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Marasmus and Kwashiorkor by Nutritional Ignorance Related to Vegetarian Diet and Infants with Atopic Dermatitis in South Korea  

Chung Sang-Jin (성균관대학교 의학연구소)
Han Young Shin (성균관대학교 의학연구소)
Chung Seung Won (성균관대학교 의학연구소)
Ahn Kang-Mo (성균관대학교 의과대학 삼성서울병원 소아과학교실)
Park Hwa Young (성균관대학교 의과대학 삼성서울병원 소아과학교실)
Lee Sang Il (성균관대학교 의과대학 삼성서울병원 소아과학교실)
Cho Young Yeun (삼성서울병원 병원 영양계)
Choi Hye Mi (서울대학교 식품영양학과)
Publication Information
Journal of Nutrition and Health / v.37, no.7, 2004 , pp. 540-549 More about this Journal
Abstract
Infants and children with food related Atopic Dermatitis (AD) need extra dietary efforts to maintain optimal nutrition due to food restriction to prevent allergy reactions. However, nutrition ignorance and food faddism make patients even more confused and practice desirable diet more difficult. The objective of this study was to report the AD patients' malnutrition cases in Korea. We report on 2 cases of severe nutritional deficiency caused by consuming macrobiotic diets which avoid processed foods and most animal foods, i.e. one of vegetarian diet. Case 1, a 12-month-old male child, was admitted with severe marasmus. Because of a history of AD, he was started on mixed grain porridge at 3 months without any breast milk or formula feeding. His caloric intake was 66% and protein intake was 69% of the recommended dietary allowance. Patient's height and weight was under 3th percentile. On admission the patient was unable to crawl or roll over. Case 2, a 9-month-old AD female patient, was diagnosed with kwashiorkor and rickets. She was also started on mixed grain porridge at 100 days due to AD. Her caloric intake has been satisfied recommended dietary allowance until 7 months, however, she conducted sauna bath therapy and reduced both energy and protein intake at 8 months. The amount of protein intake for case 2 was higher than recommended dietary allowance, but, sauna therapy and severe AD with intakes of low guality protein may increase patient's protein requirement resulting in kwashiorkor. Case 2 patient's height and weight was on 3th percentile. Both cases showed low intake of calcium, iron, zinc, vitamin A, vitamin E and especially very low intake of vitamin B$_{12}$ and vitamin D. Allergy tests for certain foods had not done prior to admission for both cases. They followed the dietary advise operated by macrobiotic diet internet site. In conclusion, AD infants' parents and caregivers should contact a pediatrician trained as a specialist in allergy for accurate diagnosis. For infant patients, breast or formula feeding including hypoallergenic formula should be continued until their one year of age. When certain foods need to be restricted or to follow special diets such as vegetarian diet, consultation with pediatrician and dietitian is needed.d.
Keywords
atopic dermatitis; infant; marasmus; kwashiorkor; rickets; macrobiotic diet;
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  • Reference
1 Halken SA, Host AB. Prevention. Curr Opin Allergy Clin Immunol 1(3) : 229-236, 2001
2 Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc 101: 670-677, 2001   DOI   ScienceOn
3 The American Dietetic Association. Position on of the American Dietetic Association: Vegetarian diets. J Am Diet Assoc 97: 1317-1321, 1997   DOI   ScienceOn
4 Roberts IF, West RJ, Ogilvie D, Dillon MJ. Malnutrition in infants receiving cult diets: a form of child abuse. Br Med J 1: 296-298, 1979   DOI   PUBMED
5 National Rural Living Science Institute. Food Composition Tables. 6th Ed. 2001
6 Korean Pediatric: Society. Growth standards for Korean children, 1998
