Bone health assessment of food allergic children on restrictive diets: a practical guide

Doulgeraki, Artemis; Manousakis, Emmanouel; Papadopoulos, Nikolaos G.

doi:10.1515/jpem-2016-0162

Cited by 21 publications

(14 citation statements)

References 39 publications

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“…Exclusive breastfeeding was reconfirmed to be risk factor [2,21]. Notably, approximately half of the patients with symptomatic vitamin D deficiency had a restricted and/or unbalanced diet, which is consistent with the recent practical guide that restriction of cow's milk or multiple food items may increase the risk of metabolic bone disorders [22]. Unlike overseas [2,23], active vitamin D was used to treat patients with symptomatic vitamin D deficiency in the current study.…”

Section: Symptomatic Vitamin D Deficiencysupporting

confidence: 77%

Incidence rate and characteristics of symptomatic vitamin D deficiency in children: a nationwide survey in Japan

et al. 2018

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There is concern that vitamin D deficiency is prevalent among children in Japan as well as worldwide. We conducted a nationwide epidemiologic survey of symptomatic vitamin D deficiency to observe its incidence rate among Japanese children. A questionnaire inquiring the number of new patients with vitamin D deficiency rickets and/or hypocalcemia for 3 years was sent to 855 randomly selected hospitals with a pediatrics department in Japan. In this survey, we found that 250 children were diagnosed with symptomatic vitamin D deficiency. The estimated number of patients with symptomatic vitamin D deficiency per year was 183 (95% confidence interval (CI): 145-222). The overall annual incidence rate among children under 15 years of age was 1.1 per 100,000 population (95% CI: 0.9-1.4). The second survey has provided detailed information on 89 patients with symptomatic vitamin D deficiency under 5 years of age in hospitals in the current research group. The nationwide and second surveys estimated the overall annual incidence rate of symptomatic vitamin D deficiency in children under 5 years of age to be 3.5 (2.7-4.2) per 100,000 population. The second survey revealed 83% had bowed legs, 88% had exclusive breastfeeding, 49% had a restricted and/or unbalanced diet and 31% had insufficient sun exposure among the 89 patients. This is the first nationwide survey on definitive clinical vitamin D deficiency in children in Japan. Elucidating the frequency and characteristics of symptomatic vitamin D deficiency among children is useful to develop preventative public health strategies.

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Section: Symptomatic Vitamin D Deficiencysupporting

confidence: 77%

Incidence rate and characteristics of symptomatic vitamin D deficiency in children: a nationwide survey in Japan

et al. 2018

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“…Vitamin D and calcium are important to prevent rickets and osteomalacia ( 45 ). Vitamin D supplements were used by nearly all participants (86%), and ensured RDI to be fulfilled.…”

Section: Discussionmentioning

confidence: 99%

Micronutrient Status and Nutritional Intake in 0‐ to 2‐Year‐old Children Consuming a Cows’ Milk Exclusion Diet

Kvammen

Thomassen

Eskerud

et al. 2018

J. pediatr. gastroenterol. nutr.

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Objectives:To study micronutrient status and nutritional intake from complementary feeding in children on a cows’ milk exclusion (CME) diet.Methods:Fifty-seven children with cows’ milk allergy, younger than 2 years, were included in a cross-sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3-day food diary. The results were analyzed according to 3 feeding patterns: mainly breast-fed (mBF), partially breast-fed, and no breast milk group (nBM).Results:The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p-tHcy), s-B12, s-folate, b-Hb, s-ferritin, s-zinc, and s-25(OH)D. There were no significant differences between feedings groups, except for B12-biomarkers. The mBF had higher p-tHcy (P < 0.000) and lower s-B12 (P = 0.002) compared nBM. Vitamin B12 deficiency (p-tHcy >6.5 μmol/L combined with s-B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group (P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p-tHcy (r = −0.479, P = 0.001) and positively with s-B12 (r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b-Hb (r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements (r = 0.456, P = 0.001).Conclusion:The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.

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“…The main adverse health effects of LI occur as a result of milk avoidance and reduced calcium intakes. Avoidance of dairy products may lead to nutritional rickets in young children [ 72 ], as well as low bone mineral density and increased fracture risk later in life [ 73 ]. Calcium intake is a marker for dietary adequacy and closely correlates with the intake of other micronutrients [ 74 ].…”

Section: Treatment Of Lactose Intolerancementioning

confidence: 99%

Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited

Heine

Al-Refaee

Bachina

et al. 2017

World Allergy Organization Journal

111

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Lactose is the main carbohydrate in human and mammalian milk. Lactose requires enzymatic hydrolysis by lactase into D-glucose and D-galactose before it can be absorbed. Term infants express sufficient lactase to digest about one liter of breast milk daily. Physiological lactose malabsorption in infancy confers beneficial prebiotic effects, including the establishment of Bifidobacterium-rich fecal microbiota. In many populations, lactase levels decline after weaning (lactase non-persistence; LNP). LNP affects about 70% of the world’s population and is the physiological basis for primary lactose intolerance (LI). Persistence of lactase beyond infancy is linked to several single nucleotide polymorphisms in the lactase gene promoter region on chromosome 2. Primary LI generally does not manifest clinically before 5 years of age. LI in young children is typically caused by underlying gut conditions, such as viral gastroenteritis, giardiasis, cow’s milk enteropathy, celiac disease or Crohn’s disease. Therefore, LI in childhood is mostly transient and improves with resolution of the underlying pathology. There is ongoing confusion between LI and cow’s milk allergy (CMA) which still leads to misdiagnosis and inappropriate dietary management. In addition, perceived LI may cause unnecessary milk restriction and adverse nutritional outcomes. The treatment of LI involves the reduction, but not complete elimination, of lactose-containing foods. By contrast, breastfed infants with suspected CMA should undergo a trial of a strict cow’s milk protein-free maternal elimination diet. If the infant is not breastfed, an extensively hydrolyzed or amino acid-based formula and strict cow’s milk avoidance are the standard treatment for CMA. The majority of infants with CMA can tolerate lactose, except when an enteropathy with secondary lactase deficiency is present.

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Bone health assessment of food allergic children on restrictive diets: a practical guide

Abstract: Ensuring optimal bone accrual in a food allergic child is an important task for the clinician and requires close monitoring of the restrictive diet and prompt therapeutic intervention, in an effort to avoid rickets or osteopenia.

Cited by 21 publications

References 39 publications

Incidence rate and characteristics of symptomatic vitamin D deficiency in children: a nationwide survey in Japan

Incidence rate and characteristics of symptomatic vitamin D deficiency in children: a nationwide survey in Japan

Micronutrient Status and Nutritional Intake in 0‐ to 2‐Year‐old Children Consuming a Cows’ Milk Exclusion Diet

Lactose intolerance and gastrointestinal cow’s milk allergy in infants and children – common misconceptions revisited

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