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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequencies of vitamin D sufficiency levels in infants with cow&#39;s milk protein allergy and in the control group&#44; treated at an outpatient clinic in a university hospital&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Fisher&#39;s exact test&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; vitamin D deficiency has been recognized as a frequent problem&#44; which is observed in adults&#44; children&#44; and sometimes even in the neonatal period&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Classically&#44; vitamin D deficiency is associated with bone diseases&#44; but in recent years it has been associated with several extraosseous outcomes&#44; including immune diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> It appears to occur more frequently in certain groups of individuals&#59; therefore&#44; the Endocrinology Society recommends screening for vitamin D deficiency only in the group of individuals considered to be at risk&#46; This risk group would comprise individuals of black ethnicity&#44; as well as those who are obese&#44; pregnant and lactating women&#44; and individuals with certain diseases&#44; such as endocrine and renal diseases&#44; among others&#46; Individuals with cow&#39;s milk protein allergy &#40;CMPA&#41; are not included in the risk group&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In turn&#44; some international studies&#44; mainly carried out in children with the immediate forms of CMPA&#44; mediated by IgE&#44; suggested a higher frequency of vitamin D deficiency in this group&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> Low levels of vitamin D in children are associated with factors such as poor maternal&#8211;fetal transfer due to maternal hypovitaminosis&#44; inadequate sun exposure&#44; inappropriate use of vitamin D supplements&#44; and low dietary intake&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Studies on vitamin D levels in children with CMPA are important to assess whether they are a risk group for vitamin D deficiency&#46; Since most studies that assessed vitamin D levels in children with CMPA were carried out in children without gastrointestinal manifestations&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> there are gaps on the knowledge of this problem&#46; Additionally&#44; few studies have been performed in children with CMPA living in sunny regions&#44; where adequate exposure to ultraviolet rays is assumed&#46; The present study aimed to verify whether infants with CMPA present inadequate levels of vitamin D&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was an observational&#44; cross-sectional study comparing vitamin D levels in a group of infants with clinical diagnosis of CMPA and a group of healthy infants &#40;control group&#41;&#46; The study was carried out from March 2013 to April 2015 in the pediatric gastroenterology&#44; pediatric allergology&#44; and pediatric outpatient clinics of Hospital das Cl&#237;nicas at Universidade Federal de Pernambuco &#40;HC&#47;UFPE&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The group of children with CMPA consisted of 59 infants of both genders who had clinical manifestations related to CMPA&#46; The diagnosis was attained considering the clinical history&#44; physical examination&#44; and previous history&#44; and confirmed by the open oral challenge test&#44; as indicated by the main current guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> The challenge test was contraindicated by the investigators in the following situations&#58; report of immediate manifestations associated with a positive IgE result&#59; late manifestations compatible with CMPA&#44; associated with malnutrition&#46; The comparison group consisted of 61 healthy children&#46; Children with clinical suspicion of other pathologies or factors that could influence vitamin D levels&#44; such as acute or chronic infectious diseases&#44; other inflammatory bowel diseases&#44; and renal or gastrointestinal diseases were excluded&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For the anthropometric evaluation&#44; the infant&#39;s weight was obtained and the weight&#47;age &#40;W&#47;A&#41; indicator proposed by the World Health Organization &#40;WHO&#41; was used&#46; For the evaluation of W&#47;A&#44; the following cutoffs were used&#58; &#60;&#8722;2 <span class="elsevierStyleItalic">z</span>-score for low&#44; &#8805;&#8722;2 and &#60;&#43;2 <span class="elsevierStyleItalic">z</span>-score for age-appropriate&#44; and &#8805;&#43;2 <span class="elsevierStyleItalic">z</span>-score for elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding vitamin D&#44; levels and degrees of sufficiency were analyzed&#44; categorized as insufficient&#47;deficient and sufficient&#46; Vitamin D levels were considered deficient when 25&#40;OH&#41;D was &#8804;20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; insufficient&#44; when between 21 and 29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; and sufficient&#44; when &#8805;30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;13</span></a> For this analysis&#44; a blood sample &#40;4<span class="elsevierStyleHsp" style=""></span>mL&#41; was collected by a trained professional&#44; stored in a tube with separator gel&#44; and then taken to the laboratory connected with the research&#46; 25&#40;OH&#41;D was measured using the chemiluminescence technique using the LIAISON<span class="elsevierStyleSup">&#174;</span> commercial kit&#46; Parents of children who had inadequate levels of vitamin D were warned of the need for supplementation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The WHO categorization was used to classify the current practice of breastfeeding &#40;BF&#41;&#59; children were considered as in exclusive breastfeeding &#40;EBF&#41; when they received only breast milk&#44; without other liquids or solids&#59; in predominant BF&#44; when they received&#44; in addition to breast milk&#44; water or water-based preparations&#59; in supplemented BF&#44; when they received&#44; in addition to breast milk&#44; any solid or semi-solid food for the purpose of complementing it&#44; not replacing it&#59; and in mixed or partial BF&#44; when they received breast milk and other types of milk&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">When evaluating sun exposure&#44; the guidelines of the Brazilian Society of Pediatrics &#40;SBP&#41; were used&#44; which recommends that the child should receive direct exposure of the skin to sunlight after the second week of life&#59; a weekly quota of 30<span class="elsevierStyleHsp" style=""></span>min of sun exposure with the child wearing only diapers is considered sufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The construction of the database was performed using the Epi-Info software&#44; version 6&#46;04d &#40;Epi-info 6&#46;04&#44; WHO&#47;CDC&#44; Atlanta&#44; USA&#41;&#46; Statistical analyses were performed using the SPSS software&#44; version 13&#46;0 for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Continuous variables were tested for normality of distribution using the Kolmogorov&#8211;Smirnov test&#44; being expressed as mean and standard deviation when showing a symmetric distribution&#44; and as median and quartiles when the distribution was asymmetric&#46; Differences in frequency and association between categorical variables were assessed by Pearson&#39;s chi-squared or Fisher&#39;s exact tests&#44; when indicated&#46; For all tests&#44; the significance level was set at 5&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The children&#39;s parents or tutors were verbally informed about the study aims and signed the free and informed consent form&#46; The study project was registered at the National Committee of Research Ethics &#40;CONEP&#47;Plataforma Brasil&#41; and submitted to the approval of the Ethics Committee on Research in Human Beings of the Centro de Ci&#234;ncias da Sa&#250;de at Universidade Federal de Pernambuco&#44; under CAAE No&#46; 12878313&#46;4&#46;0000&#46;5208&#47;2013&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The median age of the total sample was 8&#46;5 months &#40;P25&#58; 6&#46;0&#44; P75&#58; 14&#46;0&#41;&#44; whereas in children with CMPA the median was 7&#46;0 months &#40;P25&#58; 4&#44; P75&#58; 13&#41;&#44; and in the control group&#44; it was 9&#46;0 months &#40;P25&#58; 6&#46;0&#44; P75&#58; 16&#46;0&#41;&#46; The socioeconomic and biological characteristics of the sample are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; and among them&#44; it was observed that the mothers of children with CMPA had a better level of schooling than those of the children in the comparative group &#40;69&#46;5&#37; <span class="elsevierStyleItalic">vs&#46;</span> 