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Partially hydrolyzed 100% whey protein infant formula and atopic dermatitis risk reduction: A systematic review of the literature

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Partially hydrolyzed 100% whey protein infant formula and atopic dermatitis risk reduction: A systematic review of the literature

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Abstract

The incidence of atopic dermatitis (AD) is increasing worldwide. Clinical studies have observed reduced risks of AD among infants fed with 100% whey partially hydrolyzed infant formula (PHF-W) compared with intact protein cow's milk formula. To evaluate this potential relationship more comprehensively, a systematic review of the literature was conducted. Studies (n = 18, representing 12 distinct study populations) that specified the protein source of the formula, evaluated healthy-term infants, compared the use of PHF-W with intact protein cow's milk formula, and reported results for AD were included. A critical assessment of the methodological quality of studies was conducted. In all studies, a reduced incidence of AD and/or atopic manifestations that included AD was observed. The cumulative incidence of AD was significantly lower among infants over at least 3 years of follow-up in the PHF-W group compared with the intact protein cow's milk group. Exclusive breastfeeding should be encouraged as the primary means to prevent atopic risk. However, when infants are not exclusively breastfed, PHF-W may be considered an effective measure to potentially reduce the risk of developing AD.

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... The prevalence and severity of atopic manifestations in children has increased significantly over the last few decades (1)(2)(3)(4) . As allergic diseases (including asthma, eczema, hay fever and food allergies) are complex multifactorial disorders involving a combination of genetic and environmental interactions, environmental factors must have been the key to explain the variations and changes in allergy prevalence (2,5,6) . ...
... When infants are not exclusively breastfed, partially hydrolysed formula (infant formula where cow's milk proteins were modified by hydrolysation processes) may be considered an effective measure to potentially reduce the risk of developing atopic dermatitis (3,6,(29)(30)(31) . Specifically, it was observed that feeding with partially-hydrolysed wheyprotein formula instead of intact protein cow's milk formula reduces the risk of atopic dermatitis in infants, particularly in infants with a family history of allergy (3,6,13,14,29) . ...
... When infants are not exclusively breastfed, partially hydrolysed formula (infant formula where cow's milk proteins were modified by hydrolysation processes) may be considered an effective measure to potentially reduce the risk of developing atopic dermatitis (3,6,(29)(30)(31) . Specifically, it was observed that feeding with partially-hydrolysed wheyprotein formula instead of intact protein cow's milk formula reduces the risk of atopic dermatitis in infants, particularly in infants with a family history of allergy (3,6,13,14,29) . Depending on the degree of modification, hydrolysed cow's milk formulas are differentiated into extensively and partially hydrolysed whey or casein hydrolysates (6) . ...
Article
Over the past several decades, the incidence of atopic diseases such as asthma, atopic dermatitis and food allergies has increased dramatically. Although atopic diseases have a clear genetic basis, environmental factors, including early infant nutrition, may have an important influence on their development. Therefore, attempts have been made to reduce the risk of the development of allergy using dietary modifications, mainly focused on longer breast-feeding and delayed introduction or elimination of foods identified as potentially most allergenic. Recently, there is also an increasing interest in the active prevention of atopy using specific dietary components. Many studies have shown that breast-feeding may have the protective effect against future atopic dermatitis and early childhood wheezing. Concerning complementary feeding, there is evidence that the introduction of complementary foods before 4 months of age may increase the risk for atopic dermatitis. However, there is no current convincing evidence that delaying introduction of solids after 6 months of age has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow's milk protein formula or human subject's milk, and this includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs and foods containing peanut protein. In conclusion, as early nutrition may have profound implications for long-term health and atopy later in life, it presents an opportunity to prevent or delay the onset of atopic diseases.
... Many whey protein-derived peptides have been described to demonstrate ACE inhibition activity. Whey protein hydrolysates (WPH) containing peptides derived from the α-lactalbumin (f 99-110) fraction has been shown to demonstrate ACE inhibitory activity, specifically in the sequences (f 99-108), (f [104][105][106][107][108], and (f [105][106][107][108][109][110]. It was reported that the whey protein fraction (α-lactalbumin) (f 50-53) exhibited antihypertensive activity at IC 50 = 733.3 ...
... Many whey protein-derived peptides have been described to demonstrate ACE inhibition activity. Whey protein hydrolysates (WPH) containing peptides derived from the α-lactalbumin (f 99-110) fraction has been shown to demonstrate ACE inhibitory activity, specifically in the sequences (f 99-108), (f [104][105][106][107][108], and (f [105][106][107][108][109][110]. It was reported that the whey protein fraction (α-lactalbumin) (f 50-53) exhibited antihypertensive activity at IC 50 = 733.3 ...
... Public concern for atopic dermatitis (a condition where the skin is swollen, scaly with itchy rashes) is continuously increasing worldwide with infants being more susceptible to it. Recently, a meta-analysis showed that infants fed with a hydrolyzed form of whey protein developed reduced symptoms of atopic dermatitis as compared to the control subjects that were given plain bovine milk [106]. These results suggested that diets included with whey protein might play an effective role to protect the infants from atopic dermatitis. ...
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With the increased consumer demand for nutritional foods, it is important to develop value-added products, which will not only catch the attention of a wider consumer group but also provide greater benefits in terms of enhanced nutrition and functionality. Milk whey proteins are one of the most valued constituents due to their nutritional and techno-functional attributes. Whey proteins are rich in bioactive peptides, possessing bioactive properties such as being antioxidant and antihypertensive as well as having antimicrobial activities, which, when ingested, confers several health benefits. These peptides have the potential to be used as an active food ingredient in the production of functional foods. In addition to their bioactivities, whey proteins are known to possess enhanced functional attributes that allow them to be utilized in broad applications, such as an encapsulating agent or carrier materials to entrap bioactive compounds, emulsification, and in edible and active packaging. Hence, over the recent years, several whey protein-based ingredients have been developed and utilized in making formulations for a wide range of foods to harness their beneficial properties. This review highlights the bioactive properties, functional characteristics, associated processing limitations, and applications of different whey protein fractions and derivatives in the field of food formulations, encapsulation, and packaging.
... Dermatitis atopi (eksim atopi) merupakan penyakit kulit kronik dengan karakteristik gatal dan inflamasi pada kulit. 11 Etiologi spesifik terjadinya dermatitis atopi masih belum jelas. Kombinasi genetik, faktor imunologi, dan lingkungan dipertimbangkan memiliki kontribusi terhadap patogenesis terjadinya dermatitis atopi. ...
... Namun, pada bayi dengan risiko tinggi atopi yang tidak mendapat ASI eksklusif maka dapat diberikan formula hidrolisat parsial sebagai pencegahan berkembanganya manifestasi alergi terutama dermatitis atopi di kemudian hari. 11 Peran formula hidrolisat parsial untuk pencegahan penyakit alergi terutama dermatitis atopi telah dibuktikan pada beberapa uji klinis. Pencegahan alergi melalui 3 mekanisme yaitu sumber protein seperti whey, kasein, atau kombinasi, metode hidrolisis (parsial atau ekstensif ), dan tipe enzim (pH, temperatur). ...
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Full-text available
Latar belakang. Formula hidrolisat parsial merupakan salah satu alternatif pemberian nutrisi yang dapat mencegah penyakit alergi di kemudian hari. Tujuan. Mengetahui efektivitas formula hidrolisat parsial untuk mencegah penyakit alergi pada anak dikemudian hari. Metode. Penelusuran pustaka database elektronik yaitu Pubmed, Cochrane, dan Highwire. Hasil. Telaah sistematis mendapatkan bahwa semua studi mendapatkan insidens Dermatitis Atopi (DA) yang menurun dengan atau tanpa manifestasi atopi. Insidens kumulatif setelah 3 tahun ditemukan lebih rendah secara bermakna pada bayi yang mendapat formula hidrolisat parsial. Kesimpulan. Pemberian formula hidrolisat parsial terbukti dapat mencegah timbulnya manifestasi alergi terutama dermatitis atopi pada usia 1 tahun dan efek pencegahan ini konsisten jangka panjang.
... Se requieren más estudios prospectivos en la región para desarrollar estrategias públicas de prevención en salud y diagnóstico temprano 7,21,33,37,42,48,50,[53][54][55][56][57][58][59] . ...
... Este estudio describe la información recolectada de las historias clínicas de un grupo de pacientes y analiza su comportamiento clínico en un período de tiempo, no cuenta con grupo control y el tamaño está dado por el número de pacientes disponibles que cumplieron los criterios de inclusión. Nuevos estudios prospectivos deben llevarse a cabo para desarrollar estrategias públicas de prevención en salud y diagnóstico temprano de esta entidad, especialmente en el grupo pediátrico 7,21,33,37,42,48,50,[53][54][55][56][57][58][59] . ...
Article
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Introduction: Quality of life and nutritional status of infants with cow's milk protein allergy (CMA) can be compromised without a proper diagnosis and treatment. Objective: To describe digestive symptoms, family and perinatal history and nutritional status of ≤ 12 month infants with CMA between June 2007 and August 2011. Patients and Method: A retrospective and descriptive study in ≤ 12 month old infants suspecting CMA was performed. Family history, perinatal and clinical characteristics were studied. Cases without food test or open challenge test, or whose reason for consultation corresponded to other pathology were excluded. The program STATA 11.1 was used for statistical analysis and p
... Unfortunately, as has been a constant in this subject, there are no studies designed correctly that can answer this question and therefore we still do not know if different results will be obtained with the application of broader prevention strategies. [31]. ...
... Research investigating the role of specific infant formulas for AD/atopic disease-prevention demonstrates the preventive effect on AD of partially hydrolyzed whey protein and extensively hydrolyzed casein formulas. [15][16][17][18][19] However, studies of AD treatment with infant formula changes are lacking. Nevertheless, our findings indicate that concerns about allergic disease influence AD management. ...
Article
Full-text available
To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US. A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 24), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity. Significant differences were observed in referrals to healthcare professionals (P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians. Significant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed.
... Eight systematic reviews with or without a meta-analysis met the inclusion criteria (10)(11)(12)(13)(14)(15)(16)(17). Two reviews (12,13) included trials coauthored by the investigator (R.K. Chandra) whose data have been questioned (18); thus, these reviews were excluded. ...
Article
Full-text available
AIM:: The aim of this review is to provide recommendations on the use of hydrolysates in infants when formula feeding is initiated. We performed an overview of reviews followed by a systematic review of subsequently published trials. We did find eight systematic reviews; only one study of limited quality was published afterwards. Certain extensively hydrolyzed casein and certain partially hydrolyzed whey formulas are appropriate for reducing the risk of allergy in infants at high risk when formula feeding is initiated CONCLUSION:: In high risk infants, when breastfeeding is not possible, hydrolysates of documented safety and efficacy have an indication in infant feeding up to the age of 4 to 6 months.
... Existe evidencia que sugiere que cuando un lactante de riesgo deja de recibir leche materna debiera recibir una FL parcialmente hidrolizadas, o sea una FL donde las proteínas han sido modificadas mediante hidrolización 93,94 . Se ha observado que la alimentación con una FL de proteína de suero parcialmente hidrolizada (y no con proteína de leche de vaca intacta) reduce el riesgo de dermatitis atópica en lactantes, particularmente en aquellos con historia familiar de alergia 95 . ...
Article
Full-text available
The incidence of atopic diseases such as asthma, atopic dermatitis and food allergies has increased exponentially in recent decades. Although atopic diseases have a clear genetic basis, environmental factors such as the diet, seems to play an important role in its development. This article summarizes main studies exploring whether feeding practices of mothers and infants intervenes in the development of allergic diseases. The potential role of dietary practices of the mother and infants for the prevention and/or management of allergies in infants is discussed. The available evidence was analyzed for: 1) does mothers consumption of essential fatty acids, prebiotics and probiotics modulates the onset of allergic disorders?, 2) Does breastfeeding and artificial formula prevent/trigger the onset of allergy symptoms? 3) Does timing of introduction of solid feeding and the selection of certain common food allergens participate in achieving oral tolerance in infants? Accumulated evidence in recent years suggest that exposure to allergens early in life may promote immune tolerance and contribute to prevent infant food sensitization.
