Skip to main content
×
×
Home

Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics

  • C. Dupont (a1), J. P. Chouraqui (a2), D. de Boissieu (a1), A. Bocquet (a3), J. L. Bresson (a1), A. Briend (a4), D. Darmaun (a5), M. L. Frelut (a1), J. Ghisolfi (a6), J. P. Girardet (a7), O. Goulet (a1), R. Hankard (a8), D. Rieu (a9), M. Vidailhet (a10) and D. Turck (a11)...
Abstract

The diagnosis of cows' milk protein allergy (CMPA) requires first the suspicion of diagnosis based on symptoms described in the medical history, and, second, the elimination of cows' milk proteins (CMP) from the infant's diet. Without such rigorous analysis, the elimination of CMP is unjustified, and sometimes harmful. The elimination diet should be strictly followed, at least until 9–12 months of age. If the child is not breast fed or the mother cannot or no longer wishes to breast feed, the first choice is an extensively hydrolysed formula (eHF) of CMP, the efficacy of which has been demonstrated by scientifically sound studies. If it is not tolerated, an amino acid-based formula is warranted. A rice protein-based eHF can be an alternative to a CMP-based eHF. Soya protein-based infant formulae are also a suitable alternative for infants >6 months, after establishing tolerance to soya protein by clinical challenge. CMPA usually resolves during the first 2–3 years. However, the age of recovery varies depending on the child and the type of CMPA, especially whether it is IgE-mediated or not, with the former being more persistent. Once the child reaches the age of 9–12 months, an oral food challenge is carried out in the hospital ward to assess the development of tolerance and, if possible, to allow for the continued reintroduction of CMP at home. Some children with CMPA will tolerate only a limited daily amount of CMP. The current therapeutic options are designed to accelerate the acquisition of tolerance thereof, which seems to be facilitated by repeated exposure to CMP.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Professor C. Dupont, email christophe.dupont@nck.aphp.fr
References
Hide All
1 Høst, A (2002) Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol 89, Suppl. 1, 3337.
2 Noimark, L & Cox, HE (2008) Nutritional problems related to food allergy in childhood. Pediatr Allergy Immunol 19, 188195.
3 Tuokkola, J, Kaila, M, Pietinen, P, et al. (2008) Agreement between parental reports and patient records in food allergies among infants and young children in Finland. J Eval Clin Pract 14, 984989.
4 Savilahti, E (2000) Food-induced malabsorption syndromes. J Pediatr Gastroenterol Nutr 30, Suppl., S61S66.
5 Ferrara, M, Coppola, L, Coppola, A, et al. (2006) Iron deficiency in childhood and adolescence: retrospective review. Hematology 11, 183186.
6 Chouraqui, JP, Dupont, C, Bocquet, A, et al. (2008) Feeding during the first months of life and prevention of allergy (in French). Arch Pediatr 15, 431442 (Committee on Nutrition of the French Society of Pediatrics).
7 Committee on Nutrition of the French Society of Pediatrics (2000) The use of antigen reduced infant formulae (in French). Arch Pediatr 7, 302306.
8 Vandenplas, Y, Koletzko, S, Isolauri, E, et al. (2007) Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 92, 902908.
9 Commission Directive 1999/21/EC of 25 March 1999 on dietary foods for special medical purposes (1999) Off J Eur Commun (7 April 1999) L 91/29. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri = OJ:L:1999:091:0029:0036:EN:PDF (accessed 15 July 2011).
10 Commission Directive 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC (2006) Off J Eur Union (30 December 2006). L 401/1. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri = OJ:L:2006:401:0001:0033:EN:PDF (accessed 15 July 2011).
11 Aggett, PJ, Haschke, F, Heine, W, et al. (1993) Comment on antigen-reduced infant formulae. ESPGAN Committee on Nutrition. Acta Paediatr 82, 314319.
12 Høst, A, Koletzko, B, Dreborg, S, et al. (1999) Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 81, 8084.
13 Taylor, SL, Hefle, SL, Bindslev-Jensen, C, et al. (2004) A consensus protocol for the determination of the threshold doses for allergenic foods: how much is too much? Clin Exp Allergy 34, 689695.
