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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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Bion V, Lockett GA, Soto-Ramírez N, Zhang H, Venter C, Karmaus W, Holloway JW, Arshad SH. Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease. Allergy 2016; 71:661-70. [PMID: 26714430 DOI: 10.1111/all.12833] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND WHO guidelines advocate breastfeeding for 6 months, and EAACI guideline recommends exclusive breastfeeding for 4-6 months. However, evidence for breastfeeding to prevent asthma and allergic disease is conflicting. We examined whether following recommended breastfeeding guidelines alters the long-term risks of asthma, eczema, rhinitis or atopy. METHODS The effect of nonexclusive (0, >0-6, >6 months) and exclusive breastfeeding (0, >0-4, >4 months) on repeated measures of asthma (10, 18 years), eczema, rhinitis, and atopy (1-or-2, 4, 10, 18 years) risks was estimated in the IoW cohort (n = 1456) using log-linear models with generalized estimating equations. The Food Allergy and Intolerance Research (FAIR) cohort (n = 988), also from the IoW, was examined to replicate results. RESULTS Breastfeeding (any or exclusive) had no effect on asthma and allergic disease in the IoW cohort. In the FAIR cohort, any breastfeeding for >0-6 months protected against asthma at 10 years (RR = 0.50, 95% CI = 0.32-0.79, P = 0.003), but not other outcomes, whilst exclusive breastfeeding for >4 months protected against repeated rhinitis (RR = 0.36, 95% CI = 0.18-0.71, P = 0.003). Longer breastfeeding was protective against late-onset wheeze in the IoW cohort. CONCLUSION The protective effects of nonexclusive and exclusive breastfeeding against long-term allergic outcomes were inconsistent between these colocated cohorts, agreeing with previous observations of heterogeneous effects. Although breastfeeding should be recommended for other health benefits, following breastfeeding guidelines did not appear to afford a consistent protection against long-term asthma, eczema, rhinitis or atopy. Further research is needed into the long-term effects of breastfeeding on allergic disease.
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Affiliation(s)
- V. Bion
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
| | - G. A. Lockett
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
| | - N. Soto-Ramírez
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - H. Zhang
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - C. Venter
- School of Health Sciences and Social Work; University of Portsmouth; Portsmouth UK
- The David Hide Asthma and Allergy Research Centre; St. Mary's Hospital; Isle of Wight UK
| | - W. Karmaus
- Division of Epidemiology, Biostatistics and Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - J. W. Holloway
- Human Development and Health; Faculty of Medicine; University of Southampton; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - S. H. Arshad
- The David Hide Asthma and Allergy Research Centre; St. Mary's Hospital; Isle of Wight UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
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Lodge CJ, Tan DJ, Lau MXZ, Dai X, Tham R, Lowe AJ, Bowatte G, Allen KJ, Dharmage SC. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr 2015; 104:38-53. [PMID: 26192405 DOI: 10.1111/apa.13132] [Citation(s) in RCA: 331] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/29/2015] [Accepted: 07/14/2015] [Indexed: 02/06/2023]
Abstract
AIM To systematically review the association between breastfeeding and childhood allergic disease. METHODS Predetermined inclusion/exclusion criteria identified 89 articles from PubMed, CINAHL and EMBASE databases. Meta-analyses performed for categories of breastfeeding and allergic outcomes. Meta-regression explored heterogeneity. RESULTS More vs. less breastfeeding (duration) was associated with reduced risk of asthma for children (5-18 years), particularly in medium-/low-income countries and with reduced risk of allergic rhinitis ≤5 years, but this estimate had high heterogeneity and low quality. Exclusive breastfeeding for 3-4 months was associated with reduced risk of eczema ≤2 years (estimate principally from cross-sectional studies of low methodological quality). No association found between breastfeeding and food allergy (estimate had high heterogeneity and low quality). Meta-regression found differences between study outcomes may be attributable to length of breastfeeding recall, study design, country income and date of study inception. Some of the protective effect of breastfeeding for asthma may be related to recall bias in studies of lesser methodological quality. CONCLUSION There is some evidence that breastfeeding is protective for asthma (5-18 years). There is weaker evidence for a protective effect for eczema ≤2 years and allergic rhinitis ≤5 years of age, with greater protection for asthma and eczema in low-income countries.
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Affiliation(s)
- CJ Lodge
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
| | - DJ Tan
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- NHMRC Centre of Research Excellence for Chronic Respiratory Disease; School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - MXZ Lau
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - X Dai
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - R Tham
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - AJ Lowe
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
| | - G Bowatte
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - KJ Allen
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
- Institute of Inflammation and Repair; University of Manchester; UK
| | - SC Dharmage
- Allergy and Lung Health Unit; Centre for Epidemiology and Biostatistics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
- Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics; Royal Children's Hospital; Parkville Victoria Australia
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Seo JH, Kim HY, Jung YH, Lee E, Yang SI, Yu HS, Kim YJ, Kang MJ, Kim HJ, Park KS, Kwon JW, Kim BJ, Kim HB, Kim EJ, Lee JS, Lee SY, Hong SJ. Interactions between innate immunity genes and early-life risk factors in allergic rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:241-8. [PMID: 25840711 PMCID: PMC4397364 DOI: 10.4168/aair.2015.7.3.241] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/25/2014] [Accepted: 07/29/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Allergic rhinitis (AR) is a common chronic disease. Many factors could affect the development of AR. We investigated early-life factors, such as delivery mode, feeding method, and use of antibiotics during infancy, which could affect the development of AR. In addition, how interactions between these factors and innate gene polymorphisms influence the development of AR was investigated. METHODS A cross-sectional study of 1,828 children aged 9-12 years was conducted. Three early-life factors and AR were assessed by a questionnaire. Skin prick tests were done. Polymorphisms of TLR4 (rs1927911) and CD14 (rs2569190) were genotyped. RESULTS Use of antibiotics during infancy increased the risk of AR (aOR [95% CI] 1.511 [1.222-2.037]) and atopic AR (aOR [95% CI], 1.565 [1.078-2.272]). There were synergistic interactions between caesarean delivery, formula feeding, and use of antibiotics in the rate of atopic AR (aOR [95% CI], 3.038 [1.256-7.347]). Additional analyses revealed that the risk for the development of AR or atopic AR subjects with the TLR4 CC genotype were highest when all the 3 early-life factors were present (aOR [95% CI], 5.127 [1.265-20.780] for AR; 6.078 [1.499-24.649] for atopic AR). In addition, the risk for the development of AR or atopic AR in subjects with the CD14 TT genotype were highest when all the 3 early-life factors were present (aOR [95% CI], 5.960 [1.421-15.002] for AR; 6.714 [1.440-31.312] for atopic AR). CONCLUSIONS Delivery mode, feeding method, and use of antibiotics during infancy appeared to have synergistic interactions in the development of AR. Gene-environment interactions between polymorphism of innate genes and early- life risk factors might affect the development of AR.