... Partially or extensively hydrolyzed formulas are two alternative protein sources that have been shown to reduce the risk of AD and other allergies compared to CMF in these high-risk infants [20][21][22][23][24] . In particular, the German Infant Nutritional Intervention (GINI), the largest comparative trial of infant formula in high-risk infants, found that nonexclusively breastfed infants with atopic heredity randomized to a partially hydrolyzed whey-based formula (PHF-W) versus CMF for the first 4 months of life experienced a lower cumulative incidence of AD 6 years following birth (27.4 vs. 39.1%; ...
Article
Full-text available
Atopic dermatitis (AD) is one of the most common skin conditions among infants. Proteins found in cow's milk formula (CMF) have been found to be attributable to heightened AD risk, particularly in infants with familial AD heredity. Previous studies have suggested that intervention with partially hydrolyzed formula in nonexclusively breastfed infants can have a protective effect against AD development. The aim of the present study was to compare the estimates of the economic impact of reducing the AD incidence by feeding a partially hydrolyzed whey-based formula (PHF-W) instead of a standard CMF to high-risk nonexclusively breastfed urban infants for the first 17 weeks of life in the Philippines, Malaysia, and Singapore. In each country, a mathematical model simulated AD incidence and burden from birth to 6 years of age of using PHF-W versus CMF in the target population using data from the German Infant Nutritional Intervention study. The models integrated literature, current cost and market data, and expert clinician opinion. Modeled outcomes included AD risk reduction, time spent after AD diagnosis, AD symptom-free days, quality-adjusted life years (QALYs), and costs (direct and indirect). Outcomes were discounted at 3% per year. Costs were expressed in USD. Feeding high-risk infants PHF-W instead of CMF resulted in an estimated absolute 14% (95% CI 1-24) AD risk reduction, a 0.69-year (95% CI 0.25-1.13) reduction in the time spent after AD diagnosis per child, reductions of 16-38 AD days, and gains in 0.02-0.04 QALYs, depending on the country. The per-child AD-related 6-year cost-saving estimates of feeding high-risk infants with PHF-W versus CMF were USD 739 in Singapore, USD 372 in Malaysia, and USD 237 in the Philippines. © 2015 S. Karger AG, Basel.
... The incidence of atopic dermatitis (a chronic skin disease characterized by swollen, scaly and itchy rashes) is increasing worldwide, infants being a major vulnerable group. A meta-analysis of systematic review revealed that incidence of atopic dermatitis was considerably lower among infants in the partially hydrolyzed whey-based formula group compared to the bovine milk group (Alexander et al. 2010). The finding suggested that whey-based formula might protect infants from atopic dermatitis. ...
Article
Full-text available
The looming food insecurity demands the utilization of nutrient-rich residues from food industries as value-added products. Whey, a dairy industry waste has been characterized to be excellent nourishment with an array of bioactive components. Whey protein comprises 20 % of total milk protein and it is rich in branched and essential amino acids, functional peptides, antioxidants and immunoglobulins. It confers benefits against a wide range of metabolic diseases such as cardiovascular complications, hypertension, obesity, diabetes, cancer and phenylketonuria. The protein has been validated to boost recovery from resistance exercise-injuries, stimulate gut physiology and protect skin against detrimental radiations. Apart from health invigoration, whey protein has proved its suitability as fat replacer and emulsifier. Further, its edible and antimicrobial packaging potential renders its highly desirable in food as well as pharmaceutical sectors. Considering the enormous nutraceutical worth of whey protein, this review emphasizes on its established and emerging biological roles. Present and future scopes in food processing and dietary supplement formulation are discussed. Associated hurdles are identified and how technical advancement might augment its applications are explored. This review is expected to provide valuable insight on whey protein-fortified functional foods, associated technical hurdles and scopes of improvement.
... Studies have shown that whey intake, even in infants with a positive family history, compared to standard formulas can reduce the risk of atopic dermatitis in the future (Alexander et al., 2010). ...
... However, some researchers have suggested that only the extensive hydrolysis giving peptides with MW less than 3 kDa is acceptable for more sensitive infants to avoid any reactions (Chan et al., 2002). Alexander et al. (2010) have extensively reviewed the benefits of partially hydrolyzed 100% whey protein for infant formula and suggested that it was effective to reduce the risk of incidence of atopic dermatitis. ...
Article
The byproduct of cheese-producing industries, cheese whey, is considered as an environmental pollutant due to its high BOD and COD concentrations. The high organic load of whey arises from the presence of residual milk nutrients. As demand for milk-derived products is increasing, it leads to increased production of whey, which poses a serious management problem. To overcome this problem, various technological approaches have been employed to convert whey into value-added products. These technological advancements have enhanced whey utilization and about 50% of the total produced whey is now transformed into value-added products such as whey powder, whey protein, whey permeate, bioethanol, biopolymers, hydrogen, methane, electricity bioprotein (single cell protein) and probiotics. Among various value-added products, the transformation of whey into proteinaceous products is attractive and demanding. The main important factor which is attractive for transformation of whey into proteinaceous products is the generally recognized as safe (GRAS) regulatory status of whey. Whey and whey permeate are biotransformed into proteinaceous feed and food-grade bioprotein/single cell protein through fermentation. On the other hand, whey can be directly processed to obtain whey protein concentrate, whey protein isolate, and individual whey proteins. Further, whey proteins are also transformed into bioactive peptides via enzymatic or fermentation processes. The proteinaceous products have applications as functional, nutritional and therapeutic commodities. Whey characteristics, and its transformation processes for proteinaceous products such as bioproteins, functional/nutritional protein and bioactive peptides are covered in this review.
... A rodent study has shown that ingested whey protein stimulates immune cell proliferation and migration to the secondary lymphoid organs (Badr, Ebaid, Mohany, & Abuelsaad, 2012b). A clinical trial and a meta-analysis revealed that atopic dermatitis instances in infants belonging to whey-based formula group were lower by 16% compared to those in the bovine milk group (Alexander, Schmitt, Tran, Barraj, & Cushing, 2010; Krakowski, Eichenfield, & Dohil, 2008 ). Immunological analyses of whey protein concentrate-fed mice blood showed a reduction of inflammatory cytokines such as IL-1α, IL-1β, IL- 10 and TNF-α. ...
Article
The prospecting for nutrients has catapulted whey protein to the forefront of the functional food sector. This protein, filtered from cheese whey, has been characterized to contain a plethora of healthy components such as essential amino acids, bioactive peptides, antioxidants and immunomopotentiators. Consequently, whey protein has been validated to confer radical scavenging, anti-inflammatory, antitumour, immunostimulatory, hypotensive, gut homeostasis, antiobesity, antidiabetic, muscle biosynthesis, osteoprotective and radioprotective roles. As the multifarious benefits of whey protein cumulate amidst the dramatic rise in metabolic and degenerative health issues, it seems imperative to harness their potential. This review presents the significant biological aspects of whey protein and its derivatives. Further, it rationalizes their incorporation in functional foods.
... Results from studies (24)(25)(26) and some, (21,27,28) but not all, (29) meta-analyses show a reduction in AD incidence with early feeding of high-risk infants with partially hydrolysed 100% whey-based (PHF-W) or extensively hydrolysed casein-based (EHF-C) formulas compared to CMF. In particular, a clinical trial involving 110 Singapore children with firstdegree atopic family history followed from birth to 30 months of age showed that the onset of AD was delayed when exclusively fed with PHF-W compared to CMF. (30) The cumulative eczema incidence in the PHF-W group compared to the CMF group was significantly lower at three months, six months, 12 months, 18 months and 24 months, and lower (28.3% vs. 43.9%), ...
Article
Full-text available
Introduction: Previous trials have demonstrated reductions in atopic dermatitis (AD) incidence when healthy, high-risk, non-exclusively breastfed infants were fed until four months of age with 100% whey-based partially hydrolysed formula (PHF-W) versus standard cow's milk formula (CMF). We assessed this intervention's cost-effectiveness in Singapore. Methods: Modelling techniques were used to simulate, from birth to Month 30, the incidence, and clinical and economic burden of AD in high-risk, non-exclusively breastfed infants fed with PHF-W or CMF for up to four months. Epidemiologic and clinical data were from a local comparative trial. Expert opinion informed AD treatment patterns and outcomes. Outcomes included reduction in AD risk, time spent with AD, days without AD flare, quality-adjusted life years (QALYs) and direct/indirect costs. Multivariate probabilistic sensitivity analysis assessed model parameter uncertainty. Results: Over 30 months, with the use of PHF-W instead of CMF, the proportion of children who developed AD and time spent with AD decreased by 16.0% (28.3% vs. 44.3%) and 6.4 months, respectively, while time without AD flare and QALYs increased by 14.9 days and 0.021 QALYs per patient, respectively. Estimated AD-related discounted cost per child for PHF-W and CMF was SGD 771 and SGD 1,309, respectively (net savings = SGD 538). PHF-W was less expensive and more effective than CMF for 72.5%, and costs less than SGD 50,000 per QALY for 87.2% of all multivariate simulations. Conclusion: Early short-term nutritional intervention with PHF-W instead of CMF may reduce AD incidence and costs in healthy, high-risk, non-exclusively breastfed infants in Singapore.
... Thus, meta-analyses and systematic reviews have offered conflicting results of pooled data regarding such benefits. 2,[14][15][16][17]38 The literature search noted multiple potential definitions of "at-risk" or "high-risk" for the development of allergic disease, complicating delineation of a consistent population being studied. Risk The panel reached unanimous consensus that there may be limited instances in which data could potentially be extrapolated from at-risk populations to the general population. ...
Article
Objectives: Guidance and evidence supporting routine use of partially hydrolyzed formula (pHF) versus intact cows' milk protein (CMP) formula are limited in non-exclusively breastfed infants. The aim of this review was to better clarify issues of routine use of pHF in non-exclusively breastfed infants who are not at risk for allergic disease by using a systematic review and Delphi Panel consensus. Methods: A systematic review and Delphi consensus panel (consisting of eight8 international pediatric allergists and gastroenterologists) was conducted to evaluate evidence supporting growth, tolerability, and effectiveness of pHF in non-exclusively breastfed infants. Results: None of the studies reviewed identified potential harm of pHF use compared with CMP in non-exclusively breastfed infants. There was an expert consensus that pHF use is likely as safe as intact CMP formula, given studies suggesting these have comparable nutritional parameters. No high-quality studies were identified evaluating the use of pHF to prevent allergic disease in non-exclusively breastfed infants who are not at risk for allergic disease (e.g., lacking a parental history of allergy). Limited data suggest that pHF use in non-exclusively breastfed infants may be associated with improved gastric emptying, decreased colic incidence, and other common functional gastrointestinal symptoms compared with CMP. However, because the data are of insufficient quality, the findings from these studies have to be taken with caution. No studies were identified that directly compared the different types of pHF, but there was an expert consensus that growth, allergenicity, tolerability, effectiveness, and clinical role among such pHF products may differ. Conclusions: Limited data exist evaluating routine use of pHFs in non-exclusively breastfed infants, with no contraindications identified in the systematic review. An expert consensus considers pHFs for which data were available to be as safe as CMP formula as growth is normal. The preventive effect on allergy of pHF in infants who are not at risk for allergic disease has been poorly studied. Cost of pHF versus starter formula with intact protein differs from country to country. However, further studies in larger populations are needed to clinically confirm the benefits of routine use of pHF in non-exclusively breastfed infants. These studies should also address potential consumer preference bias.
... 12 Nestlé has funded two similar reviews covering the same subject area, both yielding results comparable with the Alexander and Cabana review. 13,14 Eczema and disease associations Several studies have explored the possible links between a range of conditions and atopic diseases and eczema. A meta-analysis by Chen et al. 15 demonstrated a reduced risk of developing gliomas in patients with allergic diseases in general [odds ratio (OR) = 0.60; 95% CI 0.52-0.61] ...
