ESPE Abstracts

Background: The primary source of dietary calcium is often cow’s milk. Previous studies show a reduced bone mineral density (BMD), measured by dual energy x-ray absorptiometry, in children with cow’s milk allergy (CMA). No studies using peripheral quantitative computed tomography (pQCT) to determine bone health have been carried out in subjects with CMA. Long-term effects of a milk elimination diet during infancy on bone health are unknown.

Methods: Participants from a randomised controlled trial evaluating the effect of probiotics on atopic eczema (AE) from 1999-2001 were recruited to a follow-up visit at the age of 16-18 years; age-matched controls were also included. Participants in the original study had AE and suspected CMA, and either a positive or negative result from a double-blind placebo controlled oral cow’s milk challenge. During a study visit, anthropometric values were measured, and bone health was assessed by pQCT (Stratec XCT 2000 L) of non-dominant radius and left tibia. An electronic study questionnaire collected data on physical activity, and dairy consumption via a 20-item food frequency questionnaire. Groups were compared by Kruskal-Wallis tests, and by ANCOVA.

Results: 130 participants were included (median age 17.3 years, range 16.1-18.3 years, 62% females). Of the participants with AE and CMA during infancy (CMA group, n = 43) all but one were milk tolerant. After adjusting for mean daily supervised physical activity during the past 5 years and for age-adjusted body mass index, the CMA group had, compared to participants with AE and a suspicion of CMA (CMA refuted group, n = 38), lower total volumetric BMD (vBMD) in the distal radius, Z-scores -1.49 vs -0.78, respectively (P = 0.016). At the distal tibia, the CMA group had, compared to controls (n = 49), lower total vBMD (Z-scores -0.05 vs +0.01, P = 0.003) and lower trabecular vBMD (Z-scores +0.20 vs +0.51, P = 0.007).

Conclusion: A history of a milk elimination diet due to CMA is associated with reduced vBMD in adolescence at multiple measurement sites, even when milk has been reintroduced into the diet.