27&#46;9&#44; college&#47;university level of schooling&#41;&#44; as well as higher family income &#40;51&#46;7&#37; <span class="elsevierStyleItalic">vs&#46;</span>18&#37;&#44; &#62;four Brazilian minimum wages&#41;&#46; A predominance of cesarean delivery &#40;89&#46;8&#37;&#41; was observed in the group of children with CMPA&#46; There was also a higher frequency of atopy among mothers &#40;62&#46;7&#37; <span class="elsevierStyleItalic">vs&#46;</span> 34&#46;4&#37;&#41; and fathers &#40;46&#46;6&#37; <span class="elsevierStyleItalic">vs&#46;</span> 28&#46;3&#37;&#41; of children with CMPA&#46; When the nutritional status was evaluated&#44; a higher percentage of normal weight was observed in the sample&#44; with similar frequencies in both groups &#40;91&#46;5&#37; in the CMPA group and 96&#46;6&#37; in the control group&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In children with a diagnosis of CMPA&#44; the most frequent clinical manifestations were of the immediate type &#40;59&#46;3&#37;&#41;&#58; angioedema&#44; urticaria and skin hyperemia&#44; vomiting&#44; diarrhea&#44; cough&#44; and wheezing&#46; The late manifestations were&#58; regurgitation and vomiting compatible with gastroesophageal reflux disease &#40;GERD&#41;&#44; diarrhea&#44; diarrhea with blood &#40;compatible with colitis&#41;&#44; proctitis&#44; low weight gain or weight loss&#44; excessive crying and abdominal distension&#44; bowel disorders&#44; and atopic eczema&#46; Among the immediate manifestations&#44; the most prominent were urticaria in 28&#46;8&#37;&#44; angioedema in 15&#46;3&#37;&#44; and cough in 15&#46;3&#37;&#46; In the group with late manifestations&#44; 40&#46;7&#37; had vomiting and diarrhea&#44; 35&#46;6&#37; had signs of colitis&#44; and 22&#37; had symptoms compatible with GERD&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The mean levels of vitamin D among children with CMPA were 30&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;33<span class="elsevierStyleHsp" style=""></span>ng&#47;mL and 35&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;74<span class="elsevierStyleHsp" style=""></span>ng&#47;mL in the control group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the frequencies of the different levels of vitamin D sufficiency in both groups&#44; indicating that among the total number of children&#44; there was a higher frequency of deficiency levels in those with CMPA &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs&#46;</span> 8&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#46; It is noteworthy that none of the children were receiving vitamin D supplementation at the time of the interview and only nine of the mothers of children with CMPA reported receiving vitamin D supplementation during the gestational period&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> indicates that among the children with CMPA&#44; those who received exclusive&#47;predominant BF at the time of the interview had a higher frequency of vitamin D deficiency&#59; 25&#46;9&#37; of children were deficient and only 3&#46;1&#37; showed sufficient levels&#46; This finding was also observed in those receiving partial BF &#40;25&#46;9&#37; <span class="elsevierStyleItalic">vs&#46;</span> 6&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Most children with CMPA who were not breastfed &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; who were fed infant formulas&#41; showed sufficiency levels &#40;78&#46;1&#37;&#41;&#46; In the comparison group&#44; there was no association between different dietary practices and vitamin D sufficiency levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;189&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In the group of allergic children&#44; the frequency of sun exposure did not interfere with the level of vitamin D sufficiency&#59; the results were similar in those with deficiency&#47;insufficiency and in those with sufficient degrees &#40;among those with deficient&#47;sufficient degrees&#44; 14 were adequately exposed to sunlight&#44; whereas 12 were not&#59; among those with sufficient degrees&#44; 17 were adequately exposed and 13 were not&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;972&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In this study&#44; carried out among children who mostly had normal weight and were breastfed for similar periods of times&#44; children with immediate and late CMPA had a higher percentage of deficiency when compared with healthy children &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 8&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#46; Although vitamin D levels were normal in both groups&#44; a lower mean was observed in allergic children &#40;30&#46;93 <span class="elsevierStyleItalic">vs</span>&#46; 35&#46;29&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#44; reinforcing the tendency of allergic children to have lower vitamin levels&#46; Some studies have already investigated the association between vitamin D deficiency and food allergy&#44; but most of them were performed in children with the immediate form of CMPA&#44; IgE-mediated&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> This study also raises the question about the late form&#44; non-IgE-mediated&#44; which usually manifests through gastrointestinal symptoms&#46; There is an empirical basis for believing that insufficient levels of vitamin D in the early stages of life may interfere with the development of immunity&#44; contributing to the onset of allergic diseases&#44; including food allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> The main mechanism through which it would act in immune regulation would be to favor a greater differentiation of naive T lymphocytes into T regulatory cells &#40;Tregs&#41;&#44; which would inhibit both TH1 and TH2 harmful immune responses&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a> It should be considered that&#44; although deficient levels of vitamin D were observed in infants with CMPA&#44; the cross-sectional design of the study did not allow to establish a causal association between vitamin D deficiency and the occurrence of allergy&#46; It can be speculated that the association may be the opposite&#44; considering that the pathogenesis of CMPA itself may have favored low vitamin D levels&#44; both because it allows malabsorption and because it can be associated with the inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The systemic inflammatory response&#44; which might be generated during the allergic process&#44; may be associated with low concentrations of fat-soluble vitamins&#44; including vitamin D&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> The low levels could also be associated to the fact that the mothers of children with CMPA in EBF adopted a diet that restricted cow&#39;s milk and dairy products&#44; without vitamin D supplementation&#44; a fact already associated with deficiencies of vitamin D and other micronutrients&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The main sources of vitamin D for infants are dietary intake&#44; sun exposure&#44; and vitamin supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Breast milk can provide a protective effect against the development of several types of allergies due to the presence of immunological factors and functional nutrients that favor a healthy microenvironment for immune system development and intestinal maturation&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> However&#44; as it has low concentrations of vitamin D&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> children receiving BF&#44; especially those in EBF and without adequate sun exposure&#44; may represent a group at higher risk for vitamin D deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Low levels of vitamin D were observed in allergic children who were receiving BF&#44; and a higher frequency of deficient&#47;insufficient levels of vitamin D was observed among children with CMPA who were submitted to EBF&#47;predominant BF &#40;25&#46;9&#37;&#41;&#46; Evidence suggests that children who develop CMPA&#44; even those in EBF&#44; have genetic factors that predispose them to this outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> It is possible that&#44; in an infant receiving EBF who already has a genetic predisposition to CMPA&#44; the occurrence of vitamin D deficiency acts as a trigger for the development of the disease&#46; In this sense&#44; it was observed that of the eight infants who were in EBF&#47;predominant BF and developed CMPA &#40;most of them allergic colitis&#41;&#44; seven were found to have inadequate levels of vitamin D&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Studies carried out in different countries suggest the need for supplementation of infants receiving BF&#44; and sometimes of the mother&#44; even when they live