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The effect of diet in infancy on asthma in young adults: the Merthyr Allergy Prevention Study
Sadiyah Hand1, Frank Dunstan2, Ken Jones3
1Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
Insights
Early infant diet impacts allergy risk. Cow's milk exclusion or soy milk introduction in the first four months increased adult risks of atopy and asthma in high-risk infants.
Area of Science:
- Allergy and immunology
- Pediatric allergy
- Nutritional immunology
Background:
- Early infant diet is a potential factor influencing the development of allergic diseases.
- The Merthyr Allergy Prevention Study (MAPS) investigated the long-term effects of early infant feeding on allergic disease risk.
Purpose of the Study:
- To determine if a cow's milk exclusion diet in the first four months of life reduces the risk of allergic diseases, including asthma, compared to a normal diet.
- To assess the impact of early soya milk introduction on allergic disease risk.
Main Methods:
- A randomized controlled trial (MAPS) involving high-risk infants.
- Intervention group received a soya milk preparation; control group received a normal diet.
- Standardized questionnaires and clinical assessments were conducted at multiple time points up to age 23 years.
Main Results:
- Infants in the intervention group showed a significantly increased risk of atopy (adjusted OR 2.97) and asthma (OR 2.07) at age 23.
- No significant increase in wheeze risk was observed in the intervention group (OR 1.43).
- Early cow's milk exposure correlated with decreased wheeze and asthma risk; early soya milk exposure correlated with increased atopy and asthma risk.
Conclusions:
- Cow's milk exclusion or early soya milk introduction in the first four months of life is associated with an increased risk of atopy, wheeze, and asthma in adulthood for high-risk infants.
- These findings suggest that early dietary interventions in infancy may have long-term implications for allergic disease development.
Introduction:
Early infant diet might influence the risk of subsequent allergic disease.
Methods:
The Merthyr Allergy Prevention Study (MAPS) was a randomised controlled trial in infants at high risk of allergic disease. The trial determined whether a cow's milk exclusion diet for the first 4 months of life decreased the risk of allergic disease including asthma compared with a normal diet. A soya milk preparation was offered to those in the intervention group. A standardised questionnaire for allergic disease was completed at ages 1, 7, 15 and 23 years, with clinical assessment at 1, 7 and 23 years. The effect of the intervention on the risk of atopy, asthma and wheeze at age 23 years was determined.
Findings:
487 subjects entered the study; at age 23 years 299 completed the questionnaire, of which 119 attended clinical assessment. Subjects randomised to the intervention group had a significantly increased risk of atopy (adjusted OR 2.97, 95% CI 1.30 to 6.80; p=0.01) and asthma (OR 2.07, 95%CI 1.09 to 3.91; p=0.03) at age 23 years, but not wheeze (OR 1.43, 95%CI 0.87 to 2.37; p=0.16). Earlier exposure to cow's milk was associated with a decreased risk of wheeze and asthma at age 23 years, while earlier exposure to soya milk was associated with an increased risk of atopy and asthma.
Interpretation:
In infants at high risk of allergic disease, either cow's milk exclusion or early soya milk introduction for the first 4 months of life increases the risk of atopy, wheeze and asthma in adulthood.
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