Abstract
Background-Objective: With recent evidence suggesting that growth is no longer considered a major issue in children with food allergies (FA) on elimination diet, priority has shifted to diet quality to establish healthy eating patterns and prevent non-communicable diseases. The Diet Quality Index – International (DQI-I) could be useful for assessing the overall diet quality of FA-children. This study aimed to evaluate the impact of elimination diet on DQI-I in children with FA and the accuracy of DQI-I in reflecting nutrient intake.Materials-methods: In a prospective, cross-sectional, cohort study of FA-children (2–14 years), nutritional intake was evaluated using a 7-day food frequency questionnaire, 24-h dietary recall, and the DQI-I.Results: Of the 76 children recruited, 44.7% had multiple allergies. Mean overall DQI-I score was 52 points, with only 28% of participants having good overall DQI-I (≥60 points). DQI-I moderation and balance were the most affected domains. Participants with multiple allergies had higher DQI-I moderation and balance and lower vitamin D and Ca intake. Compared to toddlers, schoolchildren had higher DQI-I variety and lower moderation and received higher vitamin B2, vitamin B12, Ca, P, and Zn. The number of allergies, age, and milk avoidance were independently associated with adjusted DQI-I moderation and balance, energy, and certain micronutrient intake. Higher percentages of participants with good DQI-I received adequate amounts of Mn and vitamins A, B6, C, and folate than those with poor DQI-I.Conclusions: In children with FA on elimination diet, the DQI-I accurately captured the deflection of diet quality related to the development of chronic, non-communicable diseases through its moderation and balance components. This is DQI-I's main purpose as a healthy diet indicator and as such it would be a useful tool responding to the needs of the contemporary shifting of priorities in FA-children's diet from quantity to quality. Nevertheless, it does not accurately reflect the intake of certain micronutrients potentially compromised by elimination diets. Therefore, regular nutritional assessment utilizing both the DQI-I and tools assessing individual nutrient intakes along with professional nutrition counseling should be integral parts of the individualized management of children with FA to ensure adequate nutrient intake and establish healthy dietary patterns.
Highlights
Elimination diets are central in the management of food allergies (FA) [1, 2]
Children with FA undergoing elimination diets have low diet quality characterized by low moderation and balance
Our findings combined with previous reports in healthy children, showing a low diet quality assessed by the Diet Quality Index – International (DQI-I), indicate that even though children with FA may be on increased risk of low diet quality due to avoidance of specific food products or groups, low diet quality seems to be a concern and a public health issue for the general pediatric population
Summary
Elimination diets are central in the management of food allergies (FA) [1, 2]. avoidance of specific foods may be a difficult task for children, while the high rate of growth renders them susceptible to energy, macronutrient, and micronutrient insufficiency [3, 4]. With recent evidence suggesting that growth issues are no longer considered as a major problem in pediatric patients with FA on elimination diet, the significance of establishing healthy eating patterns to prevent non-communicable diseases makes the diet quality during this sensitive period of life ever so important, shifting priority from quantity to quality [4, 14,15,16]. This priority highlights the importance of accurately assessing the diet quality of children with FA utilizing tools appropriate for pediatric population [17]. Materials-methods: In a prospective, cross-sectional, cohort study of FA-children (2–14 years), nutritional intake was evaluated using a 7-day food frequency questionnaire, 24-h dietary recall, and the DQI-I
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