in a sunny region&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> None of the children in this study received vitamin supplementation&#44; and only nine mothers of children with CMPA &#40;15&#46;3&#37;&#41; and four mothers of healthy children &#40;6&#46;6&#37;&#41; were taking supplementation&#46; It was observed that in Brazil&#44; the indication of vitamin D supplementation in the prenatal and breastfeeding periods is not yet a common practice&#44; and this perhaps needs to be considered&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Sun exposure is considered one of the most important determinants of vitamin D status&#46; Infants&#8217; vitamin D levels tend to decline over the first few months of life if they are not exposed to sunlight or if they do not receive an adequate dietary intake of vitamin D&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> In the Northeast of Brazil&#44; abundant solar irradiation occurs during most of the year&#46; However&#44; living in a sunny region may not protect infants from this vitamin deficiency&#46; When analyzing the association between sun exposure and vitamin D levels in this study&#44; it was observed that adequate sun exposure did not ensure sufficient levels of vitamin D&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In a recent study carried out in this same region&#44; insufficient levels of vitamin D were also observed in the mother&#47;newborn binomial&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> corroborating other data that indicate that even in cities with high solar irradiation&#44; high frequencies of vitamin D deficiency may occur&#46; The fact that sun exposure was not associated with adequate levels of vitamin D in this study may have been due to the influence of other factors&#44; such as the time of day when the child was exposed&#44; skin color&#44; and the use of sunscreen&#44; which were not possible to be analyzed&#46; It is probable that fear of the sun&#39;s harmful effects on the skin hindered adequate sun exposure&#59; in fact&#44; dermatologists recommend that babies aged up to 6 months should not be exposed to direct sunlight&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">When analyzing the results of this study&#44; its limitations should be considered&#46; The complexity of the problem to be assessed was one of the main difficulties found&#44; and other factors that could be related to vitamin D levels were not controlled&#44; such as the restriction of milk and dairy products in the maternal diet&#44; the use of vitamin D supplementation during pregnancy&#44; and adherence to these recommendations&#44; as well as the type of delivery and other aspects associated with the baby&#39;s intestinal microbiota&#46; Sample heterogeneity was considered one of the problems due to individual differences of the disease&#46; Social class bias may also have occurred&#44; as families with better socioeconomic status might have sought the pediatric gastroenterology outpatient clinic&#44; aiming at obtaining a medical report to receive the specialized formulas provided by the public healthcare services&#46; Difficulties inherent to the questionnaire application may also have occurred&#44; since the questionnaire was applied by two different researchers&#59; the reliability of the information provided by the mothers should also be considered&#46; The sample size was small&#44; perhaps insufficient to subsidize changes in guidelines previously established by regulatory societies&#59; however&#44; they are sufficient to serve as a warning and to trigger complementary randomized and prospective studies on the subject&#46; A larger sample size could allow CMPA infants to be grouped and analyzed according to the clinical manifestations &#40;immediate and late&#41;&#44; considering the different immunological mechanisms involved in the pathogenesis of CMPA&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The lack of a consensus regarding the cutoff points that define vitamin D status was also considered to be a bias&#44; making it difficult to understand which values would have a pathogenic effect and compromising the comparison with studies that used other reference values&#46; While the American Endocrinology Society states that deficient levels are those below 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL and sufficient values are those equal to or greater than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> the US Institute of Medicine &#40;2010&#41; considers levels above 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL as appropriate&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> In this study&#44; sufficient levels were those equal to or greater than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The findings of the present study suggest a higher frequency of inadequate levels of vitamin D in infants with different clinical manifestations of CMPA&#46; Despite the several limitations of the study&#44; the data may indicate the need to investigate vitamin D levels in infants with CMPA&#46; The practice of EBF&#47;predominant BF was related to inadequate levels&#44; mainly in children diagnosed with CMPA&#44; whereas sun exposure did not appear to confer a protective effect to this group&#46; The fact that allergic infants did not use vitamin D supplementation may have contributed to the study findings&#46; Therefore&#44; it is probably not safe to rely on sun exposure as a source of vitamin D&#44; especially in infants in EBF&#44; and routine supplementation should be evaluated&#46; It is suggested that other studies be carried out to demonstrate the association and better elucidate the factors associated with inadequate vitamin D levels in infants with CMPA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;<span class="elsevierStyleGrantSponsor" id="gs1">CNPq</span>&#41;&#44; through financial aid from the universal notice of 2012&#47;2013 under registration number 488488&#47;2013-3&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To verify whether infants with cow&#39;s milk protein allergy have inadequate vitamin D levels&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included 120 children aged 2 years or younger&#44; one group with cow&#39;s milk protein allergy and a control group&#46; The children were recruited at the pediatric gastroenterology&#44; allergology&#44; and pediatric outpatient clinics of a university hospital in the Northeast of Brazil&#46; A questionnaire was administered to the caregiver and blood samples were collected for vitamin D quantification&#46; Vitamin D levels &#60;30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL were considered inadequate&#46; Vitamin D level was expressed as mean and standard deviation&#44; and the frequency of the degrees of sufficiency and other variables&#44; as proportions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infants with cow&#39;s milk protein allergy had lower mean vitamin D levels &#40;30&#46;93 <span class="elsevierStyleItalic">vs</span>&#46;35&#46;29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41; and higher deficiency frequency &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46;8&#46;2&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41; than the healthy controls&#46; Exclusively or predominantly breastfed infants with cow&#39;s milk protein allergy had higher frequency of inadequate vitamin D levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Regardless of sun exposure time&#44; the groups had similar frequencies of inadequate vitamin D levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;972&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lower vitamin D levels were found in infants with CMPA&#44; especially those who were exclusively or predominantly breastfed&#44; making these infants a possible risk group for vitamin D deficiency&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Verificar se lactentes com alergia &#224; prote&#237;na do leite de vaca &#40;APLV&#41; apresentam n&#237;veis inadequados de vitamina D&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal&#44; envolvendo 120 crian&#231;as de at&#233; 2 anos de idade&#44; sendo um grupo com APLV e outro de compara&#231;&#227;o&#44; captadas dos ambulat&#243;rios de Gastroenterologia Pedi&#225;trica&#44; Alergologia Pedi&#225;trica e Puericultura de um hospital universit&#225;rio&#44; no Nordeste brasileiro&#46; Foi aplicado um formul&#225;rio e coletadas amostras sangu&#237;neas para a an&#225;lise da vitamina D&#44; sendo considerados inadequados os n&#237;veis<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46; N&#237;veis de vitamina D foram expressos em m&#233;dia e desvio padr&#227;o&#44; e a frequ&#234;ncia dos graus de sufici&#234;ncia e demais vari&#225;veis&#44; em propor&#231;&#245;es&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lactentes