延缓给予婴儿固体食物可能增加之后过敏风险


  【24drs.com】December 11, 2009 — 根据一项在线发表于12月7日小儿医学期刊的前瞻性、出生世代研究结果指出,延缓给予婴儿固体食物可能增加之后过敏风险。
  
  芬兰坦佩雷大学的Bright I. Nwaru哲学硕士写到,在出生后头六个月仅餵食母乳以预防过敏性疾病的建议可能缺乏强烈的证据。相反的,延缓引进蛋类、牛乳、谷类以及其它固体食物已经被证实与异位性皮肤炎、湿疹和过敏敏感化(不论是否有症状)有关。在目前这项研究中,我们想要在一群HLA(人类白血球抗原使得对第一型糖尿病具敏感性,考虑到反转因果关系)评估在出生后第一年,引进不同固体食物的时间,与食物及吸入性过敏敏感化反应之间的关系。
  
  研究者们分析994位HLA使得对第一型糖尿病具敏感性儿童,在5岁时有关于餵乳、引进固体食物时的年龄、过敏原特异免疫球蛋白E(IgE)浓度,这些儿童被收纳到芬兰裔第一型糖尿病预测与预防(DIPP)营养研究。以逻辑式回归法分析引进固体食物年龄与过敏敏感化反应的关系。
  
  仅餵食乳汁的时间中位数为1.8个月(范围从0-10个月)。饮食中,延缓引进马铃薯(>4个月)、燕麦(>5个月)、黑麦(>7个月)、小麦(>6个月)、肉类(>5.5个月)、鱼类(>8.2个月)与蛋类(>10.5个月)都直接且显著地与对食物过敏原敏感化反应有关,即使在校正潜在的影响因子后也是如此。
  
  延缓引进马铃薯、黑麦、肉类及鱼类,都显著地与对任何吸入性过敏原产生敏感化反应有关。
  
  蛋类、燕麦以及肉类是与对食物过敏原敏感化反应最重要的食物,在纳入所有固体食物的模式中显著地与终点有关。对吸入性过敏原敏感化作用而言,马铃薯与鱼类是最重要的食物。当考虑到双亲的过敏性鼻炎与气喘时,研究者们发现并没有反转因果关系的存在。
  
  研究作者们写到,延缓引进固体食物与对食物及吸入性过敏原发生过敏敏感化反应风险增加有关。在目前这项研究中,我们所观察到的是与之前研究报告延迟引进固体食物可能无法预防儿童发生过敏性疾病相符。
  
  这项研究的限制包括,试验族群仅餵食母乳的时间中位数较短,且选择HLA使得对第一型糖尿病具敏感力的族群,限制了其应用性。除此之外,试验终点是对食物及吸入性过敏原的敏感化反应,因此这些结果可能不能代表引进固体食物的时间对于气喘、异位性湿疹、或是其它过敏性预后的影响。这些试验终点的事件数目很小,造成无法达到任何有意义分析的统计力量。
  
  研究作者们的结论是,对我们的试验族群延长后续监测,将可以厘清目前观察到的是否可以转换为临床过敏预后。这些发现挑战目前有关婴儿餵食以预防过敏性疾病的建议。
  
  芬兰研究院;芬兰小儿医学研究基金会;Juho Vainio基金会;Yrjo Jahnsson基金会;来自Turku,Oulu、以及坦佩雷大学的研究经费;欧盟生化医学2计划;公共卫生博士计划赞助这项研究。研究作者们表示已无相关资金上的关系。

Delaying Solid Foods in Infant Diet May Increase Later Risk for Allergies

By Laurie Barclay, MD
Medscape Medical News

December 11, 2009 — Late introduction of solid foods into the infant diet is associated with an increased risk for allergic sensitization to food and inhalant allergens at age 5 years, according to the results of a prospective, birth cohort study reported online in the December 7 issue of Pediatrics.

"The recommendation of exclusive breastfeeding for the first 6 months for the prevention of allergic diseases may lack strong scientific evidence," write Bright I. Nwaru, MPhil, MSc, from University of Tampere in Tampere, Finland, and colleagues. "Conversely, increased risk for atopic dermatitis, eczema, and allergic sensitization (with or without symptoms) has been associated with delayed introduction of egg, milk, cereals, and other solids....In the present study, we aimed to assess the association between age at the introduction of different solid foods during the first year of life and food and inhalant allergic sensitizations in a cohort of 5-year-old children with HLA [human leukocyte antigen]-conferred susceptibility to type 1 diabetes, taking into account reverse causality."

The investigators analyzed data regarding breast-feeding, age when solid foods were introduced, and allergen-specific immunoglobulin E (IgE) levels at 5 years from 994 children with HLA-conferred susceptibility to type 1 diabetes mellitus who were enrolled in the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) nutrition study. Logistic regression allowed analysis of the association between age at the introduction of solid foods and allergic sensitization.

Median duration of exclusive breast-feeding was 1.8 months (range, 0 -10 months). Late dietary introduction of potatoes (> 4 months), oats (> 5 months), rye (> 7 months), wheat (> 6 months), meat (> 5.5 months), fish (> 8.2 months), and eggs (> 10.5 months) was directly and significantly associated with sensitization to food allergens, after adjustment for potential confounders.

Late introduction of potatoes, rye, meat, and fish was significantly associated with sensitization to any inhalant allergen.

Eggs, oats, and wheat were the most important foods related to sensitization to food allergens, in models that included all solid foods that were significantly related to the endpoints. For sensitization to inhalant allergens, potatoes and fish were the most important foods. When parental allergic rhinitis and asthma were considered, the investigators found no evidence of reverse causality.

"Late introduction of solid foods was associated with increased risk of allergic sensitization to food and inhalant allergens," the study authors write. "Our observations in the present study are in accordance with reports showing that delayed introduction of solid foods may not prevent the development of allergic diseases in children."

Limitations of this study include short median duration of exclusive breast-feeding in the study population and selection of birth cohort based on HLA-conferred susceptibility to type 1 diabetes, limiting generalizability. In addition, the endpoints were sensitization against food and inhalant allergens, so these results may not indicate the effects of timing of the introduction of solid foods on actual asthma, atopic eczema, or other clinical allergic outcomes. The number of these endpoints was small, resulting in insufficient statistical power for any meaningful analysis.

"Extended follow-up monitoring of our study cohort will clarify whether our present observations can be translated into clinical allergic outcomes," the study authors conclude. "These findings challenge the current recommendations regarding infant feeding for the prevention of allergic diseases."

The Academy of Finland; the Finnish Pediatric Research Foundation; the Juho Vainio Foundation; the Yrjo Jahnsson Foundation; medical research funds from Turku, Oulu, and Tampere University Hospitals; Juvenile Diabetes Research Foundation; the Novo Nordisk Foundation; the University of Tampere Foundation; the European Union Biomed 2 Program; and the doctoral programs in Public Health supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 7, 2009.

    
相关报导
较早开始吃固体食物的婴儿较容易过敏?
2013/11/20 上午 10:53:42

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