延緩給予嬰兒固體食物可能增加之後過敏風險


  【24drs.com】December 11, 2009 — 根據一項線上發表於12月7日小兒醫學期刊的前瞻性、出生世代研究結果指出,延緩給予嬰兒固體食物可能增加之後過敏風險。
  
  芬蘭坦佩雷大學的Bright I. Nwaru哲學碩士寫到,在出生後頭六個月僅餵食母乳以預防過敏性疾病的建議可能缺乏強烈的證據。相反的,延緩引進蛋類、牛乳、穀類以及其他固體食物已經被證實與異位性皮膚炎、濕疹和過敏敏感化(不論是否有症狀)有關。在目前這項研究中,我們想要在一群HLA(人類白血球抗原使得對第一型糖尿病具敏感性,考慮到反轉因果關係)評估在出生後第一年,引進不同固體食物的時間,與食物及吸入性過敏敏感化反應之間的關係。
  
  研究者們分析994位HLA使得對第一型糖尿病具敏感性兒童,在5歲時有關於餵乳、引進固體食物時的年齡、過敏原特異免疫球蛋白E(IgE)濃度,這些兒童被收納到芬蘭裔第一型糖尿病預測與預防(DIPP)營養研究。以邏輯式迴歸法分析引進固體食物年齡與過敏敏感化反應的關係。
  
  僅餵食乳汁的時間中位數為1.8個月(範圍從0-10個月)。飲食中,延緩引進馬鈴薯(>4個月)、燕麥(>5個月)、黑麥(>7個月)、小麥(>6個月)、肉類(>5.5個月)、魚類(>8.2個月)與蛋類(>10.5個月)都直接且顯著地與對食物過敏原敏感化反應有關,即使在校正潛在的影響因子後也是如此。
  
  延緩引進馬鈴薯、黑麥、肉類及魚類,都顯著地與對任何吸入性過敏原產生敏感化反應有關。
  
  蛋類、燕麥以及肉類是與對食物過敏原敏感化反應最重要的食物,在納入所有固體食物的模式中顯著地與終點有關。對吸入性過敏原敏感化作用而言,馬鈴薯與魚類是最重要的食物。當考慮到雙親的過敏性鼻炎與氣喘時,研究者們發現並沒有反轉因果關係的存在。
  
  研究作者們寫到,延緩引進固體食物與對食物及吸入性過敏原發生過敏敏感化反應風險增加有關。在目前這項研究中,我們所觀察到的是與之前研究報告延遲引進固體食物可能無法預防兒童發生過敏性疾病相符。
  
  這項研究的限制包括,試驗族群僅餵食母乳的時間中位數較短,且選擇HLA使得對第一型糖尿病具敏感力的族群,限制了其應用性。除此之外,試驗終點是對食物及吸入性過敏原的敏感化反應,因此這些結果可能不能代表引進固體食物的時間對於氣喘、異位性濕疹、或是其他過敏性預後的影響。這些試驗終點的事件數目很小,造成無法達到任何有意義分析的統計力量。
  
  研究作者們的結論是,對我們的試驗族群延長後續監測,將可以釐清目前觀察到的是否可以轉換為臨床過敏預後。這些發現挑戰目前有關嬰兒餵食以預防過敏性疾病的建議。
  
  芬蘭研究院;芬蘭小兒醫學研究基金會;Juho Vainio基金會;Yrjo Jahnsson基金會;來自Turku,Oulu、以及坦佩雷大學的研究經費;歐盟生化醫學2計劃;公共衛生博士計劃贊助這項研究。研究作者們表示已無相關資金上的關係。

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.

    
相關報導
較早開始吃固體食物的嬰兒較容易過敏?
2013/11/20 上午 10:53:42

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