com APLV quando comparados aos saud&#225;veis&#44; apresentaram uma menor m&#233;dia do n&#237;vel da vitamina D &#40;30&#44;93 vs 35&#44;29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41; e maior frequ&#234;ncia de defici&#234;ncia &#40;20&#44;3&#37; vs 8&#44;2&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#46; Maior frequ&#234;ncia de n&#237;veis inadequados de vitamina D foi observada nas crian&#231;as com APLV que estavam em aleitamento materno exclusivo&#47;predominante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Independentemente do per&#237;odo de exposi&#231;&#227;o solar&#44; a frequ&#234;ncia de um status inadequado de vitamina D foi semelhante entre os grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;972&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Menores n&#237;veis de vitamina D foram observados em lactentes com APLV&#44; especialmente naquelas em aleitamento materno exclusivo&#47;predominante&#44; configurando este como um poss&#237;vel grupo de risco para essa defici&#234;ncia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Silva CM&#44; da Silva SA&#44; Antunes MM&#44; Silva GA&#44; Sarinho ES&#44; Brandt KG&#46; Do infants with cow&#39;s milk protein allergy have inadequate levels of vitamin D&#63; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;632&#8211;8&#46;</p>"
      ]
    ]
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        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequencies of vitamin D sufficiency levels in infants with cow&#39;s milk protein allergy and in the control group&#44; treated at an outpatient clinic in a university hospital&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Fisher&#39;s exact test&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CMPA&#44; cow&#39;s milk protein allergy&#59; MW&#44; Brazilian minimum wages&#59; EBF&#44; exclusive breastfeeding&#59; W&#44; weight&#59; A&#44; age&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#43;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#8722;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;months&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Maternal level of schooling</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elementary&#47;High school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>College&#47;University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Income in MW</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Atopy mother</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Atopy father</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Type of delivery</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transvaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cesarean section&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Gestational age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preterm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;612&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Full-term&#47;Post-term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Maternal supplementation with vitamin D during pregnancy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Time of EBF &#40;months&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Anthropometric assessment &#40;W&#47;A&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Excess weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#43;</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vitamin D</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vitamin D</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Deficiency&#47;Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Deficiency&#47;Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Current BF practice</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exclusive&#47;Predominant</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46;9&#8211;46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;2&#8211;18&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;2&#8211;40&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1&#8211;14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Partial</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46;9&#8211;46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;1&#8211;22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;8&#8211;17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complementary</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;8&#8211;34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0&#8211;46&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;2&#8211;44&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Does not breastfeed</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;78&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;63&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46;2&#8211;54&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;6&#8211;90&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;6&#8211;82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;0&#8211;78&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Vitamin D status of infants with CMPA and of the control group followed at an outpatient clinic of a university hospital&#44; in relation to the feeding practice&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p>"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Merewood"
                            1 => "S&#46;D&#46; Mehta"
                            2 => "X&#46; Grossman"
                            3 => "T&#46;C&#46; Chen"
                            4 => "J&#46;S&#46; Mathieu"
                            5 => "M&#46;F&#46; Holick"
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                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-2158"
                      "Revista" => array:6 [
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                        "link" => array:1 [
                          0 => array:2 [
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                            0 => "C&#46;J&#46; Rosen"
                            1 => "J&#46;S&#46; Adams"
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                  "host" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Recomenda&#231;&#245;es da Sociedade Brasileira de Endocrinologia e Metabologia &#40;SBEM&#41; para o diagn&#243;stico e tratamento da hipovitaminose D"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;S&#46; Maeda"
                            1 => "V&#46;Z&#46; Borba"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                            0 => "K&#46;J&#46; Allen"
                            1 => "J&#46;J&#46; Koplin"
                            2 => "A&#46;L&#46; Ponsonby"
                            3 => "L&#46;C&#46; Gurrin"
                            4 => "M&#46; Wake"
                            5 => "P&#46; Vuillermin"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2013.01.017"
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                        "paginaInicial" => "1109"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23453797"
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            ]
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Latitude&#44; sunlight&#44; vitamin D&#44; and childhood food allergy&#47;anaphylaxis"
                      "autores" => array:1 [
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                          "etal" => false
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                            0 => "R&#46;J&#46; Mullins"
                            1 => "C&#46;A&#46; Camargo"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11882-011-0230-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Allergy Asthma Rep"
                        "fecha" => "2012"
                        "volumen" => "12"
                        "paginaInicial" => "64"
                        "paginaFinal" => "71"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22006065"
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              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of eczema and food allergy is associated with latitude in Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46;J&#46; Osborne"
                            1 => "O&#46;C&#46; Ukoumunne"
                            2 => "M&#46; Wake"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2012.01.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22305679"
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            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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Original article
Do infants with cow's milk protein allergy have inadequate levels of vitamin D?
Lactentes com alergia à proteína do leite de vaca apresentam níveis inadequados de vitamina D?
Cristiane M. Silvaa,
Corresponding author
cris.marrocos@yahoo.com.br

Corresponding author.