Article
This review provides a summary of key findings from 18 systematic reviews on atopic eczema, published or indexed between January 2009 and 24 August 2010. There was no good evidence on the possible benefit of organic food consumption and eczema. Maternal intake of fish or fish oil may be associated with a reduced risk of eczema in offspring, although further studies are needed. There is some evidence that partially hydrolysed infant formulas rather than standard formulas may be associated with a reduced risk of eczema in infants, but there are shortcomings in the existing evidence. An inverse relationship has been found between gliomas/acute lymphoblastic leukaemia and allergic disease/eczema, but there appears to be no association between multiple sclerosis and eczema. Attention deficit hyperactivity disorder does appear to be associated with eczema, but there is no evidence of a causal link. The risk of eczema seems to be increased in urban compared with rural areas. Some new evidence has suggested superiority of 1% pimecrolimus over potent and mild corticosteroids at 6 months but not 12 months, and there is some evidence for superiority of 0.03% and 0.1% tacrolimus over 1% pimecrolimus. An updated Cochrane Review still found no evidence of a benefit from any form of antistaphylococcal treatment in managing clinically infected or uninfected eczema. The evidence base is poor for bath emollients, occlusive treatments (e.g., wet and dry wraps) and woven silk clothing in treating eczema. In general, the methods used in most systematic reviews of eczema need to be reported more clearly, especially with regard to a more vigorous quality assessment of included studies. Included studies are frequently heterogeneous, proxy reporting is common, and appropriate disease definitions are often lacking. Better adherence to existing guidance on trial reporting and prospective registration of clinical trials may help improve the quality of studies.
... Furthermore, it is also richer in nonprotein nitrogen compounds, namely nucleotides and free amino acids, making it suitable for the production of baby food, removing the need to add these nutritional components [7]. Sheep milk contains a higher concentration of whey proteins than cow and goat milk [8], and therefore the resulting cheese whey is used, in some dairies, for the production of whey cheeses, through a process of thermal precipitation of the whey proteins. However, the production process of these whey cheeses has low efficiency, since it leads to the release of another byproduct (second cheese whey), which still contains about 50% of the initial protein and almost all the lactose [9,10]. ...
Article
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The amount of cheese whey generated from the production of speciality sheep and goat cheese is significantly growing due to the acclaimed nutritional and medicinal benefits of the milk from these species. However, most of the cheese whey generated has no applications, thus giving rise to environmental problems. This work focuses on the study of the performance of the nanofiltration process for recovering the permeates of ultrafiltration from sheep and goat cheese whey. Nanofiltration experiments were carried out with membranes of nanofiltration (NF) in total recirculation and concentration modes, at 25 °C. Nanofiltration of the ultrafiltration permeates from sheep cheese whey was done at a pressure of 3.0 × 106 Pa and a circulation velocity of 1.42 m·s−1, until a volume concentration factor (VCF) of 2.5. Nanofiltration of the permeates from ultrafiltration of goat cheese whey was performed at a pressure of 2.0 × 106 Pa and a circulation velocity of 0.94 m·s−1, until a VCF of 2.0. From the results, it was concluded that osmotic pressure was the most important factor affecting the performance of the process. In both cases, the final permeates had a much lower organic load and its future use in the process of cheese making should be evaluated.
... Whey hydrolysate formula is less allergenic when compared to standard IF and possibly decreases the risk that the infant will later develop allergies (Szajewska, Mrukowicz, & Stoinska, 2004). A meta-analysis review revealed that the incidence of atopic dermatitis was noticeably lower among infants fed partially (Alexander, Schmitt, Tran, Barraj, & Cushing, 2010). The findings suggest that whey-based formula might protect infants from atopic dermatitis. ...
... 9 These hydrolyzed formulas are derived either from whey or caseins and still contain large peptide fragments. They were shown to reduce the risk of atopic dermatitis 10 and to prevent the development of clinical symptoms of CMA 11 in some studies, although not in others. 12 BALB/c mice are a good model for at-risk individuals, because they show Th2 biased immune responses. ...
Article
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Partially hydrolyzed milk formulas have been proposed for primary prevention in at risk infants, but evidence of their efficiency and elucidation of underlying mechanisms are still lacking. Thanks to a Th2-biased mouse model mimicking at risk patients, we aimed to assess the potency of a partially hydrolyzed whey formula (pHWF) to induce oral tolerance thus preventing further cow’s milk (CM) allergy. Methods: BALB/c mice were gavaged with pHWF, standard milk formula (SF), or vehicle only (PBS+). All mice were then orally sensitized to CM using cholera toxin and further chronically exposed to CM. Humoral (IgE, IgG1, IgG2a) and cellular (Th2/Th1/Th17 cytokine secretion ; frequency of CD4+GATA3 + and CD4+CD25+Foxp3+ T cells in spleen) responses against β-lactoglobulin (BLG) and whole caseins (CAS) were assessed, as well as a marker of elicitation of allergic reaction (mMCP1) released after an oralchallenge with CM. Results: All markers of sensitization and of allergic reaction were evidenced in PBS+ mice and were significantly enhanced upon chronic exposure. Gavage with SF totally and durably prevented sensitization and elicitation of the allergic reaction. Conversely, pretreatment with pHWF only reduced BLG-specific sensitization (IgE, Th2 cytokines), with no significant effect on sensitization to caseins. However, pHWF pretreatment significantly reduced mMCP-1 concentration in plasma after CM challenges. CD4+CD25+Foxp3+ Treg cells frequency could not be correlated with tolerance efficiency. Conclusion: pHWF only partially prevents the further development of CM allergy in this Th2 - biased model. A hydrolysate from both whey and caseins fractions may be more efficient.
... Different types of foreign proteins may have different effects on the health of children. [19,[74][75][76][77]. In addition, the potential for the presence of heterogeneity and small-study effects were quantitatively evaluated. ...
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Infant feeding is an important early-life exposure that may influence the development of atopic disease. The optimal timing of introduction of food allergens, including cow’s milk (CM), is not known. This study aims to systematically review the evidence describing the effects of timing of CM or cow’s milk formula (CMF) introduction to the infant diet on the development of atopic diseases during childhood. Pubmed, Embase, CINAHL, Cochrane CENTRAL, and CNKI were searched through May 30, 2019. Study screening and data extraction by two reviewers followed the PRISMA statement. Data were extracted independently in duplicate, and meta-analyses were performed by pooling unadjusted and adjusted odds ratio (OR) separately. Heterogeneity was explored using I² and publication bias by funnel plots and Begg’s tests. In total, 45 studies from 20 countries were included. Meta-analyses using adjusted data showed that no associations were observed between early introduction of CM or CMF and the risk of asthma (< 4 vs. ≥ 4 months: OR 1.16, 95% confidence interval (CI) 0.89, 1.51), wheeze (< 6 vs. ≥ 6 months: OR 1.15, 95% CI 0.85, 1.56), and eczema or atopic dermatitis (< 6 vs. ≥ 6 months: OR 0.96, 95% CI 0.65, 1.41). Overall, quite little high-quality evidence was identified to allow for definitive conclusions on the association between early CM or CMF introduction and risk of allergic diseases. Our meta-analysis on this topic highlights the specific gaps in information for public recommendations regarding CM or CMF feeding practice in an early stage of life, particularly before 3 months of age.
... The process relying on enzymatic or chemical hydrolysis, depending on the manufacturer, results in peptides under 5kDa. In comparing partially to extensively hydrolyzed diets, partially hydrolyzed are characterized by generally lower cost, protein content, osmolality and higher palatability (Alexander et al. 2010). Affordability and palatability can be important factors of successful elimination diet in dogs and cats. ...
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Cutaneous adverse food reaction (CAFR) is a common disease, affecting about 1-2% of dogs and cats. Diagnosis of the CAFR is made through elimination diet coupled with diet challenge, as methods like skin tests, patch tests, basophil degranulation tests and assessment of IgG and IgE serum levels are not sensitive enough. A partially hydrolysed salmon and pea hypoallergenic diet was evaluated in the diagnosis and treatment of CAFR in dogs and cats. The diet was used in the treatment of 13 dogs and 12 cats for 10 weeks. The Pruritus Visual Analog Scale (PVAS; dogs and cats), Canine Atopic Dermatitis Extent and Severity Index (CADESI-04; dogs) and the Scoring Feline Allergic Dermatitis (SCORFAD; cats) were used for effectiveness evaluation. In dogs, a significant decrease was reported in both CADESI-04 (from 17.3±7.5 to 10.15±7.4; p=0.028) and PVAS (from 7±1.3 to 4.76±1.8; p=0.003) after four weeks of treatment. Also in cats, both the PVAS (from 6.75±1.8 to 4±2.3; p=0.006) and SCORFAD (from 4.16±1.9 to 2.58±1.2; p=0.029) decreased significantly after four weeks. After eight weeks, a significant improvement was observed in almost all the animals. Evaluated diet was useful in the treatment of the CAFR in dogs and cats.
... A meta-analysis of systematic review revealed that the incidence of atopic dermatitis was considerably lower among infants in the partially hydrolysed whey-based formula group compared to the bovine milk group [12]. ...
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Introduction: Sweet whey is known for its various pharmacological uses as an anti-inflammatory and antioxidant agent. This is because whey proteins accelerate the release of bioactive peptides, increase the level of intracellular glutathione and the production of interleukin IL-8. However, the potential skin care effects of whey, especially in its unprocessed state, are still not clear. Aim: To evaluate in vivo the cosmetic features of sweet whey baths and wet wraps on human skin. Material and methods: Thirteen healthy Caucasian adult females with no dermatological diseases were examined. We used the Courage-Khazaka MPA-9 device to evaluate the effects of sweet whey baths/wet wraps on skin hydration, transepidermal water loss (TEWL) and melanin and erythema index and pH level in human skin. Results: It appeared that bathing in the sweet whey solution significantly improved the barrier function of the skin in comparison with tap water treated control area on the face cheek as well as on the forearm by decreasing the value of transepidermal water loss with statistical significance. Skin hydration was enhanced only on the facial skin. No significant differences concerning other parameters were observed. Conclusions: We showed that sweet whey may have decreased the TEWL level and fixed the barrier function of epidermis in this way. It seems that a bath solution with sweet whey is well tolerated and may promote local blood circulation without affecting the pH value of the skin.
... The infants may suffer from atopic dermatitis as being a major vulnerable group. A meta-analysis of the systematic review revealed that atopic dermatitis incidence was considerably lower among infants in the partially hydrolyzed wheybased formula group than the bovine milk group [34]. The finding suggested that whey-based formula might protect infants from atopic dermatitis. ...
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Background: Protein is an essential portion of food that exerts beneficial effects on body composition and metabolism. However, protein-rich foods are costly and scarcely available in developing countries, and protein deficiency is a significant public health concern. In this situation, searching for additional dietary protein sources is of utmost importance due to decreasing resources because of the growing global population. The current literature review is about whey protein as it is the cheapest, readily available protein source. Methods: Milk is formed of two proteins, casein and whey. Whey is different from the casein in milk and is formed as a by-product of the cheese-making process. Whey (the liquid left after milk curdling) was deemed a waste by the dairy industry for decades. However, it is the cheapest protein source for the poor growing populations in developing countries. Whey protein is a complete protein as it contains all nine essential amino acids. It is low in lactose content. Conclusion: Human body cannot make essential amino acids, so it is necessary to get enough of them from the diet. Due to the availability of carbohydrates, fat, immunoglobulins, lactose, and minerals, including essential amino acids in whey protein, it is necessary for human energy. There are many benefits related to whey protein consumption, such as muscle building and loss of fat. New possible therapeutic properties of whey protein have to be investigated further for the full utility to humans.
... Lactoferrin has been shown in vivo to stimulate cytokines in the guts and suppressing cancer growth in colon. Research established that consuming 3.0 g of bovine lactoferrin on a regular basis enhance the IFN levels that reduces the propagation of colorectal polyps [86]. While the available evidence is limited and the conclusion is far from definitive, but it might play a role of foundation for further research regarding anticancer experiments [21]. ...
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Whey proteins in bovine milk are a mixture of globular proteins manufactured from whey which is a byproduct of cheese industry. Whey protein is categorized to contain plethora of healthy components due to wide range of pH, promising nutritional profile with cost effective and diverse functionality. Reportedly there are three categories of whey protein, whey protein concentrate (WPC) (29–89%); whey protein isolate (WPI) 90% and whey protein hydrolysate (WPH) on the basis of proteins present in them. Whey proteins is composed of β-lactoglobulin (45–57%), immunoglobulins (10–15%) α-lactalbumin (15–25%), glicomacropeptide (10–15%), lactoperoxidase (<1%) and lactoferrin nearly (1%). Whey protein plays an important role and is validated to confer anti-inflammatory and immunostimulatory roles related to all metabolic syndromes. According to molecular point of view whey proteins decrease inflammatory cytokines (IL-1α, IL-1β, IL-10 and TNF- α); inhibits ACE and NF-κB expression; promotes Fas signaling and caspase-3 expression; elevates GLP-1, PYY, CCK, G1P and leptin; chelate and binds Fe+3, Mn+3 and Zn+2. In this chapter we will discuss significant biological role of whey proteins related to inflammatory health issues.
