Early feeding profiles based on breastfeeding, infant formula and introduction of solid foods

Background

As early feeding practices may be related with allergy at older age, we aimed to investigate infant-feeding profiles in the first year of life and their determinants in the PARIS (Pollution and Asthma Risk: an Infant Study) cohort.

Methods

This study included 3446 infants. Feeding data was collected using standardized questionnaires at 1, 3, 6, 9 and 12 months. At each time, we considered 6 variables such as (i) breastfeeding (no, mixed, exclusive), consumption of formula (no, yes): (ii) regular formula, (iii) hypoallergenic, (iv) with pre-/probiotics, or (v) extensively hydrolyzed/soya, as well as (vi) solid foods introduction (no, yes: 0, 1, ≥2 allergenic foods). Children with similar feeding profiles over the first year of life were grouped together using multidimensional longitudinal cluster analysis. Socio-demographic and health determinants of these profiles were examined using multinomial logistic regression models.

Results

Five distinct profiles were identified. Profile 1 (45%) included children mainly fed with regular formula. Children from Profile 2 (27%) were exclusively breastfed during the first 3 months. Children from the other three profiles were moderately breastfed and differed regarding the type of formula consumed: pre-/probiotics for Profile 3 (17%), hypoallergenic for Profile 4 (7%), or extensively hydrolyzed/soya for Profile 5 (4%). Profiles did not seem to differ regarding timing of solid foods introduction, except Profile 5 starting later. Compared to Profile 1, children from Profiles 2 to 5 were more likely to have parental history of allergy and higher family socioeconomic status (SES). Profile 5 appeared to be influenced by early health outcomes such as eczema or food reactions.

Conclusions

We identified different early feeding profiles. Parental history of allergy, SES and early health outcomes seem to be important determinants of these profiles. Associations of these profiles with the development of allergic disease will be studied.

Key messages

These results are important to better understand early-life feeding practices and their contributors. Their possible role in helping to prevent allergic diseases in later life will be further studied.

Paving the way of systems biology and precision medicine in allergic diseases: the MeDALL success story: Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015

MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large-scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy-related diseases. To complement the population-based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda.

Phenotyping asthma, rhinitis and eczema in MeDALL population-based birth cohorts: an allergic comorbidity cluster

BACKGROUND

Asthma, rhinitis and eczema often co-occur in children, but their interrelationships at the population level have been poorly addressed. We assessed co-occurrence of childhood asthma, rhinitis and eczema using unsupervised statistical techniques.

METHODS

We included 17 209 children at 4 years and 14 585 at 8 years from seven European population-based birth cohorts (MeDALL project). At each age period, children were grouped, using partitioning cluster analysis, according to the distribution of 23 variables covering symptoms 'ever' and 'in the last 12 months', doctor diagnosis, age of onset and treatments of asthma, rhinitis and eczema; immunoglobulin E sensitization; weight; and height. We tested the sensitivity of our estimates to subject and variable selections, and to different statistical approaches, including latent class analysis and self-organizing maps.

RESULTS

Two groups were identified as the optimal way to cluster the data at both age periods and in all sensitivity analyses. The first (reference) group at 4 and 8 years (including 70% and 79% of children, respectively) was characterized by a low prevalence of symptoms and sensitization, whereas the second (symptomatic) group exhibited more frequent symptoms and sensitization. Ninety-nine percentage of children with comorbidities (co-occurrence of asthma, rhinitis and/or eczema) were included in the symptomatic group at both ages. The children's characteristics in both groups were consistent in all sensitivity analyses.

CONCLUSION

At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster. Future research including time-repeated assessments and biological data will help understanding the interrelationships between these diseases.

Onset and persistence of respiratory/allergic symptoms in preschoolers: new insights from the PARIS birth cohort

BACKGROUND

The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms throughout preschool years.

METHODS

As part of the PARIS cohort, symptoms of wheezing, dry night cough, rhinitis and dermatitis were collected annually from birth to age 4 years. K-means clustering was used to group into phenotypes children with similar symptoms trajectories over the study period. Associations of phenotypes with IgE sensitization and risk factors were studied using multinomial logistic regression.

RESULTS

Besides a group with low prevalence of symptoms considered as reference (n = 1236, 49.0%), four distinct respiratory/allergic phenotypes were identified: two transient [transient rhinitis phenotype (n = 295, 11.7%), transient wheeze phenotype (n = 399, 15.8%)], without any relation with IgE sensitization, and two persistent [cough/rhinitis phenotype (n = 284, 11.3%), dermatitis phenotype (n = 308, 12.2%)], associated with IgE sensitization. Transient rhinitis phenotype was only associated with tobacco smoke exposure, which could irritate the airways. Transient wheeze phenotype was related to male sex and contact with other children (older siblings, day care attendance). Lastly, risk factors for both IgE-associated phenotypes encompassed parental history of allergy, potential exposure to allergens and stress, known to be associated with the development of allergic diseases.

CONCLUSION

This study provides evidence for the existence of different respiratory/allergic phenotypes before school age. The fact that they differ in terms of sensitization and risk factors reinforces the plausibility of distinct phenotypes, potentially linked to irritation and infections for the transient phenotypes and to allergy for the persistent phenotypes.