Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student Research

Nutritional adequacy and dietary compliance in children and adults on elimination diets

Anna Chiu
Master of Science (Nutrition and Dietetics), University of Wollongong
Supervisors: Anne Swain, Robert Loblay, Velencia Soutter
June 1997

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The degree of dietary restriction required when following an elimination diet has raised concerns that nutritional adequacy may be compromised, particularly in children who required the exclusion of staple foods such as milk and wheat. Maternal and adult eating behaviours and psychological status may also have an influence on compliance and nutritional adequacy. The nutritional intake of 15 children and 5 adults who attended the allergy clinic at RPAH was analysed before and during the Simplified Elimination Diet (SED) by using 5-day weighed food records. A series of validated questionnaires was used to assess the eating behaviours, psychological status and personality traits of 26 compliers and 7 non-compliers. The results in 15 children were then combined with those of Soutar in mainly adults. Dietary investigations revealed that the nutrient intake in children on the SED adequately met the RDI recommendations, except for calcium. In many cases, the intake of calcium was already poor prior to dietary intervention. In adults, calcium, iron and zinc intakes were improved on the SED, but a lower intake of vitamin A, in particular b-carotene was observed (p<0.05). Nutritional adequacy of children on the SED was maintained by the presciption of a milk substitute or calcium supplement and close dietary supervision. This was particularly so in those who needed milk free SED. The mothers and adults who complied with the SED, all had normal scores for the eating disorders and psychological questionnaires and were therefore assessed to be psychologically normal. Non-compliers had significantly higher scores, indicating they had higher levels of disordered eating, emotional distress, depressive illness, neurotic behaviour and anxious personality types.