Glycemic response in children with insulin-dependent diabetes mellitus after high- or low-glycemic-index breakfast.

To examine the effects of various carbohydrate foods on postprandial glycemia in diabetic children, we fed a mixed, isocaloric diet containing either high- or low-glycemic-index (GI) breakfast foods to 22 children with poorly controlled insulin-dependent diabetes mellitus (IDDM) and measured blood sugar response with and without adjustment of insulin doses. We found that IDDM children fed a high-GI meal showed a significantly higher serum glucose level than those fed a low-GI meal. However, such differences were not seen when the preprandial dose of regular insulin was adjusted to the amount of carbohydrate in feedings. Thus, as long as proper adjustment of insulin is made, the type of carbohydrate in a single mixed meal does not appear to have a significant effect on the postprandial glycemic response in children with long-standing poorly controlled IDDM.

Parental health beliefs as a cause of nonorganic failure to thrive.

Parental misconceptions and health beliefs concerning what constitutes a normal diet for infants is reported as a cause for failure to thrive. There were seven patients (four boys, three girls), 7 to 22 months of age, who were evaluated for poor weight gain and linear growth. They were only consuming 60% to 94% of the recommended caloric intake for age and sex. The children's caloric intake had been restricted by their parents. They were concerned that the children would become obese, develop atherosclerosis, become junk food dependent, and/or develop eating habits that the parents believed were unhealthy. The parents instituted diets consistent with health beliefs currently in vogue and recommended by the medical community for adults who are at risk for cardiovascular disease. These diets caused the infants to experience inadequate weight gain and have a decreased linear growth rate. With nutritional counseling, all food restrictions were removed, the caloric intake was increased to 94% to 147% of the recommended intake for age. The weight gain rate increased significantly (P less than .05) from 0.1 +/- 0.1 kg/mo to 0.4 +/- 0.3 kg/mo, and the linear growth rate increased significantly (P less than .05) from 0.4 +/- 0.4 cm/mo to 1.0 +/- 0.6 cm/mo within 3 months of therapy. Exaggerated concerns about excessive food intake in childhood and/or concern about the sequelae of eating an improper diet has resulted in this entity of failure to thrive due to parental health beliefs.

Breast feeding and insulin-dependent diabetes mellitus in children.

We have evaluated the hypothesis of a protective effect of human milk on the development of insulin dependent diabetes mellitus (IDDM). We studied the feeding histories of 95 diabetic children and compared them with controls consisting of their non-diabetic siblings and a pair matched group of nondiabetic peers of the same age, sex, geographical location, and social background. The incidence of breast feeding in diabetic children was 18%. This was similar to the control group. The duration of breast feedings was also similar among all three groups. There was no difference in the age of introduction of solid food between diabetic and nondiabetic children. Twice as many diabetic children, however, received soy containing formula in infancy as compared to control children. The mean age of onset of IDDM was not related to the type of feeding during infancy. The incidence of positive thyroid antibodies was two and one half times higher in formula-fed diabetic children than in breast-fed ones. In our studies we were unable to document any relationship between the history of breast feeding and subsequent development of IDDM in children.