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Jornal de Pediatria

Print version ISSN 0021-7557On-line version ISSN 1678-4782

J. Pediatr. (Rio J.) vol.80 no.5 Porto Alegre  2004 



The nutrition specialist's role in choosing special diets



Ary Lopes Cardoso

PhD. Assistant physician; Chief of the Nutrology Unit, Instituto da Criança do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), Brazil



Whenever the use of an exclusion diet is indicated in pediatric practice, a responsible medical posture is imperative. The study by Medeiros et al.,1 published in this Jornal, deserves the readers' attention because it manages to demonstrate how this can and should be achieved.

Countless nutritional risks, the consequences of macro and micronutrient deficiencies, can be run when diets excluding certain foods are adopted. Several authors2-5 highlight a series of medium and long term problems, with the greatest emphasis, for patients under two years, accorded to diets excluding cow's milk.

Medeiros et al. demonstrate the nutritional deficits of the children studied by means of anthropometric data and by listing the intake of macro and micronutrients, especially of calcium. Irrespective of the results, the great merit of this work is its demonstration of the value of multidisciplinary involvement. The participation of the doctor, in conjunction with a nutritionist together with the social assessment are fundamental to guiding the choice of diet to that which most adequately substitutes the excluded items.

Non-compliance with medical prescriptions has become a constant reality for Brazilian pediatricians. This is most notorious when the subject is exclusion diets. Nutritional risks are run,6 becoming more serious to the extent that they remain undetected7 or uncorrected. Some examples of risk situations,8,9 and possibly even of immediate severity10 in which exclusion diets are imposed, have been described and discussed in the light of their nutritional aspects in work previously published in this Jornal.

Unfortunately, social, cultural and economic realities are the primary determinant factors in poor compliance with exclusion diet prescriptions. This is often translated into the diet being prepared inadequately, with insufficient (or excessive) nutrient intake; the allergic and/or inflammatory process being sustained by transgressions, allergy caused by substitute foods and varying degrees of malabsorption, both of macro and micronutrients, among others.

The participation of the nutrition specialist is necessary to the discussion and planning of care when an exclusion diet is being considered. Among other reasons are the capacity to assess nutritional requirements from anthropometric data and other body evaluation methods, to interpret the nutritional survey developed in conjunction with the nutritionist and for knowledge on the characteristics of the new ingredients that are contained in the new formulae and complete diets that are periodically launched onto the market in arithmetic progression.11,12



1. Medeiros LCS, Speridião PGL, Sdepanian VL, Fagundes-Neto U, Morais MB. Ingestão de nutrientes e estado nutricional de crianças em dieta isenta de leite de vaca e derivados. J Pediatr (Rio J). 2004;80:363-70.

2. Henriksen C, Eggesbo M, Halvorsen R, Botten G. Nutrient intake among two-year-old children on cow's milk-restricted diets. Acta Paediatr. 2000;89:272-8.

3. Arvola T, Holmberg-Marttila D. Benefits and risks of elimination diets. Ann Med. 1999;31:293-8.

4. Mofidi S. Nutritional management of pediatric food hypersensitivity. Pediatrics. 2003;111:1645-53.

5. Christie L, Hine RJ, Parker JG, Burks W. Food allergies in children affect nutrient intake and growth. J Am Diet Assoc. 2002;102:1648-51.

6. Palma D. Avaliação da condição nutricional. J Pediatr (Rio J). 1995;71:125.

7. Mello ED. O que significa a avaliação do estado nutricional. J Pediatr (Rio J). 2002;78:357-8.

8. Hamamoto LA, Cardoso AL, Marques HS, Gomes C. Balanço de energia em lactentes filhos de mães soropositivas para o HIV. J Pediatr (Rio J). 2000;76:119-24.

9. Alves GMS, Morais MB, Fagundes-Neto U. Estado nutricional e teste do hidrogênio no ar expirado com lactose e lactulose em crianças indígenas terenas. J Pediatr (Rio J). 2002;78:113-9.

10. Machado RS, Kawakami E, Goshima S, Patricio FR, Fagundes-Neto U. Gastrite hemorrágica por alergia ao leite de vaca: relato de dois casos. J Pediatr (Rio J). 2003;79:363-8.

11. Walker-Smith J, Murch S. Gastrointestinal food allergy. In: John A Walker-Smith, editor. Diseases of the Small Intestine in Childhood. 4th ed. ISIS - Medical Media; 1999. p. 205-234.

12. Boehm G, Fanaro S, Jelinek J, Stahl B. Prebiotic concept for infant nutrition. Acta Paediatr Suppl. 2003;91:64-7.

6. Palma D. Avaliação da condição nutricional. J Pediatr (Rio J). 1995;71:125.

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