Maternal and Infant Dietary Patterns Are Not Related to Food Allergy Risk in Singapore Children: GUSTO Cohort Study

Abstract

Background: We previously reported that delayed allergenic food introduction in infancy did not increase food allergy risk until age 4 y within our prospective cohort. However, it remains unclear whether other aspects of maternal or infant diet play roles in the development of childhood food allergy.

Objectives: We examined the relationship between maternal pregnancy and infant dietary patterns and the development of food allergies until age 8 y.

Methods: Among 1152 Singapore Growing Up in Singapore Towards healthy Outcomes study mother-infant dyads, the infant's diet was ascertained using food frequency questionnaires at 18 mo. Maternal dietary patterns during pregnancy were derived from 24-h diet recalls. Food allergy was determined through interviewer-administered questionnaires at regular time points from infancy to age 8 y and defined as a positive history of allergic reactions, alongside skin prick tests at 18 mo, 3, 5, and 8 y.

Results: Food allergy prevalence was 2.5% (22/883) at 12 mo and generally decreased over time by 8 y (1.9%; 14/736). Higher maternal dietary quality was associated with increased risk of food allergy (P ≤ 0.016); however, odds ratios were modest. Offspring food allergy risk ≤8 y showed no associations with measures of infant diet including timing of solids/food introduction (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.42, 1.92), infant's diet quality (aOR: 0.93; 95% CI: 0.88, 0.99) or diet diversity (aOR: 0.84; 95% CI: 0.6, 1.19). Most infants (89%) were first introduced to cow milk protein within the first month of life, while egg and peanut introduction were delayed (58.3% introduced by mean age 8.8 mo and 59.8% by mean age 18.1 mo, respectively).

Conclusions: Apart from maternal diet quality showing a modest association, infant's allergenic food introduction, diet quality, and dietary diversity were not associated with food allergy development in this Asian pediatric population. Interventional studies are needed to evaluate the efficacy of these approaches to food allergy prevention across different populations.

Keywords: Asian children; allergenic food introduction; allergy prevention; food allergy; solids introduction.

FIGURE 1

Timing of introduction of (A) solids, (B) egg, peanut, cow milk protein, and prawn over 3 y. Among the 4 main allergens, cow milk protein was introduced into the infant’s diet the earliest (beginning from birth), while peanut and egg introduction into the infant’s diet occurred later in life, at around 18 mo and 8 mo, respectively. Although data on egg, peanut and cow milk protein was collected ≤3 y follow-up, data on timing of prawn introduction was only collected ≤1 y. // indicates the time point when data collection for timing of prawn introduction stopped. Those who had yet to introduce prawn by 12 mo were classified as 0 mo to not exclude these participants from the total sample size in the graph.