Pediatr Gastroenterol Hepatol Nutr.  2021 Jul;24(4):392-402. 10.5223/pghn.2021.24.4.392.

Growth in Infants with Cow's Milk Protein Allergy Fed an Amino AcidBased Formula

  • 1Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
  • 2Hôpital Necker-Enfants Malades, Université de Paris Descartes, Paris, France
  • 3Paediatric Allergy Unit, University Hospitals of Geneva, Geneva, Switzerland
  • 4Nestlé Health Science, Vevey, Switzerland
  • 5Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense, Denmark
  • 6Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
  • 7Cytel Software Corp, Cambridge, MA, USA
  • 8Paediatric Gastroenterology and Hepatology Unit, La Fe University Hospital, Valencia, Spain
  • 9Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
  • 10Research Institute, Marien-Hospital, Wesel, Germany
  • 11Children's Hospital Zhejiang, University School of Medicine, Hangzhou, China


The present study assessed the role of an amino acid-based formula (AAF) in the growth of infants with cow's milk protein allergy (CMPA).
Non-breastfed, term infants aged 0–6 months with symptoms suggestive of CMPA were recruited from 10 pediatric centers in China. After enrollment, infants were started on AAF for two weeks, followed by an open food challenge (OFC) with cow's milk-based formula (CMF). Infants with confirmed CMPA remained on AAF until 9 months of age, in conjunction with a cow's milk protein-free complementary diet. Body weight, length, and head circumference were measured at enrollment and 9 months of age. Measurements were converted to weight-for-age, length-for-age, and head circumference-for-age Z scores (WAZ, LAZ, HCAZ), based on the World Health Organization growth reference.
Of 254 infants (median age 16.1 weeks, 50.9% male), 218 (85.8%) were diagnosed with non-IgE-mediated CMPA, 33 (13.0%) tolerated CMF, and 3 (1.2%) did not complete the OFC. The mean WAZ decreased from 0.119 to −0.029 between birth and enrollment (p=0.067), with significant catch-up growth to 0.178 at 9 months of age (p=0.012) while being fed the AAF. There were no significant changes in LAZ (0.400 vs. 0.552; p=0.214) or HCAZ (−0.356 vs. −0.284; p=0.705) from the time of enrollment to age 9 months, suggesting normal linear and head growth velocity.
The amino acid-based study formula, in conjunction with a cow's milk proteinfree complementary diet, supported normal growth till 9 months of age in a cohort of Chinese infants with challenge-confirmed non-IgE-mediated CMPA.


Anthropometry; Food hypersensitivity; Nutrition; Infant formula; Challenge test
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