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Güngör D, Nadaud P, Dreibelbis C, et al. Feeding a Lower Versus Higher Intensity, Proportion, or Amount of Human Milk to Mixed-Fed Infants and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic Review [Internet]. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2019 Apr.

Cover of Feeding a Lower Versus Higher Intensity, Proportion, or Amount of Human Milk to Mixed-Fed Infants and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic Review

Feeding a Lower Versus Higher Intensity, Proportion, or Amount of Human Milk to Mixed-Fed Infants and Food Allergies, Allergic Rhinitis, Atopic Dermatitis, and Asthma: A Systematic Review [Internet].

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WHAT IS THE RELATIONSHIP BETWEEN FEEDING A LOWER VERSUS HIGHER INTENSITY, PROPORTION, OR AMOUNT OF HUMAN MILK TO MIXED-FED INFANTS AND FOOD ALLERGIES, ALLERGIC RHINITIS, ATOPIC DERMATITIS, AND ASTHMA?

PLAIN LANGUAGE SUMMARY

What is the question?

  • The question is: What is the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma?

What is the answer to the question?

  • There is no evidence to determine the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the lifespan.

Why was this question asked?

  • This important public health question was identified and prioritized as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.

How was this question answered?

  • A team of Nutrition Evidence Systematic Review staff conducted a systematic review in collaboration with a group of experts called a Technical Expert Collaborative.

What is the population of interest?

  • The population of interest was generally healthy infants and toddlers (ages 0-24 months) who were in studies examining food allergies, allergic rhinitis, and atopic dermatitis throughout the lifespan and asthma from childhood through adulthood (ages 2 years and up).

What evidence was found?

  • No evidence was found to answer this systematic review question.

How up-to-date is this review?

  • This review includes literature from 01/1980 to 03/2016.

FULL REVIEW

Systematic review question

What is the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma?

Conclusion statement

There is no evidence to determine the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the lifespan.

Grade

Grade Not Assignable

Summary

  • This systematic review examines comparisons of mixed-fed infants fed different intensities, proportions, or amounts of human milk. Mixed feeding was defined as feeding human milk and infant formula but not complementary foods or beverages such as cow’s milk. Human milk was defined as mother’s own milk provided at the breast (i.e., nursing) or expressed and fed fresh or after refrigeration or freezing. Donor milk (e.g., banked milk) was not examined in this review. Infant formula was defined as commercially-prepared infant formula meeting FDA7 and/or Codex Alimentarius8 international food standards. Complementary foods and beverages was defined as foods and beverages other than human milk or infant formula provided to an infant or young child to provide nutrients and energy.
  • This systematic review examines available evidence related to food allergies, allergic rhinitis, and atopic dermatitis from birth through adulthood and asthma from childhood through adulthood (outcomes prior to childhood may represent transient recurrent wheeze9).
  • No articles published since 1980 met the inclusion criteria for this systematic review

Research recommendations

Studies need to be designed and conducted to examine the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the lifespan.

Infant-feeding research will continue to rely on observational designs, because of ethical issues related to randomizing infant to be fed less or no human milk; however, researchers should endeavor to minimize bias through sound research design and conduct. In general, infant-feeding researchers should:

  • Move toward collecting data consistently using valid and reliable methods
  • Increase the precision with which they define infant-feeding variables
  • Incorporate effect modification into their study design whenever possible in case different biological or environmental characteristics modify the impact of infant feeding on the outcomes
  • Assess baseline differences in critical confounding variables between comparison groups, and make statistical adjustments as necessary
  • Address temporality and reverse causality when outcomes are measured from birth to 24 months

ANALYTIC FRAMEWORK

The analytic framework (Figure 1) illustrates the overall scope of the systematic review, including the population, exposures, comparators, and outcomes of interest. It also includes definitions of key terms. This is the analytic framework for the systematic review conducted to examine the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma.

