1
|
Venter C, Meyer R, Groetch M, Nowak-Wegrzyn A, Mennini M, Pawankar R, Kamenwa R, Assa'ad A, Amara S, Fiocchi A, Bognanni A. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update - XVI - Nutritional management of cow's milk allergy. World Allergy Organ J 2024; 17:100931. [PMID: 39228431 PMCID: PMC11369454 DOI: 10.1016/j.waojou.2024.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 09/05/2024] Open
Abstract
Cow's milk allergy (CMA) is one of the most common presentations of food allergy in early childhood. Management of CMA involves individualized avoidance of cow's milk and other mammalian milk and foods containing these. Optimal elimination of cow's milk avoidance includes: label reading; information about safe and nutritious substitute foods; appropriate choice of infant formula or a plant-based food; establishing tolerance to baked milk and monitoring nutritional intake and growth. Substitute formulas are divided into soy formula (not hydrolyzed), milk-based extensively hydrolyzed formulas, rice based extensive, and partially hydrolyzed formulas and amino acid-based formulas. The use of other mammalian milks is not recommended for the management of cow's milk allergy due to a high level of cross-reactivity and nutritional concerns. For toddlers who are eating well, children, and adults, a suitable plant-based beverage may be a suitable alternative to a specialized formula, following careful nutritional considerations. Families need to be instructed on finding suitable nutritious foods and how to prepare suitable meals at home. Individuals with CMA also need to know how to identify and treat acute severe reactions.
Collapse
Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Rosan Meyer
- Department of Medicine, Imperial College, London. Department Medicine KU Leuven, Belgium. Department Nutrition and Dietetics, Winchester University, UK
| | - Marion Groetch
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai. New York, NY, USA
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Childrens' Hospital, New York, NY, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Maurizio Mennini
- NESMOS Department, Sapienza University, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Rose Kamenwa
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center – Cincinnati Ohio, USA
| | | | - Alessandro Fiocchi
- Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
| | - Antonio Bognanni
- Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele (Milano), Italy
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Malekiantaghi A, Aghajani M, Shabani-Mirzaee H, Vigeh M, Eftekhari K. Growth in healthy infants with cow's milk protein allergy fed extensively hydrolyzed or amino acid-based formulas. BMC Nutr 2024; 10:101. [PMID: 39030656 PMCID: PMC11264743 DOI: 10.1186/s40795-024-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/25/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Cow's milk protein allergy (CMPA) is one of the most common food allergies in the first year of life. Special formulas for infants with CMPA include extensively hydrolyzed (EHFs) and amino acid-based (AAFs) formulas. The aim of this study was to evaluate the growth of infants fed with these special formulas. METHODS This was a prospective chart review study that evaluated the growth criteria of infants with CMPA fed with EHFs or AAFs until one year of age. These infants were referred to the gastroenterology clinic of Bahrami Children's Hospital from April 2021 to April 2022. These infants were divided into two groups, the group fed with EHFs and AAFs. Then growth criteria were evaluated in both groups. RESULTS Fifty-eight children were enrolled in the study, of which 51.7% were girls. Forty were consuming the EHFs formulas. The median time of both diagnosis and treatment was 60 days. The most common clinical manifestations were gastroesophageal reflux, dysentery, eczema, vomiting, and cough, respectively. The diagnosis of the disease in the AAFs group was significantly earlier than in the other group. The growth of children in both groups was completely proportional to their age and growth criteria at birth. Comparing the groups, all growth parameters were higher in the EHFs group. CONCLUSION This study showed that the growth criteria (weight, length, and head circumference) were suitable for each group and were in accordance with the WHO growth charts compared to the birth criteria. But in the group fed with EHFs, compared to AAFs, the growth rate was higher.
Collapse
Affiliation(s)
- Armen Malekiantaghi
- Department of Pediatric Gastroenterology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbobeh Aghajani
- Department of Pediatric, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabani-Mirzaee
- Department of Pediatric Endocrinology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Vigeh
- Maternal-Fetal Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Eftekhari
- Department of Pediatric Gastroenterology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Pediatric Gastroenterology and Hepatology Research Center, Bahrami Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Dziechciarz P, Stróżyk A, Horvath A, Cudowska B, Jedynak-Wąsowicz U, Mól N, Jarocka-Cyrta E, Zawadzka-Krajewska A, Krauze A. Nutritional status and feeding difficulties in children up to 2 years of age with cow's milk allergy. J Pediatr Gastroenterol Nutr 2024; 79:131-139. [PMID: 38291802 DOI: 10.1002/jpn3.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND/OBJECTIVES To assess the nutritional status and incidence of feeding difficulties in Polish children up to 2 years of age with cow's milk allergy (CMA) on cow's milk proteins-free diet. METHODS A cross-sectional, multi-center study included children aged 6 months to 2 years with confirmed or suspected (without oral food challenge) diagnosis of CMA on the elimination diet for at least 1 month. The primary outcomes were an assessment of proportion of children with impaired nutritional status (with the weight for length and body mass index (BMI) z-score > 1 and <-1), and feeding difficulties according to the Montreal Children's Hospital Feeding Scale. Children with confirmed and suspected CMA were assessed separately. RESULTS A 144 children with confirmed CMA and 88 with suspected CMA were included (57 and 78% with multiple food allergies, respectively). Among children with confirmed CMA, one-third (35.5%) of participants had any nutritional status impairment regardless of definition. Among those, most of children had mild malnutrition (10.4 vs. 9%) and possible risk of overweight (11.1 vs. 9.7%; following respectively BMI for age and weight for length z-scores). Only 16.0% of children had feeding difficulties. Feeding difficulties was identified to be a risk factor for moderate malnutrition compared to children without feeding difficulties (odds ratio 10, 95% confidence interval: 4-27). CONCLUSIONS Mild malnutrition and possible risk of overweight are concern in children up to 2 years of age on cow's milk proteins-free diet. Feeding difficulties are less common, however, may affect the nutritional status.
Collapse
Affiliation(s)
- Piotr Dziechciarz
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Agata Stróżyk
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Cudowska
- Department of Paediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Bialystok, Poland
| | | | - Nina Mól
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Jarocka-Cyrta
- Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia & Mazury, Olsztyn, Poland
| | - Anna Zawadzka-Krajewska
- Department of Pneumonology and Allergology for Children, Medical University of Warsaw, Warsaw, Poland
| | | |
Collapse
|
4
|
Raitano V, Pecoraro L, Sboarina A, Brugnara M, Piacentini G, Pietrobelli A. Children with cow milk allergy could have feeding difficulties that must not be underestimated. Minerva Pediatr (Torino) 2024; 76:455-457. [PMID: 38240718 DOI: 10.23736/s2724-5276.23.07454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Vincenzo Raitano
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Luca Pecoraro
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy -
| | | | - Milena Brugnara
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| |
Collapse
|
5
|
Chebar-Lozinsky A, De Koker C, Dziubak R, Rolnik DL, Godwin H, Dominguez-Ortega G, Skrapac AK, Gholmie Y, Reeve K, Shah N, Meyer R. Assessing Feeding Difficulties in Children Presenting with Non-IgE-Mediated Gastrointestinal Food Allergies-A Commonly Reported Problem. Nutrients 2024; 16:1563. [PMID: 38892497 PMCID: PMC11173616 DOI: 10.3390/nu16111563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Many guidelines have been published to help diagnose food allergies, which have included feeding difficulties as a presenting symptom (particularly for non-IgE-mediated gastrointestinal allergies). This study aimed to investigate the prevalence of feeding difficulties in children with non-IgE-mediated gastrointestinal allergies and the association of such difficulties with symptoms and food elimination. An observational study was performed at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. Children aged 4 weeks to 16 years without non-allergic co-morbidities who improved on an elimination diet using a previously published Likert scale symptom score were included. This study recruited 131 children, and 114 (87%) parents completed the questionnaire on feeding difficulties. Feeding difficulties were present in 61 (53.5%) of the 114 children. The most common feeding difficulties were regular meal refusals (26.9%), extended mealtimes (26.7%), and problems with gagging on textured foods (26.5%). Most children (40/61) had ≥2 reported feeding difficulties, and eight had ≥4. Children with feeding difficulties had higher rates of constipation and vomiting: 60.7% (37/61) vs. 35.8% (19/53), p = 0.008 and 63.9% (39/61) vs. 41.5% (22/53), p = 0.017, respectively. Logistic regression analysis demonstrated an association between having feeding difficulties, the age of the child, and the initial symptom score. Gender and the number of foods excluded in the elimination diet were not significantly associated with feeding difficulties. This study found that feeding difficulties are common in children with non-IgE-mediated gastrointestinal allergies, but there is a paucity of food allergy specific tools for establishing feeding difficulties, which requires further research in the long-term and consensus in the short term amongst healthcare professions as to which tool is the best for food allergic children.
