Evaluation of the nutritional status, food diversity and growth parameters in children admitted by food elimination with suspected food allergy

Food allergy is an abnormal and exaggerated immune response to a specific food. It has the potential to impair the quality of life of the patient and their family, and may also lead to morbidity and mortality. The current generally accepted treatment standard of care for food allergies is to identify the offending food and eliminate it from the diet. The currently generally accepted treatment for food allergies is to identify the responsible food and eliminate it from the diet. However, nutritional deficiencies and growth retardation may occur.if the caloric and nutritional equivalent of the eliminated food is not added to the diet while removing the responsible food from the diet, deficiencies in nutritional intake may result, which could lead to growth retardation. Despite there are numerous studies on the subject of growth parameters and nutritional deficiencies in patients with food allergies the literatüre, the majority of these studies have focused on a particular type of food allergy or on a specific and limited age group. Consequently, there are lack of comprehensive studies comparing macro and micronutrient intakes, food diversity, laboratory measurements, and anthropometric measurements according to the reference values of national and World Health Organization (WHO) criteria in children underwent food elimination with suspected food allergy with age- and gender-matched healthy children. The study included 40 patients younger than 10 years of age admitted to the Paediatric Allergy & Immunology outpatient department of Pamukkale University Hospital with food elimination for at least 3 months and 40 healthy children younger than 10 years of age admitted to the Paediatrics outpatient clinics of Pamukkale University Hospital. The following variables were recorded: demographic and clinical characteristics, breastfeeding or formula feeding status, time of initiation supplementary food, whether or not iron or vitamin supplements were taken, if so, the dose and duration of iron or vitamin supplements, and which foods were eliminated in patients who eliminated foods. Body weight, height and head circumference were measured and, body mass index (BMI), height-for-age, weight-for-height, and Z-scores were calculated in accordance with the reference values proposed by Neyzi and the World Health Organisation. All subjects were required to complete a food diary for a period of three days comprising two consecutive weekdays and one consecutive weekend. These diaries were uploaded to the Nutrition Information System (BeBis) by the dietician responsible for the study group, and the daily dietary intake of macro- and micronutrients, along with food diversity, was calculated for each subject separately. Blood samples were collected from all subjects for the purpose of conducting a complete blood count, total protein, albumin, creatinine, blood urea nitrogen, sodium, potassium, chlorine, calcium, phosphorus, magnesium, alkaline phosphatase, iron, iron binding capacity, transferrin saturation, ferritin, parathormone, 25 OH vitamin D, vitamin B12, folate, copper, zinc, manganese, and selenium measurements. According to our study results, the age, gender, gestational week and birth weight, parental education level, and average monthly household income of the food elimination group and healthy controls were found to be similar. Although dietary macronutrient and micronutrient intakes and food diversity were similar in the two groups, significant differences were observed in several anthropometric parameters. Children in the food elimination group exhibited lower body weight percentiles, height percentiles, and Z scores according to the Neyzi reference values, as well as lower weight-for-height percentiles and Z scores according to the World Health Organization reference values, compared to healthy controls. This difference was more striking among children youngerthan two years of age. Additionally, within the food elimination group, the anthropometric measurements were significantly lower in patients who eliminated two or more foods than in those who eliminated a single food, regardless of the food. Moreover, detailed testing revealed that 37.5% of patients in the food elimination group did not have an actualfood allergy. Our findings demonstrated that weight, height and head circumference measurements were significantly lower in patients who eliminated two or more foods, particularly in children under the age of two, without a notable discrepancy in macronutrient or micronutrient intake compared to healthy children. This highlights the importance of avoiding unnecessary food eliminations without confirming the diagnosis of food allergy and emphasises the necessity for close monitoring of growth parameters in children diagnosed with food allergy and undergoing food elimination.