14 Moneret-Vautrin, DA & Kanny, G (2004) Update on threshold doses of food allergens: implications for patients and the food industry. Curr Opin Allergy Clin Immunol 4, 215219.
15 Bindels, JG & Boerma, JA (1994) Hydrolysed cow's milk formulae. Pediatr Allergy Immunol 5, 189190.
16 Rosendal, A & Barkholt, V (2000) Detection of potentially allergenic material in 12 hydrolyzed milk formulas. J Dairy Sci 83, 22002210.
17 Wahn, U, Wahl, R & Rugo, E (1992) Comparison of the residual allergenic activity of six different hydrolyzed protein formulas. J Pediatr 121, S80S84.
18 Hoffman, KM & Sampson, HA (1997) Serum specific-IgE antibodies to peptides detected in a casein hydrolysate formula. Pediatr Allergy Immunol 8, 185189.
19 Plebani, A, Restani, P, Naselli, A, et al. (1997) Monoclonal and polyclonal antibodies against casein components of cow milk for evaluation of residual antigenic activity in 'hypoallergenic' infant formulas. Clin Exp Allergy 27, 949956.
20 Mäkinen-Kiljunen, S & Sorva, R (1993) Bovine beta-lactoglobulin levels in hydrolysed protein formulas for infant feeding. Clin Exp Allergy 23, 287291.
21 Niggemann, B, von Berg, A, Bollrath, C, et al. (2008) Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy. Pediatr Allergy Immunol 19, 348354.
22 Høst, A & Samuelsson, EG (1988) Allergic reactions to raw, pasteurized, and homogenized/pasteurized cow milk: a comparison. A double-blind placebo-controlled study in milk allergic children. Allergy 43, 113118.
23 Sampson, HA, Bernhisel-Broadbent, J, Yang, E, et al. (1991) Safety of casein hydrolysate formula in children with cow milk allergy. J Pediatr 118, 520525.
24 Oldaeus, G, Björkstén, B, Einarsson, R, et al. (1991) Antigenicity and allergenicity of cow milk hydrolysates intended for infant feeding. Pediatr Allergy Immunol 2, 156164.
25 Oldaeus, G, Bradley, CK, Björkstén, B, et al. (1992) Allergenicity screening of “hypoallergenic” milk-based formulas. J Allergy Clin Immunol 90, 133135.
26 Giampietro, PG, Kjellman, NI, Oldaeus, G, et al. (2001) Hypoallergenicity of an extensively hydrolyzed whey formula. Pediatr Allergy Immunol 12, 8386.
27 Dean, TP, Adler, BR, Ruge, F, et al. (1993) In vitro allergenicity of cows' milk substitutes. Clin Exp Allergy 23, 205210.
28 Halken, S, Høst, A, Hansen, LG, et al. (1993) Safety of a new, ultrafiltrated whey hydrolysate formula in children with cow milk allergy: a clinical investigation. Pediatr Allergy Immunol 4, 5359.
29 Caffarelli, C, Plebani, A, Poiesi, C, et al. (2002) Determination of allergenicity to three cow's milk hydrolysates and an amino acid-derived formula in children with cow's milk allergy. Clin Exp Allergy 32, 7479.
30 Terheggen-Lagro, SW, Khouw, IM, Schaafsma, A, et al. (2002) Safety of a new extensively hydrolysed formula in children with cow's milk protein allergy: a double blind crossover study. BMC Pediatr 2, 10.
31 Verwimp, JJ, Bindels, JG, Barents, M, et al. (1995) Symptomatology and growth in infants with cow's milk protein intolerance using two different whey-protein hydrolysate based formulas in a primary health care setting. Eur J Clin Nutr 49, Suppl. 1, S39S48.
32 Hill, DJ, Murch, SH, Rafferty, K, et al. (2007) The efficacy of amino acid-based formulas in relieving the symptoms of cow's milk allergy: a systematic review. Clin Exp Allergy 37, 808822.
33 de Boissieu, D & Dupont, C (2002) Allergy to extensively hydrolyzed cow's milk proteins in infants: safety and duration of amino-acid based formula. J Pediatr 141, 271273.
