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

Abstract

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.

Nutritional disorders resulting from food allergy in children

“…Nevertheless, there are some important messages from these studies: micronutrient deficiencies do frequently occur in food allergic children and these may include nutrients that have not received significant attention (ie iodine, zinc and vitamin B12) in nutritional assessment in the past. In addition to this, in those studies that have performed both dietary analysis and blood markers, there is often a poor correlation between dietary intake and actual deficiency . In early childhood, breastfeeding, vs hypoallergenic formula (without/without lactose) vs mixed feeding may also impact on the micronutrient status .…”

Effects of dietary intervention on vitamin B12 status and cognitive level of 18-month-old toddlers in high-poverty areas: a cluster-randomized controlled trial

“…In view of the limitations of MMA, such as the high cost of analysis, the need for gas chromatography mass spectrometry, and especially in developing countries, the possibility of concentrations being increased by bacterial overgrowth [17], in this study, both serum vitamin B 12 and tHcy were selected as the biological basis for the assessment of the vitamin B 12 status of toddlers. The metabolic conversion of tHcy to methionine is inhibited if the coenzyme methionine synthase is not saturated with vitamin B 12 , leading to the accumulation of tHcy [18]. The results of this study showed that the serum vitamin B 12 level of young children was negatively correlated with tHcy.…”

“…According to the World Health Organization (WHO) [12, 16, 17], serum vitamin B 12 concentrations of < 200 pg/mL, 200–300 pg/mL and > 300 pg/mL were used to classify individuals as deficient, marginally deficient, or adequate, respectively. However, stand-alone marker of serum vitamin B 12 has been proven insufficient for the unequivocal diagnosis of vitamin B 12 deficiency [18]. Therefore, a tHcy concentration of > 12 μmol/L was also used to obtain a correct diagnosis, based on the suggestions in the recent literature [1].…”

Growth in Infants with Cow's Milk Protein Allergy Fed an Amino Acid-Based Formula

“…Causative factors include prolonged dietary restrictions as part of a single or multiple allergen avoidance, associated feeding difficulties, and atopic comorbidities, rather than differences in energy expenditure or nutritional needs [ 18 19 20 21 ]. Moreover, infants and young children receiving an unsupervised cow's milk exclusion diet have an increased risk of micronutrient deficiencies, mainly due to insufficient iron, calcium, and vitamin B12 intake [ 17 22 ].…”