Risk Of Nutritional Deficiencies Research Articles

Is vitamin C enough? A case report of scurvy in a five-year-old girl and review of the literature

BackgroundNumerous cases of scurvy secondary to diet limitations have been reported in the literature with most being boys with special needs. To date, the focus of the literature describing vitamin C deficiency has been the medical sequelae of the deficiency. There has been little attention given underlying diet limitations causing the vitamin C deficiency.Case presentationA five-year-old female with typical development initially presented with rash, then later for pain in both lower extremities. After evaluation revealed vitamin C deficiency, she was admitted into an intensive day treatment feeding program. A feeding assessment found she had life-long problems with eating and had a diet that never exceeded ten foods. Across the course of treatment, she learned to eat 29 new foods. At six-month follow-up her body mass index had increased from the 1st to the 61st percentile. At one-year follow-up her body mass index was at the 85th percentile. All sequalae of her deficiency resolved.ConclusionsThis case is unusual as most reported studies describe males with special needs. The severity of her eating issues suggest providers may consider referral to allied health professionals to address diet limitations for both children identified with nutrient deficiencies as well as children whose selective eating places them at risk for nutritional deficiencies or problems with growth. The child we described was anemic, like 42% of children described in the case literature on scurvy and like 32% of the children in this literature, our patient was underweight. In the literature, comorbid nutrient deficiencies were reported in 22% of the scurvy case studies. We suggest vitamin C supplementation is a necessary component for addressing vitamin C deficiency, but insufficient for addressing the diet limitations causing the nutrient deficiency.

Are vegetarian diets nutritionally adequate? A revision of the scientific evidence

Vegetarian diets are booming and, although these diets have been linked to some health benefits, the low bioavailability of some micronutrients in plant foods may result in risk of nutritional deficiencies, which makes necessary adequate planning of these diets. In this regard, vitamin B12 deficiency in vegetarians has been evidenced and there is a consensus on the need of supplementation of this vitamin. Vitamin D deficiency may be more frequent than in omnivores, particularly during the winter, when skin synthesis is minimal. The low bioavailability of iron, zinc and selenium in vegetables can also affect nutritional status of vegetarians. Furthermore, vegetarian diets are usually deficient in polyunsaturated fatty acids of the omega-3 family, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. On the other hand, these diets appear to provide adequate quantities of other vitamins, such as ascorbic acid, folic acid and the fat-soluble vitamins A and E. In this review, the characteristics of the intake of macro- and micronutrients of vegetarian diets and the diet and health relationships are presented. In addition, data on nutritional status of this population are also shown and suggestions on nutritional recommendations to prevent deficiencies are given. Finally, the possible clinical application of controlled interventions with vegetarian diets is presented.

Scoping Review: Medicinal Benefits of Cannabis Related to Stimulating Appetite in Populations at Risk for Nutritional Deficiency

Describe the benefits of cannabis use related to stimulating appetite in populations are risk for nutritional deficiencies and effectively understand the effects of cannabis in relation to hunger hormones.

Missing the early signs of thiamine deficiency. A case associated with a liquid-only diet

BackgroundWernicke encephalopathy (WE) predominantly occurs in alcoholic patients. Few case reports have described this diagnosis as a result of dieting. The diagnosis is often missed or delayed resulting in permanent and severe neurologic sequelae and even death. The typical neurological signs may be absent or missed during the early stages of thiamine deficiency.Case reportA 23-year-old female presented to the hospital with confusion, bilateral lateral rectus palsy, and ataxia. Based on the typical neurological triad, WE was suspected. The brain MRI was also typical for WE. Prompt clinical improvement was seen within days after intravenous thiamine supplementation. A detailed medical history revealed that during the past 3 months she had been following a liquid-only diet and had lost about 30 kg. During that time, she had visited the emergency department on multiple occasions due to fatigue, nausea, and vomiting.ConclusionA high level of suspicion is required by physicians to recognize that fatigue, nausea, and vomiting may represent early signs of thiamine deficiency in patients at risk for nutritional deficiencies. Empirical thiamine supplementation may be reasonable in such cases.

