Early introduction of food reduces food allergy – Pro and Con Preventing food allergy: protocol for a rapid systematic review Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity Introduction of Complementary Foods and the Relationship to Food Allergy What do review papers conclude about food and dietary patterns? Improved general health status in an unselected infant population following an allergen reduced dietary intervention programme The ZUFF-STUDY-PROGRAMME
Part I: study design and 6-month nutritional behaviour
 [Effects of feeding intervention on development of eczema in atopy high-risk infants: an 18-month follow-up study]. Maternal compliance with nutritional recommendations in an allergy preventive programme World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Smartphone Applications for Promoting Healthy Diet and Nutrition: A Literature Review. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Prebiotics A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne inFANT Program Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Early food for future health: a randomized controlled trial evaluating the effect of an eHealth intervention aiming to promote healthy food habits from early childhood Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study. Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years follow‐up Associations between Maternal Antioxidant Intakes in Pregnancy and Infant Allergic Outcomes Immune Components in Human Milk Are Associated with Early Infant Immunological Health Outcomes: A Prospective Three-Country Analysis Introduction of Complementary Foods and the Relationship to Food Allergy Dietary patterns in infancy: the importance of maternal and family influences on feeding practice. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis.
Over the past two decades we have been debating the question of whether the age of commencement of complementary feeding affects the risk of developing food allergy . We ate up the notion that delayed introduction of more allergenic foods in early childhood , would help overcome the increasing rates of food allergy , then we promptly spat it out again despite limited evidence . Recently high- quality r and omised controlled trial evidence has given us the confidence to swallow the concept that allergenic foods , like egg and peanut , should be given to infants . We now need to recommend that when an infant is developmentally ready , a variety of nutritious foods should be introduced to ensure high diet diversity , including the ‘ more allergenic ’ foods during infancy . This article is protected by copyright . All rights reserved Background The European Academy of Allergy and Clinical Immunology is developing guidelines about how to prevent and manage food allergy . As part of the guidelines development process , a systematic review is planned to examine published research about the prevention of food allergy . This systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology , prevention , diagnosis and clinical management , and impact on quality of life , which will be used to inform clinical recommendations . The aim of this systematic review will be to assess the effectiveness of approaches for the primary prevention of food allergy . Methods Seven bibliographic data bases will be search ed from their inception to September 30 , 2012 for systematic review s , r and omized controlled trials , quasi-r and omized controlled trials , controlled clinical trials , controlled before- and -after studies , interrupted time series and cohort studies . Cohort studies will be included due to an inability to r and omize with interventions such as breastfeeding . Studies that focused on the development of either food sensitization ( a proxy measure ) or food allergy will also be eligible for inclusion . Studies will be critically appraised using the Critical Appraisal Skills Program and Cochrane Risk of Bias tools , as appropriate . Discussion There is a lack of rigorous evidence to support recommendations about how to prevent the development of food allergy . It would appear that it is important to see the prevention of food allergy in the context of individual , family and wider factors that may influence its development . There is much left to learn about preventing food allergy , and this is a priority given the high societal and healthcare costs involved . This systematic review will help to further this learning The potential influence of maternal obesity on infant gut microbiota may occur either through vertically transmitted microbes or through the dietary habits of the family . Recent studies have suggested that the heritability of obesity may partly be caused by the transmission of “ obesogenic ” gut microbes . However , the findings presented here suggest that maternal obesity per se does not affect the overall composition of the gut microbiota and its development after introduction of complementary foods . Rather , progression in complementary feeding is found to be the major determinant for gut microbiota establishment . Exp and ing our underst and ing of the influence of complementary diet on the development and establishment of the gut microbiota will provide us with the knowledge to tailor a beneficial progression of our intestinal microbial community . ABSTRACT The first years of life are paramount in establishing our endogenous gut microbiota , which is strongly affected by diet and has repeatedly been linked with obesity . However , very few studies have addressed the influence of maternal obesity on infant gut microbiota  , which may occur either through vertically transmitted microbes or through the dietary habits of the family . Additionally , very little is known about the effect of diet during the complementary feeding period , which is potentially important for gut microbiota development . Here , the  gut microbiotas  of two different cohorts of infants , born either of a r and om sample of healthy mothers ( n = 114 ) , or of obese mothers ( n = 113 ) , were profiled by 16S rRNA amplicon sequencing . Gut microbiota data were compared to breastfeeding patterns and detailed individual dietary recordings to assess effects of the complementary diet . We found that  maternal obesity  did not influence microbial diversity or specific taxon abundances during the complementary feeding period . Across cohorts , breastfeeding duration and composition of the complementary diet were found to be the major determinants of gut microbiota development . In both cohorts , gut microbial composition and alpha diversity were thus strongly affected by introduction of family foods with high protein and fiber contents . Specifically , intake of meats , cheeses , and Danish rye bread , rich in protein and fiber , were associated with increased alpha diversity . Our results reveal that the transition from early infant feeding to family foods is a major determinant for gut microbiota development . IMPORTANCE The potential influence of maternal obesity on infant gut microbiota may occur either through vertically transmitted microbes or through the dietary habits of the family . Recent studies have suggested that the heritability of obesity may partly be caused by the transmission of “ obesogenic ” gut microbes . However , the findings presented here suggest that maternal obesity per se does not affect the overall composition of the gut microbiota and its development after introduction of complementary foods . Rather , progression in complementary feeding is found to be the major determinant for gut microbiota establishment . Exp and ing our underst and ing of the influence of complementary diet on the development and establishment of the gut microbiota will provide us with the knowledge to tailor a beneficial progression of our intestinal microbial community OBJECTIVES : To address questions regarding breastfeeding , complementary feeding , allergy development , and current infant-feeding recommendations . METHODS : This was a nested , case-control within a cohort study in which mothers of 41 infants diagnosed with food allergy by the age of 2 years ( according to double-blind , placebo-controlled food challenge ) and their 82 age-matched controls kept prospect i ve food diaries of how their infants were fed in the first year of life . RESULTS : Infants who were diagnosed with food allergy by the time they were 2 years of age were introduced to solids earlier ( ≤16 weeks of age ) and were less likely to be receiving breast milk when cow ’s milk protein was first introduced into their diet . CONCLUSIONS : This study supports the current American Academy of Pediatrics ’ allergy prevention recommendations and the European Society of Pediatric Gastroenterology , Hepatology and Nutrition recommendations on complementary feeding to not introduce solids before 4 to 6 months of age . It also supports the American Academy of Pediatrics ’ breastfeeding recommendations that breastfeeding should continue while solids are introduced into the diet and that breastfeeding should continue for 1 year , or longer , as mutually desired by mother and infant Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways . Therefore , associations between single nutrients and chronic disease may be difficult to identify and interpret , but when dietary patterns ( DPs ) are examined the combination of many food factors will be considered . An explorative literature search of published review articles was conducted to obtain a fuller underst and ing of current DPs in epidemiological research , to discuss pros and cons of DPs in nutrition research , and to identify results of studies linking DPs to chronic disease risk in adults . R and omized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits . Systematic review s of feeding trials and prospect i ve population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs . However , to date only a few review articles of DP studies have followed a systematic process using independent review ers with strict inclusion , exclusion , and study quality criteria . Diets with plenty of plants foods , fish , and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases . In contrast , Western-type DPs with food products low in essential nutrients and high in energy , like sugar-sweetened beverages , sweets , refined cereals and solid fats ( e.g. butter ) , and high in red and processed meats , are associated with adverse health effects . An emphasis on high- quality original research , and systematic review s following a structured process to objective ly select and judge studies , is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease Summary Background : The best nutritional option for newborn infants is mother 's milk . However , some newborn babies may not be exlusively breastfed during the first months of life , potentially leading to reduced overall health status and the early onset of allergic diseases in some infants . Considerable research has been devoted to the development and assessment of infant nutrition programmes , particularly to the prevention of allergies in high-risk infants . However , equal numbers of infants with and without an elevated familial risk of allergies will eventually develop allergic diseases . Therefore , optimizing nutritional programmes for the early infant population as a whole is an important – but as yet insufficiently studied – area