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Effective prevention, curative treatment, and accurate, rapid diagnosis of allergies are still major unmet needs according to the EAACI and EFA. As at least 60 million people are daily burdened by the consequences of their allergic disease(s), the need for more research is not only stressed by patient organizations, but also by health care professionals and the World Health Organization. Even though knowledge of the mechanisms underlying allergic responses is rapidly increasing, there are still a number of critical questions to be answered. In this chapter, a brief introduction on the use of biologicals, allergen-specific immunotherapy, and dietary compounds to actively reduce the allergic responses is provided with recommended literature for more detailed information about the individual topics. Furthermore, the current believes about the usefulness or risks of maternal allergen intake on the susceptibility of the infant are discussed. Finally, the debate on the suitability of partial or extensive hydrolyzates for specific target groups is summarized and is put into context with an opportunity to induce tolerance induction.
Article
The immunomodulatory potential of fragments derived from the cow's milk allergen bovine β-lactoglobulin (BLG) was assessed in a mouse model of oral tolerance (OT) [Adel-Patient, K.; Wavrin, S.; Bernard, H.; Meziti, N.; Ah-Leung, S.; Wal, J. M. Oral tolerance and Treg cells are induced in BALB/c mice after gavage with bovine β-lactoglobulin. Allergy2011, 66 (10), 1312-1321]. Native BLG (nBLG) and chemically denatured BLG (lacking S-S bridges, dBLG), products resulting from their hydrolysis using cyanogen bromide (CNBr) and some synthetic peptides, were produced and precisely characterized. CNBr hydrolysates correspond to pools of peptides of various sizes that are still associated by S-S bridges when derived from nBLG. nBLG, dBLG, and CNBr hydrolysate of nBLG efficiently prevented further sensitization. CNBr hydrolysate of dBLG was less efficient, suggesting that the association by S-S bridges of peptides increased their immunomodulatory potential. Conversely, synthetic peptides were inefficient even if covering 50% of the BLG sequence, demonstrating that the immunomodulatory potential requires the presence of all derived fragments of BLG and further supporting the use of partially hydrolyzed milk proteins to favor OT induction in infants with a risk of atopy.
Chapter
Whey protein is a mixture of proteins obtained from whey, the liquid milk component that separates during the production of cheese and other dairy products. While the major whey protein components include α-lactalbumin, β-lactoglobulin, BSA, and the fraction of proteose-peptone, the minor whey protein components include immunoglobulins, lactoferrins, ceruloplasmins, as well as certain enzymes such as lipase, xanthine oxidase, and lysozyme. Three types of whey proteins include whey protein isolate, whey protein concentrate, and whey protein hydrolysate, with various compositions. Whey protein has high protein efficiency ratio (PER), high biological value (BV), and contains sulfur containing amino acids, including methionine and cysteine, that boost immune functions by intracellular conversion to glutathione. Whey proteins are suitable for nutraceuticals and functional food formulations due to their anticarcinogenic, anti-diabetic, antihypertensive, antioxidant, cardioprotective, hypotensive, immune improvement, and immunomodulatory properties, among others. However, more control studies are required to explore their applications for other targeted therapies.
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Exclusive breastfeeding and postponement of complementary foods to four to six months of age are recommended for the prevention of food allergies. However, many infants receive formula milk for a number of reasons. Various types of formula are indicated to prevent or treat allergy and food intolerance.
Article
Children of allergic parents or siblings are special risk group for allergy development. The most important method of primary prevention of allergic diseases is mode of feeding. Exclusive breastfeeding in the period of first 4-6 months of life is recommended in allergy prevention. If it is impossible, feeding with partially hydrolyzed formula allows to avoid allergy development in many cases. Many formulas contain additional components with biological activity. Some of them, for example probiotics and prebiotics, long-chain polyunsaturated fatty acids and nucleotides can be effective in prevention of allergic diseases. It is postulated to introduce of new products into infant diet gradually and singly, not before 4th month and not later then the end of 6th month of life.
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Enzymatic hydrolysis of milk proteins has been the subject of numerous research studies and patents. The driving force for these studies has been the increased utilization of milk proteins. The industrial uses of milk proteins are based on their unique composition, functionality and nutritive value. The diversity of milk protein fraction, the large number of proteinases and controlled hydrolysis conditions used resulted in the preparation of hydrolysates suitable for several purposes. Enzymatic hydrolysis of milk proteins modifies the technofunctional and biofunctional properties of the hydrolysates depending on the enzyme(s) and hydrolysis conditions used. Milk protein hydrolysates (MPH) are used commonly in normal and clinical nutrition and as functional food ingredient. In the present review emphasis has been made to highlight methods applied for the preparation of MPH, and the functional properties and utilization of the obtained hydrolysates.
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Background: Research in early childhood allergy prevention (ECAP) is flourishing and new intervention strategies have proven to be promising. Due to the dynamic nature of ECAP, gaps between what is known and how guidelines inform practice are likely. A living systematic review (LSR) can narrow this gap by incorporating new evidence as it becomes available. No efficacy comparisons across various ECAP interventions for similar outcomes have been carried out. Networks of randomised clinical trials can be evaluated in the context of a network meta-analysis (NMA). We aim to establish a LSR on the efficacy and safety of any intervention investigated in randomised controlled trials (RCT) to prevent the occurrence of allergic sensitisation (AS), symptoms or diagnoses of allergic diseases in infancy and early childhood (0-3 years). Methods: A baseline SR will synthesise the evidence from existing SRs of RCTs as well as RCTs not yet considered in these. After completion of the baseline SR we propose to conduct a LSR. Using this methodology, we aim to undertake constant evidence surveillance, three-monthly search updates, and review updates every three months, should new evidence emerge. Conclusions: The ECAP evidence landscape has undergone dramatic transformations and this process is likely to continue. As a response to this, a LSR offers the potential to allow more timely synthesis of new evidence as it emerges. Long gaps between updates of SRs makes it harder for guidelines and recommendations to be up to date. Users of information, such as parents, may be confused if they encounter new evidence that is not part of a trusted guideline. A LSR approach allows us to continuously search the literature and update the evidence-base of existing ECAP interventions resulting in a decreased timespan from evidence accrual to informing clinical practice.
Article
Background/aim: Whey protein is a mixture of globulins isolated from whey and mainly composed of β-lactoglobulin, α-lactoalbumin, and lactoferrin. In this study, whey protein was hydrolyzed using various proteases, and the macrophage activation was evaluated. Materials and methods: Hydrolyzed whey protein was prepared using various proteases to evaluate phagocytic activity and cytokine productivity. Results: The results of SDS-PAGE and gel permeation chromatography (GPC) analysis indicated that the molecular weight of whey protein was reduced using various proteases. The hydrolyzed whey protein showed a concentration-dependent induction of macrophage phagocytic activity. In addition, the hydrolyzed whey protein significantly enhanced the production of the inflammatory cytokine, TNF-α. Production of the anti-inflammatory cytokine, IL-10, was not observed at concentrations up to 1 μg, but significant production was confirmed at 100 μg. Conclusion: Hydrolyzed whey protein can induce the phagocytic activity of macrophages and activation of the inflammatory/anti-inflammatory functions of the macrophages depends on the concentration of the hydrolyzed whey protein.
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Background: Research in early childhood allergy prevention (ECAP) is flourishing and new intervention strategies have proven to be promising. Due to the dynamic nature of ECAP, gaps between what is known and how guidelines inform practice are likely. A living systematic review (LSR) can narrow this gap by incorporating new evidence as it becomes available. No efficacy comparisons across various ECAP interventions for similar outcomes have been carried out. Networks of randomised clinical trials can be evaluated in the context of a network meta-analysis (NMA). We aim to establish a LSR on the efficacy and safety of any intervention investigated in randomised controlled trials (RCT) to prevent the occurrence of allergic sensitisation (AS), symptoms or diagnoses of allergic diseases in infancy and early childhood (0-3 years). Methods: A baseline SR will synthesise the evidence from existing SRs of RCTs as well as RCTs not yet considered in these. After completion of the baseline SR we propose to conduct a LSR. Using this methodology, we aim to undertake constant evidence surveillance, three-monthly search updates, and review updates every three months, should new evidence emerge. Conclusions: The ECAP evidence landscape has undergone dramatic transformations and this process is likely to continue. As a response to this, a LSR offers the potential to allow more timely synthesis of new evidence as it emerges. Long gaps between updates of SRs makes it harder for guidelines and recommendations to be up to date. Users of information, such as parents, may be confused if they encounter new evidence that is not part of a trusted guideline. A LSR approach allows us to continuously search the literature and update the evidence-base of existing ECAP interventions resulting in a decreased timespan from evidence accrual to informing clinical practice.
Article
There is a strong current trend for using complementary and alternative medications to treat atopic dermatitis. Atopic dermatitis is a common, chronic, pruritic, and inflammatory skin disease. It can have a profound, negative effect on patients' quality of life. Mild cases of atopic dermatitis can be controlled by the application of moisturizers and topical corticosteroids. However, in severe cases, application of immunosuppressive medication is unavoidable but it can have adverse effects. In traditional Persian medicine, diseases similar to resistant atopic dermatitis are treated with whey in combination with decoction of field dodder. Both whey and field dodder have anti-inflammatory properties. Consumption of whey can also aid skin repair, mitigate pruritus, and help combat the high level of stress experienced by patients. Therefore, it is hypothesized that consumption of traditional medicinal treatment of whey with decoction of field dodder can be applied as a complementary treatment for atopic dermatitis. © The Author(s) 2015.
Article
Aim The role of nutrition in preventing atopic diseases including atopic dermatitis has recently gained interest in the medical community. Caregivers of infants and children at an increased risk for developing atopic dermatitis often employ exclusion diets or other measures in hopes of preventing the development of this burdensome disease. This paper reviews the current literature in regard to the role of preventative dietary measures in the context of atopic dermatitis, with a special focus on the topics of hydrolyzed formula, early versus delayed introduction of certain foods, and fatty acid supplementation. Methods Literature pertaining to preventative dietary measures for infants at risk for atopic dermatitis was reviewed. Results Analysis of the literature suggests that hydrolyzed formula should not be routinely offered to infants for prevention of atopic dermatitis. Formulas utilized should contain concentrations of polyunsaturated fatty acids similar to that in breast milk. Finally, infant caregivers should not delay or restrict introduction of food, which can be more harmful than helpful to the patient. Conclusion Recommendations to caretakers providing for infants at risk for atopic dermatitis should include infant consumption of breastmilk, and avoid delayed introduction of foods.
Article
The development of a cost-effective prevention strategy for atopic dermatitis would represent a major public health advance. The disease is highly prevalent around the world and often heralds the onset of immunoglobulin-E-mediated allergic diseases. Most studies to date have utilized allergen avoidance strategies or dietary supplementation. More recently, a relatively large body of literature supports the use of probiotic supplementation to prevent atopic dermatitis, although the effect is modest and more confirmatory studies are needed. The use of partially hydrolyzed formulas for high-risk infants may also be considered when exclusive breastfeeding is not possible. Dietary restrictions and the delayed introduction of complimentary foods are not effective and may cause harm. The data do not support dust mite avoidance or omega fatty acid supplementation. Newer prevention strategies focusing on improving skin barrier dysfunction are under evaluation. © 2003 BMJ Publishing Group, 2008, 2014 by John Wiley & Sons, Ltd.
Chapter
In this chapter, the various ingredients from milk are introduced. The chapter provides information sheets that relate to the composition of milk and its major components – milk proteins, milk salts, milk sugar and milk lipids. It discusses specific aspects of milk composition, milk protein, milk salts, milk sugar and milk lipids. Four categories of ingredients are distinguished and indicated by different coloured lines. The discussion on milk proteins includes conversion, amino acid profile, electric charge, casein micelles, and whey. The composition of milk without fat and proteins is illustrated. The chapter talks about salts in milk and milk permeate. The physicochemical properties of milk sugar, or lactose, is reviewed and its crystallization behaviour and modifications are discussed.
