A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow’s milk elimination diet
Main Article Content
Keywords
amino acid-based supplement, cow’s milk -elimination diet, dietary supplements, feeding difficulties, milk hypersensitivity (allergy)
Abstract
Introduction and Objectives: Food allergy has several negative nutritional consequences and may persist beyond the first year of lives. This study aimed to assess the role of a complete oral amino acid-based supplement in the diet of children on cow’s milk protein elimination diet because of food allergy.
Materials and Methods: This study included two groups of children aged 1–5 years paired by age and socioeconomic status: (1) study group, on cow’s milk protein elimination diet plus an oral amino acid-based supplement, and (2) control group, on cow’s milk protein elimination diet. Sociodemographic, clinical, anthropometric, and dietary data were obtained through online interviews. Two 24-h dietary recalls were collected on nonconsecutive days. Both groups comprised mostly boys.
Results: The study group presented lower values of body mass index. The frequency of feeding difficulties was similar between groups. The study group had a higher intake of energy, protein, carbohydrates, calcium, iron, zinc, phosphorus, magnesium, copper, selenium, vitamins D, E, B1, B2, B6, and B12, niacin, and folic acid compared to the control group. A higher proportion of children in the study group had adequate intake according to the recommendations made for energy, carbohydrates, iron, phosphorus, selenium, vitamins A, D, E, B1, B2, and B6, and folic acid.
Conclusions: The use of a complete oral amino acid-based supplement has a positive effect on the diet quality of preschoolers on cow’s milk elimination diet because of food allergy, promoting higher intake of energy, calcium, vitamin D, and other essential nutrients.
References
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12. Boaventura RM, Mendonça RB, Fonseca FA, Mallozi M, Souza FS, Sarni ROS. Nutritional status and food intake of children with cows’milk allergy. Allergol Immunopathol (Madr). 2019;47:544–50. 10.1016/j.aller.2019.03.003
13. de Faria DPF, Sillos MD, Speridião PGL, Morais MB. Real-life data on the effectiveness of extensively hydrolyzed protein-based formula and amino acid-based formula in regaining weight and height in infants on a cow’s milk protein elimination diet. Allergol Immunopathol (Madr). 2023 Mar 1;51(2): 177–83. 10.15586/aei.v51i2.768. eCollection 2023. https://all-imm.com/index.php/aei/article/view/768
14. Meyer R, Wright K, Vieira MC, Chong KW, Chatchatee P, Vlieg-Boerstra BJ, et al. International survey on growth indices and impacting factors in children with food allergies. J Hum Nutr Diet. 2019;32:175–84. 10.1111/jhn.12610
15. Meyer R, Rommel N, Van Oudenhove L, Fleming C, Dziubak R, Shah N. Feeding difficulties in children with food protein--induced gastrointestinal allergies. J Gastroenterol Hepatol. 2014;29:1764–9. 10.1111/jgh.12593
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19. Diniz PB, Fagondes SC, Ramsay M. Cross-cultural adaptation and validation of the Montreal Children’s Hospital Feeding Scale into Brazilian Portuguese. Rev Paul Pediatr. 2021;39:e2019377. 10.1590/1984-0462/2021/39/2019377
20. Gibson RS, Ferguson EL. An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. HarvestPlus Technical Monograph 8. Washington, DC International Food Policy Research Institute (IFPRI) and International Center for Tropical Agriculture (CIAT). © HarvestPlus; 2008, 157 p. https://ebrary.ifpri.org/digital/collection/p15738coll2/id/128218
21. Crispim SP, Kac G, Lacerda EMA, Castro IRR. Manual fotográfico de quantificação alimentar infantil. Curitiba, Brazil: Universidade Federal do Paraná; 2018, 160 p.
22. Pinheiro ABV, Lacerda EMA, Benzecry EH, Gomes MCS, Costa VM. Tabela Para Avaliação de consumo alimentar em medidas caseiras, 5th ed. Rio de Janeiro, Brazil: Atheneu; 2004, 131 p.
