Early weight gain and the development of asthma and atopy in children.

PURPOSE OF REVIEW: To provide perspective to the most recent evidence regarding the association between early weight gain in infancy and the development of asthma and atopy during childhood, and highlight the potential mechanisms involved. RECENT FINDINGS: Recently, several birth cohort studies involving more than 25 000 children have found a consistent association between early weight gain in the first 2 years of life and incident asthma during school age. Methodology differs substantially between the studies and complicates the establishment of definite conclusions. Specific mechanisms for this association have been proposed, including impairment in lung development and elevated levels of growth factors and cytokines associated with airway inflammation and remodeling. A limited number of studies indicate that early weight gain in infancy is also associated with recurrent wheezing during preschool age but not with the development of atopy. SUMMARY: A consistent association between early weight gain in infancy and incident asthma during school age has been observed in several cohort studies. The identification of this modifiable risk factor for the development of asthma opens the possibility of preventive intervention. Additional studies are necessary to clarify the involved mechanisms and some pending questions, such as the influence of early weight gain in asthma phenotypes and severity.

O papel da nutrição no primeiro ano de vida sobre a prevenção de doenças alérgicas / The role of nutrition in the first year of life on the prevention of allergic diseases

Objetivo: A prevalência das doenças alérgicas vem aumentando nas últimas décadas em todo o mundo. A prevenção primária em lactentes considerados de alto risco para atopias, com base na alimentação no primeiro ano de vida, pode constituir uma importante forma de atuação na tentativa se minimizar as manifestações da doença. Fontes dos dados: O estudo foi realizado com base em artigos relacionados à prevenção de doenças alérgicas em crianças, disponíveis nos bancos de dados PUBMED, MEDLINE, SCIELO e LILACS nos últimos 10 anos, ou anteriores a esta data, mas relevantes do ponto de vista nutricional/epidemiológico. Síntese dos dados: A determinação dos lactentes de alto risco para doenças alérgicas é um dado de alta relevância para a instituição de medidas nutricionais preventivas no primeiro ano de vida. Não há evidências de que a restrição dietética da mãe durante a gestação ou período de amamentação possa ter algum benefício na prevenção de atopia no feto/lactente. Aleitamento materno, diminuição da carga alergênica na substituição ou complementação do leite materno e a presença de determinados nutrientes na alimentação infantil são possíveis intervenções para se minimizar as alergias ao longo da infância. Conclusões: Aleitamento materno exclusivo por seis meses, a utilização de fórmulas hidrolisadas como complemento ou substituição do leite materno e a introdução de alimentos sólidos após o 4° mês de vida são apontadas como as possíveis estratégias na prevenção primária de doenças alérgicas, no que concerne à alimentação do primeiro ano de vida.

Aim: The prevalence of allergic diseases has been increasing in the past decades around the world. Primary prevention in high risk infants to develop allergies, based on some feeding aspects in the first year of life seems to be an important form of sction in order to minimize allergic symptoms. Data source: The study was conducted based on related articles about prevention of allergic diseases in infants, available on PUBMED, MEDLINE, SCIELO and LILACS data bases in the last 10 years, or previous, but relevant regarding to nutritional or epidemiological point of view. Data synthesis: The recognition of high risk infants for developing allergic diseases is the most relevant information for establishing preventive feeding measurements in the first year of life. There is no evidence that restriction diet during pregnancy or breastfeeding are effective for reducing atopy in the fetus/infant. Breastfeeding, decreasing intake of allergenic proteins and the presence of appropriate nutritional elements are possibly effective interventions for prevention of allergy during the infancy. Conclusion: Exclusive breastfeeding up to six months of life, hydrolyzed formula as complementation or substitution to breast milk and delayed solid food introduction after the fourth month are possibly some strategies for the primary prevention of allergic diseases, regarding to feeding in the first year of life.