Diet Diversity and Feeding Practices in Toddlers With and Without Food Allergy – A Cross-Sectional Study

Background/Objectives: This study aimed to evaluate diet diversity and feeding practices in toddlers with food allergy (FA) compared to healthy peers. Methods: This cross-sectional survey was conducted in Polish nurseries and included children aged 13-36 months with and without FA. Parents completed a questionnaire assessing feeding practices, anthropometric measurements, diet diversity using the Food Frequency Questionnaire and feeding difficulties using the Montreal Children’s Hospital Feeding Scale. Results: Data from 388 children (predominantly from Warsaw and from families with good socioeconomic status) were analyzed. Among them, 61 had FA confirmed by a physician (however an oral food challenge was performed only in one-third of cases). The proportion of children with underweight (≤3 percentile) was similar between the FA and non-FA groups (3.4 versus 0.9%, respectively). Compared with the non-FA group children with FA had significantly lower median overall diet diversity, food group diversity (≥ 9 food groups), food item diversity, and mean food allergen diversity. The WHO Minimum Dietary Diversity and fruit/vegetable diversity were similar in both groups. We found no difference in the proportion of children with feeding difficulties between the FA and non-FA groups (median = 18 versus 13.5%). Although a lower proportion of children with FA had introduced cow’s milk, hen’s egg, tree nuts, nuts and sesame compared with the non-FA group, only a minority had confirmed allergies to nuts, peanuts and sesame. Conclusions: Children aged 13-36 months with FA are at risk of reduced overall diet diversity and over-restriction of potentially allergenic foods.