An early childhood history of cow's milk allergy may be associated with lower adolescent radial and tibial volumetric bone mineral density compared with peers with refuted CMA and healthy controls.
Key Findings
Results
Adolescents with challenge-confirmed CMA in infancy had lower total volumetric bone mineral density at the distal radius compared with those with refuted CMA.
Lower median total vBMD at the distal radius in the CMA-confirmed group versus CMA-refuted group (Z-scores -1.49 vs -0.78)
Differences were observed after adjusting for sex, age-adjusted BMI, past 5 years' mean daily supervised physical activity, daily vitamin D intake from food and supplements, and mean daily intake of dairy products
Measurements were performed using peripheral quantitative CT (pQCT)
Participants were followed up at 15-18 years of age (median age 17.3 years)
Results
Adolescents with challenge-confirmed CMA in infancy had lower total and trabecular volumetric bone mineral density at the distal tibia compared with healthy controls.
Lower median total vBMD at the distal tibia in the CMA-confirmed group versus controls (Z-scores -0.05 vs +0.01)
Lower median trabecular vBMD at the distal tibia in the CMA-confirmed group versus controls (Z-scores +0.20 vs +0.51)
Controls were age-matched and recruited separately (n=49)
Differences were adjusted for sex, age-adjusted BMI, physical activity, vitamin D intake, and dairy product intake
Results
No differences in body composition were found between any of the study groups.
Body composition was measured using bioelectric impedance analysis
Secondary outcomes included body composition differences between CMA-confirmed, CMA-refuted, and control groups
No group differences in body composition were detected despite differences in bone density measures
Methods
The study population originated from a randomised controlled trial from 1999 to 2001 evaluating the effect of probiotics on atopic eczema, with CMA status confirmed by double-blind placebo-controlled cow's milk challenge in infancy.
Original study participants all had atopic eczema
CMA was confirmed in 43 participants and refuted in 38 participants by double-blind placebo-controlled cow's milk challenge
Follow-up occurred at 15-18 years of age
49 age-matched controls were recruited separately
Total follow-up cohort comprised 81 original trial participants plus 49 controls
62% of participants were female
Methods
The study adjusted for multiple potential confounders including physical activity, vitamin D intake, and dairy product consumption when comparing bone outcomes across groups.
Covariates included sex, age-adjusted body mass index, past 5 years' mean daily supervised physical activity, daily vitamin D intake from food and supplements, and mean daily intake of dairy products
Primary outcome was volumetric bone mineral density measured with peripheral quantitative CT
Both distal radius and distal tibia were assessed as skeletal measurement sites
Piippo S, Varimo T, Hauta-Alus H, Viljanen M, Savilahti E, Mäkitie O, et al.. (2026). Bone structure and body composition in adolescents with cow's milk allergy in infancy: a clinical cohort study.. BMJ paediatrics open. https://doi.org/10.1136/bmjpo-2025-004087