A Cross-sectional Study of Nutritional Status, Diet, and Dietary Restrictions Among Persons With an Ileostomy or Colostomy

Little is known about the nutritional status and dietary habits of persons with an intestinal stoma, and no specific dietary guidelines have been established. A cross-sectional study was conducted among patients of a Stoma Patient Health Care Service in Juiz de Fora, Brazil, to compare the nutritional status of persons with an ileostomy or colostomy and to evaluate which foods are avoided most frequently and why. Anthropometric measurements (weight, height, arm circumference, and triceps and subscapular skinfold thickness) and body fat were assessed. Habitual dietary intake (energy, protein, carbohydrate, fiber, fat, calcium, iron, sodium, potassium, thiamin, riboflavin, vitamin B6, vitamin B3 [niacin], and vitamin B12) was assessed using a validated quantitative food frequency questionnaire. Foods avoided and reasons for avoidance (increased odor, increased gas, increased output, constipation, appliance leakage, and feelings regarding leaving home) were assessed. All data were collected without personal identifiers and stored in electronic files. Data were analyzed descriptively, and the Student's t test or Mann-Whitney test was used to compare the groups. Chi-squared analysis with Yates' continuity correction or Fisher's exact test was employed to examine the differences in the frequency of avoided foods by reasons for avoidance between the 2 groups. Of the 103 participants (52 [50.5%] men, 51 [49.5%] women; mean age 60.5 ± 12.9 years); 63 (61.2%) had a colostomy and 40 (38.8%) had an ileostomy. For both groups combined, time since surgery ranged from 1 to 360 months. Anthropometric measurements and body composition did not suggest nutritional deficiencies and did not differ significantly between groups. Persons with an ileostomy had a significantly lower fat and niacin intake than persons with a colostomy (P <.05). No other dietary intake differences were observed. Avoiding foods due to appliance leakage was more common among participants with an ileostomy (8, 20%) than a colostomy (3, 4.8%), and vegetables and fruits were reported as the most problematic foods. None of the other cited reasons was significantly different. The results of this study confirm that many persons with a stoma adjust their dietary intake and avoid certain foods which, especially in persons with an ileostomy, may increase their risk for nutritional deficiencies. Additional research to assess dietary intake and nutritional status variables as well as patient needs is needed to facilitate the development of specific nutritional status monitoring and dietary recommendations for persons with an ileostomy or colostomy.

Iron deficiency after bariatric surgery: what is the real problem?

The growing prevalence of obesity explains the rising interest in bariatric surgery. Compared with non-surgical treatment options, bariatric surgery results in greater and sustained improvements in weight loss, obesity associated complications, all-cause mortality and quality of life. These encouraging metabolic and weight effects come with a downside, namely the risk of nutritional deficiencies. Particularly striking is the risk to develop iron deficiency. Postoperatively, the prevalence of iron deficiency varies between 18 and 53% after Roux-en-Y gastric bypass and between 1 and 54% after sleeve gastrectomy. Therefore, preventive strategies and effective treatment options for iron deficiency are crucial to successfully manage the iron status of patients after bariatric surgery. With this review, we discuss the risks and the contributing factors of developing iron deficiency after bariatric surgery. Furthermore, we highlight the discrepancy in the diagnosis of iron deficiency, iron deficiency anaemia and anaemia and highlight the evidence supporting the current nutritional recommendations in the field of bariatric research. In conclusion, we advocate for more nutrition-related research in patient populations in order to provide strong evidence-based guidelines after bariatric surgery.

