiber content of the diet. Electrolyte supplements, especially sodium and magnesium, are often needed.

Phenylketonuria is a rare inherited metabolic defect in which there is a deficiency of the liver enzyme phenylalanine hydroxylase. Unless this condition is diagnosed within the first few weeks of life, and treated with special diets which have a high carbohydrate content, but which are very low in phenylalanine, severe mental deficiency can result. 105 phenylketonuric (PKU) children, aged 10 months to 16 years, were examined to determine whether this special diet had any effect on the prevalence of caries in PKU children. It was concluded that caries experience in the PKU children examined was of the same order as that reported in normal children of comparable age.

A neonatal case of apo C-II deficiency with hypertriglyceridaemia and xanthomas is presented. The patient responded well to a special diet formula containing medium-chain triglycerides (MCT). This is the first case of apo C-II deficiency to be discovered during the neonatal period.

Two questionnaires were given to the participants of the Danish national marathon championship to obtain information on health, training habits, previous injuries and the medical problems sustained during and after the competition. All 60 participants replied to both questionnaires. The elite runner is training between 90-150 km per week, using one daily training session. He is generally careful about stretching and warming up and down. Forty-three per cent of runners sustained injuries in the last year that prevented them from training, but only 3% needed to stay off work. The most common reasons for not completing the race were exhaustion and injuries to the lower extremities. Sixty-one per cent of the runners who did not drink at all refreshment stations dropped out, whereas only 27% of those who did dropped out. There was no difference in relation to results or medical problems between the group who used a special diet before the run and those who did not. The major medical problems were gastrointestinal disturbances, skin lesions and pain or cramps in the lower extremities. No serious injuries were reported.

A suggested diet containing less than 200 mg cholesterol per day, with a polyunsaturate: saturate ratio of 0.9:1 was prepared for young children with familial hypercholesterolemia. A representative meal plan and calculations for a seven-day food intake allow for a practical, economical diet, low in cholesterol and saturated fat, but high in essential nutrients. The diet should provide an efficient approach to early "dietary intervention" in young children with familial hypercholesterolemia with a long-range goal of normalization of plasma cholesterol and β-lipoprotein cholesterol levels.

A brief overview on the relevance in dietary factors in both development and prevention of cancer is presented. The pharmacologic properties of various food ingredients are discussed. Establishing of a special diet for the cancer patient is suggested. In addition, avoidance of certain foods is recommended to counteract mucus production of cancer cells. Evaluation of the nutrient content of certain diets in regions with low incidence of cancer has advanced the use of certain alkali metals, i.e., rubidium and cesium, as chemotherapeutic agents. The rationale for this approach termed the “high pH” therapy resides in changing the acidic pH range of the cancer cell by cesium towards weak alkalinity in which the survival of the cancer cell is endangered, and the formation of acidic and toxic materials, normally formed in cancer cells, is neutralized and eliminated.

Dietary intakes and blood phenylalanine levels of 125 10-year-old children with PKU are reported. Of those patients, 59 discontinued the special diet at 6 years, 16 discontinued at 8 years, 5 discontinued at 6 years but returned to the diet at 8½ years, and 45 continued the diet to 10 years. Phenylalanine intake was determined by 2-day diet records. Blood phenylalanine concentrations revealed a lack of clear distinction between the diet groups; therefore, regression analysis was performed on the group as a whole. The analyses revealed significant relationships between blood phenylalanine levels from ages 6 to 10 years and each of the cognitive outcome variables, after the influences of parental IQ and the age at which treatment was initiated were controlled for. Intelligence test scores were also related to phenylalanine levels between ages 3½ and 5½ years. The findings suggest that dietary restriction of phenylalanine should continue in patients with PKU through at least 10 years of age. J Am Diet Assoc 88:1226, 1988.

