Nutritional status and food intake of children with cow’s milk allergy
Main Article Content
Keywords
Milk allergy, Nutrition status, Food intake, Vitamin A, Vitamin D, Children
Abstract
Introduction and objectives: Cow’s milk allergy (CMA) is common, especially in children. The treatment is based on the exclusion of milk and dairy products and guidance regarding the exclusion diet. This study aimed to compare the anthropometric measurements and food intake of children with CMA with those of healthy controls, and to evaluate the serum concentrations of Vitamin A and 25(OH)D in children with CMA.
Methods: This is a cross-sectional study with 27 children in the CMA group and 30 in the control group. z-Scores of body mass index and height, skinfolds, food intake and serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D, parathyroid hormone and high sensitivity C-reactive protein were evaluated.
Results: Mean age was four years (±1.9). The CMA group evidenced a lower height compared to those from the control group (p = 0.0043). The CMA group showed a lower intake of calcium (p = 0.0033) and lipids (p = 0.0123). Low serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D were found in 25.9%, 59.3%, 48.1% and 70.3% of the CMA group, respectively.
Conclusions: Children with CMA consume smaller amounts of calcium and lipids and have shorter height compared to healthy controls. Insufficient levels of vitamins A and D were frequent in the CMA group, emphasizing the need for nutritional guidance and monitoring.
References
1. Mousan G, Kamat D. Cow’s milk protein allergy. Clin Pediatr (Phila). 2016;55:1054-63, http://dx.doi.org/10.1177/0009922816664512.
2. Vieira MC, Morais MB, Spolidoro JV, Toporovski MS, Cardoso AL, Araujo GT, et al. A survey on clinical presentation and nutritional status of infants with suspected cow’ milk allergy. BMC Pediatr. 2010;10:25, http://dx.doi.org/0.1186/1471-2431-10-25.
3. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy Eur J Allergy Clin Immunol. 2014;69:1008-25, http://dx.doi.org/10.1111/all.12429.
4. Tuokkola J, Luukkainen P, Nevalainen J, Ahonen S, Toppari J, Ilonen J, et al. Eliminating cows’ milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies. Acta Paediatr Int J Paediatr. 2017;106:1142-9, http://dx.doi.org/10.1111/apa.13846.
5. Flammarion S, Santos C, Guimber D, Jouannic L, Thumerelle C, Gottrand F, et al. Diet and nutritional status of children with food allergies. Pediatr Allergy Immunol. 2011;22:161-5, http://dx.doi.org/10.1111/j.1399-3038.2010.01028.x.
6. Bauer RN, Manohar M, Singh AM, Jay DC, Kari C. The future of biologics: applications for food allergy. J Allergy Clin Immunol. 2015;135:312-23, http://dx.doi.org/10.1016/j.jaci.2014.12.1908.
7. Robbins KA, Wood RA, Keet CA. Milk allergy is associated with decreased growth in US children. J Allergy Clin Immunol. 2014;134:1466-8, http://dx.doi.org/10.1016/j.jaci.2014.08.037.
8. Medeiros LCS, Speridião PGL, Sdepanian VL, Fagundes-Neto U, Morais MB. Ingestão de nutrientes e estado nutricional de crianc¸as em dieta isenta de leite de vaca e derivados. J Pediatr (Rio J). 2004;80:363-70, http://dx.doi.org/10.2223/JPED.1220.
9. Haack A, Alencar C, Fortes RC, Jaborandy MDL. Características clínico-nutricionais e socioeconômicas de crianc¸as de 0 a 3 anos com alergia à proteína do leite de vaca usuárias do Programa de Nutric¸ão Enteral Domiciliar de um Centro de Referência no Distrito Federal. J Health Sci Inst. 2017;35:177-81.
10. Organización Mundial de la Salud. Interpretando los Indicadores de Crecimiento Interpretando los Indicadores. Curso Capacit sobre la Evaluación del Crecim del Nino. ˜ Ginebra: OMS; 2008.
11. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status, vol. 11, 1st ed. Ann Arbor: University of Michigan; 1990.
12. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message - ‘‘keep your waist circumference to less than half your height’’. Int J Obes. 2006;30:988-92, http://dx.doi.org/10.1038/sj.ijo.0803226.