Collapse
Affiliation(s)
- Adriana Chebar-Lozinsky
- Department of Allergy and Immune Disorders, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Claire De Koker
- Macassar Community Health Centre, Department of Health and Wellness, Western Cape Government, Elsenburg 7607, South Africa;
| | - Robert Dziubak
- Department of Gastroenterology, Great Ormond Street Hospital for Sick Children, London WC1N 3JH, UK
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC 3800, Australia;
| | - Heather Godwin
- Department of Gastroenterology, Great Ormond Street Hospital for Sick Children, London WC1N 3JH, UK
| | - Gloria Dominguez-Ortega
- Department of Gastroenterology, Universidad Autonoma de Madrid, 28049 Madrid, Spain;
- Department Gastroenterology and Nutrition, Nino Jesus Univesity Children Hospital, 28009 Madrid, Spain
| | | | - Yara Gholmie
- Department of Nutrition, Simmons University, Boston, MA 02115, USA;
| | - Kate Reeve
- Royal Hospital for Children and Young People in Edinburgh, Edinburgh EH16 4TJ, UK;
| | - Neil Shah
- HCA Healthcare, London W1G 0PU, UK; (A.-K.S.); (N.S.)
| | - Rosan Meyer
- Department Dietetics, University of Winchester, Winchester SO22 4NR, UK
- Department of Medicine, KU Leuven, 3000 Leuven, Belgium
| |
Collapse
|
6
|
Rodrigues VCDC, Cezar TM, Abreu CLMD, Sanudo A, Morais MBD. 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. Allergol Immunopathol (Madr) 2024; 52:42-52. [PMID: 38721954 DOI: 10.15586/aei.v52i3.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 08/22/2024]
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.
Collapse
Affiliation(s)
| | | | | | - Adriana Sanudo
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauro Batista de Morais
- Division of Pediatric Gastroenterology and Postgraduation Program in Nutrition, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil;
| |
Collapse
|
7
|
Hill SA, Nurmatov U, DunnGalvin A, Reese I, Vieira MC, Rommel N, Dupont C, Venter C, Cianferoni A, Walsh J, Yonamine G, Beauregard A, Meyer R, Vazquez-Ortiz M. Feeding difficulties in children with food allergies: An EAACI Task Force Report. Pediatr Allergy Immunol 2024; 35:e14119. [PMID: 38566436 DOI: 10.1111/pai.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
The term "feeding difficulties" refers to a spectrum of phenotypes characterized by suboptimal intake of food and/or lack of age-appropriate eating habits. While it is evident that feeding difficulties are prevalent within healthy children, no consensus has been reached for those with food allergies. The aim of this study was to systematically review all the available literature reporting the prevalence of feeding difficulties within food allergic children. We searched eight international electronic databases for all published studies until June 2022. International experts in the field were also contacted for unpublished and ongoing studies. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so narrative synthesis of quantitative data was performed. A total of 2059 abstracts were assessed, out of which 21 underwent full-text screening and 10 studies met the study criteria. In these, 12 different terms to define feeding difficulties and 11 diagnostic tools were used. Five papers included data of feeding difficulty prevalence in children with food allergies, ranging from 13.6% to 40%. Higher prevalence was associated with multiple food allergies. The current literature suggests that feeding difficulties are prevalent within food allergic children, particularly those with multiple food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging. Consensus guidelines for the diagnosis and management of feeding difficulties within food allergic children and further research on the development and perpetuation of feeding difficulties are needed to appropriately manage such patients.
Collapse
Affiliation(s)
- Sarah-Anne Hill
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Audrey DunnGalvin
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Natalie Rommel
- University Hospital Tübingen, Tübingen, Germany
- Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Christophe Dupont
- Paris Descartes University, Paris, France
- Clinique Marcel Sembat, Ramsay Group, Boulogne Billancourt, France
| | - Carina Venter
- University of Colorado/Children's Hospital Colorado, Denver, Colorado, USA
| | - Antonella Cianferoni
- Allergy and Immunology Division, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Glauce Yonamine
- Division of Nutrition, Instituto da Criança e do Adolescente, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Alexia Beauregard
- Faculty, Ellyn Satter Institute, Clinical Dietetics Branch Winn Army Community Hospital, Fort Stewart, Georgia, USA
| | - Rosan Meyer
- Imperial College London, London, UK
- University of Winchester, Winchester, UK
- University of KU Leuven, Leuven, Belgium
| | | |
Collapse
|
8
|
Yang H, Na X, Tan Y, Xi M, Yang Y, Zhao A. Correlates of feeding difficulties among children of Chinese transgender parents. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:602-618. [PMID: 39055635 PMCID: PMC11268252 DOI: 10.1080/26895269.2024.2317401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background Ensuring proper early feeding for young children is crucial, as encountering feeding difficulties (FD) during this stage can give rise to a cascade of health problems, the repercussions of which may endure into late childhood and adolescence. Children raised by transgender parents may be at risk of encountering FD, however, there is no research conducted on Chinese transgender families. Methods We designed a cross-sectional survey in which the rate of FD and its influencing factors were investigated among transgender parents in China. A total of 446 Chinese transgender parents (average age 30.39 years) were included in the analysis. Logistic regression models were applied to investigate the influencing factors of FD among children of transgender parents. We also established structural equation modeling (SEM) to explore the possible pathways among these factors and FD. Results The rate of FD in children of Chinese transgender parents is 55.4%, with 34.5% having severe FD. Coming out after having a child (AOR = 2.26, 95%CI = 1.33 ∼ 3.91), family violence (AOR = 1.06, 95%CI = 1.04 ∼ 1.09), partner violence (AOR = 1.11, 95%CI = 1.08 ∼ 1.15), no feeding education (accepting feeding education: AOR = 0.43, 95%CI = 0.25 ∼ 0.74), being discriminated during seeking of childbearing health care (AOR = 1.99, 95%CI = 1.3 ∼ 3.05), and poor relationship with partner (fair: AOR = 0.09, 95%CI = 0.03 ∼ 0.22; good: AOR = 0.06, 95%CI = 0.02 ∼ 0.15) are significantly associated with higher FD. Furthermore, through the pathway analysis, the indirect effects of education level (β=-0.151), feeding education (β = 0.145), and relationship with partner (β=-0.196) on FD are observed. Conclusions Children of Chinese transgender parents showed a high FD rate. It is crucial to help build a better family and social environment for transgender families to reduce the FD and improve children's and adolescents' health.
Collapse
Affiliation(s)
- Haibing Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaona Na
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuefeng Tan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Menglu Xi
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yucheng Yang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| |
Collapse
|
9
|
Kefford J, Marshall J, Packer RL, Ward EC. Feeding Characteristics in Children With Food Allergies: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:132-148. [PMID: 38040005 DOI: 10.1044/2023_jslhr-23-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics. OBJECTIVE The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD. METHOD This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form. RESULTS Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described. CONCLUSIONS Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24562732.