of investigation . Moreover , although safe and effective nutrition must primarily support healthy development of the infant , few studies have evaluated the overall health benefits of nutritional interventions , but have focussed on specific allergic manifestations . In animal models , an allergen-reduced moderate whey hydrolysate formula ( pHF , Nestlé Beba HA ) induces the development of oral tolerance towards cow 's milk proteins , without inducing sensitization . In infants with a high risk for allergies , pHF formulae reduce the early onset of allergic disease during the first 5 years of life by approximately 50 % compared with a dietary regimen of unaltered proteins . At present , very little is known about the overall health benefits of such a dietary intervention on the unselected infant population as a whole . Aim of the study : The aim of our prospect i ve , controlled study was to investigate the overall health benefits of an allergen-reduced nutritional programme in a newborn infant population unselected for atopic risk factors . The population in our study was a comparable as possible to the general population of healthy newborn infants . Our study included exclusive breastfeeding , use of a moderate whey hydrolysate formula ( pHF , Nestlé Beba HA ) if infant formula was needed , and delayed introduction of low-allergenic weaning foods . The study included assessment s of compliance with the dietary programme , and evaluated nutritional habits , growth , and overall health status for 24 months . The health evaluation included allergic manifestations but die – by purpose – not define or evaluate them specifically . Part I of this paper gives results for nutritional habits during the first 6 months of life , Part II gives results for growth and general health status for the same time period , Part III will present feeding habits during the second half of the first year of life , and Part IV will present results to 24 months of age . The complete study report is published as a supplement to this journal . Methods : Nuritional assignment was to demographically comparable intervention ( Z ) or control ( FF ) cohorts according to the infant 's place of birth . In the intervention cohort ( Z , n=564 ) , the recommended dietary regimen was breastfeeding and /or the pHF formula , with no weaning food before 4 months of age . In the control cohort ( FF , n=566 ) , there was no intervention . Longitudinal diet groups , defined for 4 months , excluding dropouts and noncompliants , were exclusive breastfeeding ( eBF , Z , n=201 , FF , n=162 ) , partial breastfeeding ( pBF , Z , n=222 , FF , n=311 ) , or non-breastfeeding ( nBF , Z , n=42 , FF , n=62 ) . Imbalances between groups and cohorts in confounding factors that could influence health-related symptoms were integrated as covariates into the main analyses using logistic regression . Nutritional surveillance was carried out using continuous prospect i ve monitoring . Results : The overall rate of breastfeeding , irrespective of partial or excluive breastfeeding or the additional use of weaning foods , was similar in both cohorts at 4 and 6 months . However , from ages 3 to 6 month , significantly more Z than FF infants were excluively breastfed ( p<0.05 ) , and weaning foods were introduced at a significantly later age in Z than FF ( 22 versus 18 weeks ; p<0.0001 ) . Infants in the Z cohort received fewer different kinds of weaning foods compared with FF ( 2 versus 10 ; p<0.0001 ) . Six-month rates of dropout were very low in both groups ( Z=4.3 % , FF=1.8 % ) and compliance with the programme was excellent over the strict intervention period of 4 months ( Z=86.9 % ) until the sixth month . Conclusions : A dietary recommendation that promotes breastfeeding , includes a moderate whey hydrolysate formula ( Nestlé Beba HA ) , and delays the introduction of highly allergenic weaning foods ( an allergen-reduced dietary regimen ) significantly increases breastfeeding and delays weaning in a normal infant population without any compliance problem to the moderate hydroysate formula that is quite often seen in the eHF . The regimen was followed closely , with a high degree of compliance and a low dropout rate compared with previous allergy-prevention studies . Compliance with the dietary regimen was excellent over the 4 months of intervention and throughout the following 2 months OBJECTIVE To assess the preventive effects of different dietary regimens on development of eczema and food allergy in infants at high-risk for allergy . METHODS Forty-six infants whose parents were atopic and umbilical cord IgE > 0.35 kU/L were enrolled in the study . The infants were r and omly assigned at birth to one of 2 dietary regimen protocol s : those in intervention group ( 23 cases ) were breast fed till more than 4 months of age , then followed by feeding with partially hydrolyzed formula ( pHF ) , combined solid foods avoidance until 4-month of age , egg , fish , shrimp avoidance until 12-month of age . The other 23 cases in non-intervention group were breast fed for less than 4 months , or bottle fed with cow 's milk-based formula , egg yolk was introduced at 4-month of age , and egg white at 6-month of age , besides , no any other dietary avoidance was applied . All the infants were followed-up for 18 months . The primary end point was the presence of atopic eczema . Food allergy was detected by fresh food prick-to-prick tests or in vitro sIgE or Fx5E . RESULTS At 6 months , 12 months and 18 months , the incidence of eczema in intervention group was 4.3 % ( 1/23 ) , 8.7 % ( 2/23 ) , and 17.4 % ( 4/23 ) , respectively , which was significantly reduced as compared to that of the non-intervention