Would you offer your 3 month old baby a taste of peanut butter? Hard boiled egg? How about a small tilapia with tahini sauce? That's exactly what parents did in one study published in May in the New England Journal of Medicine.1 The study found that early introduction to these foods could protect children from developing food allergies, but many parents found it difficult to follow the study’s instructions.
The study called Inquiring About Tolerance (EAT) was carried out in the UK and was carried out by Dr. Gideon lacquer headed. Lack was also the lead author of the 2015 LEAP study that found this earlier introduction of the peanut peanut allergy prevented to high-risk children.2 Previous observational studies have shown a lower rate of peanut. egg. cow's milk, and wheat Allergy in children with earlier introduction to these foods.3-6 However, LEAP and EAT are the first published randomized controlled trials on this issue that provide higher quality evidence than the previous observational studies.
In the EAT study, 1303 exclusively breastfed 3 month old babies were randomly divided into two groups. One was instructed to follow the current Great Britain recommendations Continue breastfeeding exclusively until the age of 6 months and then introduce solid foods, with the type and amount of food left to the parents. The other group was instructed to start introducing solids after three months, including six commonly allergenic foods: cow's milk yogurt, peanut, boiled egg, sesame (in the form of tahini paste), white fish, and wheat. Mothers in the early solid group were also asked to continue breastfeeding for at least 6 months.
Here is what parents were asked to do in the early introductory group (by the study protocol):
-Begin with rice cereal mixed with breast milk or water. The average school age was 3.4 months, so babies between 3 and 4 months started eating.
– Next, offer cow's milk yogurt with a goal of 4 g protein per week At 5 months. This makes up a pile of a third of a cup of whole milk yogurt, which is fed throughout the week.
-Next offer sesame, egg, fish, peanut and wheat. Each family received a randomly assigned order of introduction to these foods. The target amount was 4 g protein from each food per week. I show in the photo below how this affects the amount of actual food. Parents were asked not to introduce wheat until the age of 4 months, as previous research found a link between celiac disease and earlier wheat introduction.
On earlier paper The EAT study provides an example of one Weekly calendar (PDF) given to parents for food introduction. 7 (Please, please, please … do not allow yourself to comply with this protocol without reading until the end of this article!)
I had all of these foods on hand, so I served them up so you could see what a baby in the early introductory group of the EAT study should have been eating by 5 months. (Again, this is worth a week of food.) If you think it is difficult to include all of these foods in an infant's diet, you are not alone. One of the major limitations of the study was that many babies (and / or their parents) did not follow these dietary guidelines.
Did the timing of the introduction of these foods make a difference to the development of a food allergy?
The researchers examined the differences in food allergy between the two groups in different ways. The first was an intention-to-treat analysis that compared the incidence of food allergies, regardless of whether the subjects actually followed the study instructions or not. In this way, 5.6% of the early induction group and 7.1% of the standard induction group developed an allergy to at least one food. This difference was not significant.
The researchers next examined more closely how well the families actually followed the nutritional recommendations they received. They defined “adequate compliance” in the early induction group as consuming at least 3 g of protein per week from at least 5 of the 6 foods assigned for at least 5 weeks between the 3rd and 6th month of life. Only 43% of babies met these criteria.
As it turned out, however, these babies enjoyed significant protection against food allergies. Only 2.5% of them developed a food allergy, compared to 7.3% of the standard group who followed their instructions. There were no allergies to peanuts in the early introductory group, compared to 2.5% in the standard group. In the egg, 1.4% of the early introduction group was allergic compared to 5.5% of the standard group. These differences were all statistically significant.
Babies in the early introduction who ate less than the prescribed amounts also seemed to benefit, especially for peanuts. Those who ate only 1.5 teaspoons of peanut butter per week for 4 weeks (before the age of 6 months) had a 10-fold reduction in the risk of developing peanut allergy compared to the standard group.