34 Niggemann, B, Binder, C, Dupont, C, et al. (2001) Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol 12, 7882.
35 Burks, W, Jones, SM, Berseth, CL, et al. (2008) Hypoallergenicity and effects on growth and tolerance of a new amino acid-based formula with docosahexaenoic acid and arachidonic acid. J Pediatr 153, 266271.
36 Fiocchi, A, Restani, P, Bernardini, R, et al. (2006) A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: a multi-centre study. Clin Exp Allergy 36, 311316.
37 Reche, M, Pascual, C, Fiandor, A, et al. (2010) The effect of a partially hydrolysed formula based on rice protein in the treatment of infants with cow's milk protein allergy. Pediatr Allergy Immunol 21, 577585.
38 Bocquet, A, Bresson, JL, Briend, A, et al. (2001) Soybean-based formulas in infant nutrition (in French). Arch Pediatr 8, 12261233 (Committee on Nutrition of the French Society of Pediatrics).
39 Agostoni, C, Axelsson, I, Goulet, O, et al. (2006) Soy protein infant formulae and follow-on formulae: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 42, 352361 (ESPGHAN Committee on Nutrition).
40 Bhatia, J, Greer, F & American Academy of Pediatrics Committee on Nutrition (2008) Use of soy protein-based formulas in infant feeding. Pediatrics 121, 10621068.
41 Zeiger, RS, Sampson, HA, Bock, SA, et al. (1999) Soy allergy in infants and children with IgE-associated cow's milk allergy. J Pediatr 134, 614622.
42 Klemola, T, Vanto, T, Juntunen-Backman, K, et al. (2002) Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy: a prospective, randomized study with a follow-up to the age of 2 years. J Pediatr 140, 219224.
43 Liu, T, Howard, RM, Mancini, AJ, et al. (2001) Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol 137, 630636.
44 Fox, AT, Du Toit, G, Lang, A, et al. (2004) Food allergy as a risk factor for nutritional rickets. Pediatr Allergy Immunol 15, 566569.
45 Yu, JW, Pekeles, G & Legault, L (2006) Milk allergy and vitamin D deficiency rickets: a common disorder associated with an uncommon disease. Ann Allergy Asthma Immunol 96, 615619.
46 du Toit, G, Meyer, R, Shah, N, et al. (2010) Identifying and managing cow's milk protein allergy. Arch Dis Child Educ Pract Ed 95, 134144.
47 Kemp, AS, Hill, DJ, Allen, KJ, et al. (2008) Guidelines for the use of infant formulas to treat cows milk protein allergy: an Australian consensus panel opinion. Med J Aust 188, 109112.
48 Allen, KJ, Davidson, GP, Day, AS, et al. (2009) Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health 45, 481486.
49 Directive 2003/89/EC of the European Parliament and of the Council of 10 November 2003 amending Directive 2000/13/EC as regards indication of the ingredients present in foodstuffs (2003) Off J Eur Union (25 November 2003) L 308/15. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri = OJ:L:2004:024:0058:0064:EN:PDF (accessed 15 July 2011).
50 Martelli, A, De, Chiara, Corvo, M, et al. (2002) Beef allergy in children with cow's milk allergy; cow's milk allergy in children with beef allergy. Ann Allergy Asthma Immunol 89, Suppl. 1, 3843.
51 Tsuruta, D, Sowa, J, Kobayashi, H, et al. (2005) Fixed food eruption caused by lactose identified after oral administration of four unrelated drugs. J Am Acad Dermatol 52, 370371.
52 Moneret-Vautrin, DA, Morisset, M, Cordebar, V, et al. (2006) Probiotics may be unsafe in infants allergic to cow's milk. Allergy 61, 507508.
53 Bruni, FM, Piacentini, GL, Peroni, DG, et al. (2009) Cow's milk allergic children can present sensitisation to probiotics. Acta Paediatr 98, 321323.
54 Konstantinou, GN, Giavi, S, Kalobatsou, A, et al. (2008) Consumption of heat-treated egg by children allergic or sensitized to egg can affect the natural course of egg allergy: hypothesis-generating observations. J Allergy Clin Immunol 122, 414415.
55 Nowak-Wegrzyn, A, Bloom, KA, Sicherer, SH, et al. (2008) Tolerance to extensively heated milk in children with cow's milk allergy. J Allergy Clin Immunol 122, 342347.
