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Revisión sistemática

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Timing of food introduction to the infant diet and risk of food allergy: a systematic review and Meta-analysis

Revista 中华儿科杂志 (Chinese journal of pediatrics)
Año 2021
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OBJECTIVE: To evaluate the relationship between the timing of complementary feeding for infants and the occurrence of food allergy. METHODS: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WanFang Data database were searched for randomized controlled trials (RCTs) about the effects of early introduction of complementary foods in infants on the occurrence of food allergy. Papers published from the establishment of the databases to December 31, 2019 were extracted. The quality of the selected literature was evaluated using the risk-of-bias (ROB) tools in the Cochrane Handbook, and the RevMan 5.3 software was used for meta-analysis. For the complementary food analyzed in a few reports in literature, a systematic review was conducted. RESULTS: A total of 8 RCTs were extracted, and the systematic review and Meta-analysis were carried out according to food types. The results of Meta-analysis showed that compared with late introduction (after 6 months of age), early introduction (before 6 months of age) of eggs (RR=0.60, 95%CI 0.46-0.79) could reduce the risk of egg allergy in infants. The subgroup analysis of the six studies about eggs demonstrated that in infants with a prior or family history of allergic diseases, the introduction of eggs before 6 months of age was associated with reduced risk of egg allergy (RR=0.55, 95%CI 0.40-0.75), and the introduction of raw eggs (RR=0.67, 95%CI 0.49-0.93) and small amount of eggs (equivalent to weekly protein 0-4 g) (RR=0.55, 95%CI 0.36-0.85) before 6 months of age were also associated with reduced risk of egg allergy. In addition, egg supplementation during 4-6 months of age reduced the occurrence of egg allergy compared with supplementation before 4 months of age (RR=0.58, 95%CI 0.43-0.78). The systematic review found no conclusive relationship between early peanut introduction and peanut allergy, nor the correlation between early cow's milk protein introduction and cow's milk protein allergy (P>0.05). CONCLUSION: Early introduction (before 6 months of age) of eggs in infants' complementary foods can prevent infant egg allergy, but the limitations of the study need to be considered.

Revisión sistemática

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Preventing food allergy in infancy and childhood: systematic review of randomised controlled trials.

Revista Pediatric allergy and immunology
Año 2020
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Este artículo está incluido en 2 Síntesis amplias 45 Síntesis amplias (2 referencias)

Este artículo incluye 46 Estudios primarios 45 Estudios primarios (46 referencias)

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BACKGROUND: This systematic review of ways to prevent immediate-onset/IgE-mediated food allergy will inform guidelines by the European Academy of Allergy and Immunology (EAACI). METHODS: The GRADE approach was used. Eleven databases were searched from 1946 to October 2019 for randomised controlled trials (and large prospective cohort studies in the case of breastfeeding). The studies included heterogeneous interventions, populations and outcomes so were summarised narratively. RESULTS: Forty-six studies examined interventions to reduce the risk of food allergy in infancy (up to one year) or early childhood. The following interventions for pregnant or breastfeeding women and/or infants may have little to no effect on preventing food allergy but the evidence is very uncertain: dietary avoidance of food allergens, vitamin supplements, fish oil, probiotics, prebiotics, synbiotics and emollients. Breastfeeding, hydrolysed formulas and avoiding cow's milk formula may not reduce the risk of cow's milk protein allergy, however temporary supplementation with cow's milk formula in the first week of life may increase the risk of cow's milk allergy. Introducing well-cooked egg, but not pasteurised raw egg, from four to six months probably reduces the risk of hen's egg allergy. Introducing regular peanut consumption into the diet of an infant at increased risk beginning from four to 11 months probably results in a large reduction in peanut allergy in countries with a high prevalence. These conclusions are based on moderate certainty evidence, from single trials in high-income countries. CONCLUSIONS: Sixty percent of the included studies were published in the last ten years, but much still remains to be understood about preventing food allergy. In particular, there is a need to validate the potential benefits of early introduction of food allergens in a wider range of populations.

