Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy
Article first published online: 21 MAR 2012
© 2012 John Wiley & Sons A/S
Pediatric Allergy and Immunology
Volume 23, Issue 4, pages 307–314, June 2012
How to Cite
Meyer, R., Venter, C., Fox, A. T. and Shah, N. (2012), Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy. Pediatric Allergy and Immunology, 23: 307–314. doi: 10.1111/j.1399-3038.2012.01265.x
- Issue published online: 17 MAY 2012
- Article first published online: 21 MAR 2012
- Accepted for publication 17 December 2011
- cow’s milk allergy;
To cite this article: Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy. Pediatric Allergy Immunology 2012: 23: 307–314.
Cow’s milk protein allergy (CMPA) affects between 1.9 and 4.9% of infants and young children. This food allergy requires the complete elimination of cow’s milk and its derivatives, impacting on nutritional status. The risk of having protein energy malnutrition (PEM) in children with CMPA has been well documented. In 2007, the World Health Organisation published guidelines on the dietary management of PEM, which has impacted on the recommendations and composition on specialist feeds for many chronic diseases, but not on CMPA. The main change in management of the child with PEM is the protein energy ratio and energy requirements. The ideal protein energy ratio lies between 8.9 and 11.5%, which would ensure a deposition of about 70% lean and 30% fat mass. In addition, for optimal catch-up growth between 5 and 10 g/kg/day, energy requirements should be between 105 and 126 kcal/kg/day. Although most current hypoallergenic formulas fall well within the recommendation for protein, there is a problem in achieving energy requirements. As a result, modular additions are often made, disturbing the protein energy ratio or feeds are concentrated, which impacts on osmolality. We therefore aimed to review current guidelines on PEM and how these can be applied in the management of the malnourished child with CMPA.