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Cow's milk protein intolerance in infants under 1 year of age: a prospective epidemiological study
J J Schrander1, J P van den Bogart, P P Forget
1Department of Paediatrics, Academic Hospital Maastricht, The Netherlands.
Insights
Cow's milk protein intolerance (CMPI) affects 2.8% of infants, primarily causing gastrointestinal, skin, and respiratory symptoms. Family history of atopy showed weak associations, with limited clinical value in diagnosis.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Gastroenterology
Background:
- Cow's milk protein intolerance (CMPI) is a common concern in infants.
- Accurate diagnosis and incidence rates are crucial for effective management.
- Previous studies have varied in diagnostic criteria and population selection.
Purpose of the Study:
- To determine the incidence and clinical manifestations of CMPI in a large cohort of infants.
- To evaluate the diagnostic utility of elimination/challenge tests and family history.
- To differentiate CMPI from other infant feeding issues.
Main Methods:
- Prospective follow-up of 1158 unselected infants from birth to 1 year.
- Standardized diagnostic protocol including elimination and challenge tests after excluding lactose intolerance.
- Comparison of symptomatic infants, healthy controls, and those improving on lactose-reduced formula.
Main Results:
- The incidence of CMPI was calculated to be 2.8% (26 out of 1158 infants).
- Gastrointestinal (50%), dermatological (31%), and respiratory (19%) symptoms were most common in CMPI infants.
- Positive family history for atopy was frequent but showed weak statistical differences between CMPI and control groups.
Conclusions:
- CMPI affects a small but significant percentage of infants, presenting with diverse symptoms.
- Diagnostic criteria, including elimination/challenge tests, are essential for confirming CMPI.
- Family history of atopy has limited predictive value for diagnosing CMPI in this cohort.
Abstract:
Incidence and clinical manifestation of cow's milk protein intolerance (CMPI) were studied in 1158 unselected newborn infants followed prospectively from birth to 1 year of age. No food changes were required in 914 infants who were used as healthy controls. When CMPI was suspected (211 infants), diagnostic dietary interventions according to a standard protocol were performed. After exclusion of lactose intolerance, two positive cow's milk elimination/challenge tests were considered diagnostic of CMPI. Two hundred and eleven symptomatic infants were examined for possible CMPI. A large group of 80 infants improved on a lactose reduced formula. In 87/211 infants CMPI was excluded (sick controls). Finally CMPI was proven in 26 infants. The calculated incidence rate for CMPI was 2.8%. The principal symptoms in infants with CMPI were gastrointestinal, dermatological and respiratory in 50%, 31% and 19% respectively. A positive family history for atopy (first or second degree relatives) was more frequent in either CMPI infants (65%), or sick controls (63%) when compared to either healthy controls (35%) or infants improving on a low lactose formula (51%). Differences between patients with CMPI and sick controls were only found for the presence of atopy in at least 2 first degree relatives [(5/26 in CMPI infants and 4/87 in sick controls (P < 0.05)] and for multiorgan involvement [10/26 infants with CMPI as opposed to 12/87 in the sick control group (P < 0.02)]. These statistical differences are too weak to be of clinical value.