Revisión sistemática

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Timing of Introduction of Complementary Foods and Beverages and Growth, Size, and Body Composition: A Systematic Review

Libro USDA Nutrition Evidence Systematic Reviews
Año 2019
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BACKGROUND: Systematic reviews were conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project. The goal of this systematic review was to examine the following question: What is the relationship between timing of introduction of complementary foods and beverages (CFB) and growth, size, and body composition? Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and typically continuing to 24 months of age. CFB were defined as foods and/or beverages other than human milk or infant formula (liquids, semisolids, and solids) provided to an infant or young child to provide nutrients and energy. CONCLUSION STATEMENT AND GRADES: Moderate evidence suggests that first introduction of any complementary food or beverage (CFB) between 4-5 months compared to approximately 6 months of age is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Grade: Moderate. Limited evidence suggests that introducing CFB before 4 months of age may be associated with higher odds of overweight/obesity. Grade: Limited. There is not enough evidence to determine the relationship between introduction of CFB at 7 months of age or older on growth, size, or body composition. Grade: Grade Not Assignable. METHODS: This systematic review was conducted by a team of staff from the Nutrition Evidence Library in collaboration with a Technical Expert Collaborative. Literature search was conducted using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that evaluated the intervention or exposure of timing of CFB introduction and the outcomes of developmental milestones. A manual search was conducted to identify articles that may not have been included in the electronic databases searched. Articles were screened by two analysts? independently for inclusion based on pre-determined criteria. Data extraction and risk of bias assessment were conducted for each included study, and both were checked for accuracy. The body of evidence was qualitatively synthesized to inform development of a conclusion statement(s), and the strength of evidence was graded using pre-established criteria evaluating the body of evidence on risk of bias, adequacy, consistency, impact, and generalizability. SUMMARY OF EVIDENCE: This review includes 81 articles that examined the association between timing of introduction of CFB and growth, size, and/or body composition across the lifespan. Timing of CFB introduction is the age at which any or specific types of CFB were first consumed and was examined as early as 1 month and as late as 12 months of age. Timing of CFB introduction was not associated with growth, size, body composition, and/or weight status in the majority of included studies. A limited number of observational studies suggested that CFB introduction before 4 months of age was associated with higher odds of overweight/obesity. Given the normal variation in healthy child growth patterns, caution should be used when interpreting results between timing, types and/or amounts of CFB and outcomes for individuals based on findings at the population level.

Revisión sistemática

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Complementary feeding and bone health: a systematic review.

Revista The American journal of clinical nutrition
Año 2019
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BACKGROUND: Proper nutrition during infancy and toddlerhood is crucial for supporting healthy growth and development, including bone health. Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during late infancy and continuing to 24 mo of age. OBJECTIVES: This article aims to describe systematic reviews (SRs) conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer these questions: what is the relationship between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and bone health? METHODS: The literature was searched with the use of 4 databases (CINAHL, Cochrane, Embase, and PubMed) to identify articles published from January 1980 to July 2016 that addressed these topics and met predetermined criteria for inclusion. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS: Three articles addressed the timing of introduction of CFBs and bone health during childhood (through 18 y of age), and 2 addressed the types and/or amounts of CFBs consumed relative to bone health. CONCLUSIONS: Insufficient evidence was available to draw conclusions about the relationships between the timing of CFB introduction and types and/or amounts of CFBs consumed and bone health. Therefore, a grade was not assignable for these SRs. The ability to draw conclusions was limited by an overall lack of research, failure to adjust for several key confounding factors, and heterogeneity in studies with regard to methodology, subject populations, and results. Additional research is needed that addresses these gaps and limitations.

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Age at introduction to complementary solid food and food allergy and sensitization: a systematic review and meta-analysis.

Revista Clinical and experimental allergy
Año 2019
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Este artículo está incluido en 2 Síntesis amplias 24 Síntesis amplias (2 referencias)

Este artículo incluye 25 Estudios primarios 24 Estudios primarios (25 referencias)

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BACKGROUND AND OBJECTIVE: An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. DESIGN: We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. METHODS: Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-analysis. RESULTS: Cohort studies - Introducing complementary solids at age ≥4 months versus <4 months was not associated with food allergy (OR 1.22; 95%CI, 0.76-1.96) but was associated with food sensitization (OR 1.93; 95%CI 1.57-2.38). First exposure from age 4-6 months versus <4 months was not associated with food allergy (OR 1.01; 95%CI, 0.64-1.60) but was associated with food sensitization (OR 2.46; 95%CI 1.55-3.86). RCTs - Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95%CI, 0.44-0.90) and sensitization (OR 0.76, 95%CI, 0.51-0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95%CI 0.14-0.57). CONCLUSIONS: We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4-6 months and peanut from 4-11 months, reduced the risk of egg allergy, peanut allergy and egg sensitization. This article is protected by copyright. All rights reserved.

Revisión sistemática

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Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review.

Revista The American journal of clinical nutrition
Año 2019
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Este artículo está incluido en 1 Síntesis amplia 27 Síntesis amplias (1 referencia)

Este artículo incluye 31 Estudios primarios 27 Estudios primarios (31 referencias)

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BACKGROUND: Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES: The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS: The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS: Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS: Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.

