Asthma and lower airway disease
Timing of infant feeding in relation to childhood asthma and allergic diseases

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Background

Emerging evidence questions current recommendations on the timing of infant feeding for the prevention of childhood allergies. The evidence for asthma is inconclusive.

Objective

We sought to investigate the associations between the duration of breast-feeding and timing of introduction of complementary foods and the development of asthma and allergies by the age of 5 years.

Methods

Data were analyzed for 3781 consecutively born children. The dietary exposures were categorized into thirds and analyzed as time-dependent variables. Asthma, allergic rhinitis, and atopic eczema end points were assessed by using the International Study of Asthma and Allergies in Childhood questionnaire, whereas IgE antibodies were analyzed from serum samples at the age of 5 years. Cox proportional hazard and logistic regressions were used for the analyses.

Results

The median duration of exclusive and total breast-feeding was 1.4 months (interquartile range, 0.2-3.5 months) and 7.0 months (interquartile range, 4.0-11.0 months), respectively. Total breast-feeding of 9.5 months or less was associated with an increased risk of nonatopic asthma. Introduction of wheat, rye, oats, or barley at 5 to 5.5 months was inversely associated with asthma and allergic rhinitis, whereas introduction of other cereals at less than 4.5 months increased the risk of atopic eczema. Introduction of egg at 11 months or less was inversely associated with asthma, allergic rhinitis, and atopic sensitization, whereas introduction of fish at 9 months or less was inversely associated with allergic rhinitis and atopic sensitization.

Conclusion

Early introduction of wheat, rye, oats, and barley cereals; fish; and egg (respective to the timing of introduction of each food) seems to decrease the risk of asthma, allergic rhinitis, and atopic sensitization in childhood. Longer duration of total breast-feeding, rather than its exclusivity, was protective against the development of nonatopic but not atopic asthma, suggesting a potential differing effect of breast-feeding on different asthma phenotypes.

Section snippets

Subjects and study design

This study was based on the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) study, which started in 1994. This is a multidisciplinary, population-based prospective cohort study that examines potential means to predict and prevent the manifestation of type 1 diabetes.24 Infants born with HLA-conferred susceptibility to type 1 diabetes were recruited from 3 university hospitals in Finland (Turku, Oulu, and Tampere) and monitored at 3- to 12-month intervals for diabetes-associated

Results

Among the 3781 children who participated in the study, data available for the end points for the present analysis were as follow: asthma, 3142 (83%) children; allergic rhinitis, 3112 (82%) children; atopic eczema, 3109 (82%) children; and atopic sensitization, 3675 (97%) children. Among these children, asthma was present in 6.2% (194/3142), atopic asthma in 3.5% (107/3037), nonatopic asthma in 2.6% (79/3037), allergic rhinitis in 14% (442/3112), and atopic eczema in 37% (1165/3109), and 38%

Discussion

The current findings from a relatively large Finnish cohort show that early introduction of cereals, fish, and egg in infancy (respective to the timing of introduction of each food) might confer protection against the development of asthma, allergic rhinitis, and atopic sensitization by the age of 5 years. Furthermore, long duration of total breast-feeding was associated with protection against asthma, in particular nonatopic asthma, in childhood. There was no evidence suggesting reverse

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      Citation Excerpt :

      Despite these benefits, the influence of breastfeeding on asthma prevalence in childhood is less clear and findings within the literature remain inconsistent. Previous studies investigating this relationship have illustrated a protective effect,3-10 no effect,11-15 or even an increased risk of asthma with prolonged duration of breastfeeding.16,17 Although the most recent meta-analysis of 42 articles demonstrated an overall modest protective effect (pooled odds ratio, 0.88; 95% CI, 0.82-0.95), the authors acknowledged the low-quality nature of this result given substantial heterogeneity between studies.18

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    Supported by the Academy of Finland (grants 44105, 48724, 80846, 201988, 126813, and 129492); the Prevaller Consortium; the Foundation for Pediatric Research; the Tampere Tuberculosis Foundation; the Juho Vainio Foundation; the Yrjö Jahnsson Foundation; Medical Research Funds, Turku; Oulu and Tampere University Hospitals; the Juvenile Diabetes Research Foundation; the Novo Nordisk Foundation; and the EU Biomed 2 Program (BMH4-CT98-3314).

    Disclosure of potential conflict of interest: M. Kaila has received research support from Pirkanmaan Sairaanhoitopiiri, Tampere, Finland, and Tuberkuloosisaatio, Tampere, Finland. M. Erkkola has received research support from the University of Helsinki and the Ministry of Social Affairs and Health, lecture fees from the University of Tampere, and payment for the development of educational presentations from Helsinki Metropolia University of Applied Sciences. J. Kere has received research support from the Academy of Finland and the Sigrid Juselius Foundation and is employed by the Karolinska Institute. The rest of the other authors declare that they have no relevant conflicts of interest.

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