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Bone Abstracts (2019) 7 P172 | DOI: 10.1530/boneabs.7.P172

ICCBH2019 Poster Presentations (1) (226 abstracts)

Cow's milk allergic infants on amino acid-based medical nutrition formula maintain adequate serum concentrations of phosphorus, calcium and magnesium despite the use of acid-suppressive medication

Bryan M Harvey 1 , Simone RBM Eussen 2 , Ardy van Helvoort 2, & Lucien F Harthoorn 2

1Children’s Investigational Research Program, LLC (ChiRP), Bentonville, USA; 2Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands; 3Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.

Objectives: We recently demonstrated that cow’s milk allergic infants who received an amino acid-based formula (AAF) for 16 weeks as oral feeding had adequate mineral status (1). One factor that may negatively affect mineral solubility and bioavailability and hence mineral status, is high gastric pH (2), but data on this in infants are lacking. Therefore, the present study evaluates serum concentrations of phosphorus, calcium and magnesium in a subgroup of infants on AAF receiving acid-suppressive medication.

Methods: This was a retrospective sub-analysis of a prospective, randomized double-blind controlled study performed between 2008 and 2012 in which infants aged 0–8 months with cow’s milk allergy received an AAF (Neocate) either with or without synbiotics (3). Serum concentrations of phosphorus, calcium and magnesium were determined after 16 weeks on AAF (n=66) and compared to age-specific reference ranges. Subgroup analysis was performed for infants who were receiving acid-suppressive medication, i.e. proton-pump-inhibitors and H2-antagonists.

Results: Approximately one-third (35%) of the infants received acid-suppressive medication, mainly H2-antagonists. At baseline, mean duration of use was 57±45 days. After 16 weeks on AAF, serum phosphorus, calcium and magnesium concentrations were 1.96 [95%CI: 1.91–2.01], 2.62 [95%CI: 2.59–2.65] and 0.95 [95%CI: 0.94–0.97] mmol/l, respectively and did not significantly differ between users (P: 1.95 [95%CI: 1.88–2.03]; Ca: 2.63 [95%CI: 2.59–2.68]; Mg: 0.96 [95%CI: 0.94–0.99]) and non-users (P: 1.97 [95%CI: 1.90–2.04]; Ca: 2.61 [95%CI: 2.58–2.65]; Mg: 0.95 [95%CI: 0.92–0.97]) of acid-suppressive medication. None of the infants had mineral concentrations below the reference range.

Conclusion: Although doses, compliance and the neutralizing effect of the acid-suppressive medication were not measured in this subgroup analysis, these data indicate that cow’s milk allergic infants orally fed with AAF for 16 weeks maintain target serum concentrations of phosphorus, calcium and magnesium even when receiving these medications. Regular review of the ongoing need for acid-suppressive medication remains recommended.


(1) Harvey BM, Eussen S, Harthoorn LF et al. (2017) Mineral Intake and Status of Cow’s Milk Allergic Infants Consuming an Amino Acid-based Formula. Journal of pediatric gastroenterology and nutrition 65, 346–349.

(2) Champagne ET (1989) Low gastric hydrochloric acid secretion and mineral bioavailability. Advances in experimental medicine and biology 249, 173–184.

(3) Burks AW, Harthoorn LF, Van Ampting MT et al. (2015) Synbiotics-supplemented amino acid-based formula supports adequate growth in cow’s milk allergic infants. Pediatric allergy and immunology: official publication of the European Society of Pediatric Allergy and Immunology 26, 316–322.

Disclosure: This research was supported by Nutricia Research, Nutricia Advanced. S.E., AvH and L.H. are employees of Nutricia Research. B.H. declares no conflict of interest.

Volume 7

9th International Conference on Children's Bone Health


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