Revisión sistemática

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Complementary feeding and developmental milestones: a systematic review.

Revista The American journal of clinical nutrition
Año 2019
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Este artículo está incluido en 1 Síntesis amplia 0 Síntesis amplias (1 referencia)

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BACKGROUND: Systematic reviews were conducted as part of the USDA and the US Department of Health and Human Services Pregnancy and Birth to 24 Months Project to examine the relation between complementary feeding and developmental milestones. OBJECTIVES: The aim of this study was to describe systematic reviews examining the relationship between timing of introduction of complementary foods and beverages (CFB), and the types and amounts of CFB consumed, and developmental milestones. METHODS: The literature was searched using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that met predetermined criteria for inclusion. Data extraction and risk of bias assessment were conducted for each included study. The body of evidence for each systematic review was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded. RESULTS: Three included articles (1 randomized controlled trial; 2 observational studies) examined timing of introduction of CFB. Eight included articles (3 randomized controlled trials; 5 observational studies) examined types and amounts of CFB. There was insufficient evidence to draw conclusions about the relation between either timing of CFB introduction or types and amounts of CFB, and developmental milestones. CONCLUSIONS: The ability to draw conclusions about the relationship between complementary feeding and developmental milestones was restricted by an inadequate amount of evidence with potential for issues with reverse causality and wide variation in design, type/age of outcome assessment, exposure assessment, and reported results. Additional research to address these gaps and limitations would be useful.

Revisión sistemática

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Age of Introduction of Complementary Feeding and Overweight in Adolescence and Adulthood: A Systematic Review.

Revista Maternal & child nutrition
Año 2019
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Recent studies on early infant feeding suggest that the type of diet and age of starting complementary foods may have a positive correlation with overweight in adolescence and adulthood. This study aimed to systematically review the evidence on the relationship between the age of introduction of complementary feeding and excess weight in adolescence and adulthood. PROSPERO: CRD42017067764. The PRISMA standards were used as a reference. Articles were researched on Medline via PubMed, Web of Science, Embase, Lilacs, Ovid and Scopus, between June and December 2017. Descriptors were defined according to Medical Subject Heading. Of the 103 articles selected for complete reading, 9 were included in the review. Of these, only 3 found an association between the age of introduction of complementary feeding and overweight. Despite these findings, the studies presented a high heterogeneity, mainly due to the difference in cut-off points for the age of introduction of complementary feeding and the classification of overweight. We concluded that the evidence was not consistent enough to confirm the existence of the association.

Revisión sistemática

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Complementary feeding and micronutrient status: a systematic review.

Revista The American journal of clinical nutrition
Año 2019
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BACKGROUND: Proper nutrition during early life is critical for growth and development. OBJECTIVES: The aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)? METHODS: A literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS: Nine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status. CONCLUSIONS: Several conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.

Revisión sistemática

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Early introduction of egg and the development of egg allergy in children: A systematic review and meta-analysis

Revista International archives of allergy and immunology
Año 2018
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Este artículo está incluido en 2 Síntesis amplias 5 Síntesis amplias (2 referencias)

Este artículo incluye 6 Estudios primarios 5 Estudios primarios (6 referencias)

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Background: The timing of the introduction of egg to an infant's diet is of current interest, as new evidence raises questions regarding the benefit of delaying egg introduction. The objective of this study was to systematically review the existing literature regarding the effect of the early introduction of egg on the development of egg allergy. Methods: Literature searches were conducted in MEDLINE, EMBASE, and CENTRAL, and trial protocols were searched in Meta Register and OpenGREY. Only randomized controlled trials (RCTs) comparing early (between 3 and 6 months of age) egg introduction to no early introduction were included. The primary outcome was the development of egg allergy. Results: Of the 416 articles identified and screened, 6 RCTs met the eligibility criteria for data extraction. Allergic outcomes were evaluated in a total of 3,032 participants. A low to moderate level of evidence showed a benefit of the early introduction of egg (relative risk, RR 0.60, 95% CI 0.44-0.82, p = 0.002, mild heterogeneity, I 2 = 23%). The absolute risk reduction for a population with an incidence of egg allergy of 9.3% was 37 fewer cases (95% CI 17-52) per 1,000 people. Consumption of < 4,000 mg/week of egg protein had a greater preventive effect than a higher dose. Conclusion: This systematic review and meta-analysis showed an association between the early introduction of egg and a lower risk of egg allergy. Furthermore, the nature and dose of egg protein exposure may play a role. These findings should be addressed in the context of primary studies. © 2018 S. Karger AG, Basel.