13. Thompson F, Byers T. Dietary assessment resource manual. J Nutr. 1994;124:2245S-317S, http://dx.doi.org/10. 1093/jn/124.suppl 11.2245s.
14. Nucleus of Studies and Research in Food. Brazilian table of food composition. NEPA - Unicamp; 2011. p. 161.
15. Institute of Medicine (IOM). Dietary reference intakes: the essential guide to nutrient requirements; 2006. p. 543, http://dx.doi.org/10.1016/S0002-8223(02)90177-X.
16. Young DS. Implementation of SI units for clinical laboratory tables - style specifications and conversion tables. J Nutr Biochem. 1990;106:599-613.
17. Punchard AN, Frank JK. Free radicals: a practical approach. 1st ed. New York: IRL Press at Oxford University Press; 1996. p. 17.
18. World Health Organization. Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. World Health Organization; 2011.
19. Thomas L. Parathyroid hormone (PTH). Clinical Laboratory Diagnosis. 1st ed; 1998. p. 248-50.
20. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30, http://dx.doi.org/10.1210/jc.2011-0385.
21. Luzzio G, Blasucci L, Gallimore R, Grillo R, Rebuzzi A, Pepys M, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417-24.
22. Berni Canani R, Leone L, D’Auria E, Riva E, Nocerino R, Ruotolo S, et al. The effects of dietary counseling on children with food allergy: a prospective, multicenter intervention study. J Acad Nutr Diet. 2014;114:1432-9, http://dx.doi.org/10.1016/j.jand.2014.03.018.
23. Nicholls D, Bryant-Waugh R. Eating disorders of infancy and childhood: definition, symptomatology epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18:17-30, http://dx.doi.org/10.1016/j.chc.2008.07.008.
24. Heller-rouassant S, Eugenia M. Nino˜ pequeno, ˜ preescolar y escolar. Gac Med Mex. 2016;152 Suppl. 1:22-8.
25. Vassallo MF, Camargo CA. Potential mechanisms for the hypothesized link between sunshine, vitamin D, and food allergy in children. J Allergy Clin Immunol. 2010;126:217-22, http://dx.doi.org/10.1016/j.jaci.2010.06.011.
26. Sharief S, Jariwala S, Kumar J, Muntner P, Melamed M. Vitamin D levels and food and environmental allergies in the United States: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2011;127:1195-202, http://dx.doi.org/10.1016/j.jaci.2011.01.017.
27. Baek JH, Shin YH, Chung IH, Kim HJ, Yoo EG, Yoon JW, et al. The link between serum vitamin d level, sensitization to food allergens, and the severity of atopic dermatitis in infancy. J Pediatr. 2014;165, http://dx.doi.org/10.1016/j.jpeds.2014.06.058,849-54.e1.
28. Silva CM, Silva SA da, Antunes MM de C, Silva GAP da, Sarinho ESC, Brandt KG. Do infants with cow’s milk protein allergy have inadequate levels of vitamin D? J Pediatr(Rio J). 2017;93:632-8, http://dx.doi.org/10.1016/j.jped.2017.01.006.
29. Guo H, Zheng Y, Cai X, Yang H, Zhang Y, Hao L, et al. Correlation between serum vitamin D status and immunological changes in children affected by gastrointestinal food allergy. Allergol Immunopathol (Madr). 2018;46:39-44, http://dx.doi.org/10.1016/j.aller.2017.03.005.
30. Thurnham DI, Mburu ASW, Mwaniki DL, Wagt A De. Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc. 2005;64:502-9, http://dx.doi.org/10.1079/PNS2005468.
31. Larson L, Guo J, Williams A, Young M, Ismaily S, Addo O, et al. Approaches to assess vitamin A status in settings of inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Nutrients. 2018;10:1100, http://dx.doi.org/10.3390/nu10081100.
32. Zakariaeeabkoo R, Allen KJ, Koplin JJ, Vuillermin P, Greaves RF. Are vitamins A and D important in the development of food allergy and how are they best measured? Clin Biochem. 2014;47:804-11, http://dx.doi.org/10.1016/j.clinbiochem.2014.01.033.
33. Mikoluc B, Motkowski R, Karpinska J, Piotrowska-Jastrzebska J. Plasma levels of vitamins A and E, coenzyme Q10, and anti-ox-LDL antibody titer in children treated with an elimination diet due to food hypersensitivity. Int J Vitam Nutr Res. 2009;79:328-36, http://dx.doi.org/10.1024/0300-9831.79.5.328.
