Solid Food Introduction in Relation to Eczema: Results From a Four-Year Prospective Birth Cohort Study

Abstract

Filipiak B, Zutavern A, Koletzko S, et al. J Pediatr. 2007;151(4):352–358 PURPOSE OF THE STUDY. To assess the association between the introduction of solid foods in the first 12 months and the occurrence of eczema during the first 4 years of life in a prospective study of newborns. METHODS. Data were taken from annually administered questionnaires from a large birth cohort (recruited 1995–1998) comprising an intervention and a nonintervention group. Outcomes were doctor-diagnosed and symptomatic eczema. Multiple generalized estimation equation models were performed for the 2 study groups. RESULTS. From the 5991 recruited infants, 4753 (79%) were followed up. The 2 study groups were different in their family risk of allergies and feeding practices. No association was found between the time of introduction of solids or the diversity of solids and eczema. In the nonintervention group, a decreased risk was observed for avoidance of soybean/nuts, but an increased risk was seen in doctor-diagnosed eczema for the avoidance of egg in the first year. CONCLUSIONS. The evidence from this study supports neither a delayed introduction of solids beyond the fourth month nor a delayed introduction of the most potentially allergenic solids beyond the sixth month of life for the prevention of eczema. However, effects under more extreme conditions cannot be ruled out. REVIEWER COMMENTS. The dilemma of when to introduce solid foods during infancy continues. The data from this investigation support the notion that it is unnecessary to delay solid foods beyond the fourth month of life or allergenic solid foods beyond the sixth month of life to prevent eczema. Specifically, this investigation found no significant effect of timing or diversity of solid foods on eczema outcomes to 4 years of age. The duration of exclusive breastfeeding as compared with the timing of introduction of solid foods, including both formulas made with whole cow's milk or soy proteins, as well as extensively hydrolyzed casein and partially hydrolyzed whey protein formulas, were examined. It is interesting to note that findings from this investigation seem to indicate that there may be a period of immunologic immaturity during which whole protein in large amounts, whether solid or liquid, may promote the development of atopic disease. These data should help to settle the argument of when to introduce solid foods during infancy for the prevention of eczema and will have a direct impact on global recommendations dealing with this clinical issue.