title: The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies.
abstract: BACKGROUND
  Non immunoglobulin E (IgE) mediated allergies affecting the gastrointestinal tract require an elimination diet to aid diagnosis. The elimination diet may entail multiple food eliminations that contribute significantly to macro- and micro-nutrient intake which are essential for normal growth and development. Previous studies have indicated growth faltering in children with IgE-mediated allergy, but limited data is available on those with delayed type allergies. We therefore performed a study to establish the impact on growth before and after commencing an elimination diets in children with food protein induced non-IgE mediated gastrointestinal allergies.
  
  
  METHODS
  A prospective, observational study was performed at the tertiary gastroenterology department. Children aged 4 weeks-16 years without non-allergic co-morbidities who were required to follow an elimination diet for suspected food protein induced gastrointestinal allergies were included. Growth parameters pre-elimination were taken from clinical notes and post-elimination measurements (weight and height) were taken a minimum of 4 weeks after the elimination diet. A 3-day estimated food diary was recorded a minimum of 4 weeks after initiating the elimination diet, including also any hypoallergenic formulas or over the counter milk alternatives that were consumed.
  
  
  RESULTS
  We recruited 130 children: 89 (68.5 %) boys and a median age of 23.3 months [IQR 9.4-69.2]. Almost all children (94.8 %) in this study eliminated CM from their diet and average contribution of energy in the form of protein was 13.8 % (SD 3.9), 51.2 % (SD 7.5) from carbohydrates and 35 % (SD 7.5) from fat. In our cohort 9 and 2.8 % were stunted and wasted respectively. There was a statistically significant improvement in weight-for-age (Wtage) after the 4 week elimination diet. The elimination diet itself did not improve any of the growth parameters, but achieving energy and protein intake improved Wtage and WtHt respectively, vitamin and/or mineral supplements and hypoallergenic formulas were positively associated with WtHt and Wtage.
  
  
  CONCLUSIONS
  With appropriate dietary advice, including optimal energy and protein intake, hypoallergenic formulas and vitamins and mineral supplementation, growth parameters increased from before to after dietary elimination. These factors were positively associated with growth, irrespective of the type of elimination diet and the numbers of foods eliminated.
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Rosan
authors.initials: R
authors.lastname: Meyer
authors.affiliation: Department of Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: De Koker
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Dziubak
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Godwin
authors.affiliation: Niño Jesús University Children Hospital, Madrid, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Dominguez-Ortega
authors.affiliation: Paediatric Gastroenterology, Universidade Federal de Sao Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Chebar Lozinsky
authors.affiliation: Department of Nutrition and Dietetics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Ana-Kristina
authors.initials: AK
authors.lastname: Skrapac
authors.affiliation: Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Yara
authors.initials: Y
authors.lastname: Gholmie
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Reeve
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK ; Institute of Child Health, University College, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
keywords: Anthropometric measures; Growth; Malnutrition; Non-IgE mediated allergy; Nutrients