34. Thurnham DI, Northrop-clewes CA. Inflammation and biomarkers of micronutrient status. Curr Opin Clin Nutr Metab Care. 2016;19:458-63, http://dx.doi.org/10.1097/MCO.0000000000000323.
2. Vieira MC, Morais MB, Spolidoro JV, Toporovski MS, Cardoso AL, Araujo GT, et al. A survey on clinical presentation and nutritional status of infants with suspected cow’ milk allergy. BMC Pediatr. 2010;10:25, http://dx.doi.org/0.1186/1471-2431-10-25.
3. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy Eur J Allergy Clin Immunol. 2014;69:1008-25, http://dx.doi.org/10.1111/all.12429.
4. Tuokkola J, Luukkainen P, Nevalainen J, Ahonen S, Toppari J, Ilonen J, et al. Eliminating cows’ milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies. Acta Paediatr Int J Paediatr. 2017;106:1142-9, http://dx.doi.org/10.1111/apa.13846.
5. Flammarion S, Santos C, Guimber D, Jouannic L, Thumerelle C, Gottrand F, et al. Diet and nutritional status of children with food allergies. Pediatr Allergy Immunol. 2011;22:161-5, http://dx.doi.org/10.1111/j.1399-3038.2010.01028.x.
6. Bauer RN, Manohar M, Singh AM, Jay DC, Kari C. The future of biologics: applications for food allergy. J Allergy Clin Immunol. 2015;135:312-23, http://dx.doi.org/10.1016/j.jaci.2014.12.1908.
7. Robbins KA, Wood RA, Keet CA. Milk allergy is associated with decreased growth in US children. J Allergy Clin Immunol. 2014;134:1466-8, http://dx.doi.org/10.1016/j.jaci.2014.08.037.
8. Medeiros LCS, Speridião PGL, Sdepanian VL, Fagundes-Neto U, Morais MB. Ingestão de nutrientes e estado nutricional de crianc¸as em dieta isenta de leite de vaca e derivados. J Pediatr (Rio J). 2004;80:363-70, http://dx.doi.org/10.2223/JPED.1220.
9. Haack A, Alencar C, Fortes RC, Jaborandy MDL. Características clínico-nutricionais e socioeconômicas de crianc¸as de 0 a 3 anos com alergia à proteína do leite de vaca usuárias do Programa de Nutric¸ão Enteral Domiciliar de um Centro de Referência no Distrito Federal. J Health Sci Inst. 2017;35:177-81.
10. Organización Mundial de la Salud. Interpretando los Indicadores de Crecimiento Interpretando los Indicadores. Curso Capacit sobre la Evaluación del Crecim del Nino. ˜ Ginebra: OMS; 2008.
11. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status, vol. 11, 1st ed. Ann Arbor: University of Michigan; 1990.
12. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message - ‘‘keep your waist circumference to less than half your height’’. Int J Obes. 2006;30:988-92, http://dx.doi.org/10.1038/sj.ijo.0803226.
13. Thompson F, Byers T. Dietary assessment resource manual. J Nutr. 1994;124:2245S-317S, http://dx.doi.org/10. 1093/jn/124.suppl 11.2245s.
14. Nucleus of Studies and Research in Food. Brazilian table of food composition. NEPA - Unicamp; 2011. p. 161.
15. Institute of Medicine (IOM). Dietary reference intakes: the essential guide to nutrient requirements; 2006. p. 543, http://dx.doi.org/10.1016/S0002-8223(02)90177-X.
16. Young DS. Implementation of SI units for clinical laboratory tables - style specifications and conversion tables. J Nutr Biochem. 1990;106:599-613.
17. Punchard AN, Frank JK. Free radicals: a practical approach. 1st ed. New York: IRL Press at Oxford University Press; 1996. p. 17.
18. World Health Organization. Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. World Health Organization; 2011.
19. Thomas L. Parathyroid hormone (PTH). Clinical Laboratory Diagnosis. 1st ed; 1998. p. 248-50.
20. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-30, http://dx.doi.org/10.1210/jc.2011-0385.
