Protein and Energy Intake in Children with Cow’s Milk Protein Allergy : The results of three-day estimated food records in Swedish children 2-11 years of age compared to control group

Abstract: Background: Cow’s Milk Protein Allergy (CMA) is one of the most common food allergies among young children. There is no effective treatment for CMA aside from elimination diets, which increase the risk for malnutrition. Proper nutritional counseling on a regular basis is recommended for children with CMA in order to guarantee an adequate dietary intake. Objective: The purpose of this study was to estimate the energy and protein intake among Swedish children 2-11 years of age with CMA and compare it with control group of children with no food allergies as well as with dietary recommendations. Method: Families who were interested in participating in this study (n=20) were asked to fill in a three-day estimated food record as well as answer a questionnaire. Results: Results show that the average daily intake of energy and protein in children 2-11 years with CMA was almost 10% lower compared to non-allergic children of the same age. The estimated energy intake in both groups was close to the daily requirements of the Nordic Nutrition Recommendations (NNR), as opposed to that by the America Academy of Pediatrics (AAP). The estimated protein intake in both groups was higher than the NNR and WHO daily recommendations per kg/day. The questionnaire shows that 60% of families of children with CMA have previously received nutritional support from a clinical dietitian. Most families of allergic children choose either soya-based or oat-based products as alternatives to milk, all of which contain less protein than milk. While none of the children in both groups reached the recommended daily intake for calcium, only 30% of children with CMA took calcium supplements. None of the children in both groups reached the recommended daily intake for vitamin D. Conclusion: Results of this study suggests an increased need for nutritional guidance by a clinical dietitian on a regular basis among children aged 2-11 years with CMA, as these children were found to have almost 10% lower average daily intake of both energy and protein than non-allergic children of the same age. Alternatives to milk used among families of children with CMA contain less protein than milk. Low calcium intake among children with CMA suggests a need for calcium supplements among all children with CMA. Vitamin D intake was low among all children in this study.