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Affiliation(s)
- Ju Hee Seo
- Department of Pediatrics, Korean Cancer Center Hospital, Seoul, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Ho Jung
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Eun Lee
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Research Center for Standardization of Allergic Diseases, University of Ulsan College of Medicine, Seoul, Korea
| | - Song I Yang
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Research Center for Standardization of Allergic Diseases, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Sung Yu
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Young Joon Kim
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Mi Jin Kang
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ha Jung Kim
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Kang Seo Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Ji Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Ju Kim
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eun Jin Kim
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Osong, Korea
| | - Joo Shil Lee
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Osong, Korea
| | - So Yeon Lee
- Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
| | - Soo Jong Hong
- Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Research Center for Standardization of Allergic Diseases, University of Ulsan College of Medicine, Seoul, Korea.
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Abstract
BACKGROUND Although the health benefits of breastfeeding are widely acknowledged, opinions and recommendations are strongly divided on the optimal duration of exclusive breastfeeding. Since 2001, the World Health Organization has recommended exclusive breastfeeding for six months. Much of the recent debate in developed countries has centred on the micronutrient adequacy, as well as the existence and magnitude of health benefits, of this practice. OBJECTIVES To assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through six months. SEARCH METHODS We searched The Cochrane Library (2011, Issue 6), MEDLINE (1 January 2007 to 14 June 2011), EMBASE (1 January 2007 to 14 June 2011), CINAHL (1 January 2007 to 14 June 2011), BIOSIS (1 January 2007 to 14 June 2011), African Index Medicus (searched 15 June 2011), Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) (searched 15 June 2011), LILACS (Latin American and Caribbean Health Sciences) (searched 15 June 2011). We also contacted experts in the field.The search for the first version of the review in 2000 yielded a total of 2668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. The updated literature review in December 2006 yielded 835 additional unique citations. SELECTION CRITERIA We selected all internally-controlled clinical trials and observational studies comparing child or maternal health outcomes with exclusive breastfeeding for six or more months versus exclusive breastfeeding for at least three to four months with continued mixed breastfeeding until at least six months. Studies were stratified according to study design (controlled trials versus observational studies), provenance (developing versus developed countries), and timing of compared feeding groups (three to seven months versus later). DATA COLLECTION AND ANALYSIS We independently assessed study quality and extracted data. MAIN RESULTS We identified 23 independent studies meeting the selection criteria: 11 from developing countries (two of which were controlled trials in Honduras) and 12 from developed countries (all observational studies). Definitions of exclusive breastfeeding varied considerably across studies. Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for six months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest differences in risk of undernutrition. In developing-country settings where newborn iron stores may be suboptimal, the evidence suggests that exclusive breastfeeding without iron supplementation through six months may compromise hematologic status. Based on the Belarusian study, six months of exclusive breastfeeding confers no benefit (versus three months of exclusive breastfeeding followed by continued partial breastfeeding through six months) on height, weight, body mass index, dental caries, cognitive ability, or behaviour at 6.5 years of age. Based on studies from Belarus, Iran, and Nigeria, however, infants who continue exclusive breastfeeding for six months or more appear to have a significantly reduced risk of gastrointestinal and (in the Iranian and Nigerian studies) respiratory infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials and from observational studies from Bangladesh and Senegal suggest that exclusive breastfeeding through six months is associated with delayed resumption of menses and, in the Honduran trials, more rapid postpartum weight loss in the mother. AUTHORS' CONCLUSIONS Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are partially breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea. Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings.
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Affiliation(s)
- Michael S Kramer
- Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada.
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Hatakka K, Piirainen L, Pohjavuori S, Poussa T, Savilahti E, Korpela R. Allergy in day care children: prevalence and environmental risk factors. Acta Paediatr 2009; 98:817-22. [PMID: 19183114 DOI: 10.1111/j.1651-2227.2008.01198.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the prevalence of atopic disease among Finnish day care children and the relationship between atopy and environmental factors. METHODS A cross-sectional study of 594 day care children aged 1-6 years from Helsinki, Finland. Each child's history of atopic diseases and environmental exposure was collected in a questionnaire completed by the parents. RESULTS The prevalence of diagnosed asthma was 0.9% for the 1-3-year olds and 5.5% for the 4-6-year olds, atopic eczema/dermatis was 16% in both groups, and allergic rhinitis 5% in the younger group, 9% in the older group. According to multivariable logistic regression models, breastfeeding (exclusive > or =4 months or partial > or =6 months) reduced the risk of atopic diseases (OR = 0.60; CI(95) 0.39-0.93, p = 0.021). Atopic diseases were more common in the oldest age group, 5-6-year olds, compared to the youngest, 1-2-year olds (OR = 2.18; CI(95) 1.14-4.15, p = 0.018). One parent with atopic disease increased the child's risk (OR = 1.89; CI(95) 1.20-2.97, p = 0.006), more so if both parents had a history (OR = 3.17; CI(95) 1.48-6.78, p = 0.003). CONCLUSION Our results support the hypothesis that breastfeeding for at least six months may protect against atopic diseases. The child's greater age (5-6 years) and parental history of atopic diseases increased the risk of atopy.
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Pesonen M, Ranki A, Siimes MA, Kallio MJT. Serum cholesterol level in infancy is inversely associated with subsequent allergy in children and adolescents. A 20-year follow-up study. Clin Exp Allergy 2007; 38:178-84. [PMID: 18028461 DOI: 10.1111/j.1365-2222.2007.02875.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies suggest an association between an altered lipoprotein profile and atopy. The association has been hypothesized to be due to alterations in the dietary fat intake, a factor possibly contributing to the increase of allergic diseases in industrialized countries. OBJECTIVE We aimed at assessing whether there is an association between the serum lipid levels in infancy and subsequent development of allergic symptoms in childhood and adolescence. METHODS A cohort of 200 unselected newborns was prospectively followed up from birth to age 20 years (from 1981 to 2002) with repeated measurements of total cholesterol from birth and throughout the first year of life. The subjects were re-examined at the ages of 5, 11 and 20 years, with assessment of the occurrence of allergic symptoms, skin prick testing (SPT) and measurement of total IgE and of the total, high- and low-density lipoprotein cholesterol. RESULTS Children and adolescents with allergic symptoms, SPT positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the non-atopic subjects. The difference was not detectable in cord blood, but became significant from age 2 months onward. CONCLUSION The inverse association between the cholesterol level in infancy and subsequent manifestations of atopy seems not to be due to atopy-related dietary alterations, because it was already present in early infancy, when virtually all the infants were on a similar diet, i.e. on exclusive breastfeeding.
