Different Measures of Diet Diversity During Infancy and the Association with Childhood Food Allergy in a UK Birth Cohort Study

Abstract

Background: Diet Diversity (DD) during infancy may prevent food allergies (FA), possibly by exposing the gastrointestinal microbiota to diverse foods and nutrients.Objective: To investigate the association between four different measures of DD during infancy and development of FA over the first decade of life.Methods: A birth cohort born between 2001/2002 were followed prospectively, providing information on socio-demographic, environmental and dietary exposures. Information on age of introduction of a range of foods and food allergens were collected during infancy. Children were assessed for food allergy at 1, 2, 3 and 10 years. DD was defined using four measures in the first year of life: the World Health Organisation (WHO) definition of minimum DD at 6 months, as food diversity (FD) and fruit and vegetable diversity (FVD) at 3, 6 and 9 months, and as food allergen diversity (FAD) at 3, 6, 9, 12 months.Results: 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 WHO DD (p=0.0047), FD (p=0.0009), FAD (p=0.0048) and FVD (p=0.0174) at 6 months and FD (p=0.0392), FAD (p=0.0233), and FVD (0.0163) at 9 months significantly reduced the odds of FA over the first decade of life. DD measures at 3 months were not associated with FA but only 33% of the cohort had solid foods introduced by this age. ConclusionIncreased infant DD, as measured by four different methods, decreased the likelihood of developing FA. Highlights box:1. What is already known about this topic? Diet Diversity (DD) during infancy may be beneficial for future health.2. What does this article add to our knowledge? Increased DD measured using four different methods from 6 months onwards, in the first year of life, may decrease the likelihood of FA over the first decade. However, DD at 3 months showed no significant effect on food allergy outcomes. How does this study impact current management guidelines?These findings support the recommendation that early oral intake of a variety of foods and food allergens, once the infant is developmentally ready, will reduce incidence of food allergy in the first 10 years of life.

Incidence and timing of offspring asthma, wheeze, allergic rhinitis, atopic dermatitis, and food allergy and association with maternal history of asthma and allergic rhinitis

“…1 Children with 1 allergic presentation are more likely to develop another. 3 Genetic, 4 , 5 environmental 4 , 6 and dietary factors 7 , 8 differentially affect the development of allergic diseases, and a developmental origins component has been recently proposed. 9 , 10 …”

Dietary diversity during infancy and the association with childhood food allergen sensitization

“…Markeyvech et al 8 , using data from the German LISA cohort (n=2518), reported higher infant DD was associated with decreased risk of allergic sensitization to aeroallergens up to age 15 years among children with early skin symptoms. It is not clear why in the FAIR cohort, the reduced risk of food sensitization exists until age 2, but not until age 10, as in the case of clinical food allergy 9 , or why we did not find an association with aeroallergen sensitization. This may be due to a more pronounced effect on the microbiome in the first 1-3 years of life than in later childhood 10 .…”

Nutrition and the Immune System: A Complicated Tango

“…Proteobacteria in murine models Reduces populations in the phylum Bacteroidetes and increases Firmicutes and Proteobacteria in human studies [17][18][19][20] Higher diet diversity is associated with a more diverse gut microbiome in human studies. Diet diversity has been reported to prevent allergic disease [21], but it's direct role in the management of food allergy has not been investigated [22][23][24] High levels of butyrate and proprioate and a diet high in fermented foods, fruit and vegetables and fish infancy is also associated with reduced allergy outcomes [25].…”

“…This alteration in the immune system may be mediated through a multitude of immune antigen tolerance mechanisms including T and B regulatory cells, immune regulatory cytokines and suppressed IgE antibodies as demonstrated in other allergen tolerance models [62]. So far, all studies into diet diversity have been conducted in infancy [21,62]. A recent study indicates that both increased diet diversity and allergen diversity in the first year of life, is associated with a reduced risk of developing food allergy over the first ten years of life [21].…”

“…So far, all studies into diet diversity have been conducted in infancy [21,62]. A recent study indicates that both increased diet diversity and allergen diversity in the first year of life, is associated with a reduced risk of developing food allergy over the first ten years of life [21]. No studies focusing on diet diversity during the other life stages such as pregnancy and later life and allergy outcomes have been published.…”