23. National Academies of Sciences, Engineering, and Medicine. Dietary reference intakes for sodium and potassium. Washington, DC: The National Academies Press; 2019. 10.17226/25353
24. Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU). Human energy requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Food and Nutrition Technical Report Series 1. Rome, Italy: FAO; 2004. Available from: https://www.fao.org/3/y5686e/y5686e00.htm#Contents
25. Williams CL, Bollella M, Wynder EL. A new recommendation for dietary fiber in childhood. Pediatrics. 1995;96:985–88. https://pubmed.ncbi.nlm.nih.gov/7494677/
26. Brazilian Food Composition Data Network. Tabela Brasileira de Composição de Alimentos (TBCA), Versão 7.2. São Paulo, Brazil: Universidade de São Paulo (USP) and Food Research Center (FoRC); 2023. Available from: http://www.fcf.usp.br/tbca
27. Brazilian Institute of Geography and Statistics (IBGE). Estudo Nacional de Despesa Familiar (National Study on Family Expenditures; ENDEF). Tabelas de composição de alimentos, 5th ed. Rio de Janeiro, Brazil: IBGE; 1999, 137 p. Available from: ,https://biblioteca.ibge.gov.br/visualizacao/livros/liv6934.pdf
28. Center for Studies and Research in Food of the State University of Campinas (NEPA–UNICAMP). Tabela Brasileira de composição de alimentos (TACO), 4th ed. Campinas, Brazil: NEPA–UNICAMP; 2011, 161 p. Available from: https://www.nepa.unicamp.br/taco/tabela.php?ativo=tabela
29. US Department of Agriculture, Agricultural Research Service. Food Data Central, 2019. Available from: https://fdc.nal.usda.gov/
30. Morais MB, Toporovski MS, Tofoli MHC, Barros KV, Ferreira CHT, Silva LR. Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity. J Pediatr (Rio J). 2022;98:241–7. 10.1016/j.jped.2021.06.009
31. Braegger C, Decsi T, Dias JA, Hartman C, Kolacek S, Koletzko B, et al. Practical approach to paediatric enteral nutrition: A comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51:110–22. 10.1097/mpg.0b013e3181d336d2
32. Frizzo J, Rodrigues VCC, Speridião PGL, Morais MB. Evaluation of the complementary feeding practices, dietary intake, and nutritional status of infants on a cow’s milk protein elimination diet. J Pediatr (Rio J). 2022;98:256–63. 10.1016/j.jped.2021.06.005
33. Nogueira-de-Almeida CA, Del Ciampo LA, Martinez EZ, Contini AA, Nogueira-de-Almeida ME, Ferraz IS, et al. Clinical evolution of preschool picky eater children receiving oral nutritional supplementation during six months: A prospective controlled clinical trial. Children. 2023;10:495. 10.3390/children10030495
34. Anwar F, Yalawar M, Suryawanshi P, Ghosh A, Jog P, Khadilkar AV, et al. Effect of oral nutritional supplementation on adequacy of nutrient intake among picky-eating children at nutritional risk in India: A randomized double-blind-clinical trial. Nutrients. 2023;15:2528. 10.3390/nu15112528
35. Nogueira-de-Almeida CA, Mello ED de, Ribas Filho D, Maximino P, Fisberg M. Consensus of the Brazilian Association of Nutrology on the use of food supplements to children with eating disorders. IJN 2022;11:4–15. 10.1055/s-0038-1670717
36. Ghosh AK, Kishore B, Shaikh I, Satyavrat V, Kumar A., Shah, T., et al. Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: A randomized, controlled trial. J Int Med Res. 2018;46:2186–201. 10.1177/0300060518757355
37. Ghosh AK, Kishore B, Shaikh I, Satyavrat V, Kumar A, Shah T, et al. Continuation of oral nutritional supplementation supports continued growth in nutritionally at-risk children with picky eating behaviour: A post-intervention, observational follow-up study. J Int Med Res. 2018;46:2615–32. 10.1177/0300060518766982
38. Sheng X, Tong M, Zhao D, Leung TF, Zhang F, Hays NP, et al. Randomized controlled trial to compare growth parameters and nutrient adequacy in children with picky eating behaviors who received nutritional counseling with or without an oral nutritional supplement. Nutr Metab Insights. 2014;7:85–94. 10.4137/nmi.s15097
2. Savage J, Johns CB. Food allergy: Epidemiology and natural history. Immunol Allergy Clin North Am. 2015;35:45–59. 10.1016/j.iac.2014.09.004
3. Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, et al. An ESPGHAN position paper on the diagnosis, management and prevention of cow’s milk allergy. J Pediatr Gastroenterol Nutr. 2023. 10.1097/MPG.0000000000003897. Online ahead of print.
