Let the babies eat! The importance of a diverse diet in early infancy
Published online: January 28, 2020
‘Dietary diversity’ is defined as the number of different foods, food groups or food allergens eaten over a period of time such as the first year of life. Recently there has been considerable interest in the effect of infant diet diversity in the prevention of allergic diseases. A task force report from the European Academy of Asthma, Allergy and Immunology suggested that increased diet diversity may reduce the infant’s risk of developing allergic diseases. However, despite this increased interest only 14 papers have looked at the association between diet diversity and allergy outcomes, of which only 1 paper reported on diet diversity in early life and its association with the development of food allergy in later childhood.
In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Venter C et al assessed the effect of infant diet diversity in the first year of life on food allergy outcomes over the first 10 years of life in a population birth cohort born between 2000-2002 from the Isle of Wight, UK. Information on age of introduction of a range of foods and food allergens were collected during the first year of life. Diet diversity was defined using four different definitions: the World Health Organization (WHO) definition of minimum diet diversity at 6 months, as food diversity and fruit and vegetable diversity at 3, 6 and 9 months, and as food allergen diversity at 3, 6, 9, 12 months. Children were diagnosed with food allergy at 1, 2, 3 and 10 years of age based on oral food challenge outcome or a good clinical history and supporting allergen testing.
A total of 969 pregnant women were recruited at 12 weeks’ gestation. 900, 858, 891 and 827 offspring were assessed at 1, 2, 3 and 10 years. Univariate analysis showed that at none of the diet diversity measures used at 3 months showed any association with food allergy outcomes at any of the timepoints studied or over the first 10 years of life. At 6 months, minimum food diversity as defined by the WHO (p=0.0047) , food diversity (number of foods eat) (p=0.0009), allergen diversity (number of food allergens eaten; milk, egg, wheat, fish, soy, peanut, tree nuts, sesame) (p=0.0048) and fruit and vegetable diversity (p=0.0174) were associated with reduced food allergy outcomes over the first 10 years of life. At 9 months, food diversity, food allergen diversity, and fruit and vegetable diversity were associated with significantly reduced odds of food allergy over the first decade of life. The results showed that for each additional food introduced by 6 months, the odds of developing food allergy over the first 10 years of life was reduced by 10.8%. Similarly, for each additional allergenic food consumed by 1 year, there was a significant reduction of 33.2% in the likelihood of food allergy over the first 10 years of life.
Thus, this observational study suggests that early oral intake of a variety of foods and food allergens, once the infant is developmentally ready, may reduce incidence of food allergy in the first 10 years of life. The authors suggest that clinicians should actively encourage food and allergen intake in infancy. They note that none of the food diversity factors at 3 months showed any significance, indicating that there is no need to diversity the diet in this young age, where exclusive breast feeding remains the best strategy.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.