Eliminating cows’ milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies

Tuokkola, Jetta; Luukkainen, Päivi; Nevalainen, Jaakko; Ahonen, Suvi; Toppari, Jorma; Ilonen, Jorma; Veijola, Riitta; Knip, Mikael; Virtanen, Suvi Μ.; Kaila, Minna

doi:10.1111/apa.13846

Cited by 34 publications

(22 citation statements)

References 27 publications

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“…Brazil had the lowest BMI Z ‐score at −0.71, which was lower than the median BMI Z ‐score of 0.52 (0.44–0.61) taken from a household food insecurity study of Brazilian children aged <60 months in 2012 . For Spain, which had the lowest WH, there are no recent data available on the population prevalence of childhood undernutrition; however, all of the children from Spain had non‐IgE mediated or mixed IgE and non‐IgE mediated allergies, with cow's milk being the primary allergen, which may explain the lower growth parameters . Holland had the lowest HA, which was an unexpected finding, where stunting is documented only in 0.06% of cases .…”

Section: Discussionmentioning

confidence: 77%

“…Cow's milk contributes many nutrients that are essential for growth beyond just energy and protein. A recent Finnish study on cow's milk allergy children found that, despite the presence of sufficient energy and protein, children still had a lower HA than healthy controls . In the latter study, the median calcium intake of children with cow's milk allergy was 70% of recommended requirements and it was hypothesised that this could explain the lower HA.…”

Section: Discussionmentioning

confidence: 96%

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International survey on growth indices and impacting factors in children with food allergies

Meyer

Wright

Vieira

et al. 2018

J Human Nutrition Diet

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Background: Elimination diets required for the management of food allergies increase the risk for poor growth in children. Currently, no worldwide data exist on this topic and limited published data exist on the impact of atopic comorbidity, type of allergy and foods eliminated on growth. We therefore set out to perform a worldwide survey on growth and impacting factors in food allergic children. Methods: A prospective growth survey was performed of children (aged 0-16 years) on an elimination diet with confirmed immunoglobulin (Ig)E and non-IgE mediated food allergies. Data collected included: weight-for-age, weight-for-height, height-for-age, head circumference, body mass index, type of food allergy and eliminated foods, allergic comorbidities and replacement milk/breast milk. Multivariable regression analysis was used to establish factors that affected growth. Results: Data from 430 patients from twelve allergy centres were analysed: median age at diagnosis and data collection was 8 months and 23 months, respectively. Pooled data indicated that 6% were underweight, 9% were stunted, 5% were undernourished and 8% were overweight. Cow's milk elimination lead to a lower weight-for-height Z-scores than other food eliminations and mixed IgE and non-IgE mediated allergy had lower height-forage Z-scores than IgE mediated allergy. Children with only non-IgE mediated allergies had lower weight-for-height and body mass index. Atopic comorbidities did not impact on growth. Conclusions: Stunting is more common in children with food allergies than low weight. Children particularly at risk of poor growth are those with non-175

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 96%

International survey on growth indices and impacting factors in children with food allergies

Meyer

Wright

Vieira

et al. 2018

J Human Nutrition Diet

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“…Furthermore, the lower vitamin D status of children allergic to milk may also be related to a lower calcium intake, as calcium intake may affect 25(OH)D concentration [28]. Children on a milk-elimination diet face an increased risk of suboptimal intake of calcium [29]. …”

Section: Discussionmentioning

confidence: 99%

A History of Cow’s Milk Allergy Is Associated with Lower Vitamin D Status in Schoolchildren

Rosendahl¹,

Fogelholm²,

Pelkonen³

et al. 2017

Horm Res Paediatr

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Background/Aims: Vitamin D insufficiency is common in children. We aimed to evaluate the main determinants of vitamin D status in Finnish school-aged children, including the history of allergic diseases. Methods: We conducted a cross-sectional study on 171 ten-year-olds where serum 25-hydroxyvitamin D (25[OH]D) levels were measured, and data on food consumption and use of vitamin D supplements were collected. The history of allergic diseases was evaluated with a validated questionnaire. Results: Vitamin D insufficiency (<50 nmol/L) was observed in 16% of the children. In children with a history of cow’s milk allergy, the mean 25(OH)D levels were lower than in children without allergy (60.5 ± 12.6 nmol/L vs. 75.5 ± 22.3 nmol/L, p = 0.004). Lack of vitamin D supplementation, female gender, non-Caucasian ethnicity, and a history of milk allergy were associated with lower vitamin D status. Conclusion: The vitamin D status in our study sample of Finnish schoolchildren was sufficient, which suggests that health policy strategies – such as the recommendation of vitamin D supplementation and the fortification of food products with vitamin D – have been successful in improving vitamin D status in children. Special concern should be given to children with a history of milk allergy to ensure their vitamin D sufficiency.

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“…However, there have not been consistent findings in this regard. Some studies have found that the elimination of cow's milk, in particular, had an impact on growth . Of note is the possible interplay between cow's milk, atopic comorbidity and growth as demonstrated by Cho et al and Beck et al .…”

Section: Growth Disordersmentioning

confidence: 95%

Nutritional disorders resulting from food allergy in children

Meyer

2018

Pediatric Allergy Immunology

117

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The elimination of food allergens that contribute essential nutrients in paediatrics may lead to the development of nutritional disorders. The most common nutritional disorders include poor growth, micronutrient deficiencies and feeding difficulties. Of the aforementioned, growth faltering has been well studied and is seen as a common presenting factor in paediatric food allergy. However, the use of different criteria and cut-off values makes it difficult to establish the overall effect. The impact of number and type of foods eliminated and comorbidities has yielded varying results, although there seems to be a trend towards worsening growth with atopic dermatitis and the avoidance of cow's milk. Low micronutrient intake is common in paediatric food allergy; however, a low intake does not necessarily translate into a deficiency as measured by biomarkers. Vitamin D and calcium have been well studied, and a long-lasting impact on bone mineral density has been found. However, other micronutrient deficiencies have also been found and should also be considered. Feeding difficulties is a common complaint in clinical practice, but limited data have been published in food allergy. Poor growth and reflux/vomiting have been shown to be associated with feeding difficulties, in particular in non-IgE-mediated food allergies. There seems to be a long-lasting effect on feeding, in particular in cow's milk allergy, which needs to be taken into account with dietary input. The interplay between growth, feeding difficulties and micronutrient deficiencies has been implied in some studies, but cause and effect is not well established and requires further research.

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Eliminating cows’ milk, but not wheat, barley or rye, increases the risk of growth deceleration and nutritional inadequacies

Abstract: Children on elimination diets faced an increased risk of growth deceleration and suboptimal intake of several micronutrients.

Cited by 34 publications

References 27 publications

International survey on growth indices and impacting factors in children with food allergies

International survey on growth indices and impacting factors in children with food allergies

A History of Cow’s Milk Allergy Is Associated with Lower Vitamin D Status in Schoolchildren

Nutritional disorders resulting from food allergy in children

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