group , which was 26.1 % ( 6/23 ) , 34.8 % ( 8/23 ) , and 39.1 % ( 9/23 ) , respectively . Food allergy was found in 13.0 % ( 3/23 ) of intervention group and 34.8 % ( 9/23 ) of non-intervention group by skin prick tests or sIgE. Egg white was the most common offending food . CONCLUSION Early life dietary interventions which included breastfeeding , delayed solid food introducing , pHF feeding , and high risk food avoidance could reduce the risk of atopic eczema and food allergy development , and was probably an effective primary intervention method for infants at high risk for atopy Aims : To assess maternal compliance with nutritional recommendations in an allergy preventive programme , and identify factors influencing compliance behaviour . Methods : R and omised double-blind intervention study on the effect of infant formulas with reduced allergenicity in healthy , term newborns at risk of atopy . Maternal compliance with dietary recommendations concerning milk and solid food feeding was categorised . Results : A total of 2252 newborns were r and omised to one of four study formulas . The drop out rate during the first year of life was 13.5 % ( n = 304 ) . The rates of high , medium , and low compliance to milk feeding during weeks 1–16 were 83.4 % , 4.0 % , and 7.5 % ; the corresponding rates to solid food feeding during weeks 1–24 were 60.0 % , 12.1 % , and 22.9 % . In 5.1 % of subjects no nutritional information was available . Low compliance was more frequent among non-German parents , parents with a low level of education , young mothers , smoking mothers , and those who weaned their infant before the age of 2 months . Conclusions : Evaluation of allergy preventive programmes should take into account non-compliance for assessing the preventive effectiveness on study outcome Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants BACKGROUND Rapid developments in technology have encouraged the use of smartphones in health promotion research and practice . Although many applications ( apps ) relating to diet and nutrition are available from major smartphone platforms , relatively few have been tested in research studies in order to determine their effectiveness in promoting health . METHODS In this article , we summarize data on the use of smartphone applications  for promoting healthy diet and nutrition based upon bibliographic search es in PubMed and CINAHL with relevant search terms pertaining to diet , nutrition , and weight loss through August 2015 . RESULTS A total of 193 articles were identified in the bibliographic search es . By screening abstract s or full-text articles , a total of three relevant qualitative studies and 9 r and omized controlled trials were identified . In qualitative studies , participants preferred applications that were quick and easy to administer , and those that increase awareness of food intake and weight management . In r and omized trials , the use of smartphone apps was associated with better dietary compliance for lower calorie , low fat , and high fiber foods , and higher physical activity levels ( p=0.01 - 0.02 ) which result ed in more weight loss ( p=0.042-<0.0001 ) . DISCUSSION Future studies should utilize r and omized controlled trial research design s , larger sample sizes , and longer study periods to better establish the diet and nutrition intervention capabilities of smartphones . There is a need for culturally appropriate , tailored health messages to increase knowledge and awareness of health behaviors such as healthy eating . Smartphone apps are likely to be a useful and low-cost intervention for improving diet and nutrition and addressing obesity in the general population . Participants prefer applications that are quick and easy to administer and those that increase awareness of food intake and weight management BACKGROUND The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders . This study examines the development of atopy at age 7 years in 165 children in a high-risk cohort , previously reported from birth to age 4 years . METHODS In this prospect i ve , r and omized , controlled study of food allergen avoidance in infancy , the prophylactic-treated group consisted of infants whose mothers avoided cow 's milk , egg , and peanut during the last trimester of pregnancy and lactation and who , themselves ,  avoided cow 's milk until age 1 year ( casein hydrolysate supplementation before age 1 ) , egg until age 2 years , and peanut and fish until age 3 years . The control group consisted of maternal/infant pairs who followed st and ard feeding practice s. RESULTS Despite a significant reduction in food allergy and milk sensitization before age 2 years , none of the following differed between the groups at age 7 years : food allergy , atopic dermatitis , allergic rhinitis , asthma , any atopic disease , lung function , food or aeroallergen sensitization , serum IgE level , or presence of nasal eosinophils or nasal basophilic cells .  