Diet Quality: A Neglected Parameter in Children With Food Allergies. A Cross-Sectional Study

Assessment of the Diet Quality Index and Its Constituents in Preschool Children Diagnosed with a Food Allergy as Part of the "Living with an Allergy" Project

Pediatric food allergies (FAs) are health conditions that adversely impact the quality of life of children and their caregivers.

AIM

The primary objective of the present study was to assess the quality of the diets administered to allergic children based on the Healthy Diet Index (HID-10), to determine the influence of parental knowledge about FAs and the elimination diet, and to identify the factors that contribute to healthy food choices.

MATERIAL AND METHODS

This study was conducted as part of the "Living with an Allergy" research and educational program for preschool children, which was implemented between June 2021 and June 2023 in the city of Lublin.

RESULTS

Food allergies were diagnosed and confirmed in 241 children, including 106 boys (44%). A higher number of unhealthy dietary factors (DQI-1) was significantly associated with gender, and lower DQI values were more often noted in boys (p < 0.05). In turn, a higher number of health-promoting dietary factors (DQI-3) was significantly associated with a younger age in children (OR 1.54; 95%CI 1.17-1.74, p < 0.01) and with an older age in parents (OR 1.43; 95%CI 1.2-1.67, p < 0.05).

CONCLUSIONS

Children whose diets, including the necessary modifications, were recommended by a physician or a dietitian were characterized by significantly higher DQI values and a higher number of health-promoting dietary factors. The diets of children with FAs should consist mainly of unprocessed foods to control the intake of unhealthy products that suppress immunity.

Development and Validation of Parental Self-Efficacy Scale for Dietary Management of Children with Food Allergies

BACKGROUND

It is necessary to evaluate the parental ability to achieve nutritional adequacy while avoiding allergens for children with food allergies (FA), yet this area is currently understudies. Our study aimed to develop and validate the Parental Self-Efficacy Scale for Dietary Management of Children with Food Allergies (PSED-FA).

METHODS

PSED-FA was developed through a literature review and semi-structured interviews refined by a panel of five allergists and five dietitians, and validated using responses from caregivers of children with FA. The construction of the tool involved exploratory factor analysis (EFA), confirmatory factor analysis for model fit, and evaluation of internal consistency using Cronbach's alpha. Convergent and divergent validity were assessed using the average variance extracted (AVE), maximum shared variance (MSV), and average shared variance (ASV).

RESULTS

Participants included nine focus interview groups, with 114 individuals in the validation group. Egg whites (55.2%), tree nuts (35.2%), and peanuts (22.8%) were the most common allergens. The EFA identified three factors: preparing allergen-free meals, knowledge of nutrition management, and management of food restrictions. The goodness of fit of our model met all the criteria. The tool showed high internal consistency (overall Cronbach's alpha: 0.902) and met the criteria for both convergent (AVE >0.5) and divergent validity (AVE > MSV and ASV).

CONCLUSION

This study validated a reliable and effective tool for assessing parental self-efficacy in managing the dietary needs of children with FA. This tool can aid health professionals in evaluating parental confidence and identifying areas for improving dietary management in children with FA.

International diet quality index and revised diet quality index relationship with type 2 diabetes disease: a case-control study

Background

Type 2 diabetes mellitus (T2DM) is a global health crisis linked to increased cardiovascular risk. Research indicates that better dietary quality-higher intake of fruits, vegetables, and whole grains, and lower intake of processed foods-reduces T2DM risk. This study examines the relationship between T2DM and dietary quality indices (DQI-I and DQI-R) to determine if adherence can lower diabetes risk. By analyzing dietary patterns in individuals with and without diabetes, the research aims to identify key nutritional factors influencing disease risk and provide evidence-based dietary recommendations for prevention and management.

Methods

This case-control study involved 128 T2DM patients and 256 controls, assessing dietary intake with a validated 168-item food frequency questionnaire to calculate the Dietary Quality Index-I (DQI-I) and Dietary Quality Index-R (DQI-R). Multivariable logistic regression analysis explored the relationship between DQI-I, DQI-R, and their components with T2DM development odds.

Results

The mean (SD) age and body mass index (BMI) of participants, comprising 53.7% men, were 37.8 (7.8) years and 27.7 (3.3) kg/m2, respectively. In the final model, each standard deviation increase in the DQI-I score was associated with reduced odds of T2DM (odds ratio [OR] = 0.61; 95% confidence interval [CI] = 0.37-0.92; p = 0.046). Among the components of the DQI-I, a high adequacy score was significantly correlated with lower odds of T2DM (OR = 0.13; 95% CI = 0.05-0.36; p < 0.001). Additionally, participants in the highest tertile of the DQI-R score exhibited lower odds of T2DM compared to those in the lowest tertile (OR = 0.29; 95% CI = 0.11-0.49; p < 0.001). Furthermore, within the components of the DQI-R, a high moderation score was associated with a decreased risk of T2DM (OR = 0.19; 95% CI = 0.09-0.45; p < 0.001).

Conclusion

The case-control study suggests a potential protective effect of diets with higher scores on the Diet Quality Index-International (DQI-I) and Revised Diet Quality Index (DQI-R) in reducing T2DM risk. Future research should focus on larger sample sizes and prospective designs to further investigate the DQI-I, DQI-R, and their components in relation to T2DM and other chronic diseases.

