Infant feeding practices and risk of allergic diseases and sensitisation during the first year of life – a birth cohort study

Background and objectives: Allergic diseases are one of the most common and earliest developing health issues in early childhood. Growing evidence shows that allergic diseases, which occur more frequently in developed countries, are increasing in developing countries. Infant feeding is one of the major environmental exposures that affects the immune system and the subsequent risk of childhood allergies. This study aims to determine whether compliance with WHO recommendations for infant feeding is protective against allergy risk during the first year of life. Methods: This prospective cohort study included 380 mother-child pairs recruited from selected public health clinics at the state of Selangor and the Federal Territory of Kuala Lumpur, Malaysia. Infant feeding practices and allergic outcomes including eczema, food allergy, and wheeze were assessed at 3, 6, and 12 months of age based on parental reports. Food and inhalant allergen sensitisation were assessed based on serum allergen-specific IgE test. Results: About 46.6% of the infants were exclusively breastfed until 6 months, 97.1% had timely initiation of complementary feeding, 10.5% met minimum dietary diversity (MDD) at 6 months, and 54.5% met MDD at 12 months. A total of 27.6% of the infants had eczema, 3.8% had IgE-mediated food allergy, 6.1% had wheeze, 27.4% had food sensitisation, and 10.8% had inhalant allergen sensitisation during the first year of life. After adjustment for confounding variables, results from the multivariable generalised linear mixed model showed that higher odds of food sensitisation were found in infants who met MDD at 6 months (OR = 2.34, 95% CI = 1.045.28). No associations were found between exclusive breastfeeding and introduction of complementary feeding with allergic outcomes. Conclusions: The present study does not support an association between exclusive breastfeeding and timely initiation of complementary feeding with allergic outcomes in infants during the first year of life. Infants introduced to a high diversity of foods at 6 months had an increased risk of food sensitisation at 12 months. More studies in developing countries are needed and the underlying mechanisms should be explored to provide evidence for infant feeding recommendations for allergy prevention.