Different Measures of Diet Diversity During Infancy and the Association With Childhood Food Allergy in a UK Birth Cohort Study

Abstract

To investigate the association between 4 different measures of diet diversity (DD) during infancy and the development of food allergies (FAs) over the first decade of life.Children (n = 969) born in the Isle of Wight (United Kingdom) from 2001–2002.A prospective UK birth cohort was managed through to 10 years of age. The primary exposures of interest were sociodemographic, environmental, and dietary, assessed by questionnaires, including 4 separate parameters of DD. The primary outcome of interest was the development of FA, which was defined as either a positive oral food challenge test result or a positive skin-prick test result with a convincing clinical history.Univariate analysis revealed that increased World Health Organization DD criteria at 6 months (P = .0047), food diversity (P = .0009; P = .0392), food allergen diversity (P = .0048; P = .0233), and fruit and vegetable diversity (P = .0174; P = .0163) at 6 and 9 months, respectively, reduced the odds of FA over the first decade of life. Food allergen diversity at 12 months was significantly associated with a decreased likelihood of having FA at all time points, whereas eczema in the first year was associated with an increased risk of FA. Multivariate analyses, controlling for significant factors, including eczema, revealed that increased food allergen diversity at 6 months (P = .0111) and 12 months (P = .0005) significantly reduced the odds of food allergy over the first 10 years. For each additional food introduced by 6 months, the odds of developing FA over the first decade was reduced by 10.8%. For each additional allergenic food consumed (milk, egg, wheat, fish, soy, peanut, tree nuts, and sesame) by 1 year, there was a reduction of 33.2% in the likelihood of FA over the first 10 years of life.Increased infant diet diversity decreased the likelihood of developing FA, which was sustained over the first decade of life, even after correcting for other significant factors, including eczema.Doctor, what can I do to reduce my infant’s risk of food allergy? It is simple! We can advise not to delay introduction of allergens, and, with this study, we can also advise that a diverse diet is likely beneficial. Is this study solid evidence? The authors attempted to adjust for possible biases, but a controlled trial would be needed to confirm this observational study. Nonetheless, there is a potential rationale for their findings. A diverse diet may expose the infant to a broader microbiome, more allergens early (inducing tolerance), and diverse nutrients that could have positive benefits to immune responses. Food for thought and food for health!