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Affiliation(s)
- M Pesonen
- Department of Dermatology, Skin and Allergy Hospital, Helsinki, Finland.
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Pesonen M, Kallio MJT, Ranki A, Siimes MA. Prolonged exclusive breastfeeding is associated with increased atopic dermatitis: a prospective follow-up study of unselected healthy newborns from birth to age 20 years. Clin Exp Allergy 2006; 36:1011-8. [PMID: 16911357 DOI: 10.1111/j.1365-2222.2006.02526.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exclusive breastfeeding for the first 6 months is recommended by the World Health Organization and considered allergy preventive. However, it is not known whether prolonging exclusive breastfeeding for over 6 months provides further benefit in allergy prevention. OBJECTIVE The aim of this prospective 20-year follow-up study was to find out whether the allergy protective effect can be enhanced by prolonging strictly exclusive breastfeeding for > or =9 months of age. A total of 200 unselected healthy newborns were enrolled in the study. Their mothers were encouraged to maintain exclusive breastfeeding for as long as possible. The number of infants on strictly exclusive breastfeeding was 167 at 2, 116 at 6, 36 at 9 and 7 at 12 months of age. Of the 200 infants, 42% had a family history of allergy. The children were re-assessed at ages 5 (n=163), 11 (n=150) and 20 years (n=164) with clinical examination, skin prick testing, and parental and personal structured interviews. RESULTS Exclusive breastfeeding prolonged for > or =9 months was associated with atopic dermatitis (P=0.002) and symptoms of food hypersensitivity (P=0.02) at age 5 years, and with symptoms of food hypersensitivity at age 11 years (P=0.01), in children with a family history of allergy. CONCLUSION Prolonging strictly exclusive breastfeeding for > or =9 months was not helpful in atopy prevention, instead, it was associated with increased atopic dermatitis and food hypersensitivity symptoms in childhood.
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Affiliation(s)
- M Pesonen
- The Department of Dermatology, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
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Ludvigsson JF, Mostrom M, Ludvigsson J, Duchen K. Exclusive breastfeeding and risk of atopic dermatitis in some 8300 infants. Pediatr Allergy Immunol 2005; 16:201-8. [PMID: 15853948 DOI: 10.1111/j.1399-3038.2005.00257.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Earlier studies on breastfeeding and atopy in infants have yielded contradictory results. We examined the relationship between exclusive breastfeeding and atopic dermatitis (AD) in a cohort of infants born between 1 October 1997 and 1 October 1999 in south-east Sweden. We evaluated the risk of AD 'at least once' or 'at least three times' during the first year of life in relation to duration of exclusive breastfeeding: <4 months (short exclusive breastfeeding; SEBF) vs. > or = 4 months. All data were obtained through questionnaires. Of 8346 infants with breastfeeding data, 1943 (23.3%) had suffered from AD during the first year of life. Duration of exclusive breastfeeding was not associated with lower risk of AD (p = 0.868). SEBF did not influence the risk of any AD (OR = 1.03; 95% CI OR = 0.91-1.17; p = 0.614) or AD at least three times (OR = 0.97; 95% CI OR = 0.81-1.16; p = 0.755) during the first year of life. Adjustment for confounders did not change these point estimates. Neither was there any link between SEBF and risk of AD among infants with a family history of atopy [adjusted odds ratio (AOR) = 1.16; 95% CI AOR = 0.90-1.48; p = 0.254]. Furred pets at home were linked to a lower risk of AD both among infants with a family history of atopy (AOR = 0.76; 95% CI AOR = 0.60-0.96; p = 0.021) and among infants with no such history (AOR = 0.79; 95% CI AOR = 0.69-0.90; p < 0.001). Infants with no family history of atopy were less prone to develop AD if parents smoked (AOR = 0.76; 95% CI AOR = 0.61-0.95; p = 0.016). This study indicates that exclusive breastfeeding does not influence the risk of AD during the first year of life, while presence of furred pets at home seems to be negatively associated with AD.
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Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2005; 554:63-77. [PMID: 15384567 DOI: 10.1007/978-1-4757-4242-8_7] [Citation(s) in RCA: 279] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3-4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register. No language restrictions were imposed. The two searches yielded a total of 2,668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. Studies were stratified according to study design (controlled trials vs. observational studies) and provenance (developing vs. developed countries). The main outcome measures were weight and length gain, weight-for-age and length-for-age z-scores, head circumference, iron status, gastrointestinal and respiratory infectious morbidity, atopic eczema, asthma, neuromotor development, duration of lactational amenorrhea, and maternal postpartum weight loss. Twenty independent studies meeting the selection criteria were identified by the literature search: 9 from developing countries (2 of which were controlled trials in Honduras) and 11 from developed countries (all observational studies). Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for 6 months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest increases in the risk of undernutrition. The data are conflicting with respect to iron status but suggest that, at least in developing-country settings, where iron stores of newborn infants may be suboptimal, exclusive breastfeeding without iron supplementation through 6 months of age may compromise hematologic status. Based primarily on an observational analysis of a large randomized trial in Belarus, infants who continue exclusive breastfeeding for 6 months or more appear to have a significantly reduced risk of one or more episodes of gastrointestinal tract infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials suggest that exclusive breastfeeding through 6 months of age is associated with delayed resumption of menses and more rapid postpartum weight loss in the mother. Infants who are breastfed exclusively for 6 months experience less morbidity from gastrointestinal tract infection than infants who were mixed breastfed as of 3 or 4 months of age. No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea and faster postpartum weight loss. Based on the results of this review, the World Health Assembly adopted a resolution to recommend exclusive breastfeeding for 6 months to its member countries. Large randomized trials are recommended in both developed and developing countries to ensure that exclusive breastfeeding for 6 months does not increase the risk of undernutrition (growth faltering), to confirm the health benefits reported thus far, and to investigate other potential effects on health and development, especially over the long term.
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Affiliation(s)
- Michael S Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada H3A 1A2.
