TOPLINE

Children with non-immunoglobulin E-mediated food allergies (non-IgE-FAs) managed with dietary interventions show improved growth trajectories, particularly in BMI-for-age z-scores. Children with food protein-induced enteropathy (FPE) exhibit less favorable BMI improvement than those with food protein-induced allergic proctocolitis (FPIAP), suggesting phenotype-specific nutritional burdens.

METHODOLOGY

• Researchers conducted a retrospective single-center observational study at the Pediatric Clinic Unit of Salesi Hospital in Ancona, Italy, including 37 children (57% male) diagnosed with non-IgE-FAs between July 2022 and June 2025.
• Anthropometric, clinical, and laboratory data were collected at baseline and follow-up visits at 6, 12, and 18 months, with weight-for-age, length-for-age, and BMI-for-age z-scores calculated using Growth Calculator 4.0 software.
• Longitudinal growth trends were assessed through individual linear regression slopes, and dietary intervention effects were evaluated with ANOVA (analysis of variance) models to compare outcomes among different dietary strategies.
• Patients with fewer than two outpatient visits, those diagnosed with eosinophilic esophagitis, and those with food protein-induced dysmotility disorders were excluded from the analysis.
• All patients received standardized nutritional counseling from a specialized pediatric nutritionist at each follow-up visit, with cow’s milk allergy diagnosed in 95% of participants.

TAKEAWAY

• Slope analyses showed a significant positive trend for BMI-for-age z-scores over time (median, 0.340; interquartile range [IQR], -0.171-1.130; P = .013), indicating overall improvement in this growth parameter during the study period.
• BMI slope differed according to phenotype when comparing children with FPE and those with FPIAP (mean slope, 0.068 ± 0.795 vs 0.782 ± 0.873, respectively; P = .048), with a large standardized effect size (Cohen d, 0.851).
• Gastrointestinal symptom prevalence decreased from baseline to 6-month follow-up, with significant reductions observed for vomiting (P < .001), diarrhea (P < .001), and bloody stools (P = .004).
• No significant differences in BMI improvement were observed between children on an elimination diet, breastfed children whose mothers followed an elimination diet, and those on a free diet (P > .05 for all).

IN PRACTICE

“Although the choice of dietary strategy did not significantly affect growth outcomes in this cohort, individualized nutritional assessment and judicious use of elimination diets remain essential,” the authors of the study wrote.

SOURCE

The study was led by Gianluca Di Cesare, MD, Azienda Ospedaliero-Universitaria delle Marche, and Simona Gatti, Polytechnic University of Marche, both in Ancona, Italy. It was published online on July 22 in Nutrients.

LIMITATIONS

The study was limited by its relatively small sample size, particularly within phenotype subgroups, which reduced statistical power to detect differences across phenotypes and dietary strategies and limited generalizability of the findings. The retrospective observational design may have introduced selection bias and confounding by indication because children with more severe disease may have been preferentially managed with more restrictive dietary strategies. The single-center design may have introduced additional selection bias. Multiple statistical comparisons were performed without adjustment for multiplicity, requiring that subgroup analyses be regarded as exploratory and hypothesis-generating. Information on potentially relevant nutritional factors, including total caloric intake and macronutrient distribution, was not systematically available, precluding adjustment for these variables. The absence of a healthy control group or comparison cohort of children with IgE-mediated food allergies limited the ability to distinguish the effects of dietary management from those of other aspects of routine clinical care.

DISCLOSURES

The study received no external funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.