[Dietary intervention and follow-up study in 1-to-2-year-old children on macrobiotic diets]. / Voedingsinterventie en follow-up-onderzoek bij macrobiotisch gevoede kinderen van 1 tot 2 jaar.

As a follow-up of a population-based descriptive study on the nutritional status and growth of infants on macrobiotic diets (n = 53), an intervention study was carried out in 27 selected infants with clear nutritional deficiencies. This intervention program consisted of information on the nutrient content of macrobiotic foods, a regular newsletter, personal advice if needed, and reference to teachers in macrobiotics for further advice. Adaptation of the diet within the scope of current macrobiotic guidelines did not lead to an improvement in nutritional intake, growth and blood values. As a consequence of these findings, the macrobiotic community in the Netherlands and abroad has become more aware of the need for adaptation of the macrobiotic diet. It is recommended to include a source of dietary fat (minimum 20-25 g/day), fatty fish (minimum 100-150 g/wk) and dairy products (minimum 150-250 g/day).

High prevalence of rickets in infants on macrobiotic diets.

The vitamin D status of 53 Caucasian infants aged 10-20 mo on a macrobiotic diet and 57 matched control infants on omnivorous diets was studied. In late summer (August-November) physical symptoms of rickets were present in 28% of the macrobiotic group; these infants had lower average plasma 25(OH)D concentrations (34.0 +/- 15.3 nmol/L) (mean +/- SD) than did the macrobiotic infants without such symptoms (49.7 +/- 21.9 nmol/L, p less than 0.02). Follow-up of a subsample of 25 macrobiotic infants in March-April revealed physical symptoms of rickets in 55% of the macrobiotic infants. All concentrations in blood were considerably below those in the preceding summer; the average 25(OH)D concentration was 12.3 +/- 4.3 nmol/L. Further analysis indicated that the low availability of calcium in the macrobiotic diet was an independent factor in causing the high prevalence of rickets in summer. Avoidance of milk products in combination with a high fiber intake may damage bone development in young children.

Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets.

The blood iron, vitamin B-12, and folate status of the 1985 birth cohort of Dutch infants aged 10.1-20.4 mo fed macrobiotic diets (n = 50) and matched omnivorous control infants (n = 57) was measured. Fe deficiency (combination of Hb less than 120 g/L, ferritin less than 12 micrograms/L, and FEP greater than 1.77 mumol/L) was observed in 15% of the macrobiotic group but not in the control group (p = 0.003). Plasma vitamin B-12 concentrations in the macrobiotic group were far below those of the control group (geometrical mean: 149 and 404 pmol/L, respectively, p less than 0.001). Plasma folate concentrations were higher in the macrobiotic group (31.6 +/- 11.7 nmol/L) than in the control group (21.1 +/- 8.8 nmol/L, p less than 0.001). In the macrobiotic group mean corpuscular volume, mean corpuscular hemoglobin mass, and mean corpuscular hemoglobin concentration were higher and hematocrit and red blood cells were lower (all p less than 0.05) than in the control group. It is advised to incorporate regular servings of animal foods into the macrobiotic diet to obtain an adequate amount of vitamin B-12.

Nutritional status of infants aged 4 to 18 months on macrobiotic diets and matched omnivorous control infants: a population-based mixed-longitudinal study. II. Growth and psychomotor development.

A mixed-longitudinal study was carried out in the 1985 Dutch birth cohort of macrobiotic infants aged 4-18 months (n = 53) and 57 omnivorous control infants matched for month of birth, sex, parity, educational level of the father and the residential area. Study methods included regular anthropometric measurements and a psychomotor testing. Reported birth weight was 180 g lower in the macrobiotic group than in the control group and was positively associated with maternal weight increase during pregnancy. Between 4 and 18 months of age, mean values for all anthropometric parameters were considerably lower in the macrobiotic infants. From birth to 4 months, weight gain was less in macrobiotic infants, and from 6 months the rate of growth in weight and length decreased further, reaching its lowest value between 8 and 14 months of age. A similar pattern was also observed for other anthropometric parameters. Between 8 and 14 months, arm circumference showed an absolute decrease. During this period, increase in arm muscle mass in the macrobiotic group was only half of that in the control group. From 14 months of age, growth stabilized parallel to the 10th percentile of the Dutch references. Gross motor and language development were also slower in the macrobiotic infants. The paediatrician observed major wasting of skin and muscles in 30 per cent of them. The growth rate for weight and arm circumference was independently associated with the energy intake and the protein content of the macrobiotic diet. Growth in length was positively associated with protein content of the diet, but not with energy intake.