Micronutrient Status and Nutritional Intake in 0‐ to 2‐Year‐old Children Consuming a Cows’ Milk Exclusion Diet

Objectives: To study micronutrient status and nutritional intake from complementary feeding in children on a cows’ milk exclusion (CME) diet. Methods: Fifty‐seven children with cows’ milk allergy, younger than 2 years, were included in a cross‐sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3‐day food diary. The results were analyzed according to 3 feeding patterns: mainly breast‐fed (mBF), partially breast‐fed, and no breast milk group (nBM). Results: The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p‐tHcy), s‐B12, s‐folate, b‐Hb, s‐ferritin, s‐zinc, and s‐25(OH)D. There were no significant differences between feedings groups, except for B12‐biomarkers. The mBF had higher p‐tHcy ( P < 0.000) and lower s‐B12 ( P = 0.002) compared nBM. Vitamin B12 deficiency (p‐tHcy >6.5 μmol/L combined with s‐B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group ( P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p‐tHcy ( r = −0.479, P = 0.001) and positively with s‐B12 ( r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b‐Hb ( r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements ( r = 0.456, P = 0.001). Conclusion: The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.