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Revised Swedish infant feeding guidelines are associated with earlier introduction of allergenic foods
Jonas Österlund1, Gabriel Granåsen2, Stina Bodén1
1Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Insights
Swedish infants now consume allergenic foods like peanut and legume earlier and more frequently following updated 2019 guidelines. However, this shift in early food introduction has not yet impacted the prevalence of food allergies or sensitization in children.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health Nutrition
- Epidemiology
Background:
- Randomized controlled trials show early introduction of allergenic foods (e.g., peanut, egg) reduces food allergy risk in high-risk infants.
- International guidelines increasingly recommend introducing allergenic foods within the first year of life.
- Sweden updated national guidelines for infant solid food introduction in June 2019.
Purpose of the Study:
- To evaluate changes in the age of introduction and consumption frequency of allergenic foods after the 2019 Swedish national guideline revision.
- To assess the impact of revised guidelines on infant feeding practices regarding allergenic foods.
Main Methods:
- Comparative cohort study using data from the NorthPop Birth Cohort.
- Comparison of infants born before (June 2016-Dec 2018) and after (June 2019-Apr 2021) guideline implementation.
- Prospective data collection via web-based questionnaires on food introduction, eczema, and food allergy up to 18 months.
- Assessment of IgE sensitization at 18 months of age.
Main Results:
- Increased introduction and consumption frequency of allergenic foods (legume, peanut, soy, almond, cashew) in the first year of life post-guideline revision.
- Significant increases observed for legume (55.2% to 69.8%) and peanut (29.2% to 43.2%) introduction.
- No significant differences found in the prevalence of eczema, food allergy, or IgE sensitization to the studied foods between cohorts.
Conclusions:
- Infants in the general Swedish population are introduced to and consume allergenic foods earlier and more frequently since the 2019 guideline update.
- Despite changes in feeding practices, early manifestations of allergic disease (eczema, food allergy, sensitization) have not changed.
- Further research may be needed to understand the long-term implications of these updated feeding guidelines on allergy development.
Background:
Randomized controlled trials have demonstrated that early introduction of allergenic foods, such as peanut and egg, can reduce food allergy in high-risk children. Many international guidelines recommend introduction of allergenic foods in the first year of life, and accordingly, the Swedish National Food agency released updated guidelines in June 2019.
Objective:
Our aim was to examine whether the age at introduction and consumption frequency of allergenic foods have changed since release of the revised national guidelines on the introduction of solid foods in Sweden.
Methods:
Children born between June 2016 and December 2018 (n = 1925) were compared with children born between June 2019 and April 2021 (n = 1761) by using data from the NorthPop Birth Cohort study. Data on food introduction, eczema, and food allergy were prospectively collected until age 18 months by using web-based questionnaires. IgE sensitization was assessed at 18 age months.
Results:
The proportion of participants who had been introduced to egg, legume, soy products, peanut, almond, and cashew nut during the first year of life increased after implementation of the revised national guidelines. The most significant changes were seen for legume (from 55.2% to 69.8% [adjusted odds ratio = 1.90 (95% CI = 1.62-2.24)]) and peanut (from 29.2% to 43.2% adjusted odds ratio = 1.87 (95% CI = 1.55-2.24)]); consumption frequency had also increased. No differences in the prevalence of eczema, food allergy, or sensitization to the foods of interest were found.
Conclusion:
Since release of the revised guidelines, infants in the general population are introduced to and consume a variety of allergenic foods earlier and more frequently; however, early manifestations of allergic disease have remained unchanged.
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