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Early Nutrition and Development of Atopic Disease

A new clinical report from the AAP found little evidence that dietary interventions after age 4 to 6 months prevent atopic disease in early life.

The AAP Committee on Nutrition and Section on Allergy and Immunology recently released a clinical report on the effects of early nutritional interventions (maternal diet during pregnancy and lactation and infant nutrition) on the development of atopic disease (asthma, eczema, and food allergy) in early life. Infants with a parent or sibling with allergic disease were considered to be at high risk for developing atopic disease. Highlights of the report include:

• Most evidence does not support dietary restrictions (including milk, eggs, and peanuts) during pregnancy for preventing atopic disease.
  
• Avoidance of certain antigens (such as milk, egg, and fish) in breast-feeding mothers may protect against eczema but not asthma or food allergy.
  
• In high-risk infants, exclusive breast-feeding for at least 4 months, compared with the use of cow’s milk protein formula, reduces the risk for eczema and cow’s milk allergy during the first 2 years of life.
  
• Modest evidence exists that use of extensively hydrolyzed formulas (Nutramigen, Pregestimil, and Alimentum) and partially hydrolyzed formulas (Good Start and Enfamil Gentlease Lipil), compared with use of cow’s milk formula, may delay or prevent the development of eczema in high-risk infants who are not exclusively breast-fed during the first 4 to 6 months of life. Whether use of these formulas in low-risk infants affects the development of atopic disease is uncertain. The effects of different hydrolyzed formulas may differ.
  
• No evidence suggests that soy-based formulas prevent the development of atopic disease.
  
• Although solid food should not be introduced before age 4 to 6 months, no convincing evidence indicates that delaying food introduction beyond this period prevents the development of atopic disease.
  

Comment: These recommendations are important for all pediatricians and could have far-reaching effects because about 10% to 20% of the 4 million children born in the U.S. each year develop atopic disease. The authors have appropriately relied on Cochrane reviews and other meta-analyses when available. Unfortunately, they did not conduct meta-analyses or formally review the quality of evidence. Clearly, exclusive breast-feeding remains the preferred method for providing infant nutrition, particularly during the first 4 to 6 months of life. The role of specialized formulas, even in infants at risk for developing atopic disease, remains uncertain.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 20, 2008

Citation(s):

Greer FR et al. Effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008 Jan; 121:183.

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