4. Toca MC, Morais MB, Vásquez-Frias R, Becker-Cuevas DJ, Boggio-Marzet CG, Delgado-Carbajal L, et al. Consensus on the diagnosis and treatment of cow’s milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Rev Gastroenterol Mex (Engl Ed). 2022; 87:235–50. 10.1016/j.rgmxen.2022.01.002. Epub May 24, 2022.
5. Solé D, Silva LR, Cocco RR, Ferreira CT, Sarni RO, Oliveira LC, et al. Brazilian consensus on food allergy: 2018—Part 2—Diagnosis, treatment and prevention. Joint Position Paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology. Arq Asma Alerg Imunol. 2018;2: 39–82. 10.5935/2526-5393.20180005
6. Meyer R, Venter C, Bognanni A, Szajewska H, Shamir R, Nowak-Wegrzyn A, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guideline update—VII—Milk elimination and reintroduction in the diagnostic process of cow’s milk allergy. World Allergy Organ J. 2023;16:100785. 10.1016/j.waojou.2023.100785. eCollection July 2023.
7. Dias A, Santos A, Pinheiro JA. Persistence of cow’s milk allergy beyond two years of age. Allergol Immunopathol (Madr). 2010;38:8–12., 10.1016/j.aller.2009.07.005. Epub Oct 22, 2009.
8. Prescott S, Allen KJ. Food allergy: Riding the second wave of the allergy epidemic. Pediatr Allergy Immunol. 2011;22: 155–60. 10.1111/j.1399-3038.2011.01145.x
9. de Faria DPB, Sillos MD, Speridião PGL, Morais MB. Outcome of food intake and nutritional status after discontinuation of a cow’s-milk-free diet post negative oral food challenge in infants and children. Allergol Immunopathol (Madr). 2022;50:1–8. 10.15586/aei.v50i1.471
10. Meyer R. Nutritional disorders resulting from food allergy in children. Pediatr Allergy Immunol. 2018;29:689–704. 10.1111/pai.12960
11. Medeiros LC, Speridião PG, Sdepanian VL, Fagundes-Neto U, Morais MB. Nutrient intake and nutritional status of children following a diet free from cow’s milk and cow’s milk by--products. J Pediatr (Rio J). 2004;80:363–70. https://pubmed.ncbi.nlm.nih.gov/15505731/
12. Boaventura RM, Mendonça RB, Fonseca FA, Mallozi M, Souza FS, Sarni ROS. Nutritional status and food intake of children with cows’milk allergy. Allergol Immunopathol (Madr). 2019;47:544–50. 10.1016/j.aller.2019.03.003
13. de Faria DPF, Sillos MD, Speridião PGL, Morais MB. Real-life data on the effectiveness of extensively hydrolyzed protein-based formula and amino acid-based formula in regaining weight and height in infants on a cow’s milk protein elimination diet. Allergol Immunopathol (Madr). 2023 Mar 1;51(2): 177–83. 10.15586/aei.v51i2.768. eCollection 2023. https://all-imm.com/index.php/aei/article/view/768
14. Meyer R, Wright K, Vieira MC, Chong KW, Chatchatee P, Vlieg-Boerstra BJ, et al. International survey on growth indices and impacting factors in children with food allergies. J Hum Nutr Diet. 2019;32:175–84. 10.1111/jhn.12610
15. Meyer R, Rommel N, Van Oudenhove L, Fleming C, Dziubak R, Shah N. Feeding difficulties in children with food protein--induced gastrointestinal allergies. J Gastroenterol Hepatol. 2014;29:1764–9. 10.1111/jgh.12593