Chapter
Along with food processing, the production of agro-industrial waste in the world increases, despite the fact that it is a rich source of nutrients and bioactive compounds. In developing countries, waste materials from the agricultural industry can significantly help in obtaining valuable components for the production of various types of bio-based products. The aim of the work is to manage potato peel waste from the agri-food processing industry and to propose new nutritional and industrial applications for them. Food processing by-products are an inexpensive, affordable, and valuable starting material for the extraction of value-added products such as dietary fiber, natural antioxidants, biopolymers, and natural food additives. Potato peel waste, which is produced by various processes, such as extraction, fermentation, and other processes, can be transformed into products such as biofuels, dietary fiber, bio-fertilizers, biogas, biosorbent, antioxidants and various food additives. This work explores the use of potato skins as a source of nutraceuticals for food and non-food purposes, e.g., extraction, use of bioactive ingredients, biotechnological use, livestock feed and other applications. The practical approach will be able to be used in developing awareness of the proper management of agricultural waste, as well as in their application for the synthesis of many compounds such as lactic acid, biosorbent, biohydrogen, enzymes, etc., which serve as a basis for developing links between industry and sharing with new ideas and technologies.
Chapter
Banana is a staple fruit because it is available all through the year and it also serves as a source of income and food to a great number of people. Banana peel is the major byproduct of banana processing which account for 30% of the banana fruit and also constitute to environmental hazard. Banana peels are promising byproduct for different applications in nutraceuticals and medicinal usage due to the high dietary fiber and phenolic content present in them. Numerous studies have identified banana peels as a rich source of phytochemical compounds, mainly antioxidants such as phenolics, flavonoids, gallocatechin, anthocyanins delphinidin and cyaniding, and catecholamines, carotenoids, vitamins and minerals. This chapter consulted literature and presented scientific evidence of banana peels as a source of nutraceuticals.
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Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries.Objective To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants.Design The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up.Setting Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.Participants A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up.Interventions Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.Main Outcome Measures Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups.Results Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P = .01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).Conclusions Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.
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The short- and long-term effects of feeding with hydrolyzed formulas on growth are uncertain. Our aim was to investigate the potential differences in body mass index (BMI) over the first 6 y of life between infants fed with partially hydrolyzed whey (pHF-W), extensively hydrolyzed whey (eHF-W), extensively hydrolyzed casein (eHF-C), or cow-milk formula (CMF) and infants exclusively breastfed for the first 16 wk of life. We established a prospective, randomized, double-blind trial of full-term neonates with atopic heredity in the German birth cohort followed by the German Infant Nutritional Intervention Study through the first 6 y of life. Intention-to-treat and per-protocol analyses of absolute and World Health Organization-standardized BMI trajectories for 1840 infants (pHF-W: n = 253; eHF-W: n = 265; eHF-C: n = 250, CMF: n = 276; breastfed: n = 796) were performed. No significant differences in absolute or World Health Organization-standardized BMI trajectories were found among the pHF-W, eHF-W, CMF, and breastfed groups during the 6-y follow-up. However, in the eHF-C group, both intention-to-treat and per-protocol analyses showed a significantly slower sex-adjusted BMI gain through the 8th to 48th week of life (-0.1 to -0.2 lower BMI z score) but not beyond. Analyses of weight and length revealed that this difference is due to a slightly diminished weight gain in the first year of life because growth in length did not differ among study groups for the entire follow-up. To our knowledge, this is the first randomized trial investigating both short- and long-term effects of partially and extensively hydrolyzed formula (pHF-W, eHF-W, eHF-C), CMF, and breastfeeding on growth in one trial. Feeding with eHF-C led to a transient lower weight gain in the first year of life. No long-term consequences of different formulas on BMI were observed.
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The Authors have studied the role of various preventing diet for a primary prophylaxis of allergy in 125 newborns at risk of atopy: 30 exclusively breast-fed, 50 hypoallergenic milk fed, 30 soy milk fed, and 15 with conventional milk formula. IgE values were determined at 5 days, 6 months, and 12 months of age, IgE values at 5 days were compared to newborns not at atopic risk. The clinical follow-up lasted 4 years. Total IgE values at 5 days were significantly higher in new-born at atopic risk. Only breast-feeding subjects had IgE normal values at six months. Allergic symptoms were observed in 14% of infants with a guided diet and in 53% of infants with a conventional diet. Breast fed subjects had atopic disorders in only 8% of cases, subjects with hypoallergenic formula in 12% while soja milk fed in 25%. The Authors stress the role of breast feeding in preventing allergic disorders in subjects at atopic risk or, when human milk misses, of a hypoallergenic formula, more than soy milk and conventional formula and confirm the possibility of diet and ambiental prophylaxis of allergy.
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The allergy preventive effect of extensively (N) and partially (PH) hydrolysed cows' milk formulas compared with a regular formula (RM) was assessed in 155 infants with a family history of allergy. No cows' milk was given during the first nine months of life and no egg and fish up to 12 months of age. Breast feeding mothers avoided the same foods. At weaning the infants were randomised to one of the formula groups. The cumulative incidence of atopic symptoms at 18 months was 51, 64, and 84% in the N, PH, and RM groups, respectively. From 6 to 18 months there were significantly less cumulative atopic symptoms in the N group compared with the RM group, and significantly less than the PH group up to 6 (N = 25%; PH = 46%) and 9 months (N = 34%, PH = 58%). At 9 months significantly fewer infants in the N group (10%) than in the PH group (33%) had a positive skin prick test to eggs. The findings support an allergy preventive effect of an extensively hydrolysed formula, but not of a partially hydrolysed formula, during the first 18 months of life of high risk infants.
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Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants. The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up. Thirty-one maternity hospitals and polyclinics in the Republic of Belarus. A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up. Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies. Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups. Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28). Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.
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Feeding intolerance is common in very low birth weight (VLBW; <1500 g) infants. Hydrolyzed protein preterm infant formula (HPF) has been shown to accelerate the gastrointestinal transit of formula. The aim of this study was to investigate whether HPF improves early feeding tolerance compared with standard preterm infant formula (SPF). We hypothesized that HPF would accelerate early enteral feeding advancement. Primary outcome was the time from initiation of milk feeds until full feeds (150 mL/kg birth weight/d) were achieved in infants who received <10% human milk (HM) to exclude HM as a confounder. Because the availability of HM was not predictable at the time of enrollment, all eligible VLBW infants (n = 129) were randomly assigned in a randomized, controlled trial to receive HPF or SPF if HM was not available. Infants who received >10% HM (n = 42) were excluded. Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d. Preprandial gastric residuals were tolerated up to 5 mL/kg; otherwise, feedings were reduced or withheld. Data are shown as median (5th and 95th percentile). Forty-six and 41 (HPF vs SPF) infants received <10% HM. There was no significant difference with regard to birth weight, gestational age, and onset of milk feeds (day 3 [1-8] vs 4 [2-6]). The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding (10 [9-27] vs 12 [9-28] days). HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF.
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This short-term, prospective study was aimed to assess the effects of partially hydrolyzed formula (PHF) on the prevention of the development of atopic dermatitis in infants at high risk. The infants of parents with allergy symptoms and serum total IgE over 200 kU/L were divided into 3 groups by their feeding patterns: PHF group (n=15), standard formula (SF) group (n=32), and breast milk (BM) group (n=22). No allergenic food was given during the study period of 6 months, and breastfeeding mothers avoided egg ingestion. Their atopic symptoms were monitored every 2 months. The cumulative incidence and prevalence of atopic dermatitis at the age of 6 months were significantly less in the PHF group than in the SF group (47% vs. 78%, p<0.05; 20% vs. 59%, p<0.05). Those rates of the PHF group were also less than those of the BM group, but they were not statistically significant. There was no difference in the onset age and disease severity. These results suggest that early feeding of PHF to infants at high risk has a short-term preventive effect on the development of atopic dermatitis during the first 6 months of life. Long-term preventive effects should be evaluated.
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Previous studies of predictors of atopic dermatitis have had limited sample size, small numbers of variables, or retrospective data collection. The purpose of this prospective study was to investigate several perinatal predictors of atopic dermatitis occurring in the first 6 months of life. We report findings from 1005 mothers and their infants participating in Project Viva, a US cohort study of pregnant women and their offspring. The main outcome measure was maternal report of a provider's diagnosis of eczema or atopic dermatitis in the first 6 months of life. We used multiple logistic regression models to assess the associations between several simultaneous predictors and incidence of atopic dermatitis. Cumulative incidence of atopic dermatitis in the first 6 months of life was 17.1%. Compared with infants born to white mothers, the adjusted odds ratio (OR) for risk of atopic dermatitis among infants born to black mothers was 2.41 (95% confidence interval [CI]: 1.47, 3.94) and was 2.58 among infants born to Asian mothers (95% CI: 1.27, 5.24). Male infants had an OR of 1.76 (95% CI: 1.24, 2.51). Increased gestational age at birth was a predictor (OR: 1.14; 95% CI: 1.02, 1.27, for each 1-week increment), but birth weight for gestational age was not. Infants born to mothers with a history of eczema had an OR of 2.67 (95% CI: 1.74, 4.10); paternal history of eczema also was predictive, although maternal atopic history was more predictive than paternal history. Several other perinatal, social, feeding, and environmental variables were not related to risk of atopic dermatitis. Black and Asian race/ethnicity, male gender, higher gestational age at birth, and family history of atopy, particularly maternal history of eczema, were associated with increased risk of atopic dermatitis in the first 6 months of life. These findings suggest that genetic and pre- and perinatal influences are important in the early presentation of this condition.
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At the age of 5 years, the prevalence of atopic manifestations was analysed in 58 formula-fed ''at risk'' infants because of a history of atopic disease in at least two first degree relatives. Infants were randomly assigned to receive either a partial whey-hydrolysate formula (n: 28) or a regular cow's milli formula (n: 30) during the first 6 months of life; thereafter, feeding was unrestricted. Only non-breastfed infants were included. The groups did not differ in risk factors or in known confounding factors possibly influencing the incidence of manifestations suggestive of atopic disease. At 6 months, the prevalence of cow's milk protein (CMP) sensitivity was significantly decreased in the hydrolysate group (7% versus 43%; P: 0.002). At the age of 12 (21% versus 53%; P: 0.029), 36 (25% versus 57%; P: 0.018) and 60 months (29% versus 60%; P: 0.016) there was still a significant difference in the number of atopic manifestations, if calculated cumulatively. There was no difference between the groups if only the new cases after the age of 6 months were considered. Eczema was less frequent in the whey-hydrolysate group, but only during the Ist year of life, suggesting a decreased prevalence of CMP sensitivity. During the first 6 months, diarrhoea of non-infectious origin occurred in 8/30 infants (27%) of the adapted formula group, and in no infant in the hydrolysate group. ''Colic as single manifestation'' was considered of ''allergic'' origin in 1/28 infants in the hydrolysate group, and in 4/30 infants in the adapted formula group. If gastro-intestinal symptoms such as ''diarrhoea and colic as single manifestation'' are not considered, the number of infants with CMP sensitivity remains only significant for the first 6 months (P: 0.004). At 12, 36 and 60 months, differences are not significant (0.106, 0.116 and 0.07, respectively). The results of this study support the hypothesis that allergy prevention is antigen specific. Conclusion If mother's milk is not available and other studies confirm these results, there might be an indication for partial hydrolysates in infants with a family history of atopy, since these formulae reduce the incidence of CMP sensitivity.
