Data Support Feeding Guidelines for Allergy Prevention

Norra MacReady

May 06, 2011

May 6, 2011 — Parents who want to prevent allergies in their children should introduce solid foods no earlier than 4 months of age, and no later than 6 months, a review article suggests.

These findings support recent guidelines on early nutrition and allergy prevention released by the American Academy of Pediatrics and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition, write the authors, led by Stefanie Sausenthaler, PhD, from the German Research Center for Environmental Health in Neuherberg, Germany. The new guidelines recommend that babies be breast-fed for the first 6 months of life, with complementary feeding introduced no earlier than 17 weeks and no later than 26 weeks.

Maternal intake of certain foods during pregnancy also seemed to influence the child's risk of developing allergies, particularly eczema, and should be investigated further, the authors write in an article published online May 4 in the American Journal of Clinical Nutrition.

The guidelines make no recommendations about avoiding or delaying the introduction of potentially allergenic foods, such as fish or eggs, or regarding maternal diet during pregnancy or lactation. However, those variables have been examined in 2 studies — the German Infant Nutritional Intervention plus environmental and genetic influences (GINIplus) and Influences of Lifestyle-Related Factors on Immune System and the Development of Allergies in Childhood plus the influence of traffic emissions and genetics (LISAplus). The aim of the study "was to review the results of the LISAplus and GINIplus studies in light of the new recommendations for allergy prevention," Dr. Sausenthaler and colleagues explain.

GINIplus is an ongoing, prospective, double-blind birth cohort study in which 5991 full-term infants were recruited between September 1995 and July 1998 and randomly assigned to receive either 1 of 3 hydrolyzed formulas (the intervention group; n = 2252) or a conventional cow's milk formula (the nonintervention group; n = 3379). Infants in the intervention group were considered at high risk for allergy development, meaning they had at least 1 parent or sibling with a history of allergic diseases. They received breast milk only during the first 4 months of life, with 1 of the formulas introduced only if breast-feeding was insufficient. Solid foods were introduced slowly, starting in the fourth month of life. Infants in the nonintervention group received the standard cow's milk formula; responses to a yearly questionnaire were submitted by their parents.

LISAplus is also an ongoing, population-based birth cohort study consisting of 3097 newborns recruited between November 1997 and January 1999. The parents completed questionnaires on family history of atopy, parental education, smoking during pregnancy, and maternal diet during the final 4 weeks of pregnancy, with follow-up questionnaires on the children's health and lifestyle factors from birth to 2 years and at 4 and 6 years, submitted biannually. Blood samples also were obtained when the children were 2 and 6 years of age.

Food Intro Before 4 Months and Maternal Diet Linked to Eczema

There was no evidence that delaying introduction of solid foods beyond the fourth to sixth month of life protected against eczema, allergic rhinitis, or asthma, the authors found. In children without early skin or allergy symptoms, delaying introduction of solid food beyond the fourth month of life was associated with a borderline significant trend for a decreased risk for eczema at 6 years of age. There was also a significant association between eczema at 2 and 6 years and the introduction of a high diversity of food groups, defined as 3 to 8 food groups, at 4 months of age.

The risk for eczema or sensitivity to allergens at 2 years of age was related to a high maternal intake of margarine, vegetable oils, celery, citrus fruits, deep-fried vegetable fats, and raw peppers during pregnancy. High maternal consumption of fish had an inverse association with asthma, the authors found.

These findings suggest that the risk for later allergy and eczema is increased if solid food is introduced before 4 months of age, especially if the foods are diverse, they write. Delaying solid foods beyond 6 months of age or avoiding allergenic foods during the first year of life does not seem to protect against allergies — findings that are reflected in the new guidelines. However, "whereas the 2 societies do not support any dietary restriction during pregnancy, we showed that a high intake of margarine, vegetable oils, and some allergenic fruit and vegetables during pregnancy was associated with an increased risk of allergies, especially eczema," the authors write.

"The findings of the LISAplus and GINIplus studies mainly support the new recommendations for allergy prevention," they conclude. "The intake of margarine, vegetable oils, citrus fruit, raw sweet pepper, and celery during pregnancy seemed to increase the risk of allergic outcomes, especially eczema. This finding should be investigated further."

The study was supported by the Commission of the European Community and presented in 2010 at the conference The Power of Programming: Developmental Origins of Health and Disease. The authors have disclosed no relevant financial relationships.

Am J Clin Nutr. Published online May 4, 2011. Abstract

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