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Can We Prevent Atopic Disease by What We Feed Our Babies?

Mothers-to-be and breast-feeding mothers need not restrict their food choices, but they should plan on breast-feeding exclusively for the first 4 months, if possible.

Asthma incidence in preschoolers has increased 160%, and rates of peanut allergy and atopic dermatitis (AD) have increased two- to threefold over the past several decades. Atopic diseases have a clear genetic basis, but environmental factors are likely to play an important role. Can nutritional interventions during the first year of life decrease the risks for asthma, AD, and food allergy? Does breast-feeding help prevent atopic disease?

Pediatric allergy experts reviewed data from international studies on prevention of atopic diseases through maternal and infant dietary interventions. Most studies focused on the diet of high-risk (having a first-degree relative with AD) infants up to 6 months old.

The committee concluded:

1) Maternal dietary restrictions during pregnancy or lactation did not prevent atopic disease.

2) Compared with feeding intact cow milk protein formula, exclusive breast-feeding for at least 4 months seems to decrease risks for AD, wheezing, and cow milk allergy in the first 2 years of life.

3) Extensively or partially hydrolyzed formulas appear to better prevent atopic diseases than intact cow milk protein formulas.

4) No evidence supports the use of soy-based formula for preventing allergy.

5) Solid foods should be introduced no sooner than 4 to 6 months; no further benefit derives from delaying solids longer.

6) No studies have examined the protective effects of amino-acid–based formulas.

Comment: Well, I should have succumbed to all those peanut butter and jelly sandwich cravings, after all. However, nursing my children may have protected them from atopy.

Exclusive breast-feeding for the first 4 months should be encouraged whenever possible. Infant formulas differ: Soy formula does not prevent atopic disease. Extensively hydrolyzed formulas (Alimentum, Nutramigen, and Pregestimil) and partially hydrolyzed formulas (Good Start Supreme and Enfamil Gentlease Lipil) prevent allergy somewhat better but cost approximately 70% more than traditional formulas. Amino-acid–based formulas (Neocate and EleCare) are even more "hypoallergenic," but their cost is about 150% higher than standard formulas; they can be important for managing infants with substantial food allergies, but their use has not been studied for preventing atopic disease.

Although this report received no funding from formula makers, the original studies may have. Use of probiotics or newer nutritional formula supplementation in infants was not addressed. Proponents of the hygiene hypothesis may argue that early microbial colonization and infection play a more significant role than exposure to dietary allergens in the development of atopic diseases.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology February 15, 2008

Citation(s):

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

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