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De Boissieu D. L’allaitement et les laits « de régime » ont-ils un intérêt préventif ou curatif dans la prise en charge de la dermatite atopique de l’enfant ? Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86146-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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12
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Dunstan JA, Roper J, Mitoulas L, Hartmann PE, Simmer K, Prescott SL. The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulin A, soluble CD14, cytokine levels and fatty acid composition. Clin Exp Allergy 2004; 34:1237-42. [PMID: 15298564 DOI: 10.1111/j.1365-2222.2004.02028.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breast milk contains many immunomodulatory factors (soluble CD14 (sCD14), IgA and cytokines) with the potential to influence infant immune development. OBJECTIVE To determine if changes in breast milk omega-3 polyunsaturated fatty acid (n-3 PUFA) composition as a result of maternal dietary fish oil supplementation during pregnancy can modify levels of these immunological parameters in breast milk. METHOD In a randomized controlled trial, 83 atopic women received either 4 g fish oil capsules (containing 3.7 g n-3 PUFA) (n = 40) or 4 g olive oil capsules (n = 43) from 20 weeks gestation until delivery. Breast milk was collected 3 days post-partum and fatty acids were analysed by gas liquid chromatography and IgA, sCD14 and cytokines (IL-5, IL-6, IL-10, TNF-alpha and IFN-gamma) were quantitated by ELISA or time resolved fluorescence (TRF). RESULTS Omega-3 docosahexaenoic acid (DHA; 22:6n-3) and eicosapentaenoic acid (EPA; 20:5n-3) levels were significantly higher (P < 0.001) in breast milk from women supplemented with fish oil (n = 33, DHA mean 1.15%, SD 0.47% and EPA mean 0.16%, SD 0.07%) than in samples from the control group (n = 40, DHA mean 0.50%, SD 0.17% and EPA mean 0.05%, SD 0.02%). Breast milk arachidonic acid (AA; 20:4n-6) levels were significantly lower (P = 0.045) in the fish oil group (mean 0.55%, SD 0.12%) compared with the control group (mean 0.61%, SD 0.14%). Breast milk IgA was positively correlated with DHA (P = 0.046) and 22:5n-3 (P = 0.003), but inversely correlated with linoleic acid (LA; 18:2n-6) (P=0.034). Levels of sCD14 were also positively correlated with 22:5n-3 (P=0.009). Cytokines involved in IgA synthesis (IL-10 and IL-6) were also significantly correlated with both IgA and n-3 PUFA levels, although there were no differences in the levels of breast milk IgA, sCD14 or cytokines between study groups. CONCLUSION Supplementation with fish oil during pregnancy significantly alters early post-partum breast milk fatty acid composition. omega-3 PUFA levels were positively associated with IgA and sCD14 levels, suggesting a relationship between fatty acid status and mucosal immune function.
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Affiliation(s)
- J A Dunstan
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia
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13
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da Costa Lima R, Victora CG, Menezes AMB, Barros FC. Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents. Am J Public Health 2003; 93:1858-64. [PMID: 14600053 PMCID: PMC1448063 DOI: 10.2105/ajph.93.11.1858] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We studied the association between early life conditions and asthma in adolescence. METHODS We conducted a population-based birth cohort study involving 2250 male 18-year-olds residing in Brazil. RESULTS Approximately 18% of the adolescents reported having asthma. Several childhood factors were found to be significantly associated with increased asthma risk: being of high socioeconomic status, living in an uncrowded household, and children being breastfed for 9 months or longer. CONCLUSIONS The present results are consistent with the "hygiene hypothesis," according to which early exposure to infections provides protection against asthma. The policy implications of our findings are unclear given that risk factors for asthma protect against serious childhood diseases in developing countries.
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van Odijk J, Kull I, Borres MP, Brandtzaeg P, Edberg U, Hanson LA, Høst A, Kuitunen M, Olsen SF, Skerfving S, Sundell J, Wille S. Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations. Allergy 2003; 58:833-43. [PMID: 12911410 DOI: 10.1034/j.1398-9995.2003.00264.x] [Citation(s) in RCA: 259] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Strategies to prevent children from developing allergy have been elaborated on the basis of state-of-the-art reviews of the scientific literature regarding pets and allergies, building dampness and health, and building ventilation and health. A similar multidisciplinary review of infant feeding mode in relation to allergy has not been published previously. Here, the objective is to review the scientific literature regarding the impact of early feeding (breast milk and/or cow's milk and/or formula) on development of atopic disease. The work was performed by a multidisciplinary group of Scandinavian researchers. METHODS The search in the literature identified 4323 articles that contained at least one of the exposure and health effect terms. A total of 4191 articles were excluded mainly because they did not contain information on both exposure and health effects. Consequently, 132 studies have been scrutinized by this review group. RESULTS Of the 132 studies selected, 56 were regarded as conclusive. Several factors contributed to the exclusions. The studies considered conclusive by the review group were categorized according to population and study design. CONCLUSIONS The review group concluded that breastfeeding seems to protect from the development of atopic disease. The effect appears even stronger in children with atopic heredity. If breast milk is unavailable or insufficient, extensively hydrolysed formulas are preferable to unhydrolysed or partially hydrolysed formulas in terms of the risk of some atopic manifestations.
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Affiliation(s)
- J van Odijk
- Department of Clinical Nutrition, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
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15
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Siltanen M, Kajosaari M, Poussa T, Saarinen KM, Savilahti E. A dual long-term effect of breastfeeding on atopy in relation to heredity in children at 4 years of age. Allergy 2003; 58:524-30. [PMID: 12757455 DOI: 10.1034/j.1398-9995.2003.00150.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The long-term effect of early feeding on atopic sensitization is still unsolved. The aim of this study was to evaluate the long-term effect of breastfeeding on atopy in groups of 4-year-old children stratified by atopic heredity. METHODS We collected four groups of 4-year-old children from a birth cohort: two groups with differing backgrounds of atopic heredity, all exclusively breast-fed for at least 3 months; and two groups with differing atopic heredity, but all fed with cow's milk-based formula during their first weeks. The data were collected with a questionnaire, skin prick testing, and measurement of serum total and allergen-specific IgE levels. RESULTS Breastfeeding significantly decreased the risk of allergic rhino-conjunctivitis [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.18-0.95] and sensitization to furred pets, as measured by skin prick results, in children with atopic heredity, whereas in children without atopic heredity, breastfeeding was related to an increased risk of symptomatic atopy (OR 2.57, 95% CI 1.16-5.70), and high serum IgE values. A significant interaction was found between heredity and breastfeeding. CONCLUSIONS The long-term effect of breastfeeding was dual: in children with atopic heredity, breastfeeding protected against atopy, whereas in children without atopic heredity, it increased the risk of atopy.
