The Departments of Agriculture and of Health and Human Services has released the 2020-2025 Dietary Guidelines for Americans. Available at www.dietaryguidelines.gov, the guidelines provide recommendations on what the average American should eat and drink to promote health and help prevent chronic disease through childhood, adolescence, and adulthood.

Importantly, the prevalence of food allergy and other atopic conditions has been steadily rising, with the highest incidence being noted in younger children. “The dietary guidelines are especially important for allergists and immunologists because certain dietary measures in the first year of life can prevent onset of food allergies,” says Purvi S. Parikh, MD. The guidelines evaluated associations between maternal dietary intake—including dietary patterns—and atopic diseases in children and developed several recommendations that are relevant to allergists and immunologists (Table).

Early Introduction

“The guidelines recommend early introduction of highly allergenic foods to prevent the development of food allergies,” says Dr. Parikh. “Early introduction of egg, peanut, tree nut, soy, fish, cow’s milk, wheat, and shellfish at age 4 to 6 months may help prevent the onset of food allergies. The exception to this recommendation is if a child has severe eczema and/or already has developed an egg allergy. In these scenarios, consultation with a board-certified allergist should occur prior to early introduction to avoid potential problems. Children with severe eczema or egg allergy are considered high risk. Clinicians should also ensure that children are able to hold their head up on their own and that parents use thinned foods with breast milk or water to make the consistency safe to swallow.”

According to the guidelines, clinicians should speak to parents about exactly when and how to give peanut and egg products. While some type of allergy testing has generally been performed before introducing peanut and egg, research indicates most babies do not require such testing.

Breastfeeding Guidance

“Breast feeding, when possible, is excellent for immune protection and the prevention of infections and other immune mediated diseases,” Dr. Parikh says. “This is because children rely on passive immunity from their mother in first 6 months of life. Breast feeding has also been linked to lower rates of developing allergies. In a similar manner, overuse of disinfectants, pesticides, and other chemicals early in life predisposes children to allergies and asthma due to disruption of the microbiome and elimination of ‘good bacteria’ that are protective.” While breastfeeding is associated with many positive health outcomes, the guidelines urge clinicians to counsel mothers who are unable or do not wish to breastfeed about the benefits and present information on alternatives that promote a healthy diet.

Moderate Vitamin D Intake

The American Academy of Pediatrics recommends all infants and children receive a minimum of 400 IUs of vitamin D each day quickly after they are born because failure to get enough of this nutrient can lead to weakened bones. However, the guideline writing group found no evidence to support recommending a higher dose vitamin D beyond 400 IUs.

Introducing First Foods

Oftentimes, parents are challenged by determining when to introduce solid foods to their children. The guidelines recommend against giving complementary foods and beverages before the age of 4 months. Adding solid foods to the menu at age 4 or 5 months did not offer any significant benefits when compared with beginning these foods at age 6 months. Before the age of 6 months, babies should receive breast milk or formula.

Seizing Opportunities

The guidelines noted that every life stage provides clinicians an opportunity to encourage patients to make food choices that promote health and well-being, achieve and maintain appropriate weight, and reduce risks of diet-related chronic diseases. “Allergists and immunologists can play an integral role by adapting the recommendations to fit the cultural, personal, and individual needs and preferences in food choices,” says Dr. Parikh. “Data from ongoing and large-scale research will increase our understanding on the best approaches to managing our patients. The hope is these studies will yield more information on early introduction as this is still a fairly new concept. In general, there is still much to learn about the role of diet in allergies and asthma and the immune system.”

References

Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC. Available at: https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.