Diet Diversity: Important for the prevention and management of food allergy?
Guest Article By Carina Venter, PhD
Dr. Venter is the chair of the International Network of Dietitians and Nutritionists in Allergy, and a member of the American Academy of Allergy and Clinical Immunology (AAAAI), American College of Allergy and Clinical Immunology (ACAAI), European Academy of Allergy and Clinical Immunology (EAACI) and the British Society of Allergy and Clinical Immunology (BSACI).
Diet diversity refers to the variety of foods being eaten, and the terms, diversity or variety, are often used interchangeably (1). When the overall diet is characterized by healthy foods, diet diversity will reflect a diversity/variety of healthy foods eaten over a period of time. The opposite is also true for a diet characterized by less healthy options.
Diet diversity and allergy prevention:
- Diet diversity could affect allergy outcomes via its effect on the gut microbiome. This is supported by studies showing that higher diet diversity leads to increased microbial diversity in the elderly (2) and in the gut microbiome of infants during the weaning period as introduction of solid food progresses (3).
- Diet diversity may be associated with increased nutrient intake, particularly providing nutrients associated with prevention of allergic diseases such as omega-3 fatty acids and non-digestible fibers. (4, 5)
- A more diverse diet may also lead to exposure of different food allergens, leading to tolerance development. (6-10) However, we need to understand how increased allergen diversity impact on diet diversity and this data is currently lacking.
Studies on diet diversity and food allergy outcomes
A number of studies show conflicting data on diet diversity in early life and allergy outcomes such as asthma, eczema and rhinitis.
There is however only ONE study reporting on diet diversity in early life and FOOD ALLERGY OUTCOMES: Carole Roduit et al. published data from a multi-center European trial (Austria, Finland, France,Germany, and Switzerland) (11).
Diet diversity in this study was defined as the 15 foods most commonly eaten by 80% of the children in the study in the first year of life: any cow’s milk, yogurt, other milk product, eggs, nuts, vegetables or fruits, cereals, bread, meat, fish, soy, margarine, butter, cake, and chocolate or a second definition including the 6 major foods introduced in the first 6 months or first 12 months of life: vegetables or fruits, cereals, bread, meat, cake, and yogurt.
Children with a lower diet diversity had an increased risk of sensitization to food allergens at the age of 4.5 or 6 years. In addition, increased introduction of 0-6 items from vegetables/fruits, cereals, bread, meat, cake, and yogurt within the first 6 months or first 12 months of life, was related to reduced prevalence of reported doctor-diagnosed food allergy up to the age of 6 years.
How can we apply this knowledge with feeding a baby?
Food allergy prevention strategies may benefit from additional dietary advice on a more diverse/varied diet, though the specific foods/food groups that should be focused on, and portion sizes required to reach a “higher diet diversity” as well as the definition of higher diet diversity is unclear. There is really no need to wait for 3 days before introducing foods, however, parents may feel more comfortable introducing allergenic foods 2-3 days apart.
- Ruel MT. Is dietary diversity an indicator of food security or dietary qualiy? A review of measurement issues and research needs. International Food Policy Research Institute 2002:1-58.
- Claesson MJ, Jeffery IB, Conde S, et al. Gut microbiota composition correlates with diet and health in the elderly. Nature 2012;488(7410):178-84. doi: 10.1038/nature11319
- Savage JH, Lee-Sarwar KA, Sordillo JE, et al. Diet during Pregnancy and Infancy and the Infant Intestinal Microbiome. J Pediatr 2018 doi: 10.1016/j.jpeds.2018.07.066 [published Online First: 2018/09/04]
- Venter C, Brown KR, Maslin K, et al. Maternal dietary intake in pregnancy and lactation and allergic disease outcomes in offspring. Pediatr Allergy Immunol 2016 doi: 10.1111/pai.12682
- Garcia-Larsen V, Ierodiakonou D, Jarrold K, et al. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLoS Med 2018;15(2):e1002507. doi: https://dx.doi.org/10.1371/journal.pmed.1002507
- Matricardi PM. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: controversial aspects of the 'hygiene hypothesis'. Clin Exp Immunol 2010;160(1):98-105. doi: 10.1111/j.1365-2249.2010.04130.x [published Online First: 2010/04/27]
- Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008;122(5):984-91. doi: 10.1016/j.jaci.2008.08.039
- Perkin MR, Logan K, Marrs T, et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. Journal of Allergy & Clinical Immunology 2016;137(5):1477-86.e8. doi: https://dx.doi.org/10.1016/j.jaci.2015.12.1322
- Lundell AC, Hesselmar B, Nordstrom I, et al. Higher B-cell activating factor levels at birth are positively associated with maternal dairy farm exposure and negatively related to allergy development. Journal of Allergy & Clinical Immunology 2015;136(4):1074-82.e3. doi: https://dx.doi.org/10.1016/j.jaci.2015.03.022
- Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372(9):803-13. doi: 10.1056/NEJMoa1414850
- Roduit C, Frei R, Depner M, et al. Increased food diversity in the first year of life is inversely associated with allergic diseases. J Allergy Clin Immunol 2014;133(4):1056-64. doi: 10.1016/j.jaci.2013.12.1044
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