Collapse
Affiliation(s)
- Jennifer Kefford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Northern Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Jeanne Marshall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Australia
| | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
10
|
Charoensriwattanakul K, Wannaphahoon K, Chomtho S, Chatchatee P, Suratannon N, Kittipongpattana P, Suteerojntrakool O. Feeding Difficulties and Feeding Behaviors of Thai Children with Cow's Milk Protein Allergy. Int J Pediatr 2023; 2023:6630167. [PMID: 38033753 PMCID: PMC10686708 DOI: 10.1155/2023/6630167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background Cow's milk protein allergy (CMPA) is a common food allergy in infants and young children and may be a risk factor for feeding difficulties. Studies exploring feeding difficulties and feeding behaviors in Thai children with CMPA are scarce. Objectives To determine the prevalence of feeding difficulties and feeding behaviors in Thai children with CMPA compared to healthy controls. Methods A cross-sectional study was performed comparing children aged 1-6 years old diagnosed with CMPA and had eliminated cow's milk for at least 4 months with age-matched healthy children. Feeding difficulties were evaluated using the Montreal Children's Hospital Feeding Scale questionnaire, and feeding behaviors were measured using the Child Eating Behavior Questionnaire (CEBQ). Results One hundred and twenty-two participants were recruited (30 children with CMPA and 92 controls). The median age of the CMPA and control groups was 31.0 (14.0, 43.3) and 40.0 (28.0, 53.8) months, respectively (p value = 0.01). The CMPA group had lower calcium, phosphorus, and zinc intake than the healthy controls. The prevalence of feeding difficulties between the two groups did not show a significant difference (36.7 vs. 43.5%, p value = 0.70). The slowness in the eating subscale of feeding behaviors exhibited a lower score in the CMPA group than in the healthy group. Feeding difficulties was positively correlated with the desire to drink (β 3.079, p value = 0.011) but negatively correlated with the enjoyment of food subscale of CEBQ among the CMPA children (β -10.684, p value < 0.001). Conclusion Despite a similar prevalence of feeding difficulties between CMPA and healthy children, the CMPA group demonstrated some differences in feeding behaviors. The lower score of enjoyment of food and a higher score of desire to drink correlated with a higher degree of feeding difficulties in the CMPA children. The provision of appropriate nutrition for this group of children should be prioritized.
Collapse
Affiliation(s)
- Kununya Charoensriwattanakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Kamolmart Wannaphahoon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sirinuch Chomtho
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pantipa Chatchatee
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- HAUS IAQ Research Unit, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok 10330, Thailand
| | - Narissara Suratannon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pannipa Kittipongpattana
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Orapa Suteerojntrakool
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
11
|
Vandenplas Y, Meyer R, Nowak-Wegrzyn A, Salvatore S, Venter C, Vieira MC. The Remaining Challenge to Diagnose and Manage Cow's Milk Allergy: An Opinion Paper to Daily Clinical Practice. Nutrients 2023; 15:4762. [PMID: 38004156 PMCID: PMC10675216 DOI: 10.3390/nu15224762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Guidelines and recommendations for the diagnosis and management of cow's milk allergy (CMA) in childhood are based on scientific review of the available evidence. While this approach is the most rigorous, guidelines may not fully address all scenarios encountered by clinicians. Many symptoms of CMA overlap with other common childhood illnesses and are subjectively reported by the caregivers of the infant, as is the interpretation of the dietary interventions. Additionally, many healthcare professionals and caregivers do not follow the recommendations to perform an oral food challenge or reintroduction of cow's milk after a diagnostic elimination diet because (1) the infant is doing well and (2) the carer's fear of symptoms relapsing with this procedure. As a result, CMA in infants may be either under-diagnosed leading to reduced quality of life for families or over-diagnosed, resulting in unnecessary long-term elimination diets and increasing the risk for nutritional deficiencies. This paper discusses some of these controversial topics, focusing on misdiagnosis and mismanagement in clinical practice. The lack of objective diagnostic criteria can hamper the diagnosis and management of CMA in daily practice.
Collapse
Affiliation(s)
- Yvan Vandenplas
- UZ Brussel, KidZ Health Castle, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children’s Hospital, New York, NY 10016, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Silvia Salvatore
- Department of Pediatrics, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy;
| | - Carina Venter
- Section of Pediatric Allergy and Immunology, Children’s Hospital Colorado, University of Colorado, Aurora, CO 80045, USA
| | - Mario C. Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba 80250, Brazil;
| |
Collapse
|
12
|
Adeoya AA, Akinwusi AT, Nagatomi R. Effectiveness of nutrition education in enhancing knowledge and attitude of pupils on choice of school mid-day meal in Ibadan, Nigeria. Food Sci Nutr 2023; 11:3758-3766. [PMID: 37457152 PMCID: PMC10345704 DOI: 10.1002/fsn3.3359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 07/18/2023] Open
Abstract
Children's food choices affect their nutritional health, development, and well-being. In Nigeria, school lunch is generally unregulated; the food menu is usually at the discretion of individual vendors forcing pupils to make unsupervised food choices. This study examined the effectiveness of 6-week nutrition education in enhancing pupils' knowledge and attitude on the school mid-day meal choices in Ibadan, Nigeria. A pre-test/post-test, quasi-experimental study was conducted with 100 pupils in 4th and 5th grades in public primary schools. Multistage sampling was used to select the participants. A nutrition education module and a questionnaire were used to collect the data. Frequency counts and t-test were used for statistical analysis. Findings revealed the following dietary pattern: 44 of the pupils preferred junk food (mean 41.5, SD = 12.9), 37 were inclined toward protein-rich food (mean 37.7, SD = 12.5), 32 favored food items dense in carbohydrates (mean 34.4, SD = 9.5), and 11 showed a preference toward food with high vitamins and minerals (mean 28.4, SD = 7.5). Nutrition knowledge (t = 6.4, df = 99, p < .05); (pre-test: X¯ = 20.9 and SD = 1.0; post-test: X¯ = 22.8, SD = 2.8) and attitude toward choice of meal showed statistically significant differences (t = 4.9, df = 99, p < .05; pre-test: X¯ = 13.5 and SD = 6.8; post-test: X¯ = 18.2, SD = 7.2). We recommend that the Ministry of Education should prepare a standard lunch menu for all schools and the school authorities should enforce it through the schools' food vendors.
Collapse
Affiliation(s)
- Akindele Abimibayo Adeoya
- Medicine and Science in Sports and Exercise LaboratoryGraduate School of MedicineTohoku UniversitySendaiJapan
- Division for Interdisciplinary Advanced Research and EducationAdvanced Graduate SchoolTohoku UniversitySendaiJapan
| | - Adetoun Tayewo Akinwusi
- Department of Human Kinetics and Health Education, Faculty of EducationUniversity of IbadanIbadanNigeria
| | - Ryoichi Nagatomi
- Medicine and Science in Sports and Exercise LaboratoryGraduate School of MedicineTohoku UniversitySendaiJapan
- Division of Biomedical Engineering for Health and WelfareGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| |
Collapse
|
13
|
Lemale J, Lecoufle A, Bellaiche M. Impact of diet on sensory processing in early childhood: summary of an interactive webconference / expert roundtable discussion. Postgrad Med 2023; 135:87-92. [PMID: 36408583 DOI: 10.1080/00325481.2022.2147772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric feeding disorders can be seen in up to 45% of normally developing children aged under 5 years old, mainly during the first three years of life when the child has inadequate food intake and/or difficulty maintaining adequate growth, and/or lack of age-appropriate eating habit. This article describes the opinion of a group of experts on children eating patterns and how to manage pediatric feeding disorders, with the aim to improve the quality of life of children and their caregivers.
