Milk Substitutes Adequately Address Nutritional Needs for Individuals with Milk Allergies

Milk substitutes generally lead to positive impacts on the nutritional status of those with cow's milk allergy, according to new findings, though effects vary and consideration of variations in nutrient composition and evaluation of nutritional status may be needed.¹

These findings were the result of a new cross-sectional study conducted to evaluate children with allergies to cow’s milk and the effect of alternative milk substitutes on their nutritional status and intake of vitamins such as calcium.

This research was led by Zeynep Parlak-Hela, from the department of pediatrics at Hacettepe University Faculty of Medicine in Ankara, Turkey. The investigators noted that cow’s milk allergy is the most common medical reason for implementing plant-based beverages as a replacement for cow's milk during childhood years.²

“In this study, we aimed to determine the types of milk substitutes that are being used/preferred by children with (cow's milk allergy) older than 2 years of age and to comprehensively compare the contribution of the different milk substitutes to the nutritional status, by including data on anthropometric measurements and biochemical parameters…in addition to nutrient intake,” Parlak-Hela and colleagues wrote.

Trial Design

The Pediatric Allergy Department of Hacettepe University carried out its research from January - July 2021, assessing individuals with diagnoses of IgE-mediated allergy to cow’s milk who were also over the age of 2 years. These subjects had been given their diagnosis using 2 criteria: a positive specific IgE (sIgE ≥0.35 kU/L) and/or a positive skin prick test (≥3 mm from the negative control).

Participants also had to either have reported anaphylaxis within 2 hours of allergenic food consumption within the previous year or have a positive oral food challenge. The specific IgE for the food allergen was evaluated by the investigators through the Immuno-CAP method in the patients' sera.

Children involved in the study with conditions necessitating a specialized type of diet, systemic diseases, malabsorptive diseases, or those taking corticosteroids or other drugs impacting growth were excluded by the research team from this analysis.

The medical history of subjects, their dietary intake, and their socio-demographic data were all evaluated by the team using a questionnaire. This survey included an assessment of details such as age at the time of food allergy diagnosis, family history of atopy, previous reports of anaphylaxis, and concurrent allergic conditions.

A prospective three-day food diary was implemented by the investigators to assess dietary intake among participants. Before this, parents were given thorough instruction from a research dietitian on the recording of foods and were asked to do so for each food item consumed. To do this, household measurements with detailed descriptions were utilized.

These parents were also instructed to note the brand, type, and volume of any therapeutic formulas as well as plant-based beverages. They calculated nutrient and energy intakes through the use of a computer-aided nutrition database software program, and the investigators later determined biochemical markers of nutritional status.

Conclusions

There were 102 children with cow's milk allergy involved in this cross-sectional study overall, with subjects having a median age of 3.7 years and 68.6% of them being male. The investigators concluded that 51% of the participants had multiple allergies to different foods.

The research team reported that across all age ranges, children who had gone without consuming milk substitutes had lower intake of calcium in their diets as well as riboflavin, and vitamin D versus consumers of formula or plant-based beverages (P < .01). They found that 19.6% of the subjects had consumed therapeutic formula, 44.1% of them had consumed plant-based beverages, and 36.3% had not consumed any milk substitutes.

The team noted that the children in the formula-fed cohorts were found to have increased intake of zinc in their diets among those in the 2–3 year-old age cohort (P = .011), as well as increased intake of iron (P = .004). The formula-fed subjects were also reported to have higher levels of serum vitamin B12 (ng/L) and 25-OH vitamin D (μg/L) versus consumers of plant-based alternatives (P = .005 and P < .001, respectively.

This was also found among subjects who had not consumed any milk substitutes (P < .001). Additionally, the investigators concluded that all subjects in every age bracket who had not implemented a milk substitute were unable to achieve an adequate intake of dietary calcium.

“The variety of formulas used in the management of (cow's milk allergy) is also increasing day by day. In patients over 2 years of age, the choice of suitable formula should be evaluated taking into account their increased nutritional needs and consumption habits,” they wrote. “Our results support the need for personalized nutritional advice, given the clinical diversity affecting nutritional status, as well as the impact of individual differences in nutritional management in (cow's milk allergy).”

References

1. ^{Parlak-Hela Z, Sahiner UM, Sekerel BE, Soyer O. The contribution of milk substitutes to the nutritional status of children with cow's milk allergy. Pediatr Allergy Immunol. 2024; 35:e14202. doi:10.1111/pai.14202.}
2. ^{Singhal S, Baker RD, Baker SS. A comparison of the nutritional value of cow's milk and nondairy beverages. J Pediatr Gastroenterol Nutr. 2017; 64: 799-805.}