Article
Background: Infant formulas containing hydrolysed proteins have been widely advocated for preventing allergic disease in infants, in place of standard cow's milk formula (CMF). However, it is unclear whether the clinical trial evidence supports this. Objectives: To compare effects on allergic disease when infants are fed a hydrolysed formula versus CMF or human breast milk. If hydrolysed formulas are effective, to determine what type of hydrolysed formula is most effective, including extensively or partially hydrolysed formula (EHF/PHF). To determine whether infants at low or high risk of allergic disease, and whether infants receiving early short-term (first few days after birth) or prolonged formula feeding benefit from hydrolysed formulas. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 11), MEDLINE (1948 to 3 November 2017), and Embase (1974 to 3 November 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles and previous reviews for randomised controlled trials and quasi-randomised trials. Selection criteria: We searched for randomised and quasi-randomised trials that compared use of a hydrolysed formula versus human milk or CMF. Outcomes with ≥ 80% follow-up of participants from eligible trials were eligible for inclusion. Data collection and analysis: Two review authors independently selected trials, assessed trial quality and extracted data from the included studies. Fixed-effect analyses were performed. The treatment effects were expressed as risk ratio (RR) and risk difference (RD) with 95% confidence intervals and quality of evidence using the GRADE quality of evidence approach. The primary outcome was all allergic disease (including asthma, atopic dermatitis, allergic rhinitis and food allergy). Main results: A total of 16 studies were included.Two studies assessed the effect of three to four days infant supplementation with an EHF while in hospital after birth versus pasteurised human milk feed. A single study enrolling 90 infants reported no difference in all allergic disease (RR 1.43, 95% CI 0.38 to 5.37) or any specific allergic disease up to childhood including cow's milk allergy (CMA) (RR 7.11, 95% CI 0.35 to 143.84). A single study reported no difference in infant CMA (RR 0.87, 95% CI 0.52 to 1.46; participants = 3559). Quality of evidence was assessed as very low for all outcomes.No eligible trials compared prolonged hydrolysed formula versus human milk feeding.Two studies assessed the effect of three to four days infant supplementation with an EHF versus a CMF. A single study enrolling 90 infants reported no difference in all allergic disease (RR 1.37, 95% CI 0.33 to 5.71; participants = 77) or any specific allergic disease including CMA up to childhood. A single study reported a reduction in infant CMA of borderline significance (RR 0.62, 95% CI 0.38 to 1.00; participants = 3473). Quality of evidence was assessed as very low for all outcomes.Twelve studies assessed the effect of prolonged infant feeding with a hydrolysed formula compared with a CMF. The data showed no difference in all allergic disease in infants (typical RR 0.88, 95% CI 0.76 to 1.01; participants = 2852; studies = 8) and children (typical RR 0.85, 95% CI 0.69 to 1.05; participants = 950; studies = 2), and no difference in any specific allergic disease including infant asthma (typical RR 0.57, 95% CI 0.31 to 1.04; participants = 318; studies = 4), eczema (typical RR 0.93, 95% CI 0.79 to 1.09; participants = 2896; studies = 9), rhinitis (typical RR 0.52, 95% CI 0.14 to 1.85; participants = 256; studies = 3), food allergy (typical RR 1.42, 95% CI 0.87 to 2.33; participants = 479; studies = 2), and CMA (RR 2.31, 95% CI 0.24 to 21.97; participants = 338; studies = 1). Quality of evidence was assessed as very low for all outcomes. Authors' conclusions: We found no evidence to support short-term or prolonged feeding with a hydrolysed formula compared with exclusive breast feeding for prevention of allergic disease. Very low-quality evidence indicates that short-term use of an EHF compared with a CMF may prevent infant CMA. Further trials are recommended before implementation of this practice.We found no evidence to support prolonged feeding with a hydrolysed formula compared with a CMF for prevention of allergic disease in infants unable to be exclusively breast fed.
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This comprehensive account of the genetic and environmental factors that cause atopic dermatitis reconciles two hypotheses concerning the origin of the disease - IgE-mediated sensitization, or an intrinsic defect in epithelial cells that causes dysfunction of the skin barrier - with evidence that both mechanisms contribute. Clinical implications are discussed.
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Atopic diseases in childhood are on the increase. Much effort is thus being devoted to research into practical and feasible allergy-prevention programs. So far, the effects of adherence to an allergen-reduced diet for the first few months of life have mainly been studied in high-risk newborn populations. As the sensitivity and specificity of all feasible and practical screening parameters for selecting newborn populations with an elevated risk for allergies are still rather low, the possible inclusion of all newborns in prevention programs, insofar as they are acceptable, or even of benefit for all, and cost-effective, is now a frequently discussed topic. Very little is known about the effects of adherence to such a diet in the first 4 – 6 months within a normal infant population.
Article
A reduced risk of atopic dermatitis (AD) among healthy infants who received 100% whey protein partially hydrolyzed formula (PHF-W) compared with intact protein cow's milk formula (CMF), has been reported in several studies. To validate these observations and estimate the magnitude of this potential association with greater statistical precision, we conducted a meta-analysis of clinical trial and intervention studies. A total of 18 articles representing 12 independent study populations met our inclusion criteria. A statistically significant 44% (summary relative risk estimate [SRRE] = 0.56, 95% confidence interval 0.40-0.77) reduced risk of atopic manifestations, which included AD, was found among infants receiving PHF-W compared with infants receiving CMF. In a subanalysis of 4 studies that reported results specifically for AD and that were considered of superior methodological quality, the incidence of AD was reduced by 55% (SRRE = 0.45, 95% confidence interval 0.30-0.70). Regardless of study design, infant population, follow-up time, or study location, individual study findings were consistent because a reduced incidence of AD was reported in all of the reviewed studies. Exclusive breast-feeding should be encouraged as the standard for infant nutrition in the first months of life. For infants who are not exclusively breast-fed, feeding with PHF-W instead of CMF reduces the risk of AD in infants, particularly in infants with a family history of allergy.
Article
Breastfeeding is undisputedly preferable to formula feeding for infant nutrition because of its nutritional, immunological and psychological benefits. However, studies on the association between breastfeeding and development of atopic dermatitis (AD) have shown inconsistent results. To examine the association between exclusive breastfeeding for at least 3 months after birth and the development of AD in childhood. An electronic literature search of MEDLINE (January 1966-May 2008) and EMBASE (1980-May 2008) was conducted. Prospective cohort studies that met the predetermined criteria were independently assessed by three reviewers. The pooled effect estimate was calculated by random effects model. Heterogeneity across the studies was investigated by meta-regression analysis. Twenty-one studies with 27 study populations were included for meta-analysis. The summary odds ratio (OR) for the effect of exclusive breastfeeding on the risk of AD was 0.89 (95% confidence interval, CI 0.76-1.04). Heterogeneity was found across the studies (chi(2) = 83.6, d.f. = 26; P < 0.001). Breastfeeding was associated with a decreased risk of AD (OR 0.70; 95% CI 0.50-0.99) when analysis was restricted to the studies comparing breastfeeding with conventional formula feeding. The pooled OR for study populations with atopic heredity was 0.78 (95% CI 0.58-1.05). There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.
Article
To study the influence of hypoallergenic milk on the occurrence of allergic diseases, thirty-three high risk, normal full-term newborns were divided into two groups with comparable family allergy score (FAS) and cord serum IgE. Group A consisted of 18 babies fed since birth with regular formula, while group B included 15 babies fed breast milk and/or NAN H.A. (Hypoallergenic infant formula) for the first 6 months of life. Close clinical observations for the appearance of atopic dermatitis, allergic rhinitis and wheezing as well as serial examination of total serum IgE and milk-specific IgE antibodies were done during the first year of life. The results showed: 1) Infants fed regular formula had a higher incidence of moderate to severe atopic dermatitis (AD) and allergic rhinitis (AR) than those fed NAN H.A. (39% vs 13% for AD; and 33% vs 13% for AR), but the difference was not significant. There was no difference in the incidence of wheezing between these two groups; 2) There was no relationship between cord blood IgE and FAS; 3) Neither the cord blood IgE nor FAS influenced the occurrence of allergic diseases and total serum IgE at one year of age; 4) Hypoallergenic milk (NAN H.A.) could support normal growth and development. In conclusion, a higher incidence of moderate to severe AD and AR was found in high risk infants fed regular formula than in those fed hypoallergenic milk. However, a study with a larger number of babies and a longer period of follow-up is needed to obtain a solid conclusion.
Article
The incidence of atopic manifestations due to cow's milk proteins was analysed in five groups of 15 newborns considered to be at risk for atopy because of a positive family history. All infants were studied over a 4-month period. The infants received either an adapted formula (AdFo), breast milk or a new hypo-allergic formula (HAF). Atopic manifestations appeared in 1 out of 15 breast-fed infants compared with 18 out of 45 infants fed with an AdFo. None of the infants receiving the HAF (exclusively from birth for 2-4 months) developed symptoms of atopy. Symptoms in each infant receiving an AdFo (n = 18) disappeared with the HAF. Although the results of this study are promising, data on a larger population and double-blind investigations are needed before firm conclusions can be drawn.
Article
At the age of 5 years, the prevalence of atopic manifestations was analysed in 58 formula-fed "at risk" infants because of a history of atopic disease in at least two first degree relatives. Infants were randomly assigned to receive either a partial whey-hydrolysate formula (n: 28) or a regular cow's milk formula (n: 30) during the first 6 months of life; thereafter, feeding was unrestricted. Only non-breastfed infants were included. The groups did not differ in risk factors or in known confounding factors possibly influencing the incidence of manifestations suggestive of atopic disease. At 6 months, the prevalence of cow's milk protein (CMP) sensitivity was significantly decreased in the hydrolysate group (7% versus 43%; P: 0.002). At the age of 12 (21% versus 53%; P: 0.029), 36 (25% versus 57%; P: 0.018) and 60 months (29% versus 60%; P: 0.016) there was still a significant difference in the number of atopic manifestations, if calculated cumulatively. There was no difference between the groups if only the new cases after the age of 6 months were considered. Eczema was less frequent in the whey-hydrolysate group, but only during the 1st year of life, suggesting a decreased prevalence of CMP sensitivity. During the first 6 months, diarrhoea of non-infectious origin occurred in 8/30 infants (27%) of the adapted formula group, and in no infant in the hydrolysate group. "Colic as single manifestation" was considered of "allergic" origin in 1/28 infants in the hydrolysate group, and in 4/30 infants in the adapted formula group.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
One hundred-eight infants from atopic families were admitted to the study. Each had at least one first-degree relative affected by asthma or rhinitis, conjunctivitis, eczema, cow's milk protein intolerance. All infants not breast fed were hypoallergenic formula. 46 infants were breast fed, 39 were bottle fed by the ordinary formula and 23 received the hypoallergenic one. No other food was introduced up to 6 months. Cow's milk proteins, egg, poultry and fish were introduced after 6 months. All infants were followed up to 24 months. Incidence of allergic diseases up to 24 months was not significantly different among the 3 groups.
Article
One hundred twenty-two infants at risk of atopy on the basis of IgE screening at birth and family history of atopy were studied. The occurrence of atopic manifestations was analyzed in relation to their diets during the first 3 months of age. Only the infants receiving hypoallergenic milk were protected effectively; all other regimens (humanized cow milk, hypoallergenic milk or humanized cow milk + supplements) increased the frequency of allergic symptoms (P < .07). After a 1-year follow-up, the infants fed strictly on hypoallergenic milk during their 3 first months presented allergic symptoms less frequently than other infants (P < .007).
