Chapter 7: Special Topics in School-Age Nutrition: Pediatric Vegetarianism, Childhood Obesity, and Food Allergies Reed Mangels, PhD, RD, Inger Stallmann, MS, RD, LD, Edna Harris-Davis, MS, MPH, RD, LD, Shideh Mofidi, MS, RD, CSP

Reader Objectives: After reading the chapter and reflecting on the contents, the reader will be able to: Describe the similarities and differences between lacto-ovo vegetarian, lacto-vegetarian, vegan, macrobiotic, fruitarian, and raw foods diets. List potential health and nutritional benefits of vegetarian diets for the pediatric population.

Reader Objectives, cont. Articulate some steps that families may take to help prevent overweight in children. Realize the difference between food allergy and food intolerances. Understand basic principles of nutritional management of children with food allergies.

Pediatric Vegetarianism In the broadest sense, a vegetarian is a person who does not eat meat, fish, or poultry.

Types of Vegetarians Lacto-ovo vegetarians include dairy products and eggs in their diets. Lacto-vegetarians include dairy products but not eggs. Vegans avoid eating any animal products. Other types of vegetarian (or near-vegetarian) diets that may be encountered include macrobiotic, raw foods, and fruitarian diets. Macrobiotic diets are based largely on grains along with vegetables, especially sea vegetables, beans, fruits, nuts, soy products, and possibly fish.

Nutritional Considerations of Vegetarianism in Infancy & Childhood Growth and Energy Needs Lack of some key nutrients: protein, iron, zinc, calcium, vitamin D, vitamin B-12, and omega-3 fatty acids.

Meal Planning Guidelines The ideal plan should achieve the following goals: Meet the needs of different types of vegetarian diets, Help vegetarians meet the most recent nutrient recommendations, Focus on specific nutrients identified as being of special importance to vegetarians, Include a wide variety of foods, Meet the needs of different age groups.

Childhood Obesity Assessment of Overweight in Children: Body Mass Index for Children Growth Charts-At Risk for Overweight and Obese children are  85th percentile to  95th percentile and  95th percentile, respectively.

Health Effects of the Overweight Risk of: insulin resistance/hyperinsulinemia and non- insulin-dependent diabetes (NIDDM) metabolic, hemodynamic, thrombotic, and inflammatory disorders (hypertension and dyslipidemia) mental health problems, such as, depression, anxiety, lowered self-esteem and sometimes eating disorders

Dietary Trends Affecting Overweight Status in Children sedentary lives; lack of physical activity and excessive TV viewing eating a highly processed, synthetic diet; typical American diet today is lower in fiber and plant foods, higher in meat, high in highly refined carbohydrates family eating environment of today household food insecurity

Food Allergies A food allergy is an immune-mediated abnormal response to food (reactions are specifically to food proteins) with involvement of multiple systems in the body. IgE mediated food allergies are characterized by an acute onset of symptoms that typically involve the skin, respiratory, cardiovascular and/or the gastrointestinal tract A food intolerance does not involve the immune system, and is usually limited to the gastrointestinal system

Other Reactions to Food Proteins Anaphylaxis-can be fatal; most common foods: are peanuts, tree nuts (almond, brazil nuts, cashew, hazel nut, pecan, walnuts), and seafood Oral Allergy Syndrome- is characterized by pruritis (itching) and edema of the oral mucosa occurring after the ingestion of certain fresh fruits and vegetables Celiac Disease- hypersensitivity to gluten presenting with flatulence, steatorrhea and weight loss. Allergic Eosinophilic Esophagitis/Gastroenteritis- inflammation and infiltration of the esophagus, stomach and/or the small intestine.

Diagnostic Evaluation a careful history (including a thorough medical and reaction history), physical examination, a food/symptom diary, allergy testing (prick skin and food specific IgE antibody testing) and food challenges

Nutritional Issues In an Allergen Restricted Diets these nutrients may be limited: Milk Allergy-vitamin A, vitamin D, riboflavin, pantothenic acid, cyanocobalamin, calcium and phosphorus Egg Allergy-cyanocobalamin, riboflavin, pantothenic acid, biotin and selenium Soy Allergy-thiamin, riboflavin, pyridoxine, folate, calcium, phosphorus, magnesium, iron and zinc Wheat Allergy-thiamin, riboflavin, niacin, iron and folate if fortified Peanut Allergy-vitamin E, niacin, magnesium, manganese and chromium