The process of gradually reintroducing food allergens into an individual’s diet is referred to as a food allergen “ladder”, and the most recent edition of the original Milk Allergy in Primary (MAP) Care Guidelines, as well as the International Milk Allergy in Primary Care (IMAP), includes a shortened, improved, and international version with specific recipes, indicating the exact milk protein content, as well as the duration of heating and the temperature for each step of the ladder. Food allergen ladders are being used increasingly in clinical practice. The aim of this study was to develop a Mediterranean milk ladder based on the principles of the Mediterranean eating pattern. The protein content delivered in a portion of the final food product in each step of the ladder in the Mediterranean version corresponds to that provided in the IMAP ladder. Different recipes for the various steps were provided to increase acceptability and variety. Quantification of the total milk protein, casein content, and beta-lactoglobulin by Enzyme-linked immunosorbent assay (ELISA) could detect the gradual increase in concentrations, but the accuracy of the method was affected by the presence of the other ingredients in the mixtures. When developing the Mediterranean milk ladder, a key consideration was to reduce the amount of sugar by using limited amounts of brown sugar and substituting sugar with fresh fruit juice or honey for children aged older than one year. The proposed Mediterranean milk ladder includes principles of (a) healthy eating based on the Mediterranean diet and (b) the acceptability of foods across different age groups.

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Objectives To examine how vitamin C intake among women of reproductive age changed from 1999 to 2018 using data from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999–2000 to 2017–2018. Methods Usual vitamin C intake and prevalence of inadequate intake were estimated among pregnant and non-pregnant women 20–44 y who participated in NHANES 1999–2018 (n = 11,129), using the National Cancer Institute Method. Covariates included dietary recall sequence, intake day of the week, and dietary supplement use. Regression models were used to test for trends in vitamin c intake from foods, supplements, foods and supplements combined, and prevalence of inadequate vitamin C intake over 10 cycles of NHANES. Results 1,392 were pregnant at the time of the exam. Vitamin C intake from foods alone in pregnant women decreased from 125 ± 6.7 mg in 1999–2000 to 103 ± 5.3 mg in 2017–2018 (p for trend = .0003). Supplemental vitamin c intake among pregnant women decreased from 140 ± 2.8 mg in 1999–2000 to 56 ± 0.9 mg in 2009–2010, followed by an apparent plateau between 2011–2018 (p for trend = .02). Consequently, intake foods and supplements combined decreased from 265 ± 31.9 mg in 1999–2000 to 158 ± 16.7 mg in 2017–2018 (p for trend = .0001). Inadequate intake (% < EAR) increased from 10.5 ± 2.2% in 2001–2002 to 17.2 ± 3.1% in 2017–2018 (p for trend = .015). Vitamin C intake from foods alone in non-pregnant women (n = 9,737) decreased from 84 ± 3.9 mg in 1999–2000 to 71 ± 2.5 mg in 2017–2018 (p for trend < .0001). Supplemental vitamin C intake among non-pregnant women decreased from 101 ± 1.3 mg in 1999–2000 to 41 ± 0.5 mg in 2009–2010 followed by an increase to 86 ± 2.7 mg in 2017–2018 (p for trend = .0075). Consequently, intake from foods and supplements combined decreased from 186 ± 15.4 mg in 1999–2000 to 119 ± 5.9 mg in 2009–2010 followed by an increase to 157 ± 28.4 mg in 2017–2018 (p for trend = .0045). Inadequate intake increased from 27.5 ± 2.5% in 1999–2000 to 38.6 ± 2.4% in 2017–2018 (p for trend < .0001). Conclusions Over the past 2 decades, decreases in vitamin C intake from foods has outpaced the more recent increases in supplemental vitamin C intake among women 20–44 y. Pregnant women's vitamin C intake from both foods and supplements decreased during this time, which may result in an increased risk of infections, premature birth, and eclampsia. Funding Sources Funded by the Reckitt|Mead Johnson Nutrition.