title: Dairy and nondairy beverage consumption for childhood atopic eczema: what health advice to give?
abstract: BACKGROUND
  Many parents of children with atopic eczema (AE) practise empirical dietary avoidance and supplementation, and seek healthcare advice on whether consumption of dairy and nondairy beverages may be beneficial or detrimental for this condition.
  
  
  OBJECTIVE
  We investigated if frequency of consumption of beverages was associated with disease severity and quality of life (QoL).
  
  
  METHODS
  Parent-reported frequency of drinks and beverages were recorded in consecutive children with AE, and disease severity (Nottingham Eczema Severity Score; NESS), QoL (Children's Dermatology Life Quality Index; CDLQI), skin hydration (SH), transepidermal water loss (TEWL), blood pressure (BP), resting heart rate (RHR) and body mass index (BMI) were evaluated.
  
  
  RESULTS
  AE was associated with worse QoL than miscellaneous non-AE skin diseases (P < 0.001). Compared with children without AE, there was a trend for children with AE to drink less milk (P = 0.06) and more miscellaneous beverages (such as Chinese herbal tea and soymilk; P = 0.03). In children with AE, NESS correlated with CDLQI (ρ = 0.66, P < 0.001) and reduced SH (ρ = -0.32, P < 0.001), whereas CDLQI correlated with a higher RHR (ρ = 0.25, P < 0.01). Multiple logistic regression showed that male sex (OR = 0.44, 95% CI 0.20-0.97; P = 0.04) and drinking fresh milk (OR = 0.42, 95% CI 0.20-0.93; P = 0.03) were independent factors associated with less severe disease. Moderate to severe impairment of CDLQI was associated with NESS (OR = 1.48, 95% CI 1.28-1.71; P < 0.001) and RHR (OR = 1.05, 95% CI 1.02-1.08; P < 0.01) but not with reported habits of beverage consumption. Concerning cardiovascular health in AE, frequency of formula milk consumption was associated with RHR (ρ = 0.17, P = 0.04), and soft drink consumption was associated with higher systolic blood pressure (SBP) (ρ = 0.18, P = 0.04).
  
  
  CONCLUSIONS
  This study provides evidence for parental/patient guidance. Children with AE who reported more fresh milk consumption had less severe disease. There was no correlation between consumption of nondairy beverages with disease severity or QoL, but frequency of soft drink consumption correlated with SBP. With these results being supported by a literature review, it is reasonable to advise parents that fresh milk can be consumed by unsensitized children with AE. Soft drinks and other beverages should not be consumed in excess for optimal cardiovascular health and for other health reasons.
authors.affiliation: Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: K L
authors.initials: KL
authors.lastname: Hon
authors.affiliation: Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Y C
authors.initials: YC
authors.lastname: Tsang
authors.affiliation: Pilot Laboratory, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macau, China.
authors.forename: T C W
authors.initials: TC
authors.lastname: Poon
authors.affiliation: Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: N H H
authors.initials: NH
authors.lastname: Pong
authors.affiliation: Hong Kong Dermatology Foundation Ltd, Hong Kong SAR, China.
authors.forename: N M
authors.initials: NM
authors.lastname: Luk
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
authors.forename: T N H
authors.initials: TN
authors.lastname: Leung
authors.affiliation: Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: C M
authors.initials: CM
authors.lastname: Chow
authors.affiliation: Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: T F
authors.initials: TF
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000818:Animals; D001628:Beverages; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D015930:Diet Records; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008892:Milk; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000503:physiopathology; D014870:Water Loss, Insensible / Q000502:physiology