Collapse
Affiliation(s)
- Julie Lemale
- Nutrition et Gastroentérologie Pédiatriques - Hôpital Universitaire Armand Trousseau-APHP, 6 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Audrey Lecoufle
- Centre de Référence des Affections Chroniques et Malformatives de l'œsOphage (CRACMO), CHU Lille. Avenue Eugène Avinée, 59000 Lille, France
| | - Marc Bellaiche
- Nutrition et Gastroentérologie Pédiatrique - Hôpital Robert Debré-APHP, 48 Boulevard Sérurier, 75019 Paris, France
| |
Collapse
|
14
|
Mudholkar A, Korostenski L, Blackwell D, Lane AE. Factors associated with the early emergence of atypical feeding behaviours in infants and young children: A scoping review. Child Care Health Dev 2023; 49:1-19. [PMID: 35301737 PMCID: PMC10084441 DOI: 10.1111/cch.13005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Atypical feeding behaviours such as significantly limited food preferences, hypersensitivity to food textures or temperatures and pocketing food without swallowing are common concerns in child health. Current reports indicate an inter-relationship between early growth, feeding problems and developmental disorders, yet little is known about how these behaviours develop in early childhood. There is also a lack of consensus about clinical definitions for atypical feeding behaviours, diagnostic thresholds and the associated precursors. To date, there has been no synthesis of the extant literature about factors associated with the early onset of atypical feeding behaviours in young children. OBJECTIVE This scoping review aimed to characterize the factors associated with the early emergence of atypical feeding behaviours in typically developing young children. METHODS CINAHL, MEDLINE, PsycINFO and Scopus databases were searched. Studies published in the last 5 years were included if they examined factors associated with the development of atypical eating behaviours in infants and young children. Of the 2137 records obtained after the search strategy was applied, 202 full-text articles were retrieved for a more detailed examination and to ensure they met the inclusion criteria. This resulted in 54 studies being included in this scoping review. RESULTS Of the 54 studies, three studies analysed precursors responsible for atypical feeding behaviours, and 51 studies discussed the factors associated with the early emergence of feeding difficulties. Multiple factors, including genetic factors, breastfeeding, late introduction of solids and lumpy foods, complementary feeding techniques, parental mental health, prematurity and child factors including temperament, were identified. There is inconsistent evidence for the associations between breastfeeding exposure and feeding difficulties. CONCLUSIONS This study identified multiple factors potentially associated with the early onset of atypical feeding behaviours in young children; however, there is insufficient evidence at this time to support specific recommendations for early feeding practices in young children. More methodologically rigorous studies are needed to extend these findings.
Collapse
Affiliation(s)
- Asmita Mudholkar
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne.,School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs
| | - Larissa Korostenski
- Department of Neonatology, John Hunter Children's Hospital, Newcastle, Australia
| | - Dianne Blackwell
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne.,School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Alison E Lane
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne
| |
Collapse
|
15
|
Nocerino R, Coppola S, Carucci L, Paparo L, De Giovanni Di Santa Severina AF, Berni Canani R. Body growth assessment in children with IgE-mediated cow's milk protein allergy fed with a new amino acid-based formula. FRONTIERS IN ALLERGY 2022; 3:977589. [PMID: 36133404 PMCID: PMC9483007 DOI: 10.3389/falgy.2022.977589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Amino acid-based formula (AAF) is a relevant dietary option for non-breastfed children. The present study was designed to evaluate the body growth pattern in cow's milk protein allergy (CMPA) children treated for 6 months with a new AAF. Methods This was an open-label, single arm study evaluating body growth pattern in immunoglobulin E (IgE)-mediated CMPA infants receiving a new AAF for 6 months. The outcomes were anthropometry (weight, length, head circumference), adherence to the study formula and occurrence of adverse events (AEs). Results Fifteen children [all Caucasian and born at term; 53.3% born with spontaneous delivery; 80% male; 80% with familial allergy risk; mean age (±SD) 3 ± 2.5 months at IgE-mediated CMPA diagnosis; mean age (±SD) 16.7 ± 5.9 months at enrolment, mean total serum IgE (±SD) 298.2 ± 200.4 kU/L] were included and completed the 6-month study. Data from fifteen age- and sex-matched healthy controls were also adopted as comparison. At baseline, all CMPA patients were weaned and were receiving the new AAF. All 15 patients completed the 6-month study period. For the entire CMPA pediatric patients’ cohort, from baseline to the end of the study period, the body growth pattern resulted within the normal range of World Health Organization (WHO) growth references and resulted similar to healthy controls anthropometric values. The formula was well tolerated. The adherence was optimal and no AEs related to AAF use were reported. Conclusions The new AAF ensured normal growth in subjects affected by IgE-mediated CMPA. This formula constitutes another suitable safe option for the management of pediatric patients affected by CMPA.
Collapse
Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Anna Fiorenza De Giovanni Di Santa Severina
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
- Correspondence: Roberto Berni Canani
| |
Collapse
|
16
|
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; 98:256-263. [PMID: 34303657 PMCID: PMC9432029 DOI: 10.1016/j.jped.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the complementary feeding practices, food intake, and nutritional status of infants on a cow's milk protein elimination diet. METHODS A cross-sectional and observational study was conducted to compare infants aged 4-18 months who were on a cow's milk protein elimination diet with a control group of healthy infants without any dietary restrictions. General information on the child's health, demographic data, and food consumption were collected. RESULTS The study included 96 infants in the elimination diet group and 99 in the control group. In the elimination diet group, the median age (in months) of introduction of solid foods (5.0 × 4.0; p < 0.001) and water (5.5 × 4.0; p < 0.05) was later, consumption of soft drinks and industrialized cookies was less frequent (p < 0.05), and a lower index of complementary feeding inadequacies (2.75 × 3.50; p < 0.001) was observed. The elimination diet group presented lower individual values of Z scores for weight/age, weight/height, and body mass index/age, although they were fed with higher amounts of energy (117.4 × 81.3 kcal/kg of weight; p < 0.001) and macro-and micronutrients, except for vitamin A. In the elimination diet group, breast milk and its substitutes contributed to more than 67% of energy intake. Although calcium consumption was a deficit in 31.5% of the infants, none received supplementation. CONCLUSION Infants on an elimination diet presented more adequate complementary feeding practices and higher nutritional intake, despite lower body weight values.
Collapse
Affiliation(s)
- Juliana Frizzo
- Universidade Federal de São Paulo, Departamento de Pediatra, Divisão de Gastroenterologia Pediátrica, Programa de Pós-Graduação em Nutrição, São Paulo, SP, Brazil
| | - Vanessa C C Rodrigues
- Universidade Federal de São Paulo, Departamento de Pediatra, Divisão de Gastroenterologia Pediátrica, Programa de Pós-Graduação em Nutrição, São Paulo, SP, Brazil
| | - Patrícia G L Speridião
- Universidade Federal de São Paulo, Departamento de Pediatra, Divisão de Gastroenterologia Pediátrica, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Curso de Nutrição, Departamento de Saúde, Educação e Sociedade, Santos, SP, Brazil
| | - Mauro B Morais
- Universidade Federal de São Paulo, Departamento de Pediatra, Divisão de Gastroenterologia Pediátrica, São Paulo, SP, Brazil; Escola Paulista de Medicina, Gastroenterologia Pediátrica, São Paulo, SP, Brazil.
| |
Collapse
|
17
|
Abstract
A cross-sectional study compared feeding difficulties in children aged 2-5 years fed a cows' milk elimination diet due to food allergy with a control group on an unrestricted diet. All data were obtained online. Specific questionnaires evaluated three types of feeding difficulties: avoidant eating, picky eating and feeding problems. The median scores of feeding difficulties in the elimination diet (n 146) and control (n 109) groups were, respectively: picky eating (31 v. 27; P = 0·148), avoidant eating (3 v. 3; P = 0·508) and feeding problems (38 v. 34, P = 0·032). Picky eating was more frequent in the elimination diet (35·4 %) than in the controls (23·3 %; P = 0·042), but no difference was observed for avoidant eating (23·9 % v. 20·4 %, P = 0·508) and feeding problems (32·1 % v. 28·4 %, P = 0·541). Picky eating was associated with lower values of weight-for-age z-scores in both groups. Multivariate analyses identified associations of the three feeding difficulties with previous food refusal and/or inappetence in the elimination diet group. Current constipation and anticipatory gagging were associated with feeding difficulties in both groups. In conclusion, children on an elimination diet presented higher frequency of picky eating and higher scores of feeding problems. Picky eating was associated with lower values of weight-for-age z-scores. Food refusal and/or inappetence as clinical manifestations of food allergy were associated with feeding difficulties at the moment of the survey. Current constipation and anticipatory gagging were associated with picky eating, avoidant eating and feeding problems.
