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Randomized Controlled Trial
. 2023 Jun 3;15(11):2622.
doi: 10.3390/nu15112622.

The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial

Theodora Boutsikou  1 , Mikaela Sekkidou  2   3 , Eva Karaglani  4 , Adamantia Krepi  1 , George Moschonis  5 , Nicolaos Nicolaou  2   3 , Nicoletta Iacovidou  1 , Rouzha Pancheva  6 , Miglena Marinova-Achkar  6 , Simoneta Popova  6 , Anastasia Kapetanaki  7 , Zoi Iliodromiti  1 , Vassiliki Papaevangelou  8 , Olympia Sardeli  8 , Evangelia Papathoma  9 , Anne Schaafsma  10 , Rolf Bos  10 , Yannis Manios  4   11 , Paraskevi Xepapadaki  12
Affiliations
Randomized Controlled Trial

The Impact of Infant Feeding Regimen on Cow's Milk Protein Allergy, Atopic Dermatitis and Growth in High-Risk Infants during the First 6 Months of Life: The Allergy Reduction Trial

Theodora Boutsikou et al. Nutrients. .

Abstract

The development of early-onset cow's milk protein allergy and atopic dermatitis during the first months of life is multifactorial, including both genetic and nutritional aspects. This study aims to assess the impact of different feeding patterns on the incidence of cow's milk protein allergy, atopic dermatitis, and growth among infants with a family history of allergy. A total of 551 high-risk infants were randomly recruited from 3 European countries in three feeding regimens: exclusive breastfeeding, partially hydrolyzed formula, or standard formula with intact protein either exclusively or supplementary to breastfeeding. During the first 6 months of intervention, amongst infants with a family history of atopic dermatitis, 6.5% of partially hydrolyzed formula-fed infants and 22.7% of exclusively breastfed infants (p = 0.007) presented with atopic dermatitis respectively. Growth as assessed by weight increase did not differ between the aforementioned groups. Although cow's milk protein allergy was not related to the different milk feeding regimens in the whole cohort, when adjusting for high breast milk intake, the respective incident was significantly lower in the infants consuming partially hydrolyzed formula (p < 0.001). This data indicates that a specific partially hydrolyzed formula could serve as a more appropriate complement to breast milk compared to a standard intact protein formula in high-risk infants, to reduce the incidence of atopic dermatitis.

Keywords: atopic dermatitis; breastfed infants; cow’s milk protein allergy; hydrolyzed formula.

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Conflict of interest statement

N.N., P.X., and Y.M. have received an honorarium for the speaker’s bureau from FrieslandCampina. P.X. has received fees for honorarium and lectures from Novartis, GlaxoSmithKline, Nutricia, Nestle, Menarini, Uriach, and Frieslandcampina, unrelated to this work. A.S. and R.B. are employees at FrieslandCampina. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the A.R.T. population. BF: breastfeeding; pHF: partially hydrolyzed formula; SF: standard formula; PP: Per-Protocol; ITT: intention-to-treat; BM: breast milk.
Figure 2
Figure 2
Changes in infants’ length-for-age z-score (LAZ) from baseline to 4 and 6 months of age per treatment arm (ITT analysis). * The asterisks indicate that the changes from baseline to 6 months observed in the SF and pHF arms are significantly higher compared to the relevant change observed in the EBF arm. The dots appearing in the figure represent outlier values.
Figure 3
Figure 3
Changes in infants’ length-for-age z-score (LAZ) from baseline to 4 and 6 months of age per treatment arm (PP analysis). * The asterisks indicate that the change from baseline to 4 months observed in the pHF arm is significantly higher compared to the relevant changes observed in the EBF and pHF arms. In addition, the asterisks show that the changes from baseline to 6 months observed in the SF and the pHF arms are significantly higher compared to the relevant change observed in the EBF arm. The dots appearing in the figure represent outlier values.
Figure 4
Figure 4
Changes in infants’ weight-for-age z-score (WAZ) from baseline to 4 and 6 months of age per treatment arm (ITT analysis). * The asterisks indicate that the changes from baseline to 4 and 6 months observed in the SF arm are significantly higher compared to the relevant changes observed in the EBF and pHF arms. The dots appearing in the figure represent outlier values.
Figure 5
Figure 5
Changes in infants’ weight-for-age z-score (WAZ) from baseline to 4 and 6 months of age per treatment arm (PP analysis). * The asterisks indicate that the changes from baseline to 6 months observed in the SF and pHF arms are significantly higher compared to the relevant change observed in the EBF arm. The dots appearing in the figure represent outlier values.
Figure 6
Figure 6
Changes in infants’ BMI-for-age z-score (BAZ) from baseline to 4 and 6 months of age per treatment arm (ITT analysis). * The asterisks indicate that the changes from baseline to 6 months observed in the SF and pHF arms are significantly higher compared to the relevant change observed in the EBF arm. The dots appearing in the figure represent outlier values.
Figure 7
Figure 7
Changes in infants’ BMI-for-age z-score (BAZ) from baseline to 4 and 6 months of age per treatment arm (PP analysis). * The asterisks indicate that the changes from baseline to 4 and 6 months observed in the SF arm are significantly higher compared to the relevant changes observed in the EBF and pHF arms. The dots appearing in the figure represent outlier values.
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