Tag Archives: solid food introduction

The “EAT” Study

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A recent study from MR Perkin et al (NEJM 2016; 374: 1733-43) examined whether early introduction (3 months) of allergenic foods in 1303 infants lowered the rate of allergies to these foods at 3 years of life compared to standard introduction (after 6 months).  The six foods: peanut, egg, cow’s milk, sesame, whitefish, and wheat.

This EAT study (“Enquiring about Tolerance”) required parents in the intervention group to give 3 rounded teaspoons of smooth peanut butter, one small egg, two portions (40-60 g) of cow’s milk yogurt, 3 teaspoons of sesame paste, 24 g of white fish, and two wheat-based cereal biscuits every week.

While the study did not reach a statistical significance, the absolute rate of allergies was modestly lower in those in the early introduction group (5.6% compared with 7.1%).  In a per-protocol analysis of those who strictly adhered to the assigned treatment regimen, there was an even lower rate of 2.4% (compared to 7.3% in the standard group).  The associated editorial (pg 1783-84) indicates that the demanding protocol limited those who adhered to the protocol and points out that those who were not adherent could have been due to reverse causation (eg. subtle avoidance to certain foods due to reactions).  The editorial conclusion: “evidence is building that early consumption rather than delayed introduction of foods is likely to be more beneficial as a strategy for the primary prevention of food allergy.”

My take: Early introduction of allergenic solids at ~3 months of age probably lowers the risk of developing allergies to these foods.

Here’s a link to <2 minute quick take summary: The EAT Study NEJM

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Reference on consensus for guidance on introducing peanuts:  J Allergy Clin Immunol 2015; 136: 258-61.

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How to Protect Children From Celiac Disease

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While many parents have asked what they can do to protect their children from celiac disease, the new answer will be more limited than in the past.  Two recent studies from NEJM indicate that timing of gluten introduction and breastfeeding do not appear to significantly influence the development of celiac disease.

Here are the links:

1st Study: Introduction of Gluten (6 months vs 12 months)

  • Results: (n=707) At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P=0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test).
  • CONCLUSIONS: Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease.

2nd Study: Gluten 16-24 weeks or Delayed  n=944

  • CONCLUSIONS As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children.

Here’s a story from Boston Globe summarizing findings: Tactics to Prevent Celiac

Bottomline: These well-designed studies argue persuasively against the previously held views that breastfeeding and timing of gluten introduction influence the development of celiac disease.

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NASPGHAN Educational materials for medical professionals –NASPGHAN Celiac Link

Timing of Solid-Food Introduction

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The “DAISY” (diabetes autoimmunity  study in the young) study indicates that the timing of solid-food introduction can influence the likelihood of developing type 1 diabetes (T1DM) (JAMA Pediatr 2013; 167: 808-15).

The participants were 1853 children at increased genetic risk for T1DM who were enrolled in a longitudinal observational cohort study in Denver. Early solid-food exposure was considered <4 months of age and late >6 months of age.

Results:

  • “Both early and late first exposure to any solid food predicted development of T1DM.”  For early exposure, the Hazard Ratio was 1.91 and for late HR was 3.02.
  • Breastfeeding at the time of introduction to wheat/barley conferred protection (HR 0.47)

The study has several limitations, particularly the relatively low numbers of children who developed T1DM (n=53).

A second study (Pediatrics 2013 [doi: 10.1542/peds2012-3692]) –thanks to Ben Gold for this reference –showed that “solid foods were introduced significantly earlier among the infants with allergies, with 35% of them receiving their first solids before and including 16 weeks, compared with 14% of control infants (P=.011).”   (Solid foods before 17 weeks linked to food allergy)

Bottomline: As with celiac disease (“Gluten–Related Disorders” (Part 1) | gutsandgrowth), current science suggests the introduction of solid foods between 4-6 months of age may diminish the risk of developing T1DM as well as food allergies.