56 Roth-Walter, F, Berin, MC, Arnaboldi, P, et al. (2008) Pasteurization of milk proteins promotes allergic sensitization by enhancing uptake through Peyer's patches. Allergy 63, 882890.
57 Carroccio, A, Cavataio, F & Iacono, G (1999) Cross-reactivity between milk proteins of different animals. Clin Exp Allergy 29, 10141016.
58 Jirapinyo, P, Densupsoontorn, N, Wongarn, R, et al. (2007) Comparisons of a chicken-based formula with soy-based formula in infants with cow milk allergy. Asia Pac J Clin Nutr 16, 711715.
59 Weisselberg, B, Dayal, Y, Thompson, JF, et al. (1996) A lamb-meat-based formula for infants allergic to casein hydrolysate formulas. Clin Pediatr (Phila) 35, 491495.
60 Cantani, A (2006) A home-made meat-based formula for feeding atopic babies: a study in 51 children. Eur Rev Med Pharmacol Sci 10, 6168.
61 Aldámiz-Echevarría, L, Bilbao, A, Andrade, F, et al. (2008) Fatty acid deficiency profile in children with food allergy managed with elimination diets. Acta Paediatr 97, 15721576.
62 Christie, L, Hine, RJ, Parker, JG, et al. (2002) Food allergies in children affect nutrient intake and growth. J Am Diet Assoc 102, 16481651.
63 Jensen, VB, Jørgensen, IM, Rasmussen, KB, et al. (2004) Bone mineral status in children with cow milk allergy. Pediatr Allergy Immunol 15, 562565.
64 Aggett, PJ, Agostoni, C, Goulet, O, et al. (2001) The nutritional and safety assessment of breast milk substitutes and other dietary products for infants: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 32, 256258.
65 Hernell, O & Lönnerdal, B (2003) Nutritional evaluation of protein hydrolysate formulas in healthy term infants: plasma amino acids, hematology, and trace elements. Am J Clin Nutr 78, 296301.
66 Seppo, L, Korpela, R, Lönnerdal, B, et al. (2005) A follow-up study of nutrient intake, nutritional status, and growth in infants with cow milk allergy fed either a soy formula or an extensively hydrolyzed whey formula. Am J Clin Nutr 82, 140145.
67 Savino, F, Castagno, E, Monti, G, et al. (2005) Z-score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice-hydrolysate formula during the first two years of life. Acta Paediatr Suppl 94, 115119.
68 Lasekan, JB, Koo, WW, Walters, J, et al. (2006) Growth, tolerance and biochemical measures in healthy infants fed a partially hydrolyzed rice protein-based formula: a randomized, blinded, prospective trial. J Am Coll Nutr 25, 1219.
69 Agostoni, C, Fiocchi, A, Riva, E, et al. (2007) Growth of infants with IgE-mediated cow's milk allergy fed different formulas in the complementary feeding period. Pediatr Allergy Immunol 18, 599606.
70 Rzehak, P, Sausenthaler, S & Koletzko, S, et al. (2009) Period-specific growth, overweight and modification by breastfeeding in the GINI and LISA birth cohorts up to age 6 years Eur J Epidemiol 24, 449467.
71 Rzehak, P, Sausenthaler, S, Koletzko, S, et al. (2009) Short- and long-term effects of feeding hydrolyzed protein infant formulas on growth at < or = 6 y of age: results from the German Infant Nutritional Intervention Study. Am J Clin Nutr 89, 18461856.
72 Floch, MH, Walker, WA, Guandalini, S, et al. (2008) Recommendations for probiotic use–2008. J Clin Gastroenterol 42, Suppl. 2, S104S108.
73 Hol, J, van Leer, EH, Elink Schuurman, BE, et al. (2008) The acquisition of tolerance toward cow's milk through probiotic supplementation: a randomized, controlled trial. J Allergy Clin Immunol 121, 14481454.
74 Høst, A & Halken, S (1990) A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy 45, 587596.
75 Hill, DJ, Firer, MA, Ball, G, et al. (1993) Natural history of cows' milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy 23, 124131.
76 Iacono, G, Cavataio, F, Montalto, G, et al. (1998) Persistent milk protein intolerance in infants: the changing faces of the same disease. Clin Exp Allergy 28, 817823.
