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Effect of cow's milk protein allergy during infancy on eating behavior at 4 years of age: A cohort study

Jardim-Botelho A, de Oliveira MBB, Motta-Franco J, Martins TG, Vieira SCF, Barreto IDC, Bezerra AV, Gurgel RQ. Effect of cow's milk protein allergy during infancy on eating behavior at 4 years of age: A cohort study. J Pediatr Gastroenterol Nutr. 2026 Apr;82(4):1119-1128. doi: 10.1002/jpn3.70348. Epub 2026 Jan 18. PMID: 41549480; PMCID: PMC13050815.

Abstract

Objectives: This study aimed to investigate the eating behaviors of preschool children who had been exposed to a restricted diet due to an oral food challenge‐confirmed diagnosis of cow's milk protein allergy (CMPA) during early infancy.

Methods: This prospective cohort study compared the eating behaviors of Brazilian children previously diagnosed with CMPA to those of a nonallergic control group. Baseline data on infant feeding, clinical history, and sociodemographic characteristics were collected and later analyzed in association with the Children's eating behavior questionnaire (CEBQ) at 4 years of age. Linear regression models were used to assess associations between CMPA and CEBQ scores, with both crude and adjusted analyses performed.

Results: A total of 74 children, with a mean age of 3.2 months at recruitment, were enrolled (30 with CMPA and 44 controls). Cesarean section delivery, rural geographic location, early introduction of substitute infant formula, and a family history of atopy were associated with higher food fussiness scores. After adjusting for early predictors of eating behaviors, the CMPA group scored significantly higher on the “desire to drink” scale (B adjusted: 2.61; p = 0.031) and on the “food fussiness” scale (B adjusted: 4.07; p = 0.017).

Conclusions: Adherence to a CME diet during infancy, following an OFCconfirmed CMPA diagnosis, was found to have a long‐term impact on eating behavior, as evidenced by higher scores on food fussiness and desire to drink scales, which are linked to feeding difficulties.

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