21. Luzzio G, Blasucci L, Gallimore R, Grillo R, Rebuzzi A, Pepys M, et al. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417-24.
22. Berni Canani R, Leone L, D’Auria E, Riva E, Nocerino R, Ruotolo S, et al. The effects of dietary counseling on children with food allergy: a prospective, multicenter intervention study. J Acad Nutr Diet. 2014;114:1432-9, http://dx.doi.org/10.1016/j.jand.2014.03.018.
23. Nicholls D, Bryant-Waugh R. Eating disorders of infancy and childhood: definition, symptomatology epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18:17-30, http://dx.doi.org/10.1016/j.chc.2008.07.008.
24. Heller-rouassant S, Eugenia M. Nino˜ pequeno, ˜ preescolar y escolar. Gac Med Mex. 2016;152 Suppl. 1:22-8.
25. Vassallo MF, Camargo CA. Potential mechanisms for the hypothesized link between sunshine, vitamin D, and food allergy in children. J Allergy Clin Immunol. 2010;126:217-22, http://dx.doi.org/10.1016/j.jaci.2010.06.011.
26. Sharief S, Jariwala S, Kumar J, Muntner P, Melamed M. Vitamin D levels and food and environmental allergies in the United States: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2011;127:1195-202, http://dx.doi.org/10.1016/j.jaci.2011.01.017.
27. Baek JH, Shin YH, Chung IH, Kim HJ, Yoo EG, Yoon JW, et al. The link between serum vitamin d level, sensitization to food allergens, and the severity of atopic dermatitis in infancy. J Pediatr. 2014;165, http://dx.doi.org/10.1016/j.jpeds.2014.06.058,849-54.e1.
28. Silva CM, Silva SA da, Antunes MM de C, Silva GAP da, Sarinho ESC, Brandt KG. Do infants with cow’s milk protein allergy have inadequate levels of vitamin D? J Pediatr(Rio J). 2017;93:632-8, http://dx.doi.org/10.1016/j.jped.2017.01.006.
29. Guo H, Zheng Y, Cai X, Yang H, Zhang Y, Hao L, et al. Correlation between serum vitamin D status and immunological changes in children affected by gastrointestinal food allergy. Allergol Immunopathol (Madr). 2018;46:39-44, http://dx.doi.org/10.1016/j.aller.2017.03.005.
30. Thurnham DI, Mburu ASW, Mwaniki DL, Wagt A De. Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc. 2005;64:502-9, http://dx.doi.org/10.1079/PNS2005468.
31. Larson L, Guo J, Williams A, Young M, Ismaily S, Addo O, et al. Approaches to assess vitamin A status in settings of inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Nutrients. 2018;10:1100, http://dx.doi.org/10.3390/nu10081100.
32. Zakariaeeabkoo R, Allen KJ, Koplin JJ, Vuillermin P, Greaves RF. Are vitamins A and D important in the development of food allergy and how are they best measured? Clin Biochem. 2014;47:804-11, http://dx.doi.org/10.1016/j.clinbiochem.2014.01.033.
33. Mikoluc B, Motkowski R, Karpinska J, Piotrowska-Jastrzebska J. Plasma levels of vitamins A and E, coenzyme Q10, and anti-ox-LDL antibody titer in children treated with an elimination diet due to food hypersensitivity. Int J Vitam Nutr Res. 2009;79:328-36, http://dx.doi.org/10.1024/0300-9831.79.5.328.
34. Thurnham DI, Northrop-clewes CA. Inflammation and biomarkers of micronutrient status. Curr Opin Clin Nutr Metab Care. 2016;19:458-63, http://dx.doi.org/10.1097/MCO.0000000000000323.
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Dec 15, 2019
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Boaventura, R., Mendonc¸a, R., Fonseca, F., Mallozi, M., Souza, F., & Sarni , R. (2019). Nutritional status and food intake of children with cow’s milk allergy. Allergologia Et Immunopathologia, 47(6), 544-550. https://all-imm.com/index.php/aei/article/view/268
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How to Cite
Boaventura, R., Mendonc¸a, R., Fonseca, F., Mallozi, M., Souza, F., & Sarni , R. (2019). Nutritional status and food intake of children with cow’s milk allergy. Allergologia Et Immunopathologia, 47(6), 544-550. https://all-imm.com/index.php/aei/article/view/268