Children with food allergy by 4 years evidence d higher 7-year ( current ) prevalences of allergic rhinitis and asthma ( p < 0.01 ) . Atopic diseases/parameters at age 7 years were shown , by multivariate analysis ( p < 0.05 ) , to be associated with several genetic and environmental risk factors ( male gender , maternal nonwhite ethnicity and asthma , and household smoking ) , as well as predictive atopic markers during infancy ( elevated serum IgE level ; egg , cow 's milk , and peanut sensitization ; and nasal eosinophils and nasal basophilic cells ) . CONCLUSIONS These findings help to : ( 1 ) eluci date the natural history of atopic disease in high-risk children ; ( 2 ) document the progression of allergy from atopic dermatitis , food allergy , and food sensitization to respiratory allergy and aeroallergen sensitization despite food allergy prevention in infancy ; ( 3 ) identify allergy predictive markers ; and ( 4 ) exp and our appreciation of the interactions of genetic and environmental factors in the development of atopy The effect of maternal and infant avoidance of allergenic foods on food allergy was examined in a prenatally r and omized , controlled trial of infants of atopic parents . The diet of the prophylactic-treated group ( N = 103 ) included ( 1 ) maternal avoidance of cow 's milk , egg , and peanut during the third trimester of pregnancy and lactation and ( 2 ) infant use of casein hydrolysate ( Nutramigen ) for supplementation or weaning , and avoidance of solid foods for 6 months ; cow 's milk , corn , soy , citrus , and wheat , for 12 months ; and egg , peanut , and fish , for 24 months . In the control group ( N = 185 ) , mothers had unrestricted diets , and infants followed American Academy of Pediatrics feeding guidelines . The cumulative prevalence of atopy was lower at 12 months in the prophylactic-treated ( 16.2 % ) compared to the control ( 27.1 % ) group ( p = 0.039 ) , result ing from reduced food-associated atopic dermatitis , urticaria and /or gastrointestinal disease by 12 months ( 5.1 % versus 16.4 % ; p = 0.007 ) , and any positive food skin test by 24 months ( 16.5 % versus 29.4 % ; p = 0.019 ) , caused primarily by fewer positive milk skin tests ( 1 % versus 12.4 % ; p = 0.001 ) . The prevalences of allergic rhinitis , asthma , and inhalant skin tests were unaffected . Serum IgE levels in the prophylactic-treated group were marginally lower only at 4 months . Thus , reduced exposure of infants to allergenic foods appeared to reduce food sensitization and allergy primarily during the first year of life Background The prevalence of allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Prebiotics – non-digestible oligosaccharides that stimulate growth of probiotic bacteria – have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of prebiotics in the prevention of allergy . Methods The WAO guideline panel identified the most relevant clinical questions about the use of prebiotics for the prevention of allergy . We performed a systematic review of r and omized controlled trials of prebiotics , and review ed the evidence about patient values and preferences , and re source requirements ( up to January 2015 , with an up date on July 29 , 2015 ) . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . Results Based on GRADE evidence to decision frameworks , the WAO guideline panel suggests using prebiotic supplementation in not-exclusively breastfed infants and not using prebiotic supplementation in exclusively breastfed infants . Both recommendations are conditional and based on very low certainty of the evidence . We found no experimental or observational study of prebiotic supplementation  in pregnant women or in breastfeeding mothers . Thus , the WAO guideline panel chose not to provide a recommendation about prebiotic supplementation in pregnancy or during breastfeeding , at this time . Conclusions WAO recommendations about prebiotic supplementation for the prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether or not to use prebiotics for the purpose of preventing allergies in healthy , term infants Background The diets , physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal . The family environment , as the first ecological niche of children , exerts an important influence on the onset of children ’s habits . Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives . The focus on parent ’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well . Objective To assess the effect of a parent-focused  early childhood obesity prevention  intervention on  first-time mothers ’ diets , physical activity and TV viewing time .  Methods The Melbourne InFANT Program is a cluster-r and omized controlled trial which involved 542 mothers over their newborn ’s first 18 months of life . The intervention focused on parenting skills and strategies , including parental modeling , and aim ed to promote development of healthy child and parent behaviors from birth , including healthy diet , increased physical activity and reduced TV viewing time . Data regarding mothers ’ diet ( food frequency question naire ) , physical activity and TV viewing times ( self-reported question naire ) were collected using vali date d tools at both baseline and post-intervention . Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups . Analysis of covariance was used to measure the impact of the intervention . Results The scores of both the " High-energy snack and processed foods " and the " High-fat foods " dietary patterns decreased more in the intervention group : -0.22 ( −0.42;-0.02 ) and −0.25 ( −0.50;-0.01 ) , respectively . No other significant intervention vs. control effects were observed regarding total physical activity , TV viewing time , and the two other dietary patterns , i.e. “ Fruits and vegetables ” and “ Cereals and sweet foods ” . Conclusions These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively . Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified Background Childhood overweight and obesity is a global public health challenge . Primary prevention initiatives targeting parents have been called for to encourage a positive feeding environment and healthy eating habits that may lay a good foundation for future health . At the same time , there is a need for interventions which combine accessibility and scalability with cost effectiveness . Today ’s parents are extensive Internet-users , but only a few r and omized controlled trials have investigated the use of Internet to promote healthy eating habits in early childhood . In Early Food for Future Health we have developed and will evaluate an Internet-based tool for parents of children between 6 and 12 months , aim ing to increase knowledge about infant nutrition and foster protective feeding behavior . Methods During springtime 2016 , parents of children aged between 3 and 5 months were recruited through Norwegian child health centres and announcements on Facebook . After completing the baseline question naire , 718 parents were individually r and omized to intervention- or control group . The intervention group received monthly emails with links to an age-appropriate web-site when their child was between 6 and 12 months . The control group received ordinary care from the child health centres . The data - collection is ongoing . All participants will be followed up at ages 12 and possibly 24 and 48 months , with question naires relating to eating behaviour and feeding practice s , food variety and diet quality . Discussion Providing guidance and counseling to parents of infants is an important task for health authorities and the public child health services . Early Food for Future health is an intervention focusing on promoting early healthy food-habits which may prevent childhood overweight and obesity . If proven to be effective , Early Food for Future Health can be used by parents and public health nurses for supplementary guidance on feeding practice s and diet . This study has the potential to provide greater insight and underst and ing regarding early parental feeding practice s , child eating behavior and the development and efficacy of Internet-based public health interventions .Trial registration IS RCT N13601567 The aim of this study was to compare the allergy-preventive effect of a partially hydrolyzed formula with two extensively hydrolyzed formulas , in infants with a high risk for development of allergic disease . High-risk infants from four Danish centres were included in the period from June 1994 to July 1995 . Five-hundred and ninety-five high-risk infants were identified . High-risk infants were defined as having biparental atopy , or a single atopic first-degree relative combined with cord blood immunoglobulin E ( IgE ) > or = 0.3 kU/l . At birth all infants were r and omized to one of three different blinded formulas .  All mothers had unrestricted diets during pregnancy and lactation and were encouraged to breast-feed exclusively . If breast-feeding was insufficient , one of the three formulas , according to r and omization , was given during the first 4 months . It was recommended not to introduce cow 's milk , cow 's milk products . and solid foods until the age of 4 months . After the age of 4 months a normal unrestricted diet and conventional cow 's milk-based formula were given when needed . All infants were followed-up prospect ively with interview and physical examination at the age of 6 , 12 , and 18 months , and if any possible atopic symptoms were reported . If food allergy was suspected , controlled elimination/challenge procedures were performed in a hospital setting . Of 550 infants included in the study , 514 were seen at all visits and 36 were excluded owing to noncompliance . Of 478 infants who completed the study , 232 were exclusively breast-fed , 79 received an extensively hydrolyzed casein formula ( Nutramigen ) , 82 an extensively hydrolyzed whey formula ( Profylac ) , and 85 a partially hydrolyzed whey formula ( Nan HA ) , during the first 4 months of life . These four groups were identical in regard to atopic predisposition , cord blood IgE , birthplace , and gender . Exclusively breast-fed children were exposed less to tobacco smoke and pets at home and belonged to higher social classes , whereas the three formula groups were identical concerning environmental factors . The frequency of breast-feeding was high ; only eight ( 2 % ) children were not breast-fed at all . The three formula groups were identical in regard to duration of breast-feeding and age at introduction of formula and solid foods . No significant differences were found in the three groups of infants receiving formula milk regarding the cumulative incidence of atopic dermatitis or respiratory symptoms . The cumulative incidence of parental-reported cow 's milk allergy was significantly higher in children fed partially hydrolyzed formula ( Nan HA ) compared with extensively hydrolyzed formula ( Nutramigen or Profylac ) at 12 and 18 months ( NanHA , 7.1 % ; Nutramigen , 2.5 % ; Profylac , 0 % ; p=0.033 ) . The cumulative incidence of confirmed cow 's milk allergy was 1.3 % ( three of 232 ) in exclusively breast-fed infants , 0.6 % ( one of 161 ) in infants fed extensively hydrolyzed formula ( Nutramigen or Profylac ) , and 4.7%(four of 85 ) in infants fed partially hydrolyzed formula ( Nan HA ) . Partially hydrolyzed formula was found to be less effective than extensively hydrolyzed formula in preventing cow 's milk allergy , 0.6 % vs. 4.7 % ( p=0.05 ) , but because of the small number of cases the results should be interpreted with caution . Compared with other similar studies the frequency ofatopic symptoms was low , even though the dietetic intervention did not include either maternal diet during lactation or dietary restrictions to the children after the age of 4 months ABSTRACT A prospect i ve case‐control study is presented to assess an allergy prevention programme in children up to 36 months of age . Infants born at three maternity hospitals were followed from birth : 279 infants with high atopic risk ( intervention group ) were compared with 80 infants with similar