Summary The electronmicroscopic examination of stool samples from 18 infants and young children with gastroenteritis, hospitalized at the Clinic of Infectious Diseases in Prague, was carried out. In ten children rotavirus was found in the faeces and the bacteriological findings were negative. Rotavirus particles were aggregated by convalescent child sera and by normal human gamma globulin. The clinical picture was characterized by the sudden onset of vomiting and fever, in one case with febrile convulsions. Diarrhoea was watery and yellow-green, and usually persisted for four to five days. The condition of the children improved rapidly after rehydratation and a special diet. Older siblings, and in one family also adult members, were frequently affected.

During a marathon relay from John O'Groats to Lands End (JOGLE) various blood and urine parameters were measured in the runners. Samples of blood and urine were taken from each runner immediately prior to the event and on two occasions during it. Subsequently a three point plot was made for each parameter measured. No special diet was taken. Food and liquid refreshment was provided during the run, the first two days of which came from the organisers. The total distance covered was 870 miles and the time taken one hundred hours and thirty-two minutes. Although the results do not approach statistical significance a trend has been shown suggesting that even with the modern running shoe injury may still occur.

Factors that relate to reproductive patterns in 129 families after the birth of a child with phenylketonuria (PKU) include birth order of the index child, age of the parents at the birth of the index child, and expressed intentions of the parents whether or not to have additional children. Factors that do not correlate with reproductive histories include knowledge of the genetic and metabolic nature of PKU, the relationship of PKU to mental retardation and special diet, parental upset about the diagnosis, sex of the affected child, parental IQ, religion, education, and social class. Correlations found related to the question, “Is PKU the reason you don't want more children?” include stress factors in family functioning, mother's upset with the diagnosis, father's concerns about being a carrier, sex of the child with PKU, and degree of knowledge about PKU. Many of the Collaborative Study clinics tend to be more concerned about the consequences of PKU on the family than on society, and feel that families should receive genetic counseling to determine their reproductive risks and future plans. Upon self-report, many clinics declare their counseling to be either “completely nondirective” or making a “conscious effort to be nondirective”.

A dietary survey was carried out in Mazanderan Province of the Caspian Littoral of Iran. The inhabitants of this province have the highest rate of esophageal cancer in the world. A total of 1,501 individuals, in 197 households, from 35 villages in different regions were studied. These regions, which were based on the staple food of the region, included the low-to-moderate risk areas of Shahsavar and Babol in central and western Mazanderan, where the staple diet is rice, and the high- and moderately high-risk areas of Turkoman Sahara (Gonbad and Gorgan) in the east, where the main food is local bread. Perhaps because of poverty and simplicity of the local dishes in the high-risk region, the inhabitants of Turkoman Sahara eat their food three to four times faster than do the people in the moderate- and low-risk regions. In this high-risk area, where the frequency of esophageal cancer is higher among females than among males, a special diet known as "majoweh" or "majum" is given to pregnant women. This food is a crushed mixture of sour pomegranate seeds, black pepper, dried raisins, and occasionally garlic; this combination irritates the esophagus because of the hot black pepper and the sharp, crushed pomegranate seeds. People in the high-risk region preserve their meat by sun drying, and a higher proportion of households in this region keep the preserved food for longer periods of time. Also, the inhabitants of the high-risk region drink more tea at a much higher temperature. Very little fruit and vegetables are consumed by the Turkomans of the high-risk region, whereas inhabitants in the low-risk area keep vegetables and citrus fruits as an important part of their usual diets.

Relatively few long-term studies of the treatment of phenylketonuria have been published in spite of the fact that the low phenylalanine diet was introduced in 1954. 1 Much controversy still exists in regard to the time when the special diet, when it is prescribed, may be discontinued. This controversy is undoubtedly related to the fact that the exact manner in which the biochemical abnormality affects mental development is still unclear. The low phenylalanine dietary regimen poses great problems for both the family and the patient, particularly when near normal or normal intelligence is attained, since the child is constantly exposed to phenylalanine-containing foods both at home where this situation can be controlled and outside the home where such control is nearly impossible. The question then arises about the necessity for weighing the presumed beneficial physiologic effect of the diet against the psychologic disturbances that its administration frequently creates. This