Collapse
|
18
|
Cattaneo C, Mameli C, D'Auria E, Zuccotti G, Pagliarini E. The Influence of Common Noncommunicable Diseases on Chemosensory Perception and Clinical Implications in Children and Adolescents. Adv Nutr 2021; 13:234-247. [PMID: 34535793 PMCID: PMC8803496 DOI: 10.1093/advances/nmab100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/06/2023] Open
Abstract
An increased incidence of noninfectious chronic diseases, such as obesity, diabetes, and allergies, has been noted in the last century, especially in the last 2 to 3 generations. Evidence suggested that the interrelation among these chronic conditions in pediatric age (e.g., children and adolescents aged 4-16 y) is complex and still unknown, reinforcing the interest of pediatricians in these diseases. Of interest is the need to better understand the link between these pathologies and sensory perception, since the chemical senses of taste and smell, together with chemesthesis, are reported to have a role in food choices and may provide a novel target for intervention in the treatment of these pathologies. This review aims to explore the current evidence on the link between these chronic conditions and chemosensory perception (i.e., taste and smell). In addition, the putative role that chemosensory perception may have on food choices and eating behavior of children and adolescents affected by these diseases are highlighted. Furthermore, the review addresses the unexplored issues that need to be investigated in this area. The literature data search suggested that no clear relation between taste and smell perception and the aforementioned diseases in young population yet exists. However, some possible trends have been highlighted in the adult population, in whom the duration of disease might have affected the relation. There is a need for further, high-quality, hypothesis-led research, with robust measures of taste and smell functions as the primary outcomes, to strengthen or deny this evidence.
Collapse
Affiliation(s)
| | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Ella Pagliarini
- Sensory and Consumer Science Lab (SCS_Lab), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| |
Collapse
|
19
|
Ercan N, Tel Adıgüzel K. Effect of early childhood cow's milk elimination diet on eating behaviours, nutrition and growth status at age 2-6 years. J Hum Nutr Diet 2021; 35:300-309. [PMID: 33974304 DOI: 10.1111/jhn.12914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The present study aimed to investigate the eating behaviour, nutritional status and growth of Caucasian children in ages 2-6 years who had a diet because of cow's milk protein allergy (CMA) [immunoglobulin (Ig)E-mediated and/or non-IgE-mediated] in early childhood. METHODS In this cross-sectional, case-control study, the cow's milk elimination (CME) group comprised children aged 0-2 years who were receiving a CME diet because of CMA, as confirmed by an oral food challenge test, and had reintroduced cow's milk for at least ≥ 3 months. The control group never had a restricted diet. Eating behaviour and children's growth was assessed. A 3-day food record was taken to determine the macronutrient and micronutrient intake of the children. Data on the children's socio-demographic, infant nutrition and family allergy history were collected from their medical records and face-to-face interviews with mothers. RESULTS In total, 62 children with a median age of 32 months were recruited for the study. The total scores of food avoidance and satiety responsiveness in the CME group (n:31) were higher than in the controls (n = 31) (p = 0.036 and 0.006, respectively). Weight-for-age and height-for-age are statistically lower in the CME group than in the control group (p < 0.001). A significant difference between groups in terms of dairy intake was recorded (p = 0.011). In the CME group, the current frequency of adequate energy, vitamin B1, folic acid, vitamin C and calcium intake was significantly lower than in the control group (p < 0.05). CONCLUSIONS Dietary interventions because of CMA at age 0-2 years can affect children's nutritional habits and parental-reported assessment of children's eating behaviours, resulting in growth restriction with insufficient micro/macronutrients and/or dairy products at the age of 2-6 years.
Collapse
Affiliation(s)
- Nazli Ercan
- Department of Child Health and Diseases, Pediatric Immunology and Allergy, Gülhane Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kübra Tel Adıgüzel
- Department of Nutrition and Dietetics, Gülhane Faculty of Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| |
Collapse
|
20
|
Durban R, Groetch M, Meyer R, Coleman Collins S, Elverson W, Friebert A, Kabourek J, Marchand SM, McWilliam V, Netting M, Skypala I, Van Brennan T, Vassilopoulou E, Vlieg-Boerstra B, Venter C. Dietary Management of Food Allergy. Immunol Allergy Clin North Am 2021; 41:233-270. [PMID: 33863482 DOI: 10.1016/j.iac.2021.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
Collapse
Affiliation(s)
- Raquel Durban
- Carolina Asthma & Allergy Center, 2600 E 7th St unit a, Charlotte, NC 28204, USA
| | - Marion Groetch
- Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Rosan Meyer
- Department of Pediatrics, Imperial College, London, UK
| | | | - Wendy Elverson
- Boston Children's Hospital Center for Nutrition, 333 Longwood Avenue, 4th floor, Boston, MA 02115, USA
| | - Alyssa Friebert
- Allergy and Immunology Clinic, 13123 East 16th Avenue Box 270, Aurora, CO 80045, USA
| | - Jamie Kabourek
- University of Nebraska-Lincoln, Food Innovation Center, Room 279c, 1901 North 21 Street, Lincoln, NE 68588, USA
| | - Stephanie M Marchand
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, 593 Eddy Street, Providence, RI 02903, USA; Food and Nutrition Services, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Vicki McWilliam
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia; Nurition Department, Women's and Children's Health Network, North Adelaide 5006, South Australia, Australia
| | - Isabel Skypala
- Imperial College, London, UK; Department of Allergy and Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, 4th Floor Fulham Wing, Sydney Street, London SW3 6NP, UK
| | - Taryn Van Brennan
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA
| | - Emillia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki 57400, Greece
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, PO Box 95500, Amsterdam 1090HM, The Netherlands
| | - Carina Venter
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA.
| |
Collapse
|
21
|
Abstract
Food allergy is a significant public health concern, with a rising prevalence. Elimination diets remain the cornerstone of food allergy management, and they are not without nutritional risk. Children who avoid nutritionally important foods, such as milk or multiple foods allergens, may be at greater risk. Even adults with food allergies may encounter challenges to meet current recommended dietary guidelines for health and reduced risk of chronic disease. The type of food allergy disorder will also impact nutritional risk. A food allergy affects food choices, nutritional intake, and health; therefore, guidance to provide nutritionally appropriate substitutes within the context of the elimination diet is invaluable.
Collapse
Affiliation(s)
- Marion Groetch
- From the Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, and
| | - Carina Venter
- From the Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, and
| |
Collapse
|
22
|
Fatores associados aos tipos de dificuldades alimentares em crianças entre 0 e 10 anos de idade: um estudo retrospectivo em um centro de referência brasileiro. SCIENTIA MEDICA 2020. [DOI: 10.15448/1980-6108.2020.1.35530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: identificar fatores associados à prevalência dos diferentes tipos de dificuldades alimentares em crianças com idade entre 0 e 10 anos.Métodos: trata-se de um estudo observacional retrospectivo com dados de crianças de 0 a 10 anos diagnosticadas com alguma dificuldade alimentar, atendidas em um centro de referência localizado no município de São Paulo, SP, Brasil. A presença da dificuldade alimentar foi analisada de acordo com o diagnóstico multidisciplinar, o aparecimento da queixa, os dados sobre a gestação e a amamentação, o estilo parental, a presença de causas orgânicas e as complicações associadas. Os dados foram tabulados no programa Microsoft Excel e as análises estatísticas foram realizadas no programa IBM SPSS Statistics 21 através de frequências absolutas e relativas, média, desvio padrão, teste do qui-quadrado e Kruskall-Wallis com o teste de post-hoc de Dunn.Resultados: foram avaliados 166 pacientes com um predomínio do sexo masculino, em idade pré-escolar e nascidos a termo. O diagnóstico mais prevalente foi de seletividade alimentar, sem doenças orgânicas ou reações associadas. Os diagnósticos de dificuldade alimentar apresentaram associação estatisticamente significativa com idade, idade gestacional de nascimento, idade e fase da alimentação de aparecimento da queixa.Conclusões: os fatores que apresentaram associação com os diferentes tipos de dificuldade alimentar foram a idade, a idade gestacional de nascimento e a idade e fase da alimentação de aparecimento da queixa. O presente estudo permite iniciar um direcionamento mais específico de ações de orientação e de prevenção de dificuldade alimentar. Dessa forma, destaca-se a importância da realização de estudos desse cunho.