atopic risk but no intervention ( non‐intervention group ) . The intervention programme included dietary measures ( exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet ) and environmental measures ( avoidance of parental smoking in the presence of the babies , day care > 2 years of life ) . Mothers in this group who had insufficient breast milk were r and omly assigned to one of two coded formulas : either a hydrolysed milk formula ( Nidina HA , Nestlé ) or a conventional adapted formula ( Nan , Nestlé ) . Other environmental measures remained the same as for the breastfeeding mothers . The non‐intervention group were either breastfed or received the usual Italian milk feeding and weaning diet , without environmental advice . The main outcome measures were anthropometric measurements and allergic disease manifestations . Normal anthropometric data were observed both in the intervention group and in the nonintervention group . The incidence of allergic manifestations was much lower in the intervention group than in the nonintervention group at 1 year ( 11.5 versus 54.4 % , respectively ) and at 2 years ( 14.9 versus 65.6 % ) and 3 years ( 20.6 versus 74.1 % ) . Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non‐intervention group from birth up to the second year of life , while urticaria and gastrointestinal disorders were only present in the non‐intervention group in the first year of life . Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non‐intervention group . Relapse of the same allergic symptom was less in the intervention group ( 13.0 % ) than in the non‐intervention group ( 36.9 % ) . In comparison to the non‐intervention group , there were fewer intervention group cases with two or more different allergic symptoms ( 8.7 versus 32.6 % ) , and they were more likely to avoid steroid treatment ( 0 versus 10.8 % ) and hospital admission ( 0 versus 6.5 % ) . Babies in the non‐intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group . In the intervention group the breastfed infants had the lowest incidence of allergic symptoms , followed by the infants fed the hydrolysed formula ( ns ) . Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants , although less than their counterparts in the non‐intervention group . Of the affected subjects in the intervention group , 80.4 % were RAST and /or Prick positive to food or inhalant allergens . Total serum IgE values detected at birth in the intervention group were not predictive , but at 1 and 2 years of age , IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy . In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups . Of the various factors tested in the non‐intervention group , the following were the most important in the pathogenesis of allergic symptoms : ( i ) formula implementation begun in the first week of life ; ( ii ) early weaning ( < 4 months ) ; ( iii ) feeding beef ( < 6 months ) ; ( iv ) early introduction of cow 's milk ( < 6 months ) ; and ( v ) parental smoking in the presence of the babies and early day care admission ( < 2 years of life ) . All the preventive measures used in this study ( exclusive breastfeeding and /or hydrolysed milk feeding , delayed and selective introduction of solid foods , and environmental advice ) were effective at the third year of follow‐up , greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease . We investigated associations between maternal intakes of β-carotene , vitamin C , vitamin E , copper and zinc , and infant allergic outcomes .  Antioxidant intakes of pregnant women ( n = 420 ) assessed prospect ively by a food frequency question naire , were examined in relation to allergic outcomes at 1 year of age ( n = 300 ) . The main relationships with allergic outcomes were seen with dietary vitamin C and copper . Specifically , higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze . After adjustment for potential confounders the relationship with wheeze remained statistically significant . There was also an inverse linear relationship between vitamin C and food allergy . Higher dietary copper intake was associated with reduced risk of eczema , wheeze and any allergic disease . The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis , and there was also an inverse linear relationship between copper and food allergy . However , these relationships were only seen for nutrients present in food . There were no relationships between β-carotene , vitamin E or zinc and any allergic outcomes . In summary , this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze , and that copper intake is associated with reduced risk of several allergic outcomes The role of breastfeeding in improving allergy outcomes in early childhood is still unclear . Evidence suggests that immune mediators in human milk ( HM ) play a critical role in infant immune maturation as well as protection against atopy/allergy development . We investigated relationships between levels of immune mediators in colostrum and mature milk and infant outcomes in the first year of life . In a large prospect i ve study of 398 pregnant/lactating women in the United Kingdom , Russia and Italy , colostrum and mature human milk ( HM ) sample s  were analysed for immune active molecules . Statistical analyses used models adjusting for the site of collection , colostrum collection time , parity and maternal atopic status . Preliminary univariate analysis showed detectable interleukin ( IL ) 2 and IL13 in HM to be associated with less eczema . This finding was further confirmed in multivariate analysis , with detectable HM IL13 showing protective effect OR 0.18 ( 95 % CI 0.04–0.92 ) . In contrast , a higher risk of eczema was associated with higher HM