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Affiliation(s)
- M Siltanen
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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16
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Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G. Breast feeding and allergic diseases in infants-a prospective birth cohort study. Arch Dis Child 2002; 87:478-81. [PMID: 12456543 PMCID: PMC1755833 DOI: 10.1136/adc.87.6.478] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the effect of breast feeding on allergic disease in infants up to 2 years of age. METHODS A birth cohort of 4089 infants was followed prospectively in Stockholm, Sweden. Information about various exposures was obtained by parental questionnaires when the infants were 2 months old, and about allergic symptoms and feeding at 1 and 2 years of age. Duration of exclusive and partial breast feeding was assessed separately. Symptom related definitions of various allergic diseases were used. Odds ratios (OR) and 95% confidence intervals (CI) were estimated in a multiple logistic regression model. Adjustments were made for potential confounders. RESULTS Children exclusively breast fed during four months or more exhibited less asthma (7.7% v 12%, OR(adj) = 0.7, 95% CI 0.5 to 0.8), less atopic dermatitis (24% v 27%, OR(adj) = 0.8, 95% CI 0.7 to 1.0), and less suspected allergic rhinitis (6.5% v 9%, OR(adj) = 0.7, 95% CI 0.5 to 1.0) by 2 years of age. There was a significant risk reduction for asthma related to partial breast feeding during six months or more (OR(adj) = 0.7, 95% CI 0.5 to 0.9). Three or more of five possible allergic disorders-asthma, suspected allergic rhinitis, atopic dermatitis, food allergy related symptoms, and suspected allergic respiratory symptoms after exposure to pets or pollen-were found in 6.5% of the children. Exclusive breast feeding prevented children from having multiple allergic disease (OR(adj) = 0.7, 95% CI 0.5 to 0.9) during the first two years of life. CONCLUSION Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease-that is, asthma, atopic dermatitis, and suspected allergic rhinitis, up to 2 years of age. This protective effect was also evident for multiple allergic disease.
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Affiliation(s)
- I Kull
- Department of Environmental Health, Stockholm County Council, Stockholm, Sweden
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17
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Abstract
BACKGROUND : Although the health benefits of breastfeeding are widely acknowledged, opinions and recommendations are strongly divided on the optimal duration of exclusive breastfeeding. Much of the debate has centered on the so-called 'weanling's dilemma' in developing countries: the choice between the known protective effect of exclusive breastfeeding against infectious morbidity and the (theoretical) insufficiency of breast milk alone to satisfy the infant's energy and micronutrient requirements beyond four months of age. The debate over whether to recommend exclusive breastfeeding for four to six months versus 'about six months' has recently become heated and acrimonious. OBJECTIVES : The primary objective of this review was to assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through six months. A secondary objective was to assess the child and maternal health effects of prolonged (greater than six months) exclusive breastfeeding versus exclusive breastfeeding for six months followed by mixed breastfeeding thereafter. SEARCH STRATEGY : Two independent literature searches were carried out, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Caribbean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews (The Cochrane Library Issue 3, 2000), and the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2000). No language restrictions were imposed. The two searches yielded a total of 2,668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. SELECTION CRITERIA : We selected all internally-controlled clinical trials and observational studies comparing child or maternal health outcomes with exclusive breastfeeding for six or more months versus exclusive breastfeeding for at least three to four months with continued mixed breastfeeding until at least six months. Studies were stratified according to study design (controlled trials versus observational studies), provenance (developing versus developed countries), and timing of compared feeding groups (three to seven months versus later). DATA COLLECTION AND ANALYSIS : Two reviewers independently assessed study quality (using a priori assessment criteria) and extracted data. MAIN RESULTS : Twenty independent studies meeting the selection criteria were identified by the literature search: nine from developing countries (two of which were controlled trials in Honduras) and 11 from developed countries (all observational studies). The two trials did not receive high methodologic quality ratings but were nonetheless superior to any of the observational studies included in this review. The observational studies were of variable quality; in addition, their nonexperimental designs were not able to exclude potential sources of confounding and selection bias. Definitions of exclusive breastfeeding varied considerably across studies. Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for six months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest differences in risk of undernutrition. The data are conflicting with respect to iron status, but at least in developing country settings where newborn iron stores may be suboptimal, suggest that exclusive breastfeeding without iron supplementation through six months may compromise hematologic status. Based primarily on an observational analysis of a large randomized trial in Belarus, infants who continue exclusive breastfeeding for six months or more appear to have a significantly reduced risk of one or more episodes of gastrointestinal infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials suggest that exclusive breastfeeding through six months is associated with delayed resumption of menses and more rapid postpartum weight loss in the mother. REVIEWER'S CONCLUSIONS : We found no objective evidence of a 'weanling's dilemma'. Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are mixed breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea. Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed country settings. Large randomized trials are recommended in both types of setting to rule out small effects on growth and to confirm the reported health benefits of exclusive breastfeeding for six months or beyond.
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Affiliation(s)
- M S Kramer
- McGill University, Faculty of Medicine, 1020 Pine Avenue West, Montreal, Quebec, Canada, H3A 1A2.
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Gdalevich M, Mimouni D, David M, Mimouni M. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 2001; 45:520-7. [PMID: 11568741 DOI: 10.1067/mjd.2001.114741] [Citation(s) in RCA: 326] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the numerous studies on the possible protective effect of breast-feeding against the onset of atopic dermatitis during childhood, this issue remains controversial. OBJECTIVE We conducted a systematic review with meta-analysis of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and atopic dermatitis. METHODS A comprehensive search of the 1966-2000 MEDLINE database and review of the reference lists of relevant articles identified 18 prospective studies that met the predefined inclusion criteria. By means of a standardized approach, 2 of the investigators independently assessed the methodologic quality of the studies, duration and exclusivity of breast-feeding, outcome measures, and control for potential confounding factors. The same approach was applied during data abstraction and evaluation of the estimates of association. Summary measures of association were then calculated. RESULTS The summary odds ratio (OR) for the protective effect of breast-feeding in the studies analyzed was 0.68 (95% confidence interval [CI], 0.52-0.88). This effect estimate was higher in the group of studies wherein children with a family history of atopy were investigated separately (OR = 0.58; CI, 0.41-0.92) than in those of combined populations (OR = 0.84; CI, 0.59-1.19). A small subset of studies of children without a history of atopy in first-degree relatives showed no association between breast-feeding and the onset of atopic dermatitis (OR = 1.43; CI, 0.72-2.86). CONCLUSION Exclusive breast-feeding during the first 3 months of life is associated with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy. This effect is lessened in the general population and negligible in children without first-order atopic relatives. Breast-feeding should be strongly recommended to mothers of infants with a family history of atopy, as a possible means of preventing atopic eczema.
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Affiliation(s)
- M Gdalevich
- Department of General Pediatrics and Pediatric Emergency Medicine, Schneider Children's Medical Center of Israel, Tel Aviv, Israel
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19
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Affiliation(s)
- K M Järvinen
- Helsinki University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland.
