Unresolved fatigue in children

Many children deal with fatigue, which makes them less resilient and causes them to have weaker immune resistance. After infections, anemia, chronic diseases, and psychosocial imbalances are ruled out, there is still a group of patients without a clear cause and for which adequate medical therapy does not exist. A possible explanation for their fatigue is a micro deficiency of minerals and vitamins. Clinical studies show that approximately 20% of children under eight do not eat enough fruit and vegetables and do not reach the minimum level of dairy intake (according to European guidelines: EFSA). We did a non-randomized controlled trial, to clinically evaluate symptoms of fatigue in children for which a nutrient-rich diet was advised.

Evaluation dietary advice

A group of 98 children (2–18 years old) with unexplained symptoms of fatigue was examined. All children were advised to keep an active lifestyle and were followed up with regular check ups by a pediatrician. Children in the intervention group were asked to follow the dietary advise for three months, whereas the control-group followed their normal diet. The dietary advice consisted of green vegetables, beef, whole milk and full-fat butter. All components were advised in normal, age adequate portion sizes. Symptoms of fatigue were measured using a PedsQL Multidimensional Fatigue Scale, and secondary outcomes were compliant with the diet and BMI.

The dietary advice effectively decreased symptoms of fatigue

At the start of the study, children in both groups already followed the dietary advice for 29%. This increased to 85% in the intervention group, compared to 32% in the control group. Children, who followed the diet showed a significant decrease in the need to sleep (CI 0.83; 14.86, p = 0.03). They slept better through the night and took fewer naps. When analyzing components of the advised diet separately, taking confounders into account, a significantly larger decrease in cognitive fatigue symptoms was seen for green vegetables (CI 2.27; 30.63, p = 0.024). Furthermore, a lower need to sleep was seen when whole milk was consumed almost daily (CI 0.02; 14.62, p = 0.049).

Benefits of pure nutrients

Our study showed that nutritional advice is an elegant, and effective method for decreasing some symptoms of medically unresolved fatigue in children. The observed positive effect on fatigue can be explained by an increased intake of minerals, vitamins and fatty acids. Four further factors can explain these results, including a beneficial effect of combining nutrients, effects of anti-oxidants, better sleep behavior due to the high concentration of melatonin in milk, and an improvement of the immune function. Vitamins and minerals have been shown to mutually benefit their absorption when consumed simultaneously. On top of this, it has been shown that pure nutrients are absorbed better than artificial nutrients. Beside vitamins and minerals, green vegetables and melatonin in whole milk contain many anti-oxidants, which can reduce oxidative stress in the human body.

Better sleep behavior with melatonin

Melatonin has more beneficial properties on fatigue, especially on sleep behavior. Whole milk is known to contain melatonin, which has been shown to be effective in improving sleep onset, maintenance of sleep, and prolongation of sleep. Our study demonstrated that whole milk is significantly associated with a decreased need to sleep or rest, and that there was a stronger decline in fatigue in children who drank more whole milk than in children who drank less whole milk.

Improved immune function

Additionally, the components of the advised diet can improve the immune function in children. Earlier studies in our hospital showed that this diet has a beneficial effect on recurrent upper respiratory tract infections. This is supported in the literature by an improvement of the immune functions by vitamins and minerals, which are present in high concentrations in the advised diet. Even without recurrent infections, improvement of the immune system can be reflected in the general wellbeing, and an increase in energy due to a decrease in pro-inflammatory cytokines.

More research in a larger, randomized trial with more supervision on the dietary intake could further validate the results shown here.

Based on: Steenbruggen, T.G.; Hoekstra, S.J.; van der Gaag, E.J. Could a Change in Diet Revitalize Children Who Suffer from Unresolved Fatigue? Nutrients 2015, 7, 1965-1977.