16. Rodrigues VCC, Speridião PGL, Sanudo A, Morais MB. Feeding difficulties in children fed a cows’ milk elimination diet. Br J Nutr. 2022;128:1190–9. 10.1017/s0007114521004165
17. Maslin K, Dean T, Arshad SH, Venter C. Fussy eating and feeding difficulties in infants and toddlers consuming a cows’ milk exclusion diet. Pediatr Allergy Immunol. 2015;26:503–8. 10.1111/pai.12427
18. Ramsay M, Martel C, Porporino M, Zygmuntowicz C. The Montreal Children’s Hospital Feeding Scale: A brief bilingual screening tool for identifying feeding problems. Paediatr Child Health 2011;16:147–51. 10.1093/pch/16.3.147
19. Diniz PB, Fagondes SC, Ramsay M. Cross-cultural adaptation and validation of the Montreal Children’s Hospital Feeding Scale into Brazilian Portuguese. Rev Paul Pediatr. 2021;39:e2019377. 10.1590/1984-0462/2021/39/2019377
20. Gibson RS, Ferguson EL. An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. HarvestPlus Technical Monograph 8. Washington, DC International Food Policy Research Institute (IFPRI) and International Center for Tropical Agriculture (CIAT). © HarvestPlus; 2008, 157 p. https://ebrary.ifpri.org/digital/collection/p15738coll2/id/128218
21. Crispim SP, Kac G, Lacerda EMA, Castro IRR. Manual fotográfico de quantificação alimentar infantil. Curitiba, Brazil: Universidade Federal do Paraná; 2018, 160 p.
22. Pinheiro ABV, Lacerda EMA, Benzecry EH, Gomes MCS, Costa VM. Tabela Para Avaliação de consumo alimentar em medidas caseiras, 5th ed. Rio de Janeiro, Brazil: Atheneu; 2004, 131 p.
23. National Academies of Sciences, Engineering, and Medicine. Dietary reference intakes for sodium and potassium. Washington, DC: The National Academies Press; 2019. 10.17226/25353
24. Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU). Human energy requirements. Report of a Joint FAO/WHO/UNU Expert Consultation. Food and Nutrition Technical Report Series 1. Rome, Italy: FAO; 2004. Available from: https://www.fao.org/3/y5686e/y5686e00.htm#Contents
25. Williams CL, Bollella M, Wynder EL. A new recommendation for dietary fiber in childhood. Pediatrics. 1995;96:985–88. https://pubmed.ncbi.nlm.nih.gov/7494677/
26. Brazilian Food Composition Data Network. Tabela Brasileira de Composição de Alimentos (TBCA), Versão 7.2. São Paulo, Brazil: Universidade de São Paulo (USP) and Food Research Center (FoRC); 2023. Available from: http://www.fcf.usp.br/tbca
27. Brazilian Institute of Geography and Statistics (IBGE). Estudo Nacional de Despesa Familiar (National Study on Family Expenditures; ENDEF). Tabelas de composição de alimentos, 5th ed. Rio de Janeiro, Brazil: IBGE; 1999, 137 p. Available from: ,https://biblioteca.ibge.gov.br/visualizacao/livros/liv6934.pdf
28. Center for Studies and Research in Food of the State University of Campinas (NEPA–UNICAMP). Tabela Brasileira de composição de alimentos (TACO), 4th ed. Campinas, Brazil: NEPA–UNICAMP; 2011, 161 p. Available from: https://www.nepa.unicamp.br/taco/tabela.php?ativo=tabela
29. US Department of Agriculture, Agricultural Research Service. Food Data Central, 2019. Available from: https://fdc.nal.usda.gov/