Evaluation of Dietary Intakes and Supplement Use in Elite Paralympic Athletes

The Paralympic Games are highly competitive and athletes need to maximize performance, one crucial aspect of which is nutrition. Dietary intakes and supplement use in high‐performance, athletes with physical disabilities remain largely unexplored and specialized recommendations are lacking. Consequently, these athletes may be at risk for nutritional deficiencies and supplement misuse. The aim of this study is to assess nutritional intakes, dietary supplementation patterns, and sources of dietary supplement information in Canadian athletes with physical disabilities. Male (n=18) and female (n=22) athletes were recruited from various Paralympic sports across Canada through sporting organizations, coaches, and social media. Males had significantly greater total energy intakes than females (male=2092 kcal/day; female=1602 kcal/day, p=0.013). Males had greater protein intakes based on body weight than females (p=0.0017), while fat and carbohydrate intakes were similar in both genders. Females consumed a significantly greater percentage of their total calories from sugar as compared to males (p=0.049). Athletes' intakes met or exceeded the majority of recommended daily allowances (RDA) for vitamins and minerals, with the exception of vitamin D, vitamin E, and magnesium. Males did not meet the RDA for folate and vitamin A, while females did not meet the RDA for iron and calcium. Athletes did not meet the AI for pantothenic acid and potassium. Females had significantly lower percent of the recommendations for calcium (p=0.031), selenium (p=0.016), and iron (p&lt;0.001) as compared to males. Supplement use is high in this population; 100% of males and 91% of females reported supplement use within the past three months. Males most regularly used sports bars, protein powder, and sport drinks, while females most regularly used vitamin D, protein powder, and fatty acids. Significant differences were noted in branched chain amino acids, as males were more likely to use this supplement (p=0.008). The top three reasons for taking supplements were “stay healthy,” “increase energy,” and “medical.” Sources of dietary supplements were reported as dietician/nutritionist, medical physician (doctor), and athletic trainer. In conclusion, elite Paralympic athletes tend to consume diets that are adequate in most macro‐ and micronutrients with a high usage of dietary supplements. Future studies should evaluate impairment levels on energy and macronutrient intakes to work towards recommendations and to adequately educate and support these athletes.Support or Funding InformationFunded by a Mount Royal University Innovation Grant (J.P.) and the National Science and Engineering Research Council of Canada (J.S.).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Examining the Effects of the Mealtime PREP Intervention for Toddlers With Sensory Food Aversions

Abstract Date Presented 3/30/2017 The Mealtime PREP intervention shows promise to improve dietary variety and mealtime behaviors and lower risk of nutritional deficiency in toddlers with sensory food aversions. Moderate to large effect sizes were observed in a small sample of 11 families trained to deliver this intervention in the home. Primary Author and Speaker: Angela Caldwell Contributing Authors: Roxanna Bendixen, Cynthia Danford, Lauren Terhorst, Elizabeth Skidmore

Changes in nutritional status of patients with different diseases during hospitalization

Objective: To evaluate changes in nutritional status of hospitalized patients with different diseases by subjective global assessment (SGA) and nutritional risk screening (NRS-2002). Methods: A prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014. Hospitalized patients with the following diseases were investigated: malignant tumor (2 487 cases), benign disease of the digestive system (1 358 cases), benign disease of the nervous system (1 043 cases), benign bone disease (451 cases), benign disease of the respiratory system(395 cases), cardiovascular disease (227 cases), benign thyroid and breast disease (179 cases), and endocrine disease (149 cases). Patients above the age of 18 and hospitalization time between 7-30 days were included. Physical indexes were measured, the NRS-2002 and SGA scores were recorded, the nutritional support were recorded during hospitalization and 24 hours after discharge from hospital. Measurement data between groups were analyzed using t test or Wilcoxon rank sum test, enumeration data and ranked data between groups were analyzed using chi-square test or Fisher exact test. Results: There were 6 638 cases of hospitalized patients, 3 861 cases were males and 2 777 were females, the male/female ratio was 1.4∶1.0; the median age was 60 years; the median height was 1.66 m; the median weight was 62 kg; the median body mass index (BMI)was 22.89 kg/m(2). At discharge, compared with that of admission, the body weight, BMI, grip strength, upper arm and calf circumferences of patients with malignant tumor were significantly decreased (t=20.15-259.67, all P<0.01); the body weight and calf circumference were significantly decreased (t=35.27, 60.40, P<0.01)of patients with digestive benign disease; the body weight of patients with benign bone diseases was decreased (t=2.12, P=0.033); the body weight, grip strength and upper arm circumference were decreased in patients with benign thyroid and breast disease (t=2.79-10.18, all P<0.01); nutritional risk incidence rate (from NRS-2002) of patients with malignant tumor was significantly higher(χ(2)=21.275, P=0.000); moderate malnutrition (from SGA) incidence rate was significantly higher(χ(2)=62.318, P=0.000; χ(2)=11.312, P<0.01) in patients with malignant tumor and with orthopedics diseases. Compared with that of admission, records of the patients with other diseases had no statistically difference at discharge, no more than 50% of the patients under risk of nutritional deficiency(except those with digestive benign diseases )received nutritional support, while the proportion of non-parenteral nutrition application was higher. Conclusion: The patients with malignant tumor have higher incidence rate of malnutrition on admission and at discharge. Doctors should pay more attention to the nutritional status(screening and evaluation) of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.