, Silvia A. da Silvaa, Margarida M. de C. Antunesb, Gisélia Alves Pontes da Silvac, Emanuel Sávio Cavalcanti Sarinhoc,d, Katia G. Brandtb
a Universidade Federal de Pernambuco (UFPE), Programa de Pós Graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
b Universidade Federal de Pernambuco (UFPE), Departamento Materno-Infantil, Serviço de Gastroenterologia Pediátrica HC-UFPE, Recife, PE, Brazil
c Universidade Federal de Pernambuco (UFPE), Departamento Materno-Infantil, Programa de Pós Graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
d Universidade Federal de Pernambuco (UFPE), Departamento Materno-Infantil, Serviço de Alergologia e Imunologia HC-UFPE, Recife, PE, Brazil
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        "titulo" => "Lactentes com alergia &#224; prote&#237;na do leite de vaca apresentam n&#237;veis inadequados de vitamina D&#63;"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequencies of vitamin D sufficiency levels in infants with cow&#39;s milk protein allergy and in the control group&#44; treated at an outpatient clinic in a university hospital&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Fisher&#39;s exact test&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Currently&#44; vitamin D deficiency has been recognized as a frequent problem&#44; which is observed in adults&#44; children&#44; and sometimes even in the neonatal period&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Classically&#44; vitamin D deficiency is associated with bone diseases&#44; but in recent years it has been associated with several extraosseous outcomes&#44; including immune diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> It appears to occur more frequently in certain groups of individuals&#59; therefore&#44; the Endocrinology Society recommends screening for vitamin D deficiency only in the group of individuals considered to be at risk&#46; This risk group would comprise individuals of black ethnicity&#44; as well as those who are obese&#44; pregnant and lactating women&#44; and individuals with certain diseases&#44; such as endocrine and renal diseases&#44; among others&#46; Individuals with cow&#39;s milk protein allergy &#40;CMPA&#41; are not included in the risk group&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In turn&#44; some international studies&#44; mainly carried out in children with the immediate forms of CMPA&#44; mediated by IgE&#44; suggested a higher frequency of vitamin D deficiency in this group&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> Low levels of vitamin D in children are associated with factors such as poor maternal&#8211;fetal transfer due to maternal hypovitaminosis&#44; inadequate sun exposure&#44; inappropriate use of vitamin D supplements&#44; and low dietary intake&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Studies on vitamin D levels in children with CMPA are important to assess whether they are a risk group for vitamin D deficiency&#46; Since most studies that assessed vitamin D levels in children with CMPA were carried out in children without gastrointestinal manifestations&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> there are gaps on the knowledge of this problem&#46; Additionally&#44; few studies have been performed in children with CMPA living in sunny regions&#44; where adequate exposure to ultraviolet rays is assumed&#46; The present study aimed to verify whether infants with CMPA present inadequate levels of vitamin D&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was an observational&#44; cross-sectional study comparing vitamin D levels in a group of infants with clinical diagnosis of CMPA and a group of healthy infants &#40;control group&#41;&#46; The study was carried out from March 2013 to April 2015 in the pediatric gastroenterology&#44; pediatric allergology&#44; and pediatric outpatient clinics of Hospital das Cl&#237;nicas at Universidade Federal de Pernambuco &#40;HC&#47;UFPE&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The group of children with CMPA consisted of 59 infants of both genders who had clinical manifestations related to CMPA&#46; The diagnosis was attained considering the clinical history&#44; physical examination&#44; and previous history&#44; and confirmed by the open oral challenge test&#44; as indicated by the main current guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> The challenge test was contraindicated by the investigators in the following situations&#58; report of immediate manifestations associated with a positive IgE result&#59; late manifestations compatible with CMPA&#44; associated with malnutrition&#46; The comparison group consisted of 61 healthy children&#46; Children with clinical suspicion of other pathologies or factors that could influence vitamin D levels&#44; such as acute or chronic infectious diseases&#44; other inflammatory bowel diseases&#44; and renal or gastrointestinal diseases were excluded&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For the anthropometric evaluation&#44; the infant&#39;s weight was obtained and the weight&#47;age &#40;W&#47;A&#41; indicator proposed by the World Health Organization &#40;WHO&#41; was used&#46; For the evaluation of W&#47;A&#44; the following cutoffs were used&#58; &#60;&#8722;2 <span class="elsevierStyleItalic">z</span>-score for low&#44; &#8805;&#8722;2 and &#60;&#43;2 <span class="elsevierStyleItalic">z</span>-score for age-appropriate&#44; and &#8805;&#43;2 <span class="elsevierStyleItalic">z</span>-score for elevated&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding vitamin D&#44; levels and degrees of sufficiency were analyzed&#44; categorized as insufficient&#47;deficient and sufficient&#46; Vitamin D levels were considered deficient when 25&#40;OH&#41;D was &#8804;20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; insufficient&#44; when between 21 and 29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; and sufficient&#44; when &#8805;30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;13</span></a> For this analysis&#44; a blood sample &#40;4<span class="elsevierStyleHsp" style=""></span>mL&#41; was collected by a trained professional&#44; stored in a tube with separator gel&#44; and then taken to the laboratory connected with the research&#46; 25&#40;OH&#41;D was measured using the chemiluminescence technique using the LIAISON<span class="elsevierStyleSup">&#174;</span> commercial kit&#46; Parents of children who had inadequate levels of vitamin D were warned of the need for supplementation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The WHO categorization was used to classify the current practice of breastfeeding &#40;BF&#41;&#59; children were considered as in exclusive breastfeeding &#40;EBF&#41; when they received only breast milk&#44; without other liquids or solids&#59; in predominant BF&#44; when they received&#44; in addition to breast milk&#44; water or water-based preparations&#59; in supplemented BF&#44; when they received&#44; in addition to breast milk&#44; any solid or semi-solid food for the purpose of complementing it&#44; not replacing it&#59; and in mixed or partial BF&#44; when they received breast milk and other types of milk&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">When evaluating sun exposure&#44; the guidelines of the Brazilian Society of Pediatrics &#40;SBP&#41; were used&#44; which recommends that the child should receive direct exposure of the skin to sunlight after the second week of life&#59; a weekly quota of 30<span class="elsevierStyleHsp" style=""></span>min of sun exposure with the child wearing only diapers is considered sufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The construction of the database was performed using the Epi-Info software&#44; version 6&#46;04d &#40;Epi-info 6&#46;04&#44; WHO&#47;CDC&#44; Atlanta&#44; USA&#41;&#46; Statistical analyses were performed using the SPSS software&#44; version 13&#46;0 for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Continuous variables were tested for normality of distribution using the Kolmogorov&#8211;Smirnov test&#44; being expressed as mean and standard deviation when showing a symmetric distribution&#44; and as median and quartiles when the distribution was asymmetric&#46; Differences in frequency and association between categorical variables were assessed by Pearson&#39;s chi-squared or Fisher&#39;s exact tests&#44; when indicated&#46; For all tests&#44; the significance level was set at 5&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The children&#39;s parents or tutors were verbally informed about the study aims and signed the free and informed consent form&#46; The study project was registered at the National Committee of Research Ethics &#40;CONEP&#47;Plataforma Brasil&#41; and submitted to the approval of the Ethics Committee on Research in Human Beings of the Centro de Ci&#234;ncias da Sa&#250;de at Universidade Federal de Pernambuco&#44; under CAAE No&#46; 12878313&#46;4&#46;0000&#46;5208&#47;2013&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The median age of the total sample was 8&#46;5 months &#40;P25&#58; 6&#46;0&#44; P75&#58; 14&#46;0&#41;&#44; whereas in children with CMPA the median was 7&#46;0 months &#40;P25&#58; 4&#44; P75&#58; 13&#41;&#44; and in the control group&#44; it was 9&#46;0 months &#40;P25&#58; 6&#46;0&#44; P75&#58; 16&#46;0&#41;&#46; The socioeconomic and biological characteristics of the sample are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; and among them&#44; it was observed that the mothers of children with CMPA had a better level of schooling than those of the children in the comparative group &#40;69&#46;5&#37; <span class="elsevierStyleItalic">vs&#46;</span> 27&#46;9&#44; college&#47;university level of schooling&#41;&#44; as well as higher family income &#40;51&#46;7&#37; <span class="elsevierStyleItalic">vs&#46;</span>18&#37;&#44; &#62;four Brazilian minimum wages&#41;&#46; A predominance of cesarean delivery &#40;89&#46;8&#37;&#41; was observed in the group of children with CMPA&#46; There was also a higher frequency of atopy among mothers &#40;62&#46;7&#37; <span class="elsevierStyleItalic">vs&#46;</span> 34&#46;4&#37;&#41; and fathers &#40;46&#46;6&#37; <span class="elsevierStyleItalic">vs&#46;</span> 28&#46;3&#37;&#41; of children with CMPA&#46; When the nutritional status was evaluated&#44; a higher percentage of normal weight was observed in the sample&#44; with similar frequencies in both groups &#40;91&#46;5&#37; in the CMPA group and 96&#46;6&#37; in the control group&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In children with a diagnosis of CMPA&#44; the most frequent clinical manifestations were of the immediate type &#40;59&#46;3&#37;&#41;&#58; angioedema&#44; urticaria and skin hyperemia&#44; vomiting&#44; diarrhea&#44; cough&#44; and wheezing&#46; The late manifestations were&#58; regurgitation and vomiting compatible with gastroesophageal reflux disease &#40;GERD&#41;&#44; diarrhea&#44; diarrhea with blood &#40;compatible with colitis&#41;&#44; proctitis&#44; low weight gain or weight loss&#44; excessive crying and abdominal distension&#44; bowel disorders&#44; and atopic eczema&#46; Among the immediate manifestations&#44; the most prominent were urticaria in 28&#46;8&#37;&#44; angioedema in 15&#46;3&#37;&#44; and cough in 15&#46;3&#37;&#46; In the group with late manifestations&#44; 40&#46;7&#37; had vomiting and diarrhea&#44; 35&#46;6&#37; had signs of colitis&#44; and 22&#37; had symptoms compatible with GERD&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The mean levels of vitamin D among children with CMPA were 30&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;33<span class="elsevierStyleHsp" style=""></span>ng&#47;mL and 35&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;74<span class="elsevierStyleHsp" style=""></span>ng&#47;mL in the control group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the frequencies of the different levels of vitamin D sufficiency in both groups&#44; indicating that among the total number of children&#44; there was a higher frequency of deficiency levels in those with CMPA &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs&#46;</span> 8&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#46; It is noteworthy that none of the children were receiving vitamin D supplementation at the time of the interview and only nine of the mothers of children with CMPA reported receiving vitamin D supplementation during the gestational period&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> indicates that among the children with CMPA&#44; those who received exclusive&#47;predominant BF at the time of the interview had a higher frequency of vitamin D deficiency&#59; 25&#46;9&#37; of children were deficient and only 3&#46;1&#37; showed sufficient levels&#46; This finding was also observed in those receiving partial BF &#40;25&#46;9&#37; <span class="elsevierStyleItalic">vs&#46;</span> 6&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Most children with CMPA who were not breastfed &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; who were fed infant formulas&#41; showed sufficiency levels &#40;78&#46;1&#37;&#41;&#46; In the comparison group&#44; there was no association between different dietary practices and vitamin D sufficiency levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;189&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In the group of allergic children&#44; the frequency of sun exposure did not interfere with the level of vitamin D sufficiency&#59; the results were similar in those with deficiency&#47;insufficiency and in those with sufficient degrees &#40;among those with deficient&#47;sufficient degrees&#44; 14 were adequately exposed to sunlight&#44; whereas 12 were not&#59; among those with sufficient degrees&#44; 17 were adequately exposed and 13 were not&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;972&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In this study&#44; carried out among children who mostly had normal weight and were breastfed for similar periods of times&#44; children with immediate and late CMPA had a higher percentage of deficiency when compared with healthy children &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 8&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41;&#46; Although vitamin D levels were normal in both groups&#44; a lower mean was observed in allergic children &#40;30&#46;93 <span class="elsevierStyleItalic">vs</span>&#46; 35&#46;29&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41;&#44; reinforcing the tendency of allergic children to have lower vitamin levels&#46; Some studies have already investigated the association between vitamin D deficiency and food allergy&#44; but most of them were performed in children with the immediate form of CMPA&#44; IgE-mediated&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> This study also raises the question about the late form&#44; non-IgE-mediated&#44; which usually manifests through gastrointestinal symptoms&#46; There is an empirical basis for believing that insufficient levels of vitamin D in the early stages of life may interfere with the development of immunity&#44; contributing to the onset of allergic diseases&#44; including food allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> The main mechanism through which it would act in immune regulation would be to favor a greater differentiation of naive T lymphocytes into T regulatory cells &#40;Tregs&#41;&#44; which would inhibit both TH1 and TH2 harmful immune responses&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a> It should be considered that&#44; although deficient levels of vitamin D were observed in infants with CMPA&#44; the cross-sectional design of the study did not allow to establish a causal association between vitamin D deficiency and the occurrence of allergy&#46; It can be speculated that the association may be the opposite&#44; considering that the pathogenesis of CMPA itself may have favored low vitamin D levels&#44; both because it allows malabsorption and because it can be associated with the inflammatory response&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The systemic inflammatory response&#44; which might be generated during the allergic process&#44; may be associated with low concentrations of fat-soluble vitamins&#44; including vitamin D&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a> The low levels could also be associated to the fact that the mothers of children with CMPA in EBF adopted a diet that restricted cow&#39;s milk and dairy products&#44; without vitamin D supplementation&#44; a fact already associated with deficiencies of vitamin D and other micronutrients&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The main sources of vitamin D for infants are dietary intake&#44; sun exposure&#44; and vitamin supplements&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Breast milk can provide a protective effect against the development of several types of allergies due to the presence of immunological factors and functional nutrients that favor a healthy microenvironment for immune system development and intestinal maturation&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> However&#44; as it has low concentrations of vitamin D&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> children receiving BF&#44; especially those in EBF and without adequate sun exposure&#44; may