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Authors' reply: Missing key factors in nutritional assessment and bone density in children with eczema.

To the Editor—With clearly outlined prospects for research, I congratulate Dr Leung and his colleagues1 for the interesting study of “Assessment of dietary food and nutrient intake and bone density in children with eczema” in the October 2017 issue of the Hong Kong Medical Journal. There are two aspects worth mentioning. As a nutrition scientist, I wonder why the authors have not integrated the consumption of beverages (water, tea, coffee, fruit juices, soft drinks, and others) and the intake of dietary magnesium into the nutritional assessment of children with eczema. One of the seven broad categories of the used food frequency questionnaire by Woo et al is ‘beverages’.2 In the local validation studies in children and adolescents cited by Leung et al, intake of beverages and magnesium was also analysed.3 It is well established that tea consumption and magnesium intake are significantly associated with bone mineral density in children and adults. It is possible that dietary intake of magnesium is also connected to protection against eczema.4 A recent analysis of the ‘Child and Adolescent Health Measurement Initiative’ with 91 642 study participants showed a positive association of severe eczema with bone problems in children. The adjusted odds ratio was 6.08 (95% confidence interval, 1.9419.12; P=0.002).5 Therefore, I cannot agree with Leung et al1 about the implication for clinical practice that “Bone mineral density assessment is unnecessary for the majority of children with eczema”. Further research is required here. I think this good study by Leung et al1 can be strengthened by additional data analysis and discussion.