Infant Feeding Clusters Are Associated With Respiratory Health and Allergy at School Age in the PARIS Birth Cohort

Abstract

To identify first year of life feeding cohorts and examine associations between respiratory health and allergy at 8 years of age and infant feeding practices.A total of 3446 infants born in Paris, France, were managed from birth to 8 years of age.Questionnaires were collected at 1,3,6,9, and 12 months of life, focusing on breastfeeding, consumption of infant formula (regular, partially hydrolyzed, extensively hydrolyzed, prebiotics and probiotics, and soy), and solid food introduction. Multidimensional longitudinal cluster analysis was used to place children with similar early feeding practices into 5 cohorts. Standardized questionnaires, physician documentation, lung function, fractional exhaled nitric oxide, and specific immunoglobulin E were collected at 8 years of life. These data were used to identify atopic morbidity correlations between feeding cohorts. Multivariable logistic and linear regression models adjusted for early respiratory and allergic outcomes and parental history of allergy.Participants were grouped into 5 feeding clusters on the basis of early feeding patterns: cluster 1 (45%): mostly regular formula; cluster 2 (27%): exclusively breastfed during the first 3 months; cluster 3: (17%) prebiotic or probiotic formula; cluster 4: (7%) partially hydrolyzed formula, and cluster 5: (4%) extensively hydrolyzed or soy formula. Compared with infants in cluster 1, children fed extensively hydrolyzed or soy formula were more likely to have diagnosis of food allergy (cluster 5). Infants fed partially hydrolyzed formula (cluster 4) had a significant lower lung function (forced expiratory volume in 1 second; forced vital capacity), higher fractional exhaled nitric oxide, and higher risk of allergic sensitization at 8 years of life, compared with that of cluster 1. Compared with infants fed mostly regular formula (cluster 1), infants exclusively breastfed during the first 3 months (cluster 2) had a lower rate of asthma diagnosis.Children breastfeeding at least 3 months in this study had protection against developing asthma and food allergy later in life, compared with other feeding groups. Infants with early partially hydrolyzed formula had higher rates of asthma and atopy at 8 years of age, even while controlling for early respiratory or allergic disease and family history of atopy.This supports previous recommendations regarding breastfeeding and the prevention of atopic conditions. The authors caution pediatricians against recommending hydrolyzed or hypoallergenic formulas universally or on the basis of family history alone and highlight potential future morbidity. This study revealed no benefits in preventing atopic disease with prebiotic or probiotic formulas, although the grouping of multiple different types of these formulas in 1 heterogenous group is a significant study limitation. The mechanisms underlying these results deserve further study.