Dietary practices of women diagnosed with environmental sensitivity.

PURPOSE: Food avoidance is central to the treatment of environmental sensitivity (ES), a chronic, often debilitating, multisystem disorder characterized by adverse reactions to non-noxious levels of environmental substances. Because prolonged food avoidance could impact nutritional health, the purpose of this research was to assess adequacy and quality of diets consumed by women diagnosed with ES. METHODS: Twelve women aged 37 to 50 recruited from the Nova Scotia Environmental Health Clinic completed a four-day food record during the spring and summer of 1998. RESULTS: When adequacy of nutrient intake was assessed by comparison to the Estimated Average Requirement, the most limited nutrients in the diet were folate, vitamin B6, vitamin B12, and magnesium. Only one woman exceeded the Adequate Intake for calcium. When diet quality was assessed using the Healthy Eating Index, the majority of women (75%) scored in the "needs improvement" category; intake of milk and dietary variety scored the lowest. Women consumed very few servings from "other foods", defined in the food guide as foods containing mostly sugar and mostly fat. CONCLUSIONS: The results of this study suggest that women diagnosed with ES would benefit from counselling on ways to increase dietary variety, which would lead to improved nutrient intake, and ways to increase calcium intake.

Symptom relief and adherence in the rotary diversified diet, a treatment for environmental illness.

CONTEXT: The rotary diversified diet, which involves food elimination and rotation of remaining allowed foods, is commonly used in the management of environmental illness. No studies have considered patient adherence while evaluating the effectiveness of the diet in controlling symptoms. OBJECTIVE: The study examined the severity of patients' perceived symptoms and dietary adherence during treatment with a rotary diversified diet. DESIGN: A prospective and exploratory study using purposive sampling and the following data collection methods: personal interviews, symptom severity questionnaires, and food records to assess dietary adherence. SETTING: Private clinic of a Toronto, Ontario physician specializing in environmental medicine. PATIENTS OR OTHER PARTICIPANTS: Twenty-five female residents of Toronto, Ontario (aged 25-67 years) diagnosed with environmental illness. INTERVENTION: Patients were treated with a rotary diversified diet for 16 weeks. MAIN OUTCOME MEASURES: Symptom severity and dietary adherence were assessed after 4, 10, and 16 weeks of treatment. Adherence was assessed by comparing food records to the diet prescription. RESULTS: At 16 weeks, patients reported a 50% decline in symptom severity for 5 of the 6 symptom categories assessed and for all categories combined. Those with closer elimination and rotation adherence reported a greater decline in gastrointestinal symptoms at 4 and 10 weeks of treatment, respectively. Improvement in total symptom severity was associated with closer rotation adherence at 10 weeks. Patients experienced difficulties in adhering to the diet. CONCLUSIONS: Results suggest that the diet, if followed, is beneficial, especially in improving gastrointestinal symptoms. Further evaluation of its effectiveness is limited by its complexity and the nature of environmental illness. Because the diet is difficult to follow over time, patients require extensive nutritional counseling and support.

Dietary adequacy of the rotary diversified diet as a treatment for "Environmental Illness".

The rotary diversified diet, used in the management of environmental illness, consists of eliminating prohibited foods from the diet and rotating remaining non-prohibited foods and their "food families" within a regular cycle. We assessed the adequacy of nutrient intakes in 22 women prescribed the diet, described the nature of supplement use, and assessed the relationship between adherence and nutrient intake levels. Except for calcium and folacin intakes, mean nutrient intakes met or exceeded recommended levels. No subjects had calcium intakes above the adequate intake for calcium; 72.7% had folate intakes below the estimated average requirement. Intakes of other nutrients, except thiamin and magnesium, were below the estimated average requirement in less than 25% of the sample; 31.8% and 45.5% of subjects, respectively, had thiamin and magnesium intakes at this level. Those who adhered more closely to the rotary diversified diet had higher intakes of vitamin C, vitamin B6, folate, and fibre than did those who followed the diet less closely. Supplements conferred some nutritional benefits; however, supplemental niacin and magnesium intakes exceeded tolerable upper intake levels. Those prescribed the rotary diversified diet require nutrition counselling from dietitians to cope with the complexity and restrictiveness of the diet.

Influencia del entorno ambiental y tipo de régimen dietético en la incidencia, duración e intensidad de los procesos infecciosos del lactante / The role of environmental factors and type of dietary regimen on morbidity in young infants

Objetivo. Estudiar las enfermedades infecciosas y su relación con el entorno ambiental en lactantes, desde su nacimiento hasta los 4 meses de edad. Material y Métodos. Han intervenido más de 600 pediatras. Se incluyó a niños de hasta 20 días que fueron reevaluados cuando tenían 4 meses, para estudiar las complicaciones infecciosas aparecidas. Análisis estadístico mediante regresión logística. Resultados. Se incluyeron 3.428 niños a término. Las infecciones oftálmicas fueron las más frecuentes (5,5 por ciento). Las bronquitis y neumonías las más graves (61 por ciento moderadas-graves) y de mayor duración (6,5 ñ 3 días). La polución, entorno fumador y convivencia con hermanos constituyen factores de riesgo. A los 4 meses, la administración de una fórmula sin nucleótidos se añadió a los factores de riesgo previos. Conclusiones. El entorno ambiental es importante en la incidencia de enfermedades infecciosas en el lactante. El riesgo aumenta por: asistencia a guarderías, polución y ambiente fumador. La alimentación con leche materna y una fórmula con nucleótidos son favorables para el desarrollo inmunológico de los lactantes. (AU)

Assessing adherence to a rotary diversified diet, a treatment for 'environmental illness'.

OBJECTIVES: To develop and test a method to assess adherence to a rotary diversified diet (RDD), a treatment for environmental illness, which is a putative disorder characterized by multiple sensitivities to foods, chemicals, or inhalants. The RDD requires the elimination of prohibited foods and rotation of remaining nonprohibited foods and their "food families" within a 4- to 7-day cycle. The regimen has yet to be validated to the satisfaction of the scientific community. DESIGN: Details of the 2 components of the RDD prescription, elimination and rotation, were documented, and a food record method of assessing adherence was developed. Adherence to the RDD was then assessed in a cohort of women who were enrolled in a larger prospective study. Test-retest reliability of the adherence assessment method was determined by calculating ratings twice on the same set of patient food records, with 1 week between trials. SUBJECTS/SETTING: All patients were contacted through a private environmental medicine clinic in Toronto, Canada. Eight patients provided the food records needed for development of the method; adherence was then assessed in 22 women aged 25 to 67 years. STATISTICAL ANALYSES: Means, standard deviations, and 95% confidence intervals for adherence ratings were calculated. The reliability of the adherence assessment method was determined by calculating Pearson correlation coefficients for adherence ratings from each trial. A paired t test was also used to determine if the mean differences in ratings between trials were significant. RESULTS: Patients experienced difficulties following both components of the RDD: 37% to 44% of foods consumed were either prohibited or allowed, but were consumed on the incorrect day. The adherence assessment method was found to have high levels of reliability. APPLICATIONS: The adherence assessment method can be used in future evaluations of the RDD, although further testing of the method is recommended. Increased involvement of dietitians with patients diagnosed with environmental illness is recommended.