concentrations of transforming growth factor β ( TGFβ ) 2 OR 1.04 ( 95 % CI 1.01–1.06 ) per ng/mL. Parental-reported food allergy was reported less often when IL13 was detectable in colostrum OR 0.10 ( 95 % CI 0.01–0.83 ) . HM hepatocyte growth factor ( HGF ) was protective for common cold incidence at 12 months OR 0.19 ( 95 % CI 0.04–0.92 ) per ng/mL. Data from this study suggests that differences in the individual immune composition of HM may have an influence on early life infant health outcomes . Increased TGFβ2 levels in HM are associated with a higher incidence of reported eczema , with detectable IL13 in colostrum showing protective effects for food allergy and sensitization . HGF shows some protective effect on common cold incidence at one year of age . Future studies should be focused on maternal genotype , human milk microbiome and diet influence on human milk immune composition and both short- and long-term health outcomes in the infant KE Grimshaw , J Maskell , EM Oliver . Pediatrics . 2013;132(6 ) . Available at : www.pediatrics.org/cgi/content/full/132/6/e1529 The study analyzed the significance of complementary feeding and breastfeeding in association with allergy development . This study was a nested case-control trial of 41 infants with food allergy diagnosed by age 2 years and 82 matched controls within a cohort study involving 1140 infants . The infants ’ food allergies were confirmed by using double-blind , placebo-controlled food challenges , the gold st and ard for diagnosing food allergies . Infants with food allergies were recruited from the PIFA ( Prevalence of Infant Food Allergy ) study in the United Kingdom . Parents kept prospect i ve daily food diaries and It is not known what constitutes an optimal diet in infancy . There are relatively few studies of weaning practice in the UK , and there is a need for prospect i ve data on the effects of  infant diet and nutrition on health in later life . We describe the dietary patterns , defined using principal components analysis of FFQ data , of 1434 infants aged 6 and 12 months , born between 1999 and 2003 . The two most important dietary patterns identified at 6 and 12 months were very similar . The first pattern was characterised by high consumption of fruit , vegetables and home-prepared foods ( ' infant guidelines ' pattern ) . The second pattern was characterised by high consumption of bread , savoury snacks , biscuits and chips ( ' adult foods ' pattern ) . Dietary pattern scores were correlated at 6 and 12 months ( r 0.46 ' infant guidelines ' ; r 0.45 ' adult foods ' ) . These patterns , which reflect wide variations in weaning practice , are associated with maternal and family characteristics . A key influence on the infant diet is the quality of the maternal diet . Women who comply with dietary recommendations , and who have high intakes of fruit and vegetables , wholemeal bread and rice and pasta , are more likely to have infants who have comparable diets -- with high ' infant guidelines ' pattern scores . Conversely , women whose own diets are characterised by high intakes of chips , white bread , crisps and sweets are more likely to have infants who have high ' adult foods ' pattern scores . The effects of these patterns on growth and development , and on long-term outcomes need to be investigated BACKGROUND Early recognition of dietary allergies in infants with atopic dermatitis is essential for avoidance of unnecessary elimination diets , amelioration of the skin disease , and secondary prevention of the development of multiple food allergies . Simple and accurate methods of identifying provocative foods are urgently needed . METHODS The usefulness of skin prick and patch tests as indicators of cow milk allergy was evaluated in 183 patients ranging in age from 2 to 36 months with double-blind , placebo-controlled ( n = 118 ) or open ( n = 65 ) cow milk challenges .  RESULTS The oral cow milk challenges were interpreted as positive in 54 % of both challenge types . Positive challenge rapidly elicited pruritus , urticaria , and /or exanthema in 49 % of cases and delayed-onset eczematous lesions in 51 % . The skin prick and patch tests gave markedly discrepant results ; prick tests were positive in 67 % of the cases with acute-onset reactions to milk challenge , whereas patch tests tended to be negative . Patch tests were positive in 89 % of those with delayed-onset reactions , although prick tests were frequently negative . CONCLUSIONS The observations indicate that IgE and T cell-mediated responses to cow milk can be distinguished in atopic dermatitis . Parallel skin testing with combined prick and patch tests can significantly enhance the accuracy in diagnosis of specific dietary allergies in patients with atopic dermatitis
Despite several intervention trials involving modifications to the maternal diet , the effect of maternal diet during pregnancy and lactation in preventing food allergy remains unclear .
Summary Earlier introduction of allergenic foods is a promising intervention to reduce the risk of some food allergies in high-risk infants .
Purpose of review In the past decade , food allergy has been increasingly recognized as an important public health issue .
The role of maternal and infant diet in the development of food allergy has been a major focus of research throughout this period .
Recently , research in this area has moved from observational studies to intervention trials , and the findings from these trials have started to influence infant feeding guidelines .
In this article , we review recent studies of dietary interventions for preventing food allergy , summarize current knowledge and discuss future research directions .