30. Morais MB, Toporovski MS, Tofoli MHC, Barros KV, Ferreira CHT, Silva LR. Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity. J Pediatr (Rio J). 2022;98:241–7. 10.1016/j.jped.2021.06.009
31. Braegger C, Decsi T, Dias JA, Hartman C, Kolacek S, Koletzko B, et al. Practical approach to paediatric enteral nutrition: A comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51:110–22. 10.1097/mpg.0b013e3181d336d2
32. Frizzo J, Rodrigues VCC, Speridião PGL, Morais MB. Evaluation of the complementary feeding practices, dietary intake, and nutritional status of infants on a cow’s milk protein elimination diet. J Pediatr (Rio J). 2022;98:256–63. 10.1016/j.jped.2021.06.005
33. Nogueira-de-Almeida CA, Del Ciampo LA, Martinez EZ, Contini AA, Nogueira-de-Almeida ME, Ferraz IS, et al. Clinical evolution of preschool picky eater children receiving oral nutritional supplementation during six months: A prospective controlled clinical trial. Children. 2023;10:495. 10.3390/children10030495
34. Anwar F, Yalawar M, Suryawanshi P, Ghosh A, Jog P, Khadilkar AV, et al. Effect of oral nutritional supplementation on adequacy of nutrient intake among picky-eating children at nutritional risk in India: A randomized double-blind-clinical trial. Nutrients. 2023;15:2528. 10.3390/nu15112528
35. Nogueira-de-Almeida CA, Mello ED de, Ribas Filho D, Maximino P, Fisberg M. Consensus of the Brazilian Association of Nutrology on the use of food supplements to children with eating disorders. IJN 2022;11:4–15. 10.1055/s-0038-1670717
36. Ghosh AK, Kishore B, Shaikh I, Satyavrat V, Kumar A., Shah, T., et al. Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: A randomized, controlled trial. J Int Med Res. 2018;46:2186–201. 10.1177/0300060518757355
37. Ghosh AK, Kishore B, Shaikh I, Satyavrat V, Kumar A, Shah T, et al. Continuation of oral nutritional supplementation supports continued growth in nutritionally at-risk children with picky eating behaviour: A post-intervention, observational follow-up study. J Int Med Res. 2018;46:2615–32. 10.1177/0300060518766982
38. Sheng X, Tong M, Zhao D, Leung TF, Zhang F, Hays NP, et al. Randomized controlled trial to compare growth parameters and nutrient adequacy in children with picky eating behaviors who received nutritional counseling with or without an oral nutritional supplement. Nutr Metab Insights. 2014;7:85–94. 10.4137/nmi.s15097
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May 1, 2024
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Castro Rodrigues, V. C. de, Maués Cezar, T., Mendes de Abreu, C. L., Sanudo, A., & de Morais, M. B. (2024). A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow’s milk elimination diet. Allergologia Et Immunopathologia, 52(3), 42-52. https://doi.org/10.15586/aei.v52i3.1053
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How to Cite
Castro Rodrigues, V. C. de, Maués Cezar, T., Mendes de Abreu, C. L., Sanudo, A., & de Morais, M. B. (2024). A real-world cross-sectional study evaluating the role of an oral amino acid-based supplement in nutrient intake by preschoolers on a cow’s milk elimination diet. Allergologia Et Immunopathologia, 52(3), 42-52. https://doi.org/10.15586/aei.v52i3.1053