Collapse
|
23
|
Fierro V, Valluzzi RL, Banzato C, Plaza MA, Bosque M, Íbero M, Echeverría LAZ, Mennini M, Dahdah L, de Castellar R, Tort G, Jiménez J. A well-tolerated new amino acid-based formula for cow's milk allergy. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:140-149. [PMID: 32109005 PMCID: PMC7212192 DOI: 10.1002/iid3.286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/25/2022]
Abstract
Objectives Infants with cow's milk allergy (CMA) are in need of a substitute formula up to 2 years. The are three requisites for a substitute of milk in CMA: tolerability, nutritional adequacy, and cost‐effectiveness. We evaluate here the tolerability of a new amino acid–based infant formula for the management of CMA. Methods In a phase III/IV prospective, multicentre, open‐label, international study, infants and children with immunoglobulin E‐mediated CMA were exposed to a diagnostic double‐blinded, placebo‐controlled food challenge with a new amino acid formula by Blemil Plus Elemental using Neocate as the placebo. If tolerant to it, the study formula was integrated into the patients’ usual daily diet for 7 days. Efficacy on day 7 was assessed in terms of symptoms associated with CMA, amount of formula consumed, nutritional and energy intake, and anthropometric data. Results Thirty children (17 M and 13 F; median age, 1.58; range, 0.08‐12.83 years) completed the open challenge and were able to consume the study formula for at least 7 days. No signs or symptoms of allergic reactions were recorded among children assuming either the test or the control formula, with a lower 95% one‐sided confidence interval for the proportion of subjects who did not experience allergic reactions above 90%. Sixteen patient under the age of two continued with the optional extension phase. Conclusions The study formula meets the American Academy of Pediatric criteria for hypoallergenicity and is well tolerated in short‐term use. During optional phase, growth of the patients was not hindered by the study formula.
Collapse
Affiliation(s)
| | | | | | - Ma A Plaza
- Hospital Sant Joan de Deu, Barcelona, Spain
| | | | | | | | | | - Lamia Dahdah
- Pediatric Allergy Unit, Bambino Gesù Hospital, Roma, Italy
| | | | - Gloria Tort
- Laboratorios Ordesa, Sant Boi de Llobregat, Spain
| | | |
Collapse
|
24
|
D'Auria E, Pendezza E, Zuccotti GV. Personalized Nutrition in Food Allergy: Tips for Clinical Practice. Front Pediatr 2020; 8:113. [PMID: 32292770 PMCID: PMC7119223 DOI: 10.3389/fped.2020.00113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Nowadays, food allergies are considered as a wide spectrum of disorders that need different approaches. The "one size fits all" approach is giving way to a "targeted approach," based on the identification of the patient's phenotype. Thus, the approach of nutritional management of food allergy has moved on from simply being "yes or no" to "how much?", "in which form?" and "for which patients?" Different factors should be considered in order to make a patient-tailored nutritional plan in clinical practice. Tailored nutritional plans may help to reduce the nutritional, social and economic burden of food allergy.
Collapse
Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| |
Collapse
|
25
|
Ball HB, Luyt D. Home-based cow's milk reintroduction using a milk ladder in children less than 3 years old with IgE-mediated cow's milk allergy. Clin Exp Allergy 2019; 49:911-920. [PMID: 30737842 DOI: 10.1111/cea.13366] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The development of tolerance to cow's milk in allergic children is best determined by supervised baked milk exposure. Widely recommended hospital-based challenges can potentially delay contact because of resource limitations. OBJECTIVE We sought to determine the efficacy and safety of our low-dose home-based reintroduction programme. METHODS In our allergy service, children with IgE-mediated cow's milk allergy who met set criteria (presenting with skin and/or gastrointestinal symptoms only and skin prick test < 8 mm) are considered for home-based milk reintroduction (HMR). Early contact is low-dose ingestion of a commercial baked milk biscuit with slow gradual further exposure followed by increasing milk contact using a milk ladder. We retrospectively reviewed 4-6 monthly attendance records assessing allergic symptoms, evolving milk tolerance, and compliance. Tolerance was determined using a 7 scale scoring system based on the milk ladder. RESULTS The clinic attendance and dietetic contact records of 86 children (49 girls) who underwent HMR were reviewed. HMR was started at a median of 13 months with 49% 8-12 months, 40% 13-18 months and 11% 19-33 months. Allergic symptoms were reported in 81 (43%) of 189 dietetic reviews, 65 (80%) of which were from the milk ladder; no patient experienced anaphylaxis requiring treatment with intramuscular adrenaline. After four reviews, only eight patients were not tolerating almost all dairy products, and there was a high rate of completion with only a further seven patients lost to the programme. CONCLUSION AND CLINICAL RELEVANCE Cow's milk can be successfully and safely reintroduced in a cautious low-dose exclusively home-based programme in the appropriate clinical and family setting.
Collapse
Affiliation(s)
- Heidi Britt Ball
- Children's Allergy Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Luyt
- Children's Allergy Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
26
|
Chong KW, Wright K, Goh A, Meyer R, Rao R. Growth of children with food allergies in Singapore. Asia Pac Allergy 2018; 8:e34. [PMID: 30402401 PMCID: PMC6209600 DOI: 10.5415/apallergy.2018.8.e34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Although it is known that children with food allergies are at risk of impaired growth, this has not been well studied in South-East Asia. Objective The aim of this cross-sectional study is to survey the growth of children with food allergies in Singapore and the factors impacting it. Methods Anthropometric data, demographic data, type of food allergy, foods eliminated, and atopic comorbidities were recorded. Malnutrition was defined using World Health Organization standards (≤-2 z-score for weight-for-height [WH], weight-for-age [WA], and height-for-age [HA]). Results Seventy-four patients (51% male) were recruited over 1 month, with median age at diagnosis of 8 months (interquartile range [IQR], 4–13 months) and at data collection of 25 months (IQR, 14–48 months). Sixty-two (84%) had IgE-mediated allergy, 8 (11%) mixed IgE and non-IgE, and 4 (5%) non-IgE-mediated allergy. Food exclusions: 55% one food, 27% two foods, 8% three to four foods, and 10% ≥5 foods. Only 1% were underweight (WA ≤ -2 z-score) and 3% had WA ≥ +2 z-score. Having a mixed type food allergy significantly reduced WA (p = 0.023). WA was significantly lower for those referred to the dietitian (p = 0.027). 5.4% were stunted (HA ≤ -2 z-score). Factors significantly associated with stunting were underlying eczema (p = 0.03) and having an IgE-mediated (p = 0.03) or mixed type food allergy (p = 0.002). One point four percent (1.4%) were undernourished (WH ≤ -2 z-score) and 1.4% were overweight (WH ≥ +2 z-score). Multivariate regression analysis found that children with mixed type food allergies were significantly shorter (z-score -1 lower). Children had a lower WA if they had skin involvement as part of their symptom presentation. Conclusion This is the first survey documenting growth in children with food allergy in Singapore. Eczema, IgE-mediated and mixed type allergies are associated with poorer growth rates in these children. Early, individualised nutritional intervention is recommended for all children with food allergy.