represent a group at higher risk for vitamin D deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Low levels of vitamin D were observed in allergic children who were receiving BF&#44; and a higher frequency of deficient&#47;insufficient levels of vitamin D was observed among children with CMPA who were submitted to EBF&#47;predominant BF &#40;25&#46;9&#37;&#41;&#46; Evidence suggests that children who develop CMPA&#44; even those in EBF&#44; have genetic factors that predispose them to this outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> It is possible that&#44; in an infant receiving EBF who already has a genetic predisposition to CMPA&#44; the occurrence of vitamin D deficiency acts as a trigger for the development of the disease&#46; In this sense&#44; it was observed that of the eight infants who were in EBF&#47;predominant BF and developed CMPA &#40;most of them allergic colitis&#41;&#44; seven were found to have inadequate levels of vitamin D&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Studies carried out in different countries suggest the need for supplementation of infants receiving BF&#44; and sometimes of the mother&#44; even when they live in a sunny region&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> None of the children in this study received vitamin supplementation&#44; and only nine mothers of children with CMPA &#40;15&#46;3&#37;&#41; and four mothers of healthy children &#40;6&#46;6&#37;&#41; were taking supplementation&#46; It was observed that in Brazil&#44; the indication of vitamin D supplementation in the prenatal and breastfeeding periods is not yet a common practice&#44; and this perhaps needs to be considered&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Sun exposure is considered one of the most important determinants of vitamin D status&#46; Infants&#8217; vitamin D levels tend to decline over the first few months of life if they are not exposed to sunlight or if they do not receive an adequate dietary intake of vitamin D&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> In the Northeast of Brazil&#44; abundant solar irradiation occurs during most of the year&#46; However&#44; living in a sunny region may not protect infants from this vitamin deficiency&#46; When analyzing the association between sun exposure and vitamin D levels in this study&#44; it was observed that adequate sun exposure did not ensure sufficient levels of vitamin D&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In a recent study carried out in this same region&#44; insufficient levels of vitamin D were also observed in the mother&#47;newborn binomial&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> corroborating other data that indicate that even in cities with high solar irradiation&#44; high frequencies of vitamin D deficiency may occur&#46; The fact that sun exposure was not associated with adequate levels of vitamin D in this study may have been due to the influence of other factors&#44; such as the time of day when the child was exposed&#44; skin color&#44; and the use of sunscreen&#44; which were not possible to be analyzed&#46; It is probable that fear of the sun&#39;s harmful effects on the skin hindered adequate sun exposure&#59; in fact&#44; dermatologists recommend that babies aged up to 6 months should not be exposed to direct sunlight&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">When analyzing the results of this study&#44; its limitations should be considered&#46; The complexity of the problem to be assessed was one of the main difficulties found&#44; and other factors that could be related to vitamin D levels were not controlled&#44; such as the restriction of milk and dairy products in the maternal diet&#44; the use of vitamin D supplementation during pregnancy&#44; and adherence to these recommendations&#44; as well as the type of delivery and other aspects associated with the baby&#39;s intestinal microbiota&#46; Sample heterogeneity was considered one of the problems due to individual differences of the disease&#46; Social class bias may also have occurred&#44; as families with better socioeconomic status might have sought the pediatric gastroenterology outpatient clinic&#44; aiming at obtaining a medical report to receive the specialized formulas provided by the public healthcare services&#46; Difficulties inherent to the questionnaire application may also have occurred&#44; since the questionnaire was applied by two different researchers&#59; the reliability of the information provided by the mothers should also be considered&#46; The sample size was small&#44; perhaps insufficient to subsidize changes in guidelines previously established by regulatory societies&#59; however&#44; they are sufficient to serve as a warning and to trigger complementary randomized and prospective studies on the subject&#46; A larger sample size could allow CMPA infants to be grouped and analyzed according to the clinical manifestations &#40;immediate and late&#41;&#44; considering the different immunological mechanisms involved in the pathogenesis of CMPA&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The lack of a consensus regarding the cutoff points that define vitamin D status was also considered to be a bias&#44; making it difficult to understand which values would have a pathogenic effect and compromising the comparison with studies that used other reference values&#46; While the American Endocrinology Society states that deficient levels are those below 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL and sufficient values are those equal to or greater than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> the US Institute of Medicine &#40;2010&#41; considers levels above 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL as appropriate&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> In this study&#44; sufficient levels were those equal to or greater than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The findings of the present study suggest a higher frequency of inadequate levels of vitamin D in infants with different clinical manifestations of CMPA&#46; Despite the several limitations of the study&#44; the data may indicate the need to investigate vitamin D levels in infants with CMPA&#46; The practice of EBF&#47;predominant BF was related to inadequate levels&#44; mainly in children diagnosed with CMPA&#44; whereas sun exposure did not appear to confer a protective effect to this group&#46; The fact that allergic infants did not use vitamin D supplementation may have contributed to the study findings&#46; Therefore&#44; it is probably not safe to rely on sun exposure as a source of vitamin D&#44; especially in infants in EBF&#44; and routine supplementation should be evaluated&#46; It is suggested that other studies be carried out to demonstrate the association and better elucidate the factors associated with inadequate vitamin D levels in infants with CMPA&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">Conselho Nacional de Desenvolvimento Cient&#237;fico e Tecnol&#243;gico &#40;<span class="elsevierStyleGrantSponsor" id="gs1">CNPq</span>&#41;&#44; through financial aid from the universal notice of 2012&#47;2013 under registration number 488488&#47;2013-3&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2016-08-16"
    "fechaAceptado" => "2017-01-06"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:5 [
            0 => "Milk allergy"
            1 => "Infant"
            2 => "Vitamin D"
            3 => "Breast feeding"
            4 => "Sunlight"
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          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec909675"
          "palabras" => array:5 [
            0 => "Alergia a leite"
            1 => "Lactente"
            2 => "Vitamina D"
            3 => "Aleitamento materno"