77 Høst, A, Halken, S, Jacobsen, HP, et al. (2002) Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 13, Suppl. 15, 2328.
78 Carroccio, A, Cavataio, F, Montalto, G, et al. (2000) Intolerance to hydrolysed cow's milk proteins in infants: clinical characteristics and dietary treatment. Clin Exp Allergy 30, 15971603.
79 Saarinen, KM, Pelkonen, AS, Mäkelä, MJ, et al. (2005) Clinical course and prognosis of cow's milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol 116, 869875.
80 Skripak, JM, Matsui, EC, Mudd, K, et al. (2007) The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 120, 11721177.
81 Kokkonen, J, Tikkanen, S & Savilahti, E (2001) Residual intestinal disease after milk allergy in infancy. J Pediatr Gastroenterol Nutr 32, 156161.
82 Høst, A, Andrae, S, Charkin, S, et al. (2003) Allergy testing in children: why, who, when and how? Allergy 58, 559569.
83 Bindslev-Jensen, C, Ballmer-Weber, BK, Bengtsson, U, et al. (2004) Standardization of food challenges in patients with immediate reactions to foods-position paper from the European Academy of Allergology and Clinical Immunology. Allergy 59, 690697.
84 Werfel, T, Ballmer-Weber, B, Eigenmann, PA, et al. (2007) Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 62, 723728.
85 Lieberman, P (2005) Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol 95, 217226.
86 Nowak-Wegrzyn, A & Muraro, A (2009) Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 9, 371377.
87 Rancé, F, Deschildre, A, Villard-Truc, F, et al. (2009) Oral food challenge in children: an expert review. Eur Ann Allergy Clin Immunol 41, 3549.
88 Allen, CW, Campbell, DE & Kemp, AS (2009) Food allergy: is strict avoidance the only answer? Pediatr Allergy Immunol 20, 415422.
89 Barbi, E, Berti, I & Longo, G (2008) Food allergy: from the loss of tolerance induced by exclusion diets to specific oral tolerance induction. Recent Pat Inflamm Allergy Drug Discov 2, 212214.
90 Rigal, N, Reiter, F, Morice, C, et al. (2005) Food allergy in the child: an exploratory study on the impact of the elimination diet on food neophobia (in French). Arch Pediatr 12, 17141720.
91 Niggemann, B, Staden, U, Rolinck-Werninghaus, C, et al. (2006) Specific oral tolerance induction in food allergy. Allergy 61, 808811.
92 Meglio, P, Bartone, E, Plantamura, M, et al. (2004) A protocol for oral desensitization in children with IgE-mediated cow's milk allergy. Allergy 59, 980987.
93 Longo, G, Barbi, E, Berti, I, et al. (2008) Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol 121, 343347.
94 Mazer, B (2009) Specific oral tolerance induction increased tolerance to milk in children with severe cow's milk allergy. Evid Based Med 14, 50.
95 Rolinck-Werninghaus, C, Staden, U, Mehl, A, et al. (2005) Specific oral tolerance induction with food in children: transient or persistent effect on food allergy? Allergy 60, 13201322.
96 Staden, U, Rolinck-Werninghaus, C, Brewe, F, et al. (2007) Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 62, 12611269.
97 de Boissieu, D & Dupont, C (2006) Sublingual immunotherapy for cow's milk protein allergy: a preliminary report. Allergy 61, 12381239.
98 Dupont, C, Kalach, N, Soulaines, P, et al. (2010) Cow's milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability and impact on allergic reactivity. J Allergy Clin Immunol 125, 11651167.
99 Hu, W, Grbich, C & Kemp, A (2007) Parental food allergy information needs: a qualitative study. Arch Dis Child 92, 771775.
100 Mikkelsen, A, Lissner, L & Borres, MP (2005) Milk allergy school: nutritional therapy in group for parents of children with cow's milk allergy/intolerance in primary health care. Pediatr Allergy Immunol 16, 8690.
101 Sicherer, SH & Simons, FE (2005) Quandaries in prescribing an emergency action plan and self-injectable epinephrine for first-aid management of anaphylaxis in the community. J Allergy Clin Immunol 115, 575583.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed