for dietary treatment of the infant, which includes use of low phenylalanine or phenylalanine-free formula. Such special formulas may be provided by the WIC program. A phenylalanine-restricted diet during infancy and early childhood normalizes blood phenylalanine levels, permitting normal mental development. Similar dietary management is indicated for individuals with other inborn errors of metabolism.

Use of Inborn Errors of Metabolism as Risk Criteria in the WIC Setting

Inborn errors of metabolism are reported to WIC programs from diagnosis by a medical care provider. Table 5-1 summarizes how many states use these risk criteria in the WIC setting.

Recommendations for Inborn Errors of Metabolism

The risks of PKU and other inborn errors of metabolism are well documented in women, infants, and children, and these risks can be identified clinically. The benefit of use of special formulas is well established. Therefore, the committee recommends use of PKU and other inborn errors of metabolism as nutrition risk criteria for women, infants, and children in the WIC program.

Chronic or Recurrent Infections

The relationship between nutrition and infection has been appreciated for centuries: tuberculosis was known as ''consumption," and HIV/AIDS was categorized as "slim disease" when first discovered in East Africa (Keusch, 1994). Individuals with chronic or recurrent infections such as tuberculosis, pneumonia, bronchitis, upper respiratory infections, otitis media, meningitis, and hepatitis may have increased nutrition needs. Nutrition deficits can impair the host's ability to sustain cellular proliferation and other defense mechanisms. HIV/AIDS is covered separately in the next section.

Prevalence of and Factors Associated with Chronic or Recurrent Infections

Data on prevalence of chronic or recurrent infections among the U.S. or the WIC population were not available to the committee. In the United States, the probability of children developing acute otitis media is understood to be very high (Infante-Rivard and Fernandez, 1993).

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