Current evidence from prospective observational epidemiological studies indicates that the current recommendation of introduction of complementary foods after 4–6 months for the prevention of aller- gies in children may lack strong scienti fi c backing. Although these recommendations were based on the speculation that the gut-mucosa of the infant is immature, thus may trigger the development of allergies if complementary foods are introduced early, the mechanisms underlying the maturational processes of the gut-mucosa are not clear.
Mostly, independent of several confounding factors and reverse causality, the available evidence points to a bene fi cial effect of early introduction of solid foods on the development of allergies, contrary to the hypothesized harmful effect. Interestingly, the speci fi c important foods with a more consistent effect include egg, cereals (oats and wheat), fi sh, and cow’s milk.
For ethical reasons, it may not be feasible to carry out a randomized controlled trial in order to con fi rm these fi ndings. Consequently, the best evidence at present to judge the role of age at introduction of complementary foods in the development of allergies remains to come from observational epide- miological studies, despite their potential for bias. Mostly, the avenues of bias in the available studies were minimized.
Because new foods are usually introduced consecutively, and not at the same time, the use of the absolute cut-off of 4–6 months to categorize the age at introduction of complementary foods may be
inadequate, since it fails to account for the varied time points at which complementary foods are introduced. Overall, the current evidence demonstrates that the current recommendations on the intro- duction of complementary foods as a strategy for preventing allergies in children need further attention. Such attention must consider the possibility of recommending speci fi c timing of introduction for the major complementary foods.
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Premature Infant Feeding
111 R.R. Watson et al. (eds.), Nutrition in Infancy: Volume 1, Nutrition and Health,
DOI 10.1007/978-1-62703-224-7_8, © Springer Science+Business Media New York 2013 M. G. Parker, M.D., M.P.A.
Boston Medical Center, Boston University School of Medicine , 771 Albany St, Dowling 4N, 4110 , Boston , MA 02118 , USA
e-mail: [email protected] L. Konnikova
Division of Newborn Medicine—Enders 961 , Harvard Medical School, Children’s Hospital , Boston , MA , USA
C. R. Martin, M.D., M.S. (*)
Assistant Professor of Pediatrics, Harvard Medical School Associate Director, NICU, Department of Neonatology Director for Cross-Disciplinary Research Partnerships, Division of Translational Research Beth Israel Deaconess Medical Center , 330 Brookline Avenue, Rose-318, Boston , MA , USA
e-mail: [email protected]
Key Points
The in fl uences of growth and nutrition in the neonate are multi-factorial requiring observational
•
studies with careful control of confounding variables and randomized control trials of nutritional practices when feasible.
Neonatal growth and nutrition have short- and long-term consequences necessitating assessment
•
of positive and negative health effects along the continuum of development from infancy to adulthood.
Reference growth charts should represent diverse, well-nourished populations with longitudinal,
•
prospective measurements; growth charts should be speci fi c to the population of interest (fetus, preterm, and term infant).
Mechanisms that may contribute to long-term health outcomes during fetal development include
•
epigenetic alterations, the formation of the microbiome, and immunomodulation.
Epigenetic modi fi cations that regulate gene expression are in fl uenced by the nutritional state of the
•
pregnant mother and infant.
A stable microbiome is essential for both the development of the GI tract and initial programming
•
of innate immunity.
Immunonutrients such as long chain polyunsaturated fatty acids, glutamine, arginine, and oligo-
•
saccharides are necessary for proper neonatal development and their de fi ciency can lead to neonatal disease.
Keywords Fetus • Preterm • Infant • Growth • Nutrition • Growth charts • Measurement tools • Research • Epigenetics • Microbiome • Immunomodulation