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Biomedical subjects

S P Wolfe

Publications and source records attributed to S P Wolfe.

5 recordsLinked to original sources
PubMed1995

'Prevention programmes'--a dietetic minefield.

Food allergy and intolerance (FAI) is undoubtedly a controversial subject surrounded by a great deal of publicity. One of the most confusing issues arises when considering the value of allergy prevention programmes. Although prevention strategies have now been extensively studied the results are still inconclusive. In childhood, atopic disorders eg asthma, eczema, dermatitis, urticaria, rhinitis and gastrointestinal related symptoms are relatively common with estimates of their prevalence ranging from two to 20 per cent (Mallet & Henocq, 1992). In addition, the proportion of young children with allergies seems to be increasing, although the extent to which food allergens contribute remains unclear (Hide, 1991; Croner, 1992; DoH, 1994). In many of these cases, prevention of unpleasant, socially and psychologically disruptive and sometimes life threatening symptoms can be achieved by dietary modification. If atopic and gastrointestinal symptoms can be prevented growth failure may not be a problem, children may miss less schooling, and if long term prevention is achieved there may be a substantial reduction in the cost of medical care these children would otherwise require. Before prevention programmes are introduced, however, careful thought should be given to the implications of dietary treatment. The programmes are difficult to administrate in terms of both resources and expense. Specifically, from a nutritional point of view, the diets employed are often socially disruptive which inevitably leads to problems with compliance. Nutritional adequacy may also be difficult to achieve unless there is close supervision by a dietitian who is experienced in the management of the complex dietary manipulations involved. Unfortunately the dietetic resources essential for the safety of the programmes may be lacking in many hospitals. Preventive practice may be aimed at either the general population or at specially identified group who are considered to be at a greater risk of developing atopic disorders. Dietary intervention studies looking at prevention in this 'at risk' group have considered maternal dietary modification during pregnancy and lactation, the use of soya and hydrolysed protein feeds and the weaning diet. The nutritional consequences of these methods of dietary manipulation will be discussed in more detail.

Breast Feeding↗
PubMed1993

A double blind lipase for lipase comparison of a high lipase and standard pancreatic enzyme preparation in cystic fibrosis.

A standard acid resistant microsphere pancreatic enzyme preparation was compared with identical capsules half filled with mini-tablets of a new high lipase preparation in a randomised double blind crossover study in children with cystic fibrosis. Each patient received his/her usual number of capsules and the same dose of lipase during each period of the study. Eighteen patients completed the study. There were fewer gastrointestinal symptoms when pancreatic enzyme was supplied as the high lipase preparation. There was also a significant improvement in fat absorption (17%, 95% confidence interval (CI) 6 to 27), reduction in faecal fat output (15.8 g/day, 95% CI 6.4 to 22.5), and faecal energy loss (789 kJ/day, 95% CI 211 to 1384). It is concluded that half filled capsules of the new high lipase preparation are more effective than the standard preparation and it is likely that filled capsules would allow patients to use fewer than half the number of pancreatic enzyme capsules.

Adolescent↗
PubMed1993

Resting energy expenditure and substrate oxidation rates in cystic fibrosis.

The resting energy expenditure (REE) and substrate oxidation rates in 16 patients with cystic fibrosis who had mild chest disease and 11 healthy controls were measured using indirect calorimetry. The mean REE (% predicted) in the patients with cystic fibrosis was 11% greater than in the controls. Five patients with cystic fibrosis were hypermetabolic but only one of these had a clinically significant reduction of respiratory function. A greater proportion of REE was derived from carbohydrate oxidation in the cystic fibrosis patients (43.5% v 29.9%). However, the 24 hour dietary intake of carbohydrate was greater in the cystic fibrosis group (49.6 v 45.8% of energy intake). These data suggest that a high dietary intake of carbohydrate may contribute to the increased oxidation of carbohydrate in these cystic fibrosis patients. All patients with cystic fibrosis, including those with apparently mild lung disease, should continue to receive a high energy diet.

Adolescent↗