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.