Diet Quality: A Neglected Parameter in Children With Food Allergies. A Cross–Sectional Study

Abstract

Background-Objective: With recent evidence suggesting that growth is no longer considered a major issue in children with food allergies (FA) on elimination diet, priority has shifted to diet quality to establish healthy eating patterns and prevent non-communicable diseases. The Diet Quality Index – International (DQI-I) could be useful for assessing the overall diet quality of FA-children. This study aimed to evaluate the impact of elimination diet on DQI-I in children with FA and the accuracy of DQI-I in reflecting nutrient intake.Materials-methods: In a prospective, cross-sectional, cohort study of FA-children (2–14 years), nutritional intake was evaluated using a 7-day food frequency questionnaire, 24-h dietary recall, and the DQI-I.Results: Of the 76 children recruited, 44.7% had multiple allergies. Mean overall DQI-I score was 52 points, with only 28% of participants having good overall DQI-I (≥60 points). DQI-I moderation and balance were the most affected domains. Participants with multiple allergies had higher DQI-I moderation and balance and lower vitamin D and Ca intake. Compared to toddlers, schoolchildren had higher DQI-I variety and lower moderation and received higher vitamin B2, vitamin B12, Ca, P, and Zn. The number of allergies, age, and milk avoidance were independently associated with adjusted DQI-I moderation and balance, energy, and certain micronutrient intake. Higher percentages of participants with good DQI-I received adequate amounts of Mn and vitamins A, B6, C, and folate than those with poor DQI-I.Conclusions: In children with FA on elimination diet, the DQI-I accurately captured the deflection of diet quality related to the development of chronic, non-communicable diseases through its moderation and balance components. This is DQI-I's main purpose as a healthy diet indicator and as such it would be a useful tool responding to the needs of the contemporary shifting of priorities in FA-children's diet from quantity to quality. Nevertheless, it does not accurately reflect the intake of certain micronutrients potentially compromised by elimination diets. Therefore, regular nutritional assessment utilizing both the DQI-I and tools assessing individual nutrient intakes along with professional nutrition counseling should be integral parts of the individualized management of children with FA to ensure adequate nutrient intake and establish healthy dietary patterns.

The Diet Quality and Nutrition Inadequacy of Pre-Frail Older Adults in New Zealand

“…As seen in this study and previously identified, the moderation and balance components of the DQI-I identified poor dietary qualities related to chronic and non-communicable disease [ 45 ]. Where the limitation of the DQI-I lie is in capturing micronutrient deficiencies, especially those relevant to disease-specific states, as seen in the paediatric allergen elimination diets [ 45 ] and, in our case, frailty prevention in older people. To manage this limitation, we looked at a broader range of micronutrients and measures of energy intake.…”

Vitamin D Levels in Asymptomatic Children and Adolescents with Atopy during the COVID-19 Era

“…In a recently published study from the same geographical region, a small percentage (1.3%) of children with an established food allergy needed administration of a dosage of vitamin D above the recommended age-specific daily requirements to maintain the 25(OH)D level within normal range [ 31 ]. Baek and colleagues suggested that low serum vitamin D levels are associated with sensitization to food allergens [ 32 ].…”

Elimination diet in food allergy: friend or foe?

“…However, with the increase in the persistence and prevalence of FA and the emergence of new evidence regarding the interface between nutrition and the functioning of the immune system, there is growing concern about the quality of the diet of children and adolescents with FA. 13 …”