Tema variado

* FROM THE AMERICAN ACADEMY OF PEDIATRICS
Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas
1. Frank R. Greer, MD,
2. Scott H. Sicherer, MD,
3. A. Wesley Burks, MD,
4. and the Committee onNutrition and Section on Allergy and Immunology
 
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Abstract
This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use ofhypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease. The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Currentevidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are notexclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis. Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit. There is also littleevidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease.
Key Words:
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atopy
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food allergies
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breastfeeding
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complementary foods
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hydrolyzed formula
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atopic dermatitis
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asthma
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INTRODUCTION
Over the past several decades, the incidence of atopic diseases such as asthma, atopic dermatitis, and food allergies has increased dramatically. Among children up to 4 years of age, the incidence of asthma has increased 160%, and the incidence of atopic dermatitis has increased twofold to threefold.1 The incidence of peanutallergy has also doubled in the past decade.2 Thus, atopic diseases increasingly are a problem for clinicians who provide health care to children.
It has been recognized that early childhood events, including diet, are likely to be important in the development of both childhood and adult diseases. This clinical report will review the nutritional options during pregnancy, lactation, and the first yearof life that may or may not affect the development of atopic disease. Although atopic diseases have a clear genetic basis, environmental factors, including early infant nutrition, may have an important influence on their development and, thus, present an opportunity to prevent or delay the onset of the disease. This clinical report replaces an earlier policy statement3 from the American Academy...