RESUMO
This study compared the bone parameters of adolescents with persistent cow's milk allergy (CMA) with those of healthy adolescents. Adolescents with CMA had compromised bone parameters (lower bone mineral density, impaired trabecular microarchitecture, and lower bone strength). Partial exclusion diet was associated with better bone parameters than total exclusion diet. BACKGROUND: Persistent immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) may impair bone parameters and increase the risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel methodology that not only assesses trabecular and cortical bone compartments and volumetric density measurements, but also evaluates bone microarchitecture and estimates biomechanical properties through finite element analysis (FEA). Both HR-pQCT and bone strength parameters derived from FEA have shown a strong correlation with fracture risk. PURPOSE: To assess the bone density, microarchitecture, and bone strength of adolescents with persistent IgE-mediated CMA (IgE-CMA). METHODS: This was an observational, cross-sectional study with female adolescents with persistent IgE-CMA and healthy control participants matched by female sex and sexual maturation. Bone parameters were assessed by areal bone mineral density (aBMD) through dual-energy X-ray absorptiometry (DXA), bone microarchitecture by HR-pQCT at the radius and tibia, and laboratory markers related to bone metabolism. RESULTS: The median age of adolescents with persistent IgE-CMA (n = 26) was 13.0 years (interquartile range (IQR) 11.4-14.7) and of healthy control participants (n = 28) was 13.6 years (IQR 11.9-14.9). Adolescents with IgE-CMA ingested 27.4% less calcium (p = 0.012) and 28.8% less phosphorus (p = 0.009) than controls. Adolescents with IgE-CMA had lower bone mineral content (BMC) (38.83 g vs. 44.50 g) and aBMD (0.796 g/cm2 vs. 0.872 g/cm2) at lumbar spine, and lower BMC (1.11 kg vs. 1.27 kg) and aBMD (0.823 g/cm2 vs. 0.877 g/cm2) at total body less head (TBLH) (p < 0.05). However, Z-scores BMC and Z-scores aBMD at lumbar spine and TBLH, when adjusted for Z-score height/age, were not significantly different between the groups. Moreover, CMA adolescents had lower bone strength at the distal tibia (S 169 kN/mm vs. 194 kN/mm; F Load 8030 N vs. 9223 N) (p < 0.05). Pairing of groups by the presence of menarche showed compromised parameters at the tibia-lower total volumetric BMD (Tt.vBMD) (293.9 mg HA/cm3 vs. 325.9 mg HA/cm3) and trabecular vBMD (Tb.vBMD) (170.8 mg HA/cm3 vs. 192.2 mg HA/cm3), along with lower cortical thickness (Ct.th) (1.02 mm vs. 1.16 mm) and bone strength (S 174 kN vs. 210 kN; F Load 8301 N vs. 9950 N)-and at the radius (S 61 kN/mm vs. 71 kN/mm; F Load 2920 N vs. 3398 N) (p < 0.05) among adolescents with IgE-CMA. Adolescents with IgE-CMA on a total exclusion diet (n = 12) showed greater impairment of bone features than those on a partial exclusion diet (n = 14), with lower lumbar spine Z-score BMC (- 0.65 vs. 0.18; p = 0.013), lumbar spine trabecular bone score (TBS) (1.268 vs. 1.383; p = 0.005), Z-score TBS (0.03 vs. 1.14; p = 0.020), TBLH Z-score BMC (- 1.17 vs. - 0.35; p = 0.012), TBLH Z-score aBMD (- 1.13 vs. - 0.33; p = 0.027), Tt.vBMD at the tibia (259.0 mg HA/cm3 vs. 298.7 mg HA/cm3; p = 0.021), Ct.th at the tibia (0.77 mm vs. 1.04 mm; p = 0.015) and Ct.th at the radius (0.16 mm vs. 0.56 mm; p = 0.033). CONCLUSION: Adolescents with persistent IgE-CMA had lower aBMD and compromised microarchitecture (impaired trabecular microarchitecture and lower bone strength). Adolescents on a partial exclusion diet had better bone parameters than those on a total exclusion diet.
Assuntos
Densidade Óssea , Imunoglobulina E , Hipersensibilidade a Leite , Humanos , Feminino , Adolescente , Imunoglobulina E/sangue , Estudos Transversais , Hipersensibilidade a Leite/fisiopatologia , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/diagnóstico por imagem , Criança , Tomografia Computadorizada por Raios X , Absorciometria de Fóton , Estudos de Casos e Controles , Animais , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologiaRESUMO
OBJECTIVE: The objective of our study was to evaluate whether gray-scale and color Doppler ultrasound can reveal intestinal inflammation in infants with cow's milk allergy (CMA). SUBJECTS AND METHODS: This study evaluated the clinical findings and grayscale and color Doppler sonograms of 34 infants. Seventeen 0- to 6-month-old infants with suspected CMA and 17 nonsymptomatic age-matched infants were evaluated by a blinded investigator who determined the percentage of vessel density and the thickness of different parts of the bowel. Clinical and sonographic variables were evaluated in the same regions of bowel considering three time points: presentation, after 4 weeks of feeding only amino acid-based formula, and after challenge test. Likelihood ratios and receiver operating characteristic (ROC) curves were used to define a cutoff point for vascular density percentage. RESULTS: The difference in the percentage of vessel density between patients with CMA (mean, 28.1%) and control infants (mean, 7.77%) was statistically significant. ROC analysis showed that a cutoff point of 18.7% could differentiate between patients with CMA and control infants with 81.8% sensitivity and 94.1% specificity. The area under the curve was 0.941. We found statistical differences in bowel wall thickness between control patients and patients with CMA. CONCLUSION: There was a significant increase in vessel density in infants younger than 6 months with CMA compared with healthy age-matched infants. The most appropriate cutoff point for vessel density was 18.7%. The results of this study suggest that Doppler ultrasound could be used as a screening tool to diagnose CMA.