Collapse
Affiliation(s)
- Kok Wee Chong
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Karen Wright
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Anne Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, United Kingdom
| | - Rajeshwar Rao
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| |
Collapse
|
27
|
Meyer R. Nutritional disorders resulting from food allergy in children. Pediatr Allergy Immunol 2018; 29:689-704. [PMID: 30044008 DOI: 10.1111/pai.12960] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
| |
Collapse
|
28
|
Viljakainen HT, Figueiredo RAO, Rounge TB, Weiderpass E. Picky eating - A risk factor for underweight in Finnish preadolescents. Appetite 2018; 133:107-114. [PMID: 30393153 DOI: 10.1016/j.appet.2018.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/22/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Picky eating (PE) is the most common cause of early-life feeding problems. However, the consequences of PE on food intake and weight development in general populations have not been established. OBJECTIVES This study aims to investigate the associations of PE and food neophobia (FN) with weight status in 5700 Finnish preadolescents. In addition, we described food consumption by PE/FN status. MATERIAL AND METHODS We utilised the Finnish Health in Teens (Fin-HIT) cohort of 9-12-year-old preadolescents, who were categorised as having PE and FN based on answers from parental questionnaires. Weight was categorised as underweight, normal weight, and overweight/obesity based on body mass index (BMI) according to IOTF age- and sex-specific cut-offs. Eating patterns were obtained with a 16-item food frequency questionnaire. Multinomial logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). RESULTS The overall prevalence of PE and FN were 34% and 14%, respectively. PE was inversely associated with overweight/obesity (OR = 0.7; 95% CI 0.6-0.8) and led to a higher risk of underweight (OR = 2.0; 95% CI 1.7-2.4), while this was not observed with FN. Compared with preadolescents without PE/FN, those with PE/FN reported consuming unhealthy foods such as pizza, hamburgers/hot dogs, and salty snacks more frequently (p < 0.0038). By the same token, these preadolescents reported consuming healthy foods such as cooked vegetables, fresh vegetables/salad, fruit/berries, milk/soured milk, and dark bread less frequently. CONCLUSIONS Among Finnish preadolescents, only PE was associated with a higher risk for underweight and inversely with overweight/obesity. PE and FN were accompanied with unhealthy eating patterns. Management of PE in children may be explored as a potential strategy for improving healthy eating and avoiding underweight in preadolescents.
Collapse
Affiliation(s)
- Heli T Viljakainen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.
| | - Rejane A O Figueiredo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Trine B Rounge
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Research, Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Elisabete Weiderpass
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Research, Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
29
|
Factors Influencing Children's Eating Behaviours. Nutrients 2018; 10:nu10060706. [PMID: 29857549 PMCID: PMC6024598 DOI: 10.3390/nu10060706] [Citation(s) in RCA: 541] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022] Open
Abstract
Relevant factors involved in the creation of some children’s food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children’s nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children’s feeding behaviours. The family system that surrounds a child’s domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child’s eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education.
Collapse
|
30
|
Gastrointestinal Symptoms of Food Challenge-proven Non-IgE Cow's Milk Allergy Are Dissipated by Early School Age. J Pediatr Gastroenterol Nutr 2018; 66:598-602. [PMID: 28922259 DOI: 10.1097/mpg.0000000000001737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the current well-being and dietary restrictions in children 6 years after food challenge-confirmed diagnosis of non-IgE cow's milk protein allergy, compared to peers with gastrointestinal symptoms but negative food challenge. This study aimed to evaluate the diagnostic process retrospectively. METHODS This is an Internet-based survey for mothers whose children underwent 6 years ago the double-blind, placebo-controlled food challenge for cow's milk (CM) because of gastrointestinal symptoms causing suspicion of non-IgE CM protein allergy. Concurrent dietary restrictions, overall well-being, medical history, and retrospective views on the food challenge were queried using a study-specific questionnaire, the Quality of life using PedsQL general score and parental stress with the Parenting Stress Index questionnaire. RESULT Mothers of 42 children (23 girls), median age of 6.7 years (range 5.7-8.6), participated in the survey, the response rate was 70%. All children now consumed cow's milk protein. The only food restrictions reported were empirical lactose-free diets in 7 children (17%). One-third of the children in both groups were presently reported to have eating-related issues such as picky eating. Quality of life was good and present parenting stress was average in both groups. The majority of the mothers (87%) felt positive or neutral about the food challenge performed in infancy. CONCLUSIONS The non-IgE CM allergy with gastrointestinal symptoms diagnosed in infancy was a transient condition with good outcome. At an early school age, nearly all children have a good quality of life and a regular diet. The use of the double-blind, placebo-controlled food challenge was well-endorsed.
Collapse
|
31
|
Nutritional management of cow's milk allergy in children: An update. Arch Pediatr 2018; 25:236-243. [PMID: 29576253 DOI: 10.1016/j.arcped.2018.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Abstract
Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term.
Collapse
|
32
|
Venter C, Brown T, Meyer R, Walsh J, Shah N, Nowak-Węgrzyn A, Chen TX, Fleischer DM, Heine RG, Levin M, Vieira MC, Fox AT. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy 2017; 7:26. [PMID: 28852472 PMCID: PMC5567723 DOI: 10.1186/s13601-017-0162-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/30/2017] [Indexed: 12/18/2022] Open
Abstract
Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, 'Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide' was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow's milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise.
Collapse
Affiliation(s)
- Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children’s Hospital Colorado , Box B518, 13123 East 16th Avenue, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Trevor Brown
- Children’s Allergy Service, Ulster Hospital, Belfast, BT16 1RH Northern Ireland, UK
| | - Rosan Meyer
- Department Paediatrics, Imperial College, London, London, W2 1NY UK
| | - Joanne Walsh
- Gurney Surgery, Castle Partnership, 101-103 Magdalen Street, Norwich, NR3 1LN UK
| | - Neil Shah
- Gastroenterology Department, Great Ormond Street Hospital, London, WC1N 3JH UK
| | - Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Tong-Xin Chen
- Department of Allergy and Immunology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127 China
| | - David M. Fleischer
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children’s Hospital Colorado , Box B518, 13123 East 16th Avenue, Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Ralf G. Heine
- Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia
| | - Michael Levin
- Division of Paediatric Allergy and Asthma, Red Cross War Memorial Children’s Hospital, University of Cape Town, Room 516, ICH Building, Cape Town, South Africa
| | - Mario C. Vieira
- Centro de Gastroenterologica Pediatrica, Department of Paediatrics, Hospital Pequeno Principe, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | - Adam T. Fox
- Department of Paediatric Allergy, Guys and St Thomas’ Hospitals NHS Foundation Trust, London, UK
- Division of Asthma, Allergy and Lung Biology, King’s College, London, London, UK
| |
Collapse
|
33
|
Impact of elimination diets on nutrition and growth in children with multiple food allergies. Curr Opin Allergy Clin Immunol 2017; 17:220-226. [DOI: 10.1097/aci.0000000000000358] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
34
|
Cole NC, An R, Lee SY, Donovan SM. Correlates of picky eating and food neophobia in young children: a systematic review and meta-analysis. Nutr Rev 2017; 75:516-532. [DOI: 10.1093/nutrit/nux024] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
35
|
Abstract
OBJECTIVES The aim of the present article was to investigate iodine status and growth in cow's milk protein allergic infants and to identify potential predictors of iodine status and growth. METHODS Fifty-seven infants under 2 years of age were included in an observational cross-sectional study. Two spot urine samples were collected and analyzed for iodine, together with a 3-day food record and a food frequency questionnaire. Urine iodine concentrations were compared with the WHO cut-off values for iodine deficiency. Measurements of weight, length, and head circumference at birth and study inclusion were converted to standard deviation scores. Subgroup analyses were performed on different feeding patterns, according to weaning status. RESULTS Median age was 9 months. Median urinary iodine concentration was 159 ug/L. One third of the children had urine iodine concentrations indicating iodine deficiency. Infants who were mainly breastfed were at highest risk and 58% were classified as deficient. Dietary factors positively associated with iodine excretion were intake of enriched baby cereals and meeting the dietary requirement for iodine. Stunting was present in 5%. Underweight and wasting was frequent at 11% and this was associated with food refusal and poor appetite, but not with iodine status. Growth failure was detected among boys. CONCLUSIONS The present study suggests that cow's milk protein allergy children have high prevalence of iodine deficiency and poor growth, however the 2 conditions were not associated. The subgroup of mainly breastfed infants was at higher risk of iodine deficiency compared to weaned infants. Subjects with feeding problems had increased risk of malnutrition.