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20
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Wright AL, Sherrill D, Holberg CJ, Halonen M, Martinez FD. Breast-feeding, maternal IgE, and total serum IgE in childhood. J Allergy Clin Immunol 1999; 104:589-94. [PMID: 10482832 DOI: 10.1016/s0091-6749(99)70328-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is controversy regarding the relationship of the effect of breast-feeding on markers of allergy such as total serum IgE in childhood. OBJECTIVE This study, using longitudinal data, tested the hypothesis that the relation of breast-feeding to IgE in childhood differs depending on maternal total IgE level. METHODS Total serum IgE was assessed with the paper radioimmunosorbent test at 4 ages in nonselected children enrolled at birth into the prospective Tucson Children's Respiratory Study. Children were classified as never breast-fed, breast-fed less than 4 months, or breast-fed 4 months or longer, on the basis of physician report or questionnaires completed by parents by the time the child was 18 months old. A longitudinal random effects model was used to test for group differences and temporal trends in IgE for children classified with reference to maternal IgE (high tertile vs all others) and breast-feeding history. A total of 664 children with 1457 observations were included. RESULTS Among children whose mothers were in the 2 lower tertiles of IgE, breast-feeding was associated with lower total serum IgE at age 6 years (24.2 vs 44.3 IU/mL for never breast-fed children; P <.02); similar trends existed at age 11 years. In contrast, for children whose mothers were in the highest tertile of IgE, breast-feeding of 4 months or longer was associated with higher IgE levels in the child compared with those never breast-fed or breast-fed less than 4 months (97.0 vs 38.9 IU/mL; P <. 005). These cross-sectional analyses were confirmed with the longitudinal random effects model, which also showed no effect of confounders. Paternal IgE showed no similar relation with child IgE. CONCLUSION Breast-feeding appears to have paradoxic relations with IgE in childhood, depending on maternal IgE level. These findings may help explain the contradictory results found in other investigations of the relation of breast-feeding to allergic symptoms and markers.
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Affiliation(s)
- A L Wright
- Respiratory Sciences Center, Arizona Health Sciences Center, Tucson 85724, USA
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21
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Affiliation(s)
- T J David
- University Department of Child Health, Booth Hall Children's Hospital, Manchester, UK
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22
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Koletzko B, Aggett PJ, Bindels JG, Bung P, Ferré P, Gil A, Lentze MJ, Roberfroid M, Strobel S. Growth, development and differentiation: a functional food science approach. Br J Nutr 1998; 80 Suppl 1:S5-45. [PMID: 9849353 DOI: 10.1079/bjn19980104] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Few other aspects of food supply and metabolism are of greater biological importance than the feeding of mothers during pregnancy and lactation, and of their infants and young children. Nutritional factors during early development not only have short-term effects on growth, body composition and body functions but also exert long-term effects on health, disease and mortality risks in adulthood, as well as development of neural functions and behaviour, a phenomenon called 'metabolic programming'. The interaction of nutrients and gene expression may form the basis of many of these programming effects and needs to be investigated in more detail. The relation between availability of food ingredients and cell and tissue differentiation and its possible uses for promoting health and development requires further exploration. The course of pregnancy, childbirth and lactation as well as human milk composition and the short- and long-term outcome of the child are influenced by the intake of foods and particularly micronutrients, e.g. polyunsaturated fatty acids, Fe, Zn and I. Folic acid supplementation from before conception through the first weeks of pregnancy can markedly reduce the occurrence of severe embryonic malformations; other potential benefits of modulating nutrient supply on maternal and child health should be further evaluated. The evaluation of dietary effects on child growth requires epidemiological and field studies as well as evaluation of specific cell and tissue growth. Novel substrates, growth factors and conditionally essential nutrients (e.g. growth factors, amino acids, polyunsaturated fatty acids) may be potentially useful as ingredients in functional foods and need to be assessed carefully. Intestinal growth, maturation, and adaptation as well as long-term function may be influenced by food ingredients such as oligosaccharides, gangliosides, high-molecular-mass glycoproteins, bile salt-activated lipase, pre- and probiotics. There are indications for some beneficial effects of functional foods on the developing immune response, for example induced by antioxidant vitamins, trace elements, fatty acids, arginine, nucleotides, and altered antigen contents in infant foods. Peak bone mass at the end of adolescence can be increased by dietary means, which is expected to be of long-term importance for the prevention of osteoporosis at older ages. Future studies should be directed to the combined effects of Ca and other constituents of growing bone, such as P, Mg and Zn, as well as vitamins D and K, and the trace elements F and B. Pregnancy and the first postnatal months are critical time periods for the growth and development of the human nervous system, processes for which adequate substrate supplies are essential. Early diet seems to have long-term effects on sensory and cognitive abilities as well as behaviour. The potential beneficial effects of a balanced supply of nutrients such as I, Fe, Zn and polyunsaturated fatty acids should be further evaluated. Possible long-term effects of early exposure to tastes and flavours on later food choice preferences may have a major impact on public health and need to be further elucidated. The use of biotechnology and recombinant techniques may offer the opportunity to include various bioactive substances in special dietary products, such as human milk proteins, peptides, growth factors, which may have beneficial physiological effects, particularly in infancy and early childhood.
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Affiliation(s)
- B Koletzko
- Kinderpoliklinik, Klinikum Innenstadt der Ludwig-Maximilians-Universität, München, Germany.
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Abstract
Clinical enteral nutrition solutions, produced by mixing chemicals or defined nutrients, have repeatedly been shown to lack important ingredients; in the formulation of these solutions several key nutrients have simply been overlooked. The aim of this particular issue of the journal is to discuss some of these nutrients that were earlier neglected, but that today have proven to have key functions, especially in stress situations such as disease. The metabolism of the body is a complex system, one can not expect that supplying the body with one or a few chemicals, natural or synthetic, will lead to maximal health and performance. Most often an amalgam of substances is needed. Only natural food has the potential to supply most of the components needed, and thereby provide effective and successful nutrition. In stress situations such as premature life, disease, or aging, or extreme conditions such as exercise, eating normal food might not be enough; in these situations supplements will prove to be of the greatest value.