Nutrition and Growth in Cystic Fibrosis.

Close attention to nutrition and growth is essential in caring for children with cystic fibrosis (CF). Growth and nutritional status should be monitored as part of routine CF care. Children with CF should achieve growth and nutritional status comparable with that of well-nourished children without CF. Children with CF are at risk for nutritional deficiencies. Optimal nutritional and growth status may be difficult to attain in this population given risk of insufficient caloric intake and likelihood of increased caloric expenditure. Various methods to attain optimal nutritional status may be used, including oral supplementation, behavioral treatment, pharmacotherapy, and enteral nutrition.

Vitamin D and bronchopulmonary dysplasia in preterm infants.

Objective:Vitamin D deficiency is associated with asthma and reactive airway disease in childhood but its potential contribution to bronchopulmonary dysplasia (BPD) in preterm infants is unknown. Preterm infants have lower levels of 25-hydroxyvitamin D (25(OH)D) at birth and are at risk for nutritional deficiencies after birth. The objective of the study was to evaluate the association of 25(OH)D concentrations at birth and at 36 weeks' corrected gestational age with BPD in preterm infants born before 29 completed weeks of gestation.Study Design:We collected umbilical cord blood samples from 44 preterm infants (gestational age <29 weeks) delivered at Brigham and Women's Hospital in Boston. In addition, with parental consent we collected venous samples at 36 weeks' corrected age from 20 preterm infants born before 29 weeks' gestation (including 6 infants with previously collected cord blood). Samples were frozen at −80 °C until subsequent measurement of 25(OH)D levels by chemiluminescence. We used multivariable logistic models to adjust for gestational age and considered other confounding variables, including maternal race, age, mode of delivery and infant sex.Results:Among 44 infants, 41 (93.2%) survived and 3 (6.8%) died before 36 weeks' corrected age. Median 25(OH)D levels at birth were 30.4 ng ml−1 in preterm infants who subsequently died or developed BPD and 33.8 ng ml−1 in infants who survived without BPD (P=0.6). Median 25(OH)D levels at corrected age of 36 weeks were 59.0 ng ml−1 among survivors without BPD and 64.2 ng ml−1 among survivors with BPD (P=0.9). Neither cord blood nor 36 weeks' corrected 25(OH)D levels were associated with odds of death or BPD (adjusted odds ratio (OR) 1.00, 95% confidence interval (CI): 0.73 to 1.37; and OR 0.93, 95% CI: 0.61 to 1.43, respectively).Conclusions:Among this population of extremely preterm infants neither cord blood nor the 36 weeks' corrected age 25(OH)D levels were associated with development of BPD. Notably, at the current level of supplementation, all extremely preterm infants in our cohort had achieved 25(OH)D levels >30 ng ml−1 by 36 weeks' corrected age, which is thought to represent sufficiency in adult and pediatric populations.

