The contribution of milk substitutes to the nutritional status of children with cow's milk allergy

Abstract Background The impact of alternative milk substitutes on the nutritional status of children with cow's milk allergy (CMA), the prevailing cause of food allergies, is unresolved. Methods A cross‐sectional study was performed in children older than 2 years with IgE‐mediated CMA. Patients' clinical characteristics, anthropometric measurements, dietary intake (by 3‐day food diary), and biochemical markers of nutritional status were assessed. Results One hundred two children with CMA (68.6% boys; median age, 3.7 years; 51% multiple food allergies) were evaluated. 44.1% of the children consumed plant‐based beverages (PBB), 19.6% therapeutic formula and 36.3% did not consume any milk substitutes. In all age groups, dietary calcium, riboflavin, and vitamin D intake of those who did not use milk substitutes were lower than those who consumed formula or PBB ( p < .01). Also in the 2–3 years old age group, dietary zinc ( p = .011) and iron intake ( p = .004) of the formula‐fed group was higher. Formula‐fed patients had higher levels of 25‐OH vitamin D (μg/L) and serum vitamin B 12 (ng/L) than PBB‐fed patients (respectively; p < .001, p = .005) and those who did not consume any milk substitute ( p < .001). Patients of all ages who did not utilize a milk substitute failed to obtain an adequate amount of dietary calcium. Conclusion The use of milk substitutes positively affects dietary calcium, riboflavin, and vitamin D intake in CMA, but their contribution is variable. Those who do not use milk substitutes are at greater risk inadequate of dietary calcium intake. Personalized nutritional advice, given the clinical diversity and the impact of individual differences, is required.