Article
A prospective case-control study is presented to assess an allergy prevention programme in children up to 36 months of age. Infants born at three maternity hospitals were followed from birth: 279 infants with high atopic risk (intervention group) were compared with 80 infants with similar atopic risk but no intervention (non-intervention group). The intervention programme included dietary measures (exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet) and environmental measures (avoidance of parental smoking in the presence of the babies, day care > 2 years of life). Mothers in this group who had insufficient breast milk were randomly assigned to one of two coded formulas: either a hydrolysed milk formula (Nidina HA, Nestlé) or a conventional adapted formula (Nan, Nestlé). Other environmental measures remained the same as for the breastfeeding mothers. The non-intervention group were either breastfed or received the usual Italian milk feeding and weaning diet, without environmental advice. The main outcome measures were anthropometric measurements and allergic disease manifestations. Normal anthropometric data were observed both in the intervention group and in the non-intervention group. The incidence of allergic manifestations was much lower in the intervention group than in the non-intervention group at 1 year (11.5 versus 54.4%, respectively) and at 2 years (14.9 versus 65.6%) and 3 years (20.6 versus 74.1%). Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non-intervention group from birth up to the second year of life, while urticaria and gastrointestinal disorders were only present in the non-intervention group in the first year of life. Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non-intervention group. Relapse of the same allergic symptom was less in the intervention group (13.0%) than in the non-intervention group (36.9%). In comparison to the non-intervention group, there were fewer intervention group cases with two or more different allergic symptoms (8.7 versus 32.6%), and they were more likely to avoid steroid treatment (0 versus 10.8%) and hospital admission (0 versus 6.5%). Babies in the non-intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group. In the intervention group the breastfed infants had the lowest incidence of allergic symptoms, followed by the infants fed the hydrolysed formula (ns). Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants, although less than their counterparts in the non-intervention group. Of the affected subjects in the intervention group, 80.4% were RAST and/or Prick positive to food or inhalant allergens. Total serum IgE values detected at birth in the intervention group were not predictive, but at 1 and 2 years of age, IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy. In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups. Of the various factors tested in the non-intervention group, the following were the most important in the pathogenesis of allergic symptoms: (i) formula implementation begun in the first week of life; (ii) early weaning (< 4 months); (iii) feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6 months); and (v) parental smoking in the presence of the babies and early day care admission (< 2 years of life). All the preventive measures used in this study (exclusive breastfeeding and/or hydrolysed milk feeding, delayed and selective introduction of solid foods, and environmental advice) were effective at the third year of follow-up, greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions
Article
We evaluated the immunogenicity and antigenicity of a formula based on partially hydrolyzed cow's milk whey protein in infants at risk of atopy and in controls. Total IgE and specific IgE, IgG, and IgG4 subclass antibodies against egg albumin and cow's milk alpha-lactalbumin, casein, and beta-lactoglobulin were measured by radioimmunoassay of cord blood and of peripheral blood at 5 days and 6 months of life in five groups of infants: 16 breast-fed infants at risk of atopy (group 1), 21 partially hydrolyzed whey formula-fed infants at risk of atopy (group 2), 14 formula-fed infants at risk of atopy (group 3), 10 breast-fed control infants (group 4), and 13 formula-fed control infants (group 5). Total IgE concentration was significantly lower in group 2 at 6 months than in groups 3 and 5 infants and similar to that observed in groups 1 and 4 infants. The concentration of specific antiegg and anti-cow's milk protein IgG and of specific anti-cow's milk alpha-lactalbumin and beta-lactoglobulin IgG4 subclass antibodies was significantly reduced in group 2 as compared to group 3 infants and similar to that found in breast-fed infants. In conclusion, the partially hydrolyzed formula was less immunogenic and antigenic than a traditional formula and was as immunogenic and antigenic as breast milk.
Article
Allergy is a common cause of illness. The effect of feeding different infant formulas on the incidence of atopic disease and food allergy was assessed in a prospective randomized double-blind study of high-risk infants with a family history of atopy. 216 high-risk infants whose mothers had elected not to breast-feed were randomized to receive exclusively a partial whey hydrolysate formula or a conventional cow's milk formula or a soy formula until 6 months of age. Seventy-two high risk infants breast-fed for > or = 4 months were also studied. Follow-up until 5 years of age showed a significant lowering in the cumulative incidence of atopic disease in the breast-fed (odds ratio 0.422 [0.200-0.891]) and the whey hydrolysate (odds ratio 0.322 [0.159-0.653) groups, compared with the conventional cow's milk group. Soy formula was not effective (odds ratio 0.759 [0.384-1.501]). The occurrence of both eczema and asthma was lowest in the breast-fed and whey hydrolysate groups and was comparable in the cow's milk and soy groups. Similar significant differences were noted in the 18-60 month period prevalence of eczema and asthma. Eczema was less severe in the whey hydrolysate group compared with the other groups. Double-blind placebo-controlled food challenges showed a lower prevalence of food allergy in the whey hydrolysate group compared with the other formula groups. Exclusive breast-feeding or feeding with a partial whey hydrolysate formula is associated with lower incidence of atopic disease and food allergy. This is a cost-effective approach to the prevention of allergic disease in children.
The prevalence of asthma has increased in developed countries in the past 2 decades. The effectiveness of intervention measures on the primary prevention of asthma has not been well studied. To assess the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants (in this study, infants are defined as persons from birth to the age of 1 year). Prospective, prenatally randomized, controlled study with follow-up through the age of 1 year. University hospital-based settings at 2 Canadian centers: Vancouver, British Columbia, and Winnipeg, Manitoba. A total of 545 high-risk infants (at least 1 first-degree relative with asthma or 2 first-degree relatives with other IgE-mediated allergic diseases) identified before birth. Avoidance of house dust mite and pet allergens and environmental tobacco smoke, encouragement of breastfeeding, and supplementation with a partially hydrolyzed formula. Probable or possible asthma, rhinitis without apparent colds, and a prick skin test result positive for common inhalant allergens. Thirty-eight (15.1%) of the 251 infants available for assessment in the intervention group and 49 (20.2%) of the 242 infants available for assessment in the control group fulfilled the criteria for possible or probable asthma (adjusted relative risk, 0.66; 90% confidence interval, 0.44-0.98). Also, 16.7% of the infants in the intervention group and 27.3% of the infants in the control group developed rhinitis without colds (adjusted relative risk, 0.51; 90% confidence interval, 0.35-0.74). The incidence of positive skin test results to 1 or more inhalant allergens was similar in both groups (4.4% in the intervention group and 4.6% in the control group). Our multifaceted intervention program resulted in a modest but significant (P= .04) reduction in the risk of possible or probable asthma and rhinitis without apparent colds at the age of 12 months in high-risk infants. In the absence of a validated definition of asthma at the age of 12 months, follow-up studies are needed to determine the effectiveness of the intervention program in the primary prevention of asthma in high-risk infants.
Article
An allergen-reduced dietary intervention programme with strict dietary requirements was implemented over the first four months of life in an unselected population-based infant cohort and compared to a non-intervention cohort (the ZUFF study). Recommendations for the dietary programme in the intervention cohort were extended, but not strictly implemented, until the end of month six. The intervention was based on breastfeeding, a moderate whey hydrolysate formula (pHF), and delayed introduction of weaning foods with a high allergenicity. This study was a prospective, controlled, and unblinded study, the first to assess the effects of an allergen-reduced, pHF-based early nutritional programme in a broad unselected infant population. Because overall healthy development of the infant is a major objective of any nutritional programme, the study evaluated the effects of the dietary intervention on infant growth and general health status rather than specific allergic manifestations. Part I of this paper gave results for nutritional behaviour only, and Part II gives results for growth and general health status during the intervention period through the sixth month of life. Assignment of study infants was to demographically comparable intervention (Z) or control (FF) cohorts according to place of birth. In the intervention cohort (Z=564), the recommended dietary regimen was breastfeeding and--if exclusive breastfeeding was not possible--supplementation with a moderately hydrolysed, allergen-reduced infant formula (pHF). Weaning foods were delayed until four months of age or later in case of weaning foods with high allergenicity. In the control cohort (FF=566), there was no specific intervention. Imbalances between cohorts in confounding (adjuvant) factors that could influence health-related outcomes were integrated as covariates into the logistic regression of the main analyses. Growth parameters included weight, length, head circumference, BMI, and Z scores (SDS). General health status was assessed by clinically significant findings in gastrointestinal, respiratory, or skin symptoms. Growth at 6 weeks and at 3 and 6 months was similar for Z and FF. Significantly fewer Z than FF infants had clinically noteworthy health findings at 3 months (Z=27% versus FF=37%, odds ratio=0.63, CI=0.48-0.82) and 6 months (Z=33% versus FF=49%, odds ratio=0.51, CI= 0.40-0.66). This corresponds to a 30 % reduction in overall health concerns at 6 months for the intervention cohort. At 3 and 6 months, differences between cohorts in most measures of general health status were strongly influenced by a lower incidence of skin symptoms in the Z cohort. Within FF, there were fewer exclusively breastfed (eBF) infants with health problems at 3 months compared with those who were partially (pBF) or non-breastfed (nBF) (eBF=31%, pBF=40%, nBF=39%, p< 0.05). In contrast, in the Z intervention cohort, the number of infants with health concerns was similar for exclusively breastfed infants and for those in whom mother's milk was supplemented or replaced by pHF (eBF=29%, pBF=25%, nBF=26%, ns). In a subanalysis of overall health findings in infants without a family risk of allergies, there were again significantly fewer Z than FF infants with any health or any skin problem. An allergen-reduced dietary recommendation that includes a moderate whey hydrolysate infant formula (pHF) has no negative effects on growth parameters up to 6 months of life in an infant population unselected for atopic risk. The dietary intervention produced improvements in general health status when compared with a control cohort that received infant formula with unhydrolysed proteins (IF), and high allergenic weaning foods at an earlier age. The difference between cohorts was principally due to fewer adverse skin findings. (ABSTRACT TRUNCATED)
Article
The use of protein hydrolysate preterm formulas is restricted because data on their nutritional adequacy are scarce. The authors evaluated the rate of growth and indices of protein metabolism in low-birth weight infants fed extensive and partial protein hydrolysate preterm formula followed for 12 weeks. A total of 61 low-birth weight infants were assigned randomly to receive extensive protein hydrolysate preterm formula (EH: n = 16), partial protein hydrolysate preterm formula (PH: n = 15), and standard preterm formula (SF; n = 15), or were fed their own mother's fortified breast milk (FBM; n = 15). The infants were investigated at study entry, and at 4, 8, and 12 weeks after study entry. There were no differences with respect to growth rate (weight gain, increments in length and head circumference), urea, albumin, prealbumin, transferrin, and plasma amino acid concentrations (except for tyrosine on a single occasion) according to the degree of hydrolysis. There were also no differences between groups fed hydrolyzed formulas and SF. However, several differences were found when EH and PH were compared with FBM. Weight gain from the entry to 12 weeks, serum urea at 12 weeks, and total plasma essential amino acids at 8 weeks were significantly higher in groups fed EH and PH than in those fed FBM. In addition, valine was significantly higher in groups fed PH (P < 0.05) than in the group fed FBM at 8 and 12 weeks, tyrosine was higher in EH and PH in comparison with FBM at 4 weeks, and in PH versus FBM at 12 weeks after study entry. This study suggests that experimental EH and PH are at least nutritionally equivalent to SFs.
Article
Despite the numerous studies on the possible protective effect of breast-feeding against the onset of atopic dermatitis during childhood, this issue remains controversial. We conducted a systematic review with meta-analysis of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and atopic dermatitis. A comprehensive search of the 1966-2000 MEDLINE database and review of the reference lists of relevant articles identified 18 prospective studies that met the predefined inclusion criteria. By means of a standardized approach, 2 of the investigators independently assessed the methodologic quality of the studies, duration and exclusivity of breast-feeding, outcome measures, and control for potential confounding factors. The same approach was applied during data abstraction and evaluation of the estimates of association. Summary measures of association were then calculated. The summary odds ratio (OR) for the protective effect of breast-feeding in the studies analyzed was 0.68 (95% confidence interval [CI], 0.52-0.88). This effect estimate was higher in the group of studies wherein children with a family history of atopy were investigated separately (OR = 0.58; CI, 0.41-0.92) than in those of combined populations (OR = 0.84; CI, 0.59-1.19). A small subset of studies of children without a history of atopy in first-degree relatives showed no association between breast-feeding and the onset of atopic dermatitis (OR = 1.43; CI, 0.72-2.86). Exclusive breast-feeding during the first 3 months of life is associated with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy. This effect is lessened in the general population and negligible in children without first-order atopic relatives. Breast-feeding should be strongly recommended to mothers of infants with a family history of atopy, as a possible means of preventing atopic eczema.
Article
To determine the effect of a partially hydrolysed formula on genetically predisposed children, with respect to the development of atopic clinical manifestations and in vitro testing of serum IgE levels (total and milk-specific). One hundred and ten infants were randomly assigned to receive either partially hydrolysed formula or standard infant formula, and were prospectively monitored from birth for clinical atopic symptoms and serum IgE levels. Eczema occurred less frequently in infants receiving partially hydrolysed formula. This was significant (P < 0.05) at 3, 6, 9, 12, 18 and 24 months. However, the significance decreased with time, although it almost reached statistical significance at 30 months by the Kaplan-Meier survival function (log-rank statistic, 3.46; P = 0.063). Although wheezing occurred less frequently in infants receiving partially hydrolysed formula, compared to those receiving standard infant formula, the difference did not reach statistical significance (P > 0.05). Exclusive feeding of hypoallergenic milk formula in the first 4 months of life has a protective effect in terms of the development of atopic dermatitis in the first 2 years of life, compared to feeding with cow's milk formula.