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Affiliation(s)
- S Bengmark
- Lund University, Ideon Research Center, Sweden
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Affiliation(s)
- J M Hill
- Department of Respiratory Medicine, West Glasgow Hospitals University Trust
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25
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Affiliation(s)
- R S Zeiger
- Southern California Medical Permanente Group, Department of Allergy, San Diego 92120, USA
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Alves J, Carlos Martins J, Rocha L, Agostinho Marques J. Aspectos epidemiológicos da asma. REVISTA PORTUGUESA DE PNEUMOLOGIA 1995. [DOI: 10.1016/s0873-2159(15)31218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Affiliation(s)
- S Strobel
- Division of Cell and Molecular Biology, Institute of Child Health, London, UK
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Abstract
This study investigated the association of asthma, allergic rhinitis, and eczema in United Arab Emirates (UAE) schoolchildren with allergic conditions in their parents. A cross-sectional, population-based study among schoolchildren aged 6-14 years was conducted in Al-Ain City, UAE. The field survey was conducted from October 1992 to May 1993. A questionnaire was distributed to 850 UAE government school students from representative, randomly selected schools with a majority of UAE nationals. The student and both or either of the parents were present during the interview. A detailed clinical history of asthma and wheezing in the target children and a history of asthma and allergic rhinitis in their parents and siblings were obtained. It was found that 13.1% of asthmatic children had mothers with asthma (relative risk (RR) = 2.67; 95% confidence intervals (CI) = 1.65-4.35), and 15.2% had fathers who were asthmatic (RR = 2.85; 95% CI = 1.81-4.49). This contrasted with 4.4% of nonasthmatic children who had fathers with asthma, and 4.1% who had mothers with asthma. A similar pattern was seen with symptoms of allergic rhinitis when it was found that 34.3% of children who had asthma had mothers with allergic rhinitis (RR: 2.74; 95% CI: 1.90-3.94). The corresponding figure for fathers was 12.7% (RR: 0.92; 95% CI: 0.5-1.7). The frequency of either parent of the asthmatic children having allergic rhinitis was 28.6%; for both parents, it was 14.5%. It was also found that asthmatic children had 12.5% of their fathers, 32.8% of their mothers, 26.4% of either of their parents, and 33.3% of both their parents suffering from allergic rhinitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Y M Abdulrazzaq
- Department of Paediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain
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29
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Abstract
Using human alpha-lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of alpha-lactalbumin was measured as concentration in serum after a human milk feed and expressed as micrograms alpha-lactalbumin/l serum/l human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of alpha-lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of alpha-lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.
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Affiliation(s)
- G Boehm
- Department of Paediatrics, University of Leipzig, Germany
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30
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Abstract
Clinical observations have suggested that the development of atopic diseases in childhood may be influenced by breast-feeding and the timing of first exposure to foreign protein, but the controversy is far from being resolved. Early weaning and introduction of foreign proteins (i.e., cow milk) have been associated with an increased prevalence of atopic symptoms in infants with a family history of atopy. Opposite results have been reported, and the effects of early protein introduction in infants not at risk of having atopic symptoms are poorly documented. Research in rodents suggests that perinatal antigen exposure is more likely to prime the immune system than to induce tolerance. Continuous feeding beyond the critical neonatal period leads to induction of tolerance. The immunologic response is dependent on the antigen dose. Protein transfer by breast-feeding can induce tolerance, though in a dose range otherwise associated with priming. The protective effect of antigen avoidance in infancy on the development of cow milk allergy and also on subsequent atopic symptoms is well documented. Protective effects have been observed in infants at risk who either were breast fed or received a hydrolyzed infant formula. Several clinical studies suggest a causative role of neonatal milk exposure in the development of cow milk allergy. Prospective, population-based studies are required to assess the true incidence of food-allergic diseases in childhood.
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Affiliation(s)
- S Strobel
- Institute of Child Health, University of London, England
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Liptay S, Bauer CP, Grübl A, Franz R, Emmrich P. Natural history of atopic disease in early childhood: is cord blood IgE a prognostic factor? A preliminary report. Clin Pediatr (Phila) 1992; 31:241-6. [PMID: 1563200 DOI: 10.1177/000992289203100411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S Liptay
- Kinderklinik und Poliklinik, Technischen Universität München, Federal Republic of Germany
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Savilahti E, Tainio VM, Salmenperä L, Arjomaa P, Kallio M, Perheentupa J, Siimes MA. Low colostral IgA associated with cow's milk allergy. ACTA PAEDIATRICA SCANDINAVICA 1991; 80:1207-13. [PMID: 1785293 DOI: 10.1111/j.1651-2227.1991.tb11810.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During a nutritional study of 198 infants, seven became allergic to cow's milk. The seven infants showed acute cutaneous manifestations during cow's milk challenge tests in hospital and six had increased levels of IgE cow's milk-specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cow's milk-specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta-lactoglobulin content and levels of cow's milk-, and beta-lactoglobulin-specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cow's milk allergy and from a comparison group (non-atopic mothers of non-atopic infants). The milk of the mothers whose infants became allergic to cow's milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cow's milk allergy if the mother's colostrum had a low total IgA content.
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Affiliation(s)
- E Savilahti
- Children's Hospital, University of Helsinki, Finland
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Savilahti E, Tainio VM, Salmenperä L, Arjomaa P, Kallio M, Perheentupa J, Siimes MA. Levels of IgA and cow milk antibodies in breast milk vs. the development of atopy in children. Low colostral IgA associated with cow milk allergy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1991; 310:417-25. [PMID: 1809019 DOI: 10.1007/978-1-4615-3838-7_54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E Savilahti
- Children's Hospital, University of Helsinki, Finland
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Lucas A, Brooke OG, Cole TJ, Morley R, Bamford MF. Food and drug reactions, wheezing, and eczema in preterm infants. Arch Dis Child 1990; 65:411-5. [PMID: 2189368 PMCID: PMC1792193 DOI: 10.1136/adc.65.4.411] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Allergic reactions were investigated in 777 preterm infants who were randomly assigned to early diet and followed up to 18 months post term. Wheezing or asthma was common (incidence 23%); it was associated with neonatal ventilation, maternal smoking, and a family history of atopy and was unexpectedly reduced in babies born by caesarean section. Even in non-ventilated infants, the incidence of subsequent wheezing was 18%, rising to an estimated 44% (using logistic regression) when the foregoing risk factors (excluding ventilation) were present. Eczema occurred in 151 infants (19%) and was strongly associated with multiple pregnancy (30% incidence in twins or triplets). Reactions to cows' milk (incidence: 4.4% from detailed history; 0.8% confirmed by challenge), other foods (10%), and drugs (5%) were within the range reported in full term infants. Milk and food reactions were associated with multiple pregnancy (19%) and a family history of atopy. Reactions to drugs were least likely to occur in infants who had been ventilated and were on multiple medications in the neonatal period, suggesting that drug tolerance may have developed. We speculate that preterm infants may be a high risk group for asthma and eczema, which could imply an association between atopy and prematurity.