Nutritional support and dietary interventions for patients with ulcerative colitis: current insights

Ulcerative colitis (UC) demonstrates a remitting and relapsing course, and patients have long believed diet plays a role in their symptoms. Ad hoc removal of foods and food groups from the diet without strong evidence for therapeutic benefit places patients at risk for nutritional deficiencies. This review discusses the need for nutritional support in UC and the role of dietary modification in its management in humans. Current evidence suggests patients with UC are not nutritionally compromised during remission, but with increasing disease activity, nutritional status is worth monitoring, in particular through body composition assessment and investigation for anemia. There is no clear evidence for dietary modulation to relieve symptoms in UC. Neither enteral nutrition nor parenteral nutrition is efficacious for symptom control or mucosal healing. While early studies suggested avoidance of dairy foods, no recent work has replicated these results. A low intake of insoluble fiber is recommended during acute disease flares; however, the role of fiber in modulating the gut microbiota and their metabolites warrants further attention. Several studies have investigated polyunsaturated fatty acids for UC; however, current evidence is not supportive for either inactive or active disease. There is emerging evidence that curcumin supplementation may be a new dietary treatment option. Often, evidence for therapeutic diets is difficult to interpret due to the reporting of combined results for both Crohn's disease and UC. In general, there is no evidenced specific dietary advice for patients with UC other than to follow healthy eating guidelines. Further work should determine if diet as treatment efficacy lies in modification of dietary patterns, thereby investigating the synergistic relationship between foods and their components, rather than investigation of single foods/nutrients. Large randomized controlled trials investigating dietary modification for UC are needed.

High Tolerability of a Rice and Carob-Based Cereal Demonstrated in Highly Allergic Infants and Children: A Randomized Open-Food Challenge Trial

Background: Food allergy is the most common cause of atopic symptoms in early childhood. Standard care is an exclusion diet to avoid symptoms, but is associated with a risk of nutritional deficiencies. Sinlac® is a rice- and carob-based infant cereal free from major allergens, providing full nutritional support for children suffering from food allergies. Apple polyphenols (AP) have been shown to have favorable anti-allergy properties. Methods: A randomized clinical trial (NCT01029184) based on open-label food challenges was conducted to compare the tolerability of Sinlac® cereals with or without AP, with that of well-known allergenic foods, in subjects with severe food allergy (aged 4-40 months). Study products were Sinlac®, Sinlac®AP (0.3% in matrix), wheat, potato, milk and hen’s egg. The primary endpoint was a positive reaction to open-label food challenges. Results: Of the 51 subjects randomized, 48 completed the study. Both Sinlac® and Sinlac®AP were significantly better tolerated by atopic infants than other allergenic foods: incidence of allergic reactions was 2% with Sinlac® and Sinlac®AP, versus 49% with wheat, potato, milk or hen’s egg. Conclusion: Sinlac® and Sinlac®AP are very well tolerated and offer a nutritionally balanced option for atopic infants and children. Studies are needed to assess the benefit of adding AP to low allergenic products.

Food consumption in patients referred for bariatric surgery with and without binge eating disorder

IntroductionThe prevalence of Binge Eating Disorder (BED) is high in obese patients referred to bariatric surgery. Although the total energy intake is increased, the risk of nutritional deficiencies in these patients is unknown. This study proposes to evaluate and compare the intakes of candidate patients for bariatric surgery with and without BED, using for this purpose the Dietary Reference Intakes. Methods116 patients referred for bariatric surgery were submitted to nutritional, laboratory and psychological assessments. ResultsAmong the patients, 46.6% had BED, of these, 25.9% had the severe form. The patients with current depression (31.9%) were more compulsive than those without depression (p<0.001). The mean age was significantly higher in patients without BED (46.94±12.05 vs 42.32±10.60, p=0.030). The only difference in anthropometric parameters individuals with and without BED was the mid-upper arm circumference (P=0.047). The percentage of energy from carbohydrates was higher in patients with BED (53.78%) than without BED (48.88%) (U=1222, P=0.018, r=−0.22). The percentage from total fat (13.63% versus 12.89%, U=1201.0, P=0.019, r=−0.22) and from saturated fat (9.04% versus 8.15%, U=1074.0, P=0.023, r=−0.21), was higher in patients without BED. When adjusted for the body weight of patients, these differences were not significant. ConclusionPatients with BED eat more carbohydrates and have larger mid-upper arm circumference in the face of similar body weight, suggesting a higher percentage of fat mass.