Article
Avoidance of individual risk factors have not been successful in preventing the development of asthma. We sought to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants. We identified 545 high-risk infants on the basis of an immediate family history of asthma. Families were randomized into intervention or control groups. Intervention measures included avoidance of house dust mite, pet allergen, and environmental tobacco smoke. Breast-feeding was encouraged with formula supplementation if necessary, and introduction of solid foods was delayed. At 2 years of age, 19.5% of the children had asthma, and 14.7% had atopy (positive skin test response to one or more common allergens). Significantly fewer children had asthma in the intervention group compared with in the control group (16.3% vs 23.0%), with 60% less persistent asthma at 2 years. There was a 90% reduction for recurrent wheeze in the intervention group compared with that seen in the control group. Exposure to maternal environmental tobacco smoke during pregnancy or the first year was a risk factor for asthma at 2 years of age. A positive skin test response, particularly to food, at 12 months predicted asthma at 2 years. There was no significant difference for atopy between the intervention and control groups, but daycare reduced atopy at 2 years. This multifaceted intervention program during a window of opportunity in the first year of life was effective in preventing asthma in high-risk children at 2 years of age. Future studies with this cohort at school age are important.
Article
To investigate if exclusive breast-feeding for 4 months is associated with atopic dermatitis during the first 3 years of life. Data on 3903 children were taken from yearly parental-administered questionnaires from a birth cohort study in Germany (recruited 1995-1998) comprised of a noninterventional (NI) and an interventional (I) subgroup. Outcomes were physician-diagnosed atopic dermatitis (AD) and itchy rash. Multiple logistic regression was performed for the entire cohort and stratified by family history of allergy and by study group adjusting for a fixed set of risk factors for allergies. Exclusive breast-feeding (52 % of children) was not associated with higher risk for AD either in the entire cohort (OR(adj,) 0.95; 95% CI, 0.79-1.14) or if stratified by family history of AD. In the I subgroup, but not in the NI subgroup, exclusive breast-feeding showed a significant protective effect on AD if compared with conventional cow's milk formula (OR(adj), 0.64; 95% CI, 0.45-0.90). These findings do not support the hypothesis that exclusive breast-feeding is a risk factor for development of atopic dermatitis but is protective if compared with conventional cow's milk. Observational studies might not be able to effectively control for selection bias and reverse causation.
Article
A randomized, double-blind study was conducted to evaluate whether use of protein hydrolysate-based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases. Preterm infants (n = 122) with at least one first-degree relative (parent or sibling) with allergic disease were randomly assigned to receive an extensively or partially hydrolysed preterm formula (intervention groups) or a standard preterm formula until 4 to 5 mo of age. Infants whose parents preferred that they be breastfed received their mothers' fortified breast milk. Intention-to-treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4-5 and 12 mo of age. However, by 12 mo, use of the extensively hydrolysed versus the standard preterm formula had significantly reduced the risk of atopic dermatitis. At 4-5 and 12 mo, there was a significantly increased risk of non-acceptance of the extensively hydrolysed formula compared with the other formulas. This study failed to show that extensively or partially hydrolysed preterm formulas in comparison with a standard preterm formula reduced the overall incidence of allergic diseases in infants at high risk for atopic disease. However, use of the extensively hydrolysed compared with a standard preterm formula significantly reduced the incidence of atopic dermatitis observed at 12 mo. Infants who received extensively hydrolysed formulas were at increased risk for intervention discontinuation for any reason, particularly non-acceptance of the formula. Because of the small number of patients eligible for this analysis, these results should be interpreted with caution.
Article
The potential of extensively or partially hydrolyzed formulas to reduce the risks for allergies is controversial. We sought to assess the preventive effect of differently hydrolyzed formulas compared with cow's milk formula (CMF) in high-risk infants. Between 1995 and 1998, 2252 infants with a hereditary risk for atopy were enrolled in the German Infant Nutritional Intervention Study and randomly assigned at birth to one of 4 blinded formulas: CMF, partially hydrolyzed whey formula, extensively hydrolyzed whey formula, and extensively hydrolyzed casein formula (eHF-C). The primary end point at 1 year of age was the presence of allergic manifestation, which was defined as atopic dermatitis (AD), gastrointestinal manifestation of food allergy, allergic urticaria, or a combination of these factors. At 12 months per protocol, analysis was performed on 945 infants exposed to study formula: 304 (13.5%) infants had left the study, 138 (6.1%) infants were excluded because of noncompliance, and 865 infants were exclusively breast-fed the first 4 months of life. The incidence of allergic manifestation was significantly reduced by using eHF-C compared with CMF (9% vs 16%; adjusted OR, 0.51; 95% CI, 0.28-0.92), and the incidence of AD was significantly reduced by using eHF-C (OR, 0.42; 95% CI, 0.22-0.79) and partially hydrolyzed whey formula (OR, 0.56; 95% CI, 0.32-0.99). Family history of AD was a significant risk factor and modified the preventive effect of the hydrolysates. Prevention of allergic diseases in the first year of life is feasible by means of dietary intervention but influenced by family history of AD. The preventive effect of each hydrolyzed formula needs to be clinically evaluated.
Article
The sequential development of allergic disease manifestations during early childhood is often referred to as the atopic march. Various epidemiologic and birth-cohort studies have begun to elucidate the evolution of allergic disease manifestations and to identify populations at risk for disease. These studies, along with intervention studies, emphasize the effects of environmental factors and genetic predisposition on the atopic march. This article discusses the populations at risk for the development of atopic conditions and the interventions that have been explored in attempts to modify the progression of allergic disease.
Article
Avoidance of any one of the individual risk factors associated with childhood asthma has not been successful in preventing its development. The purpose of this study is to determine the effectiveness of a multifaceted intervention program for the primary prevention of asthma in high-risk infants at 7 years of age. Five hundred forty-five high-risk infants with an immediate family history of asthma and allergies were prospectively randomized into intervention or control groups prenatally. Intervention measures introduced before birth and during the first year of life included avoidance of house dust, pets, and environmental tobacco smoke and encouragement of breast-feeding with delayed introduction of solid foods. Assessment of outcomes at 7 years consisted of examination by pediatric allergists, methacholine inhalation tests, and allergy skin tests. At 7 years, 469 of the 545 children were contacted, and 380 returned for further assessment. The prevalence of pediatric allergist-diagnosed asthma was significantly lower in the intervention group than in the control group (14.9% vs 23.0%; adjusted risk ratio, 0.44; 95% CI, 0.25-0.79). The prevalence of allergic rhinitis, atopic dermatitis, atopy (defined as positive skin test reactions to any common allergen), and bronchial hyperresponsiveness (defined as the provocative concentration of methacholine that induced a 20% decrease in FEV 1 from a postsaline value of less than 7.8 mg/mL) were not significantly different between the 2 groups. The prevalence of asthma (defined as wheeze without colds and the presence of bronchial hyperresponsiveness) was also significantly lower in the intervention group compared with the control group (12.9% vs 25.0%; adjusted risk ratio, 0.39; 95% CI, 0.22-0.71). The multifaceted intervention program was effective in reducing the prevalence of asthma in high-risk children at 7 years of age.
To critically examine the published literature to determine whether feeding hydrolyzed infant formulas from birth has a role in allergy prevention. We identified data through a MEDLINE search using allergy prevention and infant formulas as indexing terms. The search was restricted to 1985 through the present, English-language articles, and human subjects. Criteria for inclusion in the review were prospective controlled trials published in peer-reviewed journals. Symptoms of allergy were defined and observed by health care providers (physicians and nurses). Nine published trials evaluated the use of extensively hydrolyzed formulas, 12 evaluated the use of partially hydrolyzed formulas in high-risk infants, and 1 evaluated the use of partially hydrolyzed formulas in an unselected infant population. The reports compared hydrolyzed formulas with breastfeeding, cow's milk formulas, soy formulas, and combinations thereof. The cohort of studies consistently showed reductions in the cumulative incidence of atopic disease from 12 to 60 months of age among high-risk infants fed extensively hydrolyzed casein formulas or partially hydrolyzed whey formulas vs cow's milk formulas. No studies showed an increase in allergy risk with any hydrolyzed formulas. Extensively hydrolyzed casein formulas and partially hydrolyzed whey formulas are appropriate alternatives to breast milk for allergy prevention in infants at risk. Because atopic disease in children cannot be predicted, the use of these formulas in the general population should be considered, and one must weigh cost, compliance, and long-term benefits.
Article
The evidence for a preventive effect of breast-feeding on the development of eczema in childhood remains controversial. To investigate the effect of breast-feeding in various phenotypes of eczema to 4 years. A birth cohort of 4089 children made up the study base. Data on breast-feeding, allergic symptoms, and potential confounders were obtained from questionnaires when the children were 2 months and 1, 2, and 4 years old. At 4 years, blood specific IgE was analyzed. Children with symptoms of eczema and asthma during the period of breast-feeding were excluded in most analyses on risk assessment of eczema and asthma, respectively, to avoid disease-related modification of exposure. Exclusive breast-feeding for >or=4 months reduced the risk for eczema at the age of 4 years (odds ratio [OR], 0.78; 95% CI, 0.63--0.96) irrespective of combination with asthma, sensitization to common allergens, or parental allergic disease. This decreased risk was most evident for children with onset of eczema during the first 2 years persisting to 4 years (OR, 0.59; 95% CI, 0.45--0.77). Among children with early-onset eczema, irrespective of persistency, followed by late onset of asthma or early-onset asthma irrespective of persistency, followed by late-onset eczema to 4 years, a protective effect of breast-feeding was also seen (OR, 0.48; 95% CI, 0.30--0.76). Breast-feeding 4 months or more reduces the risk for eczema and onset of the allergy march to age 4.
One of the great controversies in pediatric allergy during the past 2 decades has been and remains the potential to prevent the development of allergy and asthma. The controversy stems largely from the lack of quality studies and conflicting data from the few studies that have been done; some studies have demonstrated significant protection and most others have shown little or no effect. Possible approaches to allergy prevention include maternal dietary restrictions during pregnancy, breastfeeding, dietary restrictions while breastfeeding, the use of hypoallergenic infant formulas, and delays in the introduction of foods into the infant's diet, both in general and specifically in regard to more allergenic foods.¹ In addition, the use of probiotics or other immunomodulatory agents and the avoidance of environmental allergens and irritants, such as tobacco smoke, have been suggested as possible approaches to allergy prevention.
Article
When babies are not exclusively breastfed, using hydrolysed infant formulas instead of ordinary cow's and soy milk formulas can reduce allergies in babies and children. Infant formulas have been designed to try to lower the chances of allergy or food intolerance developing. These include hydrolysed cow's and soy milk formulas. Hydrolysed formulas change the milk protein with the aim of preventing sensitisation or intolerance. The review of trials found that there is no evidence to support feeding with a hydrolysed formula to prevent allergy in preference to exclusive breastfeeding. In infants at high risk for allergy who are unable to be completely breastfed, there is evidence that feeding with a hydrolysed compared to a cow's milk formula reduces allergies in babies and children, including cow's milk allergy.
Article
Recommendations for primary prevention of allergic diseases in high-risk children include feeding with hydrolyzed formulas if breast-feeding is insufficient. The primary objective of the German Infant Nutritional Intervention study was to investigate the allergy preventive effect of 3 hydrolyzed formulas compared with cow's milk formula in the first 3 years of life in a randomized, double-blind trial. Between 1995 and 1998, 2252 newborns with atopic heredity were allocated to a group receiving cow's milk formula, partially or extensively hydrolyzed whey formula, or extensively hydrolyzed casein formula as a milk substitute for the first 4 months if breast-feeding was insufficient. Main outcome parameters were allergic manifestations, atopic dermatitis (AD), and asthma. After 3 years, 396 of 2252 children (17.6%) had dropped out. Breast-fed infants without formula feeding during the intervention (n = 889) were considered separately. A significant reduction of the incidence of AD was achieved with the extensively hydrolyzed casein formula in the intention-to-treat (ITT; n = 1363) and per protocol (PP; n = 904) analyses (ITT: population odds ratio [95% CI], 0.67 [0.45-0.99]; PP: adjusted odds ratio [OR(adj)], 0.53 [0.32-0.88]), and with the partially hydrolyzed whey formula in the PP analysis (ITT: population odds ratio, 0.76 [0.52-1.11]; PP:OR(adj), 0.60 [0.37-0.97]). None of the formulas reduced the incidence of asthma. The risk for AD, but not for asthma, can be reduced with certain cow's milk hydrolyzates in high-risk infants when breast-feeding is insufficient. Early nutritional intervention in high-risk children has significant influence on the incidence of AD, but not of asthma.