Adherence to Diet in Chronic Conditions: The Example of Cystic Fibrosis
Lori J. Stark
Children's Hospital Medical Center, Cincinnati, OH
Nutritional recommendations are part of the management of many chronic illnesses of childhood, such that children are instructed to eat more foods, avoid foods, eat at prescribed times, and/or eat different foods. For example, children with Type 1 diabetes are instructed to avoid foods high in sugar and to eat at regular times corresponding to insulin injections. Children with phenylketonuria (PKU) are instructed to avoid foods containing phenylalanine. Children with cystic fibrosis (CF) are instructed to consume increased energy of 120% to 150% of the recommended daily allowance (RDA) for healthy children. Children with juvenile rheumatoid arthritis (JRA) need a high-protein diet. There is also research indicating that a special ketogenic diet may be an important treatment for children with intractable seizure disorders ( Kinsman, Vining, Quaskey, Mellits, & Freeman, 1992).
In addition to the modification of diet for the treatment of chronic conditions, childhood is also seen as the optimal time to intervene on diet to prevent chronic health conditions in adulthood. For example, the American Heart Association advocates a diet low in concentrated fat and high in fiber at all ages to prevent the risk of heart disease in adulthood. Research has found that some precursors to heart disease--such as elevated blood cholesterol, high blood pressure, and obesity--are evident in childhood (Center for Disease Control, 1994; Gortmaker, Dietz, Sobol, & Wehler, 1987), and children with these risk factors are likely to carry them into adulthood ( Ernst & Obarzanek, 1994). More recently, investigators have