Higher risk of low birth weight and multiple nutritional deficiencies in neonates from mothers after gastric bypass: A case control study

Background Maternal bariatric surgery is associated with an increased risk of small-for-gestational-age infants. The risk of nutritional deficiencies in neonates of mothers with prior gastric bypass (GBP) is unclear. Methods This study compared the clinical and cord blood biological characteristics of 56 newborns of GBP mothers and 56 newborns of non-obese healthy mothers after normal pregnancy, in the Obstetrics Department of Angers University Hospital between 01/03/2008 and 31/10/2012. After GBP, the women took daily multivitamin and trace element supplements, were followed monthly once pregnant and had blood drawn at delivery for nutritional assessment. Findings GBP mothers lost 18.1 ± 6.3 kg/m 2 of BMI in the 11–69 months between surgery and pregnancy onset, reaching BMI of 30.1 ± 6.0 kg/m 2 compared with 22.3 ± 4.0 kg/m 2 in the controls ( P P P Interpretation Neonates from GBP mothers showed nutritional deficiencies and the long-term consequences remain to be explored.

Frequent Follow-Up Visits Reduce Weight Regain in Long-Term Management After Bariatric Surgery

Purpose: The objective of this retrospective study was to observe whether more frequent long-term medical follow-up visits than what occurs with the current typical follow-up schedule might prevent weight regain and nutritional deficiencies, and improve the resolution of comorbidities in bariatric patients. Materials and Methods: Clinical reports were examined of bariatric patients (n=71, 16 males, age 42±11.6 years, body mass index [BMI] 48.6±7.9 kg/m2) who had a minimum of 36 months of post-surgery follow-up. All patients had a typical follow-up after surgery at 1, 3, and 6 months. The intervention group (IG) had follow-ups at 9, 12, 15, 18, 24, 30, and 36 months, while the control group (CG) at 12, 18, 24, and 36 months after surgery. Results: Roux-en-Y gastric bypass was performed in 18 patients, while 43 patients had sleeve gastrectomy and 10 subjects had adjustable gastric banding. After 3 years, the BMI difference for the IG was 16.8±6.1 kg/m2 [95% CI 14.8–18.9], and for the CG it was 11.9±7.8 kg/m2 [95% CI 9.3–14.4] (p=0.004). The % excess weight loss was 66.3±20.9% [95% CI 59.4–73.2] for the IG and 55.7±32.2% [95% CI 45.2–66.3] for the CG (p=0.04). IG subjects had a higher rate of complete remission of diabetes mellitus (77% vs. 56%) and hypertension (74% vs. 57%). There were no statistical differences for nutritional deficiencies between the groups. The use of dietary supplements was similar (66% IG, 73% CG). Conclusions: After 3 years, there does not appear to be any influence of the frequency of follow-up visits on the risk of nutritional deficiencies and the rate of dietary supplement use. Adding more follow-up visits to the guideline schedule may help reduce weight regain and improve comorbidities.

Markers of Bone Metabolism in Obese Individuals Undergoing Laparoscopic Sleeve Gastrectomy.