7 Bjorksten B, KjeUman BN, Zeiger RS. In: Middleton E. Jr., Reed CE. Allergy principles and practice. Mosby-year Book Inc. pp.816-837, 1998
8 Dagnelie PC, Vergote FJVRA, Van Staveren WA, Van Den Verg H, Dingjan PG, Hautvast JGAJ. High prevalence of rickets in infants on macrobiotic diets. Am J Clin Nutr 51: 202-208, 1990
9 Sanders TAB, Reddy S. Vegetarian diets and children. Am J Clin Nutr 59(suppl): 1176S-1181S, 1994
10 Liu T. Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, Esterly NB, Levy ML, Schachner L, Frieden IJ. Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Archives of Dermatology 137: 630-636 2001
11 Campbell M, Lofters WS, Gibbs WN. Rastafarianism and the vegan syndrome. Br Med J 285: 1617-1618, 1982
12 Ford J, Colhoun EM. McIntosh WB, Dunnigan HG. Biochemical response of late rickets and osteomalacia to a chapati-fee diet. Br Med J 3: 446, 1972   DOI   PUBMED
13 Committee on Nutrition. Korean Pediatric Society. Clinical Nutrition in Pediatrics 1st ed. Kwangmunsa, Seoul, 2002
14 오가실 역. 'Denver Developmental Screening Test 검사지침서', 서울: 현문사, 1986
15 Williams CD. Kwashiorkor. JAMA 153: 1280-1285,1953   DOI
16 Tay YK, Kong KH, Khoo L, Goh CL, Giam YC. The prevalence: and descriptive epidemiology of atopic dennatitis in singapore: school children. Br J Dermatol 146: 101-106, 2002   DOI   ScienceOn
17 Listemick A, Christoffel K, Pace J, Chiaramonte J. Severe primary malnutrition in US children. Am J Dis Child 139: 1157-1160, 1985
18 Lee SI, Choi HM. Nutrition for infants and children. 1st ed. Kyomunsa, Seoul, 2003
19 Tomashek KM, Nesby S, Scanlon KS, Cogswell ME, Powell KE Parashar UD, Mellinger-Birdsong A, Grummer-Strawn LM, Dietz WH. Commentaries: Nutritional Rickets in Georgia. Pediatrics 107(4): E45, 2001   DOI   PUBMED   ScienceOn
20 Novembre E, De Martino M, Vierucci A. Foods and respiratory allergy. J Allergy Clin Immunol 81: 1059-1065, 1988   DOI   PUBMED
21 Dagnelie PC, Van Starveren WA. Microbiotic nutrition and child health: Results of a population-based, mixed-longitudinal cohort study in the Netherlands. Am J Clin Nutr 59 (suppl): 1187S-1196S, 1994
22 Curran JS, Barness LA. Nutrition. In: Behrman RE, Kliegman RM, Jensen HB, editors. Nelson's Textbook of Pediatrics. 16th ed. Philadelphia, WB Sounders Co, 2000
23 Sicherer SH. Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 104 (3 Pt 2) : S114-122, 1999   DOI   ScienceOn
24 Zeiger RS. Dietary aspect of food allergy prevention in infant and children, J Pediatr Gastroentrol Nutr 30, Suppl 1: S77-86, 2000   DOI
25 Arshad SH. Food allergen avoidance in primary prevention of food allergy. Allergy 56 Suppl 67: 113-116 2001   DOI
26 Dwyer JT, Diets WH, Hass GH, Suskind RM. Risk of nutritional rickets among vegetarian children. Am J Dis Child 133: 134-140 1979
27 Korea Institute for Health and Social Affairs, 2001 National health and nutrition survey -Chronic Disease-. Ministry of Health and Welfare, 2002
28 Recommended dietary allowances for Koreans, 7th revisions, The Korean Nutrition Society, Seoul, 2000
29 Committee on Nutrition. American Academy of Pediatrics. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, lL: AAP, 1998
30 Health DA. Thoughts of the aetiology of vitamin D deficiency in Asians. Postgrad Med J 59: 649-651, 1983   DOI   PUBMED   ScienceOn
31 Long CL. The energy and protein requirements of the critically ill patient. In Wright RA, Heymsfield SB (eds,) Nutritional assessment. Boston: Blackwell Scientific Publications, 1984
32 Kristal L, Klein PA. Atopic dennatitis in infants and children. Pediatr Clin North Am 47: 877-895, 2000   DOI   ScienceOn
33 Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr 113: 447-451, 1988   DOI