Elimination diet in food allergy: friend or foe?

OBJECTIVES

To review and discuss the role of an elimination diet in food-allergic children, emphasizing nutritional aspects for a better practical approach.

SOURCES

Non-systematic review of the literature.

FINDINGS

Under an elimination diet, food-allergic patients may suffer from growth impairment or obesity and compromised quality of life. Disease phenotype, age, type, number of foods excluded, comorbidities, eating difficulties, economic status, and food availability must be considered for an appropriate diet prescription. Diet quality encompasses diversity and degree of food processing, which may alter immune regulation.

CONCLUSIONS

A friendly food elimination diet prescription depends on a multidisciplinary approach beyond macro and micronutrients.

Low Emulsifier Diet in Healthy Female Adults: A Feasibility Study of Nutrition Education and Counseling Intervention

Emulsifiers are food additives commonly found in processed foods to improve texture stabilization and food preservation. Dietary emulsifier intake can potentially damage the gut mucosal lining resulting in chronic inflammation such as Crohn's disease. This study investigates the feasibility of a low-emulsifier diet among healthy female adults, as no previous reports have studied the feasibility of such a diet on healthy participants. A quasi-experimental study for a nutrition education and counseling intervention was conducted over 14 days among healthy Saudi participants aged 18 years and over. Assessment of dietary intake using 3-day food records was conducted at the baseline and 2-week follow-up. Participants attended an online educational session using the Zoom application illustrating instructions for a low-emulsifier diet. Daily exposure to emulsifiers was evaluated and nutrient intake was measured. A total of 30 participants completed the study. At baseline, 38 emulsifiers were identified, with a mean ± SD exposure of 12.23 ± 10.07 emulsifiers consumed per day. A significant reduction in the mean frequency of dietary emulsifier intake was observed at the end of the intervention (12.23 ± 10.07 vs. 6.30 ± 7.59, p < 0.01). However, intake of macronutrients and micronutrients was significantly reduced (p < 0.05). Good adherence to the diet was achieved by 40% of the participants, and 16.66% attained a 50% reduction of emulsifier intake. The study demonstrates that a low-emulsifier diet provided via dietary advice is feasible to follow and tolerable by healthy participants. However, the diet still needs further investigation and assessment of it is nutritional intake and quality before implementing it in patients with inflammatory bowel disease who are at high risk of poor nutritional intake.

Socioeconomic Status and Diet Quality in Children with and without Food Allergy

Socioeconomic status (SES) influences diet quality, but this association has not been tested in children with food allergy. In this cross-sectional study, we assessed diet quality for 173 children, including 92 participants with food allergy. We found positive associations between SES and diet quality in children both with and without food allergy.

Vitamin D Levels in Asymptomatic Children and Adolescents with Atopy during the COVID-19 Era

This study assessed vitamin D status in asymptomatic children and adolescents in Greece, with and without atopy, and possible changes during the coronavirus disease 2019 (COVID-19) pandemic. Serum levels of 25-hydroxy-vitamin D (25(OH)D) and total immunoglobulin E (IgE), and eosinophil count were measured in 340 asymptomatic children and adolescents (155 males, 185 females), mean age 8.6 ± 4.6 years, recruited over a period of 24 months (February 2019–January 2021). Atopy, defined by high level of IgE for age, was associated with vitamin D deficient status (p = 0.041). Subjects with and without atopy showed similar rates of insufficient and normal levels of 25(OH)D. The median level of 25(OH)D was significantly higher in subjects recruited during the pandemic, when home confinement rules were observed, than before the pandemic, and significantly more children had normal levels of 25(OH)D (p < 0.001), but no differences were noticed for IgE levels or eosinophil count. These results support a link between vitamin D and allergic and infectious inflammations, and specifically the association of vitamin D deficiency with asymptomatic atopy, defined as increased IgE level for age.

The Diet Quality and Nutrition Inadequacy of Pre-Frail Older Adults in New Zealand

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77-84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0-64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4-25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6-1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Update on the Role of Allergy in Pediatric Functional Abdominal Pain Disorders: A Clinical Perspective

Both functional abdominal pain disorders (FAPDs) and food allergies are relatively common in children and adolescents, and most studies report an association between FAPDs and allergic conditions. FAPDs share pathophysiologic processes with allergies, including both immune and psychological processes interacting with the microbiome. No conclusive data are implicating IgE-mediated reactions to foods in FAPDs; however, there may be patients who have IgE reactions localized to the gastrointestinal mucosa without systemic symptoms that are not identified by common tests. In FAPDs, the data appears stronger for aeroallergens than for foods. It also remains possible that food antigens initiate an IgG reaction that promotes mast cell activation. If a food allergen is identified, the management involves eliminating the specific food from the diet. In the absence of systemic allergic symptoms or oral allergy syndrome, it appears unlikely that allergic triggers for FAPDs can be reliably identified by standard testing. Medications used to blunt allergic reactions or symptomatically treat allergic reactions may be useful in FAPDs. The purpose of the current manuscript is to review the current literature regarding the role of allergy in FAPDs from a clinical perspective, including how allergy may fit in the current model of FAPDs.