Food allergies are increasing in the USA.The idea that we can at least partially reverse this trend by exposing babies to certain foods earlier is fascinating. However, the fact that so many infants in the EAT study did not follow the early adoption protocol makes it difficult to interpret the results with certainty. For example, there may have been factors that affected both the early acceptance of solids and the occurrence of allergies. Although the researchers did not believe that this was the case, more studies using a simpler protocol (possibly only two to three foods instead of six, for example) would help clarify these relationships. one such study is currently traveling in Norway.
There were no cases of anaphylaxis in the early introductory group, and hospitalization and growth rates were similar between the two groups. Parents of premature babies aged 4 to 6 months were slightly more likely to report vomiting and constipation, but not diarrhea. These differences were minor.
In one paper The EAT researchers, which were published separately earlier this year, reported no difference in breastfeeding rates after 6 months in the control group and the early introduction group (98% and 97%, respectively – much higher than the typical rates in the UK, this was however part of the EAT protocol).7 As the EAT study focused specifically on breastfed babies, it should be noted that these results may not apply to infants who have been fed infant formula.
The NEJM produced a short video summary of the study Here,
This was a careful, well-designed study on an important question that all parents had to grapple with: when should we start offering solids to our babies? The results suggest that the risk of food allergy can be reduced if babies are given solid ingredients (especially common allergens) after 3-4 months. Previous studies indicate that breastfeeding may protect against allergies at the time of introducing solids, and earlier introduction of solids may cause this combination to occur in more babies.
We are seeing more and more studies demonstrating the benefits of introducing low-risk solids earlier. This contradicts the current recommendations of the WHO, the AAP section for breastfeeding, and the NHS from Great Britain that babies should only be breastfed for six months. I hope that medical organizations will reevaluate this advice, at least in the developed world. (You can read more about my analysis of this question here.)
I find the EAT study very promising, but I'm also concerned when I think of parents trying to follow this mandatory food introductory protocol. in particular from 3 months. It is an important finding that more than half of babies and their parents have failed to follow her. You cannot make a baby eat solid food – it must have important motor and oral development skills. It rarely happens that they occur 4 months ago. Many babies are only finished after 6 months. For example, a baby must have lost the tongue thrust reflex so that he can push the food into the back of his mouth and swallow it effortlessly. It must also be able to sit comfortably upright. And she must be interested in the food!
Trying to push a baby without interest or development skills to eat can fail. The baby could repeat his displeasure with this strange stuff, the food, by spitting it out and making a fuss, and further pressure on the food could only make this negative reaction even stronger. In the meantime, parents may feel stressed if they fail in the feeding department, and that's the last thing we need.
What we can do is look for signs of readiness and give our babies the opportunity to try new foods, including these potentially allergenic ones, as soon as they are ready. I started offering solids to my babies for about 4.5 to 5 months, but didn't eat more than a few bites a day for about 6 months. For my second baby, who benefited from my hours of reading on the subject, these bites deliberately included all foods in the EAT study except Tahini.
CORRECTION: In an earlier version of this post, the amounts of food indicated in the photo were incorrectly specified. The current amounts correspond to the recommendations for parents participating in the EAT study.
- Perkin, M. R. et al. Randomized study on the introduction of allergic foods to breastfed infants. N. Engl. J. Med. 374 1733-1743 (2016).
- Du Toit, G. et al. Randomized study of peanut consumption in infants at risk of peanut allergy. N. Engl. J. Med. 0 zero (2015).
- Poole, J.A. et al. Date of initial exposure to cereal grains and risk of wheat allergy. pediatrics 117 2175-2182 (2006).
- Koplin, J.J. et al. Can early egg introduction prevent egg allergy in infants? A population based study. J. Allergy Clin. Immunol. 126 807-813 (2010).
- Du Toit, G. et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergies. J. Allergy Clin. Immunol. 122 984-991 (2008).
- Katz, Y. et al. Early exposure to cow's milk protein protects against an IgE-mediated cow's milk protein allergy. J. Allergy Clin. Immunol. 126 77-82.e1 (2010).
- Perkin, M. R. et al. Inquiring About Tolerance (EAT) study: Feasibility of early introduction of allergenic foods. J. Allergy Clin. Immunol. 137 1477-1486.e8 (2016).
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