Besides its advantages, bariatric surgery implicates a risk of nutritional deficiencies, which might result in impaired bone metabolism. We assessed the effect of laparoscopic sleeve gastrectomy (LSG) on blood markers of bone metabolism in obese patients during a 3-year observation period. In 39 obese patients (29 women, 10 men, mean BMI 51.8 ± 6.8 kg/m(2)) undergoing LSG, we measured blood concentrations of 25-hydroxyvitamin D (25(OH)D), calcium, parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and N-telopeptides crosslinks (NTx) before LSG and up to 3 years postoperatively. Vitamin D and calcium supplementations were recorded. LSG caused an excess weight loss (EWL) of 54 ± 20 % after 3 years. Before surgery, we found decreased levels of 25(OH)D and calcium in 80 and 5 % of the subjects, respectively, while increased levels of PTH, BAP, and NTx were found in 39, 28, and 21 %, respectively. Mean levels of NTx and the prevalence of elevated levels of NTx increased within 2 years (p < 0.001 and p < 0.01). Neither mean blood concentrations of 25(OH)D, calcium, PTH, and BAP nor relative prevalence of deficiencies regarding these markers changed during the study period. The supplementation rates of calcium and vitamin D increased postoperatively. Morbid obesity is associated with pronounced changes of markers of bone metabolism; LSG did neither aggravate nor ameliorate vitamin D metabolism within a 3-year time period, but led to increased bone resorption 2 years postoperatively. Routine supplementation of calcium and vitamin D is not likely sufficient to compensate the obesity-associated deficiencies in bone metabolism.

Dilute Versus Full-Strength Formula in Exclusively Formula-Fed Preterm or Low-Birth-Weight Infants

Dilute Versus Full-Strength Formula in Exclusively Formula-Fed Preterm or Low-Birth-Weight Infants

A State-Level Review of Diversity Initiatives in Congregate Meal Programs Established Under the Older Americans Act.

The Older Americans Act (OAA) congregate meal program (CMP) targets those most at risk for nutritional deficiencies, social isolation, and institutionalization. Social minorities (racial, ethnic, cultural, and sexual minorities) are at high risk for all three. This study explores state-level diversity initiatives to welcome these social minorities in CMPs. A national survey was distributed to each State Unit on Aging, all but three states participated. The majority of states (64.6%) target CMPs to a specific racial, ethnic, or cultural minority; five states target sexual minorities (lesbian, gay, bisexual, and transgender [LGBT]). Negative binomial regression results find state minority population percentage is a significant predictor of the number of diversity initiatives at CMPs. States with LGBT CMPs reported the highest levels of racial/ethnic/cultural diversity initiatives and high levels of statewide LGBT protective policies. Recommendations are suggested that build upon the diversification success of states to further the mission of OAA in reaching high-risk older adults.

Inappropriate Feeding Behaviors and Dietary Intakes in Children with Fetal Alcohol Spectrum Disorder or Probable Prenatal Alcohol Exposure

Prenatal alcohol exposure (PAE) is a leading cause of significant neurobehavioral and neurocognitive deficits. Its potential consequences for eating behaviors, nutritional status, and other nutritional issues in childhood have received little attention. Nineteen children (11 boys, 8 girls) of mean age 9.6years, referred for fetal alcohol spectrum disorder (FASD) screening and assessment, were analyzed with physical exams and caregiver questionnaires to identify possible abnormalities in food and eating behaviors. Fourteen children contributed 24-hour diet recalls and were assessed for nutritional status. Seventy-nine percent of participants were diagnosed with FASD and 63.2% had confirmed PAE. Fifty percent of girls were overweight or obese, whereas 37% of boys had reduced stature, weight, or body mass index for their age. Recurring feeding problems included constant snacking (36.8%), lack of satiety (26.3%), and picky eating/poor appetite (31.6%). None had oral feeding problems. Constipation was common (26.3%). Macronutrient intakes were largely normal, but sugar consumption was excessive (140 to 190% of recommendations) in 57% of subjects. Vitamin A intake exceeded the upper limit for 64% of participants, whereas ≥50% had intakes <80% of recommended daily allowances (RDAs) for choline, vitamin E, potassium, β-carotene, and essential fatty acids; 100% had vitamin D intakes <80% of the RDA. PAE may be associated with altered acquisition and distribution of body mass with increasing age. Disordered eating was common. The increased feeding behaviors surrounding lack of satiety suggest that self-regulation may be altered. Constipation could reflect low dietary fiber or altered gastrointestinal function. These exploratory data suggest that children with PAE may be at risk for nutritional deficiencies, which are influenced by inappropriate food preferences, disordered eating patterns, medication use, and the stressful dynamics surrounding food preparation and mealtime.