Micronutrient Status and Nutritional Intake in 0- to 2-Year-old Children Consuming a Cows' Milk Exclusion Diet. Issue 5 (May 2018)

• Record Type: Journal Article
• Authors: Kvammen, Janne A.; Thomassen, Rut A.; Eskerud, Mari B.; Rugtveit, Jarle; Henriksen, Christine
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 66:Issue 5(2018)
• Publication Date: 2018-05
• Subjects: breast-feeding -- children -- complementary feeding -- cow's milk protein–free diet -- feeding patterns -- micronutrients; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000001942
• Languages: English
• ISSNs: 0277-2116

Abstract

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.