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Affiliation(s)
- A Lucas
- MRC Dunn Nutrition Unit, Cambridge
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Lucas A, Brooke OG, Morley R, Cole TJ, Bamford MF. Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study. BMJ (CLINICAL RESEARCH ED.) 1990; 300:837-40. [PMID: 2186825 PMCID: PMC1662577 DOI: 10.1136/bmj.300.6728.837] [Citation(s) in RCA: 202] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the effect of early diet on the development of allergic reactions in infants born preterm. DESIGN Two randomised prospective trails. In trail A infants were randomly allocated banked donor milk or preterm formula as their sole diet or (separately randomised) as a supplement to their mother's expressed breast milk. In trial B infants were allocated term or preterm formula. A blind follow up examination was done 18 months after the expected date of birth. SETTING Neonatal units of hospitals in Cambridge, Ipswich, King's Lynn, Norwich, and Sheffield. Outpatient follow up. PARTICIPANTS 777 Infants with a birth weight less than 1850 g born during 1982 to 1984. MAIN OUTCOME MEASURES Development of eczema, allergic reactions to food or drugs, and asthma or wheezing by nine and 18 months after term. Whenever possible the observations were confirmed by rechallenge or clinical examination. RESULTS At 18 months after term there was no difference in the incidence of allergic reactions between dietary groups in either trial. In the subgroup of infants with a family history of atopy, however, those in trial A who received preterm formula rather than human milk had a significantly greater risk of developing one or more allergic reactions (notably eczema) by 18 months (odds ratio 3.6; 95% confidence interval 1.4 to 9.1). CONCLUSIONS Feeding neonates on formulas based on cows' milk, including those with a high protein content, did not increase the overall risk of allergy. Nevertheless, in the subgroup with a family history of atopy early exposure to cows' milk increased the risk of a wide range of allergic reactions, especially eczema.
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Affiliation(s)
- A Lucas
- MRC Dunn Nutrition Unit, Cambridge
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Pöysä L, Remes K, Korppi M, Juntunen-Backman K. Atopy in children with and without a family history of atopy. I. Clinical manifestations, with special reference to diet in infancy. ACTA PAEDIATRICA SCANDINAVICA 1989; 78:896-901. [PMID: 2603716 DOI: 10.1111/j.1651-2227.1989.tb11171.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19% of 163 children, in 23% of those with a family history of atopy and in 14% of those with no such history. Skin problems were more common in children with a family history of atopy (43%) than in the control children (19%). Of the children with a family history of atopy, 23% had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10%. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47% vs. 18%). At the age of five years, atopic disease was found in 17% of 128 children, 24% of those with a family history of atopy and 9% of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.
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Affiliation(s)
- L Pöysä
- Department of Paediatrics, Kuopio University Central Hospital, Finland
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Angioni AM, Fanciulli G, Corchia C. Frequency of and risk factors for allergy in primary school children: results of a population survey. Paediatr Perinat Epidemiol 1989; 3:248-55. [PMID: 2788877 DOI: 10.1111/j.1365-3016.1989.tb00376.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
During May 1986, a survey to assess the frequency of allergic disorders was conducted among primary school children of Alghero, Sardinia, using a structured self-administered questionnaire. The following problems were investigated: allergic conjunctivitis, asthma, wheezing, allergic rhinitis, urticaria and eczema. Of the original 1823 questionnaires distributed, 1961 (92.8%) were completed by parents and returned. Overall, 238 children (14.1%) were reported to have shown at least one episode of one or more of the above and were regarded as 'allergic'. Among the potential risk factors investigated, statistically significant differences (P less than 0.05) between allergic and non-allergic children were only found for history of allergy in at least one parent (odds ratio, OR = 2.2) and exposure to passive smoking (OR = 1.4).
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Affiliation(s)
- A M Angioni
- Department of Pediatrics, Alghero General Hospital, Italy
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David TJ. Infection and Prevention: Current Controversies in Childhood Atopic Eczema: A Review. Med Chir Trans 1989; 82:420-2. [PMID: 2685302 PMCID: PMC1292209 DOI: 10.1177/014107688908200716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T J David
- Booth Hall Children's Hospital, University of Manchester
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Tainio VM, Savilahti E, Arjomaa P, Salmenperä L, Perheentupa J, Siimes MA. Plasma antibodies to cow's milk are increased by early weaning and consumption of unmodified milk, but production of plasma IgA and IgM cow's milk antibodies is stimulated even during exclusive breast-feeding. ACTA PAEDIATRICA SCANDINAVICA 1988; 77:807-11. [PMID: 3207017 DOI: 10.1111/j.1651-2227.1988.tb10760.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We measured levels of cow's milk-specific (CM) antibodies of immunoglobulin classes G, A and M by enzyme-linked immunosorbent assay in plasma of 198 healthy infants; a variable number of samples taken at birth and at ages of 2, 4, 6, 9, 12 and 28 months were available (altogether 765 samples). The rise in the level of IgG CM antibodies was highest and most rapid in infants exposed to CM formula before the age of 1 month. The level fell by 9 months, but rose again by 12 months. This second rise was attributed to the introduction of dairy milk. Partially breast-fed and fully weaned infants had similar levels of IgG CM antibodies. The levels of IgG CM antibodies were unaffected by the infants' own atopy, their heredity for atopy, and the umbilical serum level of IgG CM antibodies. IgA and IgM CM antibodies were absent at birth. Their levels increased similarly in exclusively breast-fed infants and infants fed CM formula. We conclude that plasma IgG antibodies to cow's milk are increased by early weaning and by consumption of unmodified cow's milk. Production of plasma IgA and IgM antibodies to cow's milk is stimulated even during exclusive breast-feeding.
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Affiliation(s)
- V M Tainio
- Children's Hospital, University of Helsinki, Finland
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41
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Moneret-Vautrin D. Une prévention de l'allergie alimentaire est-elle possible ? ACTA ACUST UNITED AC 1988. [DOI: 10.1016/s0335-7457(88)80047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pöysä L, Remes K, Korppi M, Launiala K. Compliance with a dietary manipulation programme in families with infants prone to atopy. ACTA PAEDIATRICA SCANDINAVICA 1988; 77:563-8. [PMID: 3394510 DOI: 10.1111/j.1651-2227.1988.tb10701.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The success of familial compliance with a dietary manipulation programme was studied prospectively in 91 newborn babies from atopic families for up to 12 months. The control group consisted of 72 infants from non-atopic families. The percentages of infants breast-fed at the age of six months were 58% and 38% in the study group and control group, respectively. The introduction of cow's milk based formulas was postponed until the age of three months in 63% of the infants in the study group and 47% of the infants in the control group. Solid food was avoided during the first three months in 76% and 45% of the infants in the study group and control group, respectively. Maternal age, smoking and low social class were associated with poor compliance. The existence of atopic dermatitis in any member of the family was associated with good compliance. The main advantages of our programme were the increased number of children breast-fed until the age of six months, and the reduced number of infants introduced to cow's milk based formulas or solid food before three months of age.
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Affiliation(s)
- L Pöysä
- Department of Paediatrics, University Central Hospital, Kuopio, Finland
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43
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De Bont B. Positive family history of allergy and cow's milk allergy. Eur J Pediatr 1988; 147:211-2. [PMID: 3366143 DOI: 10.1007/bf00442228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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44
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Ponzone A. Prolonged exclusive breast feeding and hereditary as determinants in infantile atopy. Arch Dis Child 1987; 62:1196. [PMID: 3688930 PMCID: PMC1778543 DOI: 10.1136/adc.62.11.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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