            4 => "Luz solar"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To verify whether infants with cow&#39;s milk protein allergy have inadequate vitamin D levels&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included 120 children aged 2 years or younger&#44; one group with cow&#39;s milk protein allergy and a control group&#46; The children were recruited at the pediatric gastroenterology&#44; allergology&#44; and pediatric outpatient clinics of a university hospital in the Northeast of Brazil&#46; A questionnaire was administered to the caregiver and blood samples were collected for vitamin D quantification&#46; Vitamin D levels &#60;30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL were considered inadequate&#46; Vitamin D level was expressed as mean and standard deviation&#44; and the frequency of the degrees of sufficiency and other variables&#44; as proportions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infants with cow&#39;s milk protein allergy had lower mean vitamin D levels &#40;30&#46;93 <span class="elsevierStyleItalic">vs</span>&#46;35&#46;29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;041&#41; and higher deficiency frequency &#40;20&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46;8&#46;2&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;049&#41; than the healthy controls&#46; Exclusively or predominantly breastfed infants with cow&#39;s milk protein allergy had higher frequency of inadequate vitamin D levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Regardless of sun exposure time&#44; the groups had similar frequencies of inadequate vitamin D levels &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;972&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Lower vitamin D levels were found in infants with CMPA&#44; especially those who were exclusively or predominantly breastfed&#44; making these infants a possible risk group for vitamin D deficiency&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Verificar se lactentes com alergia &#224; prote&#237;na do leite de vaca &#40;APLV&#41; apresentam n&#237;veis inadequados de vitamina D&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal&#44; envolvendo 120 crian&#231;as de at&#233; 2 anos de idade&#44; sendo um grupo com APLV e outro de compara&#231;&#227;o&#44; captadas dos ambulat&#243;rios de Gastroenterologia Pedi&#225;trica&#44; Alergologia Pedi&#225;trica e Puericultura de um hospital universit&#225;rio&#44; no Nordeste brasileiro&#46; Foi aplicado um formul&#225;rio e coletadas amostras sangu&#237;neas para a an&#225;lise da vitamina D&#44; sendo considerados inadequados os n&#237;veis<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46; N&#237;veis de vitamina D foram expressos em m&#233;dia e desvio padr&#227;o&#44; e a frequ&#234;ncia dos graus de sufici&#234;ncia e demais vari&#225;veis&#44; em propor&#231;&#245;es&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Lactentes com APLV quando comparados aos saud&#225;veis&#44; apresentaram uma menor m&#233;dia do n&#237;vel da vitamina D &#40;30&#44;93 vs 35&#44;29<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41; e maior frequ&#234;ncia de defici&#234;ncia &#40;20&#44;3&#37; vs 8&#44;2&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#46; Maior frequ&#234;ncia de n&#237;veis inadequados de vitamina D foi observada nas crian&#231;as com APLV que estavam em aleitamento materno exclusivo&#47;predominante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Independentemente do per&#237;odo de exposi&#231;&#227;o solar&#44; a frequ&#234;ncia de um status inadequado de vitamina D foi semelhante entre os grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;972&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Menores n&#237;veis de vitamina D foram observados em lactentes com APLV&#44; especialmente naquelas em aleitamento materno exclusivo&#47;predominante&#44; configurando este como um poss&#237;vel grupo de risco para essa defici&#234;ncia&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Silva CM&#44; da Silva SA&#44; Antunes MM&#44; Silva GA&#44; Sarinho ES&#44; Brandt KG&#46; Do infants with cow&#39;s milk protein allergy have inadequate levels of vitamin D&#63; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;632&#8211;8&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequencies of vitamin D sufficiency levels in infants with cow&#39;s milk protein allergy and in the control group&#44; treated at an outpatient clinic in a university hospital&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Fisher&#39;s exact test&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CMPA&#44; cow&#39;s milk protein allergy&#59; MW&#44; Brazilian minimum wages&#59; EBF&#44; exclusive breastfeeding&#59; W&#44; weight&#59; A&#44; age&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#43;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#8722;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;months&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Maternal level of schooling</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elementary&#47;High school&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>College&#47;University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Income in MW</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Atopy mother</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Atopy father</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Type of delivery</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Transvaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cesarean section&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Gestational age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Preterm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;612&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Full-term&#47;Post-term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Maternal supplementation with vitamin D during pregnancy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Time of EBF &#40;months&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Anthropometric assessment &#40;W&#47;A&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Excess weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Socioeconomic and biological characteristics of infants with CMPA and of the control group followed at the outpatient clinic of a university hospital&#44; Recife-PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CMPA&#44; cow&#39;s milk protein allergy&#59; BF&#44; breastfeeding&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA&#43;</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMPA</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vitamin D</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vitamin D</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Deficiency&#47;Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Deficiency&#47;Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span> &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Current BF practice</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exclusive&#47;Predominant</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46;9&#8211;46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;2&#8211;18&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;2&#8211;40&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1&#8211;14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Partial</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#46;9&#8211;46&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;1&#8211;22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;8&#8211;17&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complementary</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;8&#8211;34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;1&#8211;29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0&#8211;46&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;2&#8211;44&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Does not breastfeed</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;78&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;63&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#46;2&#8211;54&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;6&#8211;90&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;6&#8211;82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;0&#8211;78&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Vitamin D status of infants with CMPA and of the control group followed at an outpatient clinic of a university hospital&#44; in relation to the feeding practice&#44; Recife&#44; PE&#44; Brazil &#40;2013&#8211;2015&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
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                    0 => array:2 [
                      "titulo" => "Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Merewood"
                            1 => "S&#46;D&#46; Mehta"
                            2 => "X&#46; Grossman"
                            3 => "T&#46;C&#46; Chen"
                            4 => "J&#46;S&#46; Mathieu"
                            5 => "M&#46;F&#46; Holick"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-2158"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "640"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20308219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The nonskeletal effects of vitamin D&#58; an endocrine society scientific statement"
                      "autores" => array:1 [
                        0 => array:2 [
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