Collapse
|
36
|
Herbert LJ, Mehta P, Sharma H. Mealtime behavior among parents and their young children with food allergy. Ann Allergy Asthma Immunol 2017; 118:345-350. [PMID: 28094121 DOI: 10.1016/j.anai.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/08/2016] [Accepted: 12/01/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families. OBJECTIVE To characterize mealtime behaviors among parents of young children with food allergy. METHODS Seventy-four parents of young children with food allergies (≤7 years of age) completed measures of mealtime behavior, perceptions of food allergy risk and severity, pediatric parenting stress, and food allergy-related quality of life. Mealtime behavior reports were compared with published data regarding typically developing children, young children with type 1 diabetes, and children with diagnosed feeding disorders (with or without related medical factors). RESULTS Parents of young children with food allergies reported frequent mealtime concerns. Specifically, they reported significantly more mealtime behavioral concerns than typically developing peers, comparable mealtime behavioral concerns to young children with type 1 diabetes, and significantly fewer mealtime behavioral concerns than children with diagnosed feeding disorders. Parental mealtime concerns were positively correlated with other parent perceptions of food allergy, such as risk of allergen exposure, illness-related parenting stress, and food allergy-related quality of life. CONCLUSION Young children with food allergy and their parents are more likely to exhibit mealtime behavioral concerns than typically developing peers and their parents. Future research should investigate the effect of food allergies and maladaptive mealtime behaviors on children's nutrition to provide clinical guidelines for parents who may benefit from psychosocial and/or nutritional support.
Collapse
Affiliation(s)
- Linda Jones Herbert
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; The George Washington University, School of Medicine and Health Sciences, Washington, DC.
| | - Priya Mehta
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; The George Washington University, School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
37
|
Wert AF, Posa D, Tsilochristou O, Schwerk N. Treatment of allergic children - Where is the progress (for the practicing allergist)? Pediatr Allergy Immunol 2016; 27:671-681. [PMID: 27614100 DOI: 10.1111/pai.12653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/12/2022]
Abstract
For any kind of therapeutic intervention in allergic diseases such as environmental control, pharmacological, or immunomodulating treatment including educational programs, children are addressed separately from adults. Health authorities like the Food and Drug Administration in the United States of America or the European Medicine Agency in Europe request a specific 'Pediatric investigational plan' with studies addressing dose-response relationship, safety, and efficacy for infants, children, and adolescents. During the last 2 years, promising advances have been reported for the treatment of a variety of allergic and immunologic disorders. This review summarizes the progress in the treatment of pediatric asthma and allergic diseases, based on publications of approximately the last 2.5 years (end of 2013 until May 2016) in and beyond this journal. Meanwhile, it highlights areas with promising novel therapeutic approaches, which are likely to change treatment for allergic children in the near future.
Collapse
Affiliation(s)
- A F Wert
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany.
| | - D Posa
- Department of Paediatric Pneumology & Immunology, Charité Medical School, Berlin, Germany
| | - O Tsilochristou
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London & Guy's, St. Thomas'National Health Service Foundation Trust, London, UK
| | - N Schwerk
- Department of Paediatric Pneumology Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
38
|
Venter C, Fleischer DM. Diets for diagnosis and management of food allergy: The role of the dietitian in eosinophilic esophagitis in adults and children. Ann Allergy Asthma Immunol 2016; 117:468-471. [PMID: 27592143 DOI: 10.1016/j.anai.2016.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/07/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Carina Venter
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Fleischer
- University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
39
|
Maslin K, Dean T, Arshad SH, Venter C. Dietary variety and food group consumption in children consuming a cows' milk exclusion diet. Pediatr Allergy Immunol 2016; 27:471-7. [PMID: 27062104 DOI: 10.1111/pai.12573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dietary variety is defined as the number of different foods or food groups consumed over a given reference period, the consensus being that dietary variety and dietary quality are positively correlated. Recently there has been considerable interest in the association between infant dietary variety and atopic disease. METHODS This was a cross-sectional study of 8- to 27-month-old children from the Isle of Wight, UK, including two groups: a group of children consuming a cows' milk exclusion (CME) diet and a control group of children consuming an unrestricted diet. Parents completed a validated food frequency questionnaire, from which dietary variety and consumption of food groups were calculated. Growth measurements were recorded. RESULTS A total of 126 participants of mean age 13.0 months were recruited. In addition to the expected differences in dairy and soya consumption, the CME group consumed sweet foods 1.6 times less frequently, non-water drinks seven times less frequently (p < 0.05) and ready-made baby foods 15 times more frequently (p < 0.01) than the control group. Overall dietary variety was significantly lower in the CME group (p < 0.01) as was variety of meat and sweet foods consumed. There was a greater concern with healthy eating in the CME group (p < 0.05). CONCLUSIONS Children consuming an exclusion diet for cows' milk allergy have an overall less varied diet, including a less varied consumption of meat and sweet foods. Efforts should be made to ensure exclusion diets are as varied as possible to optimize nutritional intake.
Collapse
Affiliation(s)
- Kate Maslin
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Tara Dean
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK.,University of Southampton, Southampton, UK
| | - Carina Venter
- School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| |
Collapse
|
40
|
Maslin K, Grimshaw K, Oliver E, Roberts G, Arshad SH, Dean T, Grundy J, Glasbey G, Venter C. Taste preference, food neophobia and nutritional intake in children consuming a cows' milk exclusion diet: a prospective study. J Hum Nutr Diet 2016; 29:786-796. [PMID: 27298213 DOI: 10.1111/jhn.12387] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows' milk allergy who consume a substitute formula and/or a cows' milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake. METHODS Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed. RESULTS One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant. CONCLUSIONS Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.
Collapse
Affiliation(s)
- K Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - K Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK
| | - E Oliver
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - G Roberts
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S H Arshad
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - T Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - J Grundy
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - G Glasbey
- David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Venter
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| |
Collapse
|
41
|
Maslin K, Grundy J, Glasbey G, Dean T, Arshad SH, Grimshaw K, Oliver E, Roberts G, Venter C. Cows' milk exclusion diet during infancy: Is there a long-term effect on children's eating behaviour and food preferences? Pediatr Allergy Immunol 2016; 27:141-6. [PMID: 26592369 DOI: 10.1111/pai.12513] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dietary restriction during infancy may influence later eating behaviour. The aim of this study was to determine whether consuming a cows' milk exclusion (CME) diet during infancy affects eating habits in later childhood, once cows' milk has been reintroduced into the diet. METHODS Children were recruited from two large birth cohort studies in the UK. A small number of participants were recruited from allergy clinic. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group, who had consumed an unrestricted diet during infancy. Parents and children completed questionnaires regarding eating behaviour and food preferences. RESULTS In total, 101 children of mean age 11.5 years were recruited (28 CME and 73 controls). The CME group scored significantly higher on 'slowness of eating' and on the combined 'avoidant eating behaviour' construct (p < 0.01). The number of foods avoided and symptoms was associated with higher levels of avoidant eating behaviour (p < 0.05). The CME group rated liking for several dairy foods (butter, cream, chocolate, full fat milk and ice cream) significantly lower than the control group (p < 0.05), although there were no significant differences seen for any other category of food. CONCLUSION This study demonstrated that consuming a CME diet during infancy has persistent and long-term effects on eating habits and food preferences. To reduce future negative eating behaviours, children's exclusion diets need to be as varied as possible and reintroduction of cows' milk products closely monitored.
Collapse
Affiliation(s)
- Kate Maslin
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Jane Grundy
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
| | - Gillian Glasbey
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
| | - Tara Dean
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK.,University of Southampton, Southampton, UK
| | | | | | | | - Carina Venter
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| |
Collapse
|
42
|
Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite 2015; 95:349-59. [DOI: 10.1016/j.appet.2015.07.026] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/15/2015] [Accepted: 07/26/2015] [Indexed: 01/20/2023]
|