Royal Prince Alfred Hospital Royal Prince Alfred Hospital
Allergy Unit

Student research

The impact of supplementation on nutritional adequacy of patients following the Royal Prince Alfred Hospital elimination diet

Stephanie Pallas
Master of Nutrition and Dietetics, The University of Sydney
Supervisors: Velencia Soutter, Robert Loblay, Anne Swain, Brooke McKinnon, Carling Chan, Kirsty Le Ray, Neelam PunAmy Wu, Rajshri Roy, Wendy Stuart-Smith
June 2015

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Aim: To assess patients' food and nutrient intake before and on Royal Prince Alfred Hospital (RPAH) elimination diet, with and without supplementation compared to the Nutrient Reference Values.

Method: Prospective patients were contacted a week prior to their RPAH allergy unit appointment. Patients who were prescribed the elimination diet were asked to fill in a patient information form, psychological questionnaires and a four day Weighed Food Record (WFR) at baseline and three weeks into the RPAH elimination diet. All data was analysed using Foodworks and Microsoft Excel and compared to the Nutrient Reference Values. Patients were categorized according to elimination diet (strict, moderate approach), wheat and/or dairy restrictions and supplement use.

Results: Thirty-two patients baseline and on elimination diet four day WFRs were analysed. The proportion of patients consuming within Acceptable Macronutrient Distribution Range for carbohydrate increased from 40%-69% and fat increased from 50% to 72%. Supplementation made no difference to folate intake at baseline, but on elimination diet 90% of patients taking a folate supplement met the Estimated Average Requirement compared to 9% without supplements. Patients on the moderate approach met their vitamin A requirements without supplements, but only a third on the strict elimination diet patients met their vitamin A requirements without supplementation. All patients calcium intake was low at baseline. On the elimination diet calcium supplementation in required particularly with those patients restricting their dairy intake.

Conclusion: Nutrients most at risk on the elimination diet include calcium, vitamin A and folate. Detailed advice regarding suitable food sources, substitutions and supplementation of these nutrients is an essential part of educating patients regarding the elimination diet and challenge protocol.