Earlier ingestion of peanut after changes to infant feeding guidelines: The EarlyNuts study
Victoria X Soriano1, Rachel L Peters1, Anne-Louise Ponsonby2
1Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
Insights
Early introduction of peanut to infants significantly increased after Australian guidelines changed. Most infants now consume peanut before 12 months, with a low rate of allergic reactions.
Area of Science:
- Allergy and immunology
- Pediatric nutrition
- Public health interventions
Background:
- Randomized controlled trials confirm early peanut introduction reduces allergy risk.
- Previous research (HealthNuts, 2007-2011) found low rates of infant peanut consumption.
- Australian guidelines updated in 2016 to recommend peanut introduction before 12 months.
Purpose of the Study:
- To assess the impact of updated guidelines on infant peanut introduction.
- To evaluate the consequences of a non-screening approach to allergenic food introduction.
- To determine the rate of peanut introduction and reactions in infants under 12 months.
Main Methods:
- Population-based, cross-sectional study (EarlyNuts) in Melbourne, Australia.
- Recruited 860 infants aged 12 months between November 2016 and October 2018.
- Used identical sampling and methods to the prior HealthNuts study.
Main Results:
- Peanut introduction by 12 months increased significantly to 88.6% (vs. 28.4% in HealthNuts).
- Median introduction age was 6 months, with 76.4% consuming peanut >4 times by 12 months.
- Preliminary data show 4.0% of peanut-consuming infants experienced possible IgE-mediated reactions.
Conclusions:
- A substantial shift towards earlier peanut introduction in infants has occurred.
- The updated guidelines appear effective in promoting timely peanut consumption.
- Further monitoring of allergic reactions is warranted.
Background:
Randomized controlled trials demonstrate that timely introduction of peanut to infants reduces the risk of peanut allergy. However, much debate remains regarding how to best achieve earlier peanut introduction at the population level. Our previous study in 2007-2011 (HealthNuts, n = 5300) indicated that few infants were consuming peanut in the first year. Australian infant feeding guidelines were updated in 2016 to recommend introducing peanut before 12 months for all infants. There were no data available on the subsequent effect on peanut introduction or peanut reactions.
Objective:
We sought to assess the consequences of a nonscreening approach to allergenic food introduction in a population-based sample of infants in their first year of life.
Methods:
EarlyNuts is a population-based, cross-sectional study of 12-month-old infants in Melbourne, Australia, recruited by using an identical sampling frame and methods to HealthNuts (72% response rate vs 73% response rate in HealthNuts). We report here on the first 860 participants recruited between November 2016 and October 2018.
Results:
Most infants (88.6%; 95% CI, 86.1% to 90.7%) had introduced peanut by 12 months (median age, 6 months), an increase from 28.4% (95% CI, 27.2% to 29.7%) in the HealthNuts study. By 12 months, the majority of these (76.4%) had consumed peanut more than 4 times, and 28% were eating peanut more than once per week. Preliminary results on parent-reported reactions show that 4.0% of those consuming peanut by 12 months had possible IgE-mediated reactions.
Conclusions:
There has been a striking shift toward earlier peanut introduction, with a 3-fold increase in peanut introduction by age 1 year in 2018 compared with 2007-2011.
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