Dietary Intake
Dietary data analysis revealed 50% of children were exceeding their
%EER by greater than 10%, although 19% were consuming less than 75%
of their %EER. Patients were consuming excessive protein intake with a
mean intake of 400% of requirements and only 5% not meeting their
protein requirements. The patients mean nutrient intake all exceeded
EARs indicating generally, that it is unlikely individuals are deficient
in specific nutrients. The percentage of children not meeting the EAR/AI
was lower than the normative data from the Australian Health Survey
(except for magnesium and calcium), however, using the crude measure of
EAR it cannot be determined if any children were at risk of deficiency.
In contrast, when dietary quality was considered, particularly with
respect to nutrients associated with increased risk of chronic disease,
large numbers of children exceeded recommendations. Sugar intake was
excessive, with nearly half (49%) of children exceeding recommendations
for total sugar intake (>20% total energy from sugars) and
61% exceeding recommendations for added sugar intake
(>10% total energy from added sugars). More than half of
the children were not meeting their AI recommendations for fibre (61%).
Sodium intake was calculated as excessive (intake >100% of
the highest bound range of AI) in 65% of children, although this
percentage was slightly lower than normative data (Table 2).
There was no significant difference between intakes of core food groups
between male and female or between patients with ALL and other diagnoses
(Supplementary Table 1). There were no significant differences in intake
for any food groups and treatment intensity except for core grain foods
(p=0.017), with core grain intake greater amongst those on moderate
intensity treatment compared to all other intensities.
Considering food group data as a further measure of dietary quality,
many children did not meet minimum serves recommended for intake of all
core food groups (Table 3). It is important to consider the intake
excluding discretionary foods, as these foods add excessive saturated
fat, sodium and sugar, and insufficient dietary fibre and whole grains.
The intake of core foods was like the Australian Health Survey normative
data. When this data was reviewed to include intake from discretionary
items, the general lack of dietary nutrient deficiency (Table 2) was
explained. Patients had a larger intake from most food groups compared
to normative data, however the discretionary nature of their intake
indicated poorer dietary quality. Half (51%) of total vegetable intake
serves were classified as discretionary according to the Australian
Dietary Guidelines. Foods contributing significantly to discretionary
vegetable intake included takeaway fries, savoury chips/crisps and
tomato sauce.
Fruit juice contributed to 47% of total fruit intake. Core foods
contributed to greater than 65% of food group intake for grains, meat
and dairy. Discretionary food items contributing to total grain food
group intake included pastry products, baked goods and sweet and savoury
biscuits. Refined grains, if from core foods (e.g. breads, cereals) are
still classified as core foods. However, whilst grains classified as
discretionary foods contributed to only 31% of grain intake, refined
grains contributed to 71% of grain intake. The Australian Dietary
Guidelines recommend grain consumption to consist mostly of whole
grains. Core foods contributing to refined grain intake included white
bread, rice and pasta. Foods contributing to meat and milk alternatives
intake were mostly classified as core foods, though there were
contribution from non-core foods, with some amounts of processed meats
including bacon and salami contributing to meat intake, and small
amounts of ice cream and chocolate contributing to dairy.