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Complementary and Allergenic Food Introduction in Infants: An Umbrella Review
Victoria X Soriano1,2, Daniela Ciciulla1,2,3, Grace Gell2
1Centre for Food and Allergy Research.
Insights
Introducing allergenic foods like peanut and egg between 4-11 months may prevent food allergies. Complementary foods should be introduced around 6 months, with no early solids before 4 months to avoid obesity risk.
Area of Science:
- Pediatric Nutrition
- Allergy Prevention
- Public Health
Background:
- Existing systematic reviews focus on individual food introductions and health outcomes.
- A comprehensive overview of the balance of harms and benefits is lacking.
Purpose of the Study:
- To systematically overview reviews on the age of introducing complementary and allergenic foods.
- To assess associated short- and long-term infant health outcomes.
Main Methods:
- Searched major databases (Medline, Embase, Cochrane, PubMed) up to July 2022.
- Included systematic reviews on food introduction before age 1.
- Assessed outcomes including allergies, autoimmune diseases, neurodevelopment, nutrition, and weight.
Main Results:
- Moderate evidence suggests introducing peanut and egg from 4-11 months reduces food allergy risk.
- No association found between complementary food introduction and food allergy or eczema.
- High certainty evidence shows no link between gluten introduction age and celiac disease.
- Introducing solids before 4 months may increase childhood obesity risk (low certainty).
Conclusions:
- Current evidence supports introducing complementary foods around 6 months.
- Introducing allergenic foods before 11 months is recommended.
- Early introduction of solids before 4 months should be avoided to mitigate obesity risk.
Background:
Multiple systematic reviews examine the introduction of foods in relation to individual health outcomes, but the balance of harms and benefits has not been overviewed systematically.
Objectives:
We aimed to perform an overview of systematic reviews on age of introduction of complementary and allergenic foods to the infant diet and long and short-term health outcomes.
Data Sources:
We searched Medline, Embase, Cochrane, and PubMed (July 25, 2022).
Study Selection:
Included systematic reviews examining the introduction of complementary or allergenic foods before age 1. Outcomes included allergic, autoimmune, and inflammatory diseases, neurodevelopment, nutrition, and weight.
Data Extraction:
Extraction and quality assessment were performed in duplicate (A Measurement Tool to Assess Systematic Reviews) and strength of evidence was assessed.
Results:
We screened 4015 articles and included 32 systematic reviews. There was moderate evidence that peanut and egg should be introduced from 4 to 11 months to prevent food allergy (6 of 10 reviews). Complementary food introduction was not associated with food allergy. Moderate certainty evidence suggested age of complementary food introduction was not associated with eczema. Age at introduction of gluten was not associated with celiac disease (high certainty evidence; 3 of 4 reviews). Low certainty evidence indicated that introducing solids before 4 months may increase the risk of childhood obesity, but not growth. There was insufficient evidence regarding an association between any food introduction and bone health, gastrointestinal diseases, autoimmune disorders, asthma, or allergic rhinitis.
Limitations:
Gray literature was not included.
Conclusions:
Current evidence supports introducing complementary foods around 6 months and allergenic foods before 11 months.
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