This is the analytic framework for the systematic review conducted to examine the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma. The target population is birth through adulthood. The exposure is the intensity/proportion/amount of human milk fed to mixed-fed infants both at a given point in time and over a period of time, and the comparator is a higher intensity/proportion/amount of human milk fed to mixed-fed infants. The endpoint health outcomes are the incidence, prevalence, and severity of food allergies, allergic rhinitis, atopic dermatitis, and asthma, and the frequency of asthma attacks. Mixed feeding is defined as feedin human milk and infant formula but not complementary foods and beverages such as cow’s milk. Human milk is defined as mother’s own milk provided at the breast or expressed and fed fresh or after refrigeration/freezing. Donor milk (e.g., banked milk) is not examined in this review. Infant formula is defined as commercially-prepared infant formula meeting FDA and/or Codex Alimentarius international food standards. Complementary foods and beverages refers to foods and beverages other than human milk or infant formula that are provided to an infant or young child to provide nutrients and energy. The critical confounders are race and ethnicity, SES, smoking, mode of delivery, type of infant formula, timing and types of complementary foods and beverages, family history of atopic disease, daycare use, number of siblings, urban versus rural setting, and presence of animals, pets, or farming.

Figure 1

Analytic framework.

SEARCH PLAN AND RESULTS

Inclusion and exclusion criteria

The inclusion and exclusion criteria (Table 1) are a set of characteristics to determine which studies will be included or excluded in the systematic review. This table provides the inclusion and exclusion criteria for the systematic review question: What is the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma?

Table 1. Inclusion and exclusion criteria.

Table 1

Inclusion and exclusion criteria.

Search terms and electronic databases used

PubMed

  • Dates searched: Dec 4, 2015 and March 28, 2016 to refine/limit search terms and remove pub type indexing
  • Search Terms:
    (breast feeding[mh] OR breastfeeding[tiab] OR breast feeding*[tiab] OR breast-feeding*[tiab] OR breastfed[tiab] OR breast-fed[tiab] OR breastfeed*[tiab] OR “breast feed”[tiab]) OR (Milk, human[mh] OR “breast milk”[tiab] OR breast-milk[tiab] OR “human milk”[tiab] OR “mother’s milk”[tiab] OR breastmilk[tiab]) OR (Bottle feeding[mh] OR bottle feeding*[tiab] OR “bottle feeding”[tiab] OR bottle-feeding*[tiab] OR bottle-fed[tiab] OR “bottle fed”[tiab])
    NOT ((aids[ti] AND “Acquired Immunodeficiency Syndrome”[Mesh]) OR hiv[ti] OR HIV/AIDS[ti] OR human immunodefic*[ti] OR Acquired Immunodefic*[ti] OR “low birth weight”[ti] OR lbw[ti] OR vlbw[ti] OR elbw[ti] OR pcb[ti] OR pcbs[ti] OR Polychlorinated Biphenyl*[ti] OR Polychlorobiphenyl Compound*[ti] OR dioxin*[ti] OR (breast[ti] AND (tumor*[ti] OR tumour*[ti] OR cancer*[ti] OR carcinoma*[ti] OR disease*[ti]))) NOT (breastfeed*[ti] OR breastfed*[ti] OR feed*[ti] OR fed[ti] OR milk[ti])
    NOT (editorial[ptyp] OR comment[ptyp] OR news[ptyp] OR letter[ptyp] OR review[ptyp] OR systematic[sb])
    Limiters; Engl/humans; 1980-

Embase

  • Date searched: Dec 5, 2015
  • Search Terms:
    ‘bottle feeding’/exp OR ‘bottle feeding’:ab,ti OR ‘bottle feedings’:ab,ti OR ‘bottle fed’:ab,ti OR bottle* NEAR/3 feed* AND [english]/lim AND [humans]/lim AND [1980-2015]/py OR ‘breast milk’/exp OR ‘human milk’:ab,ti OR ‘breast milk’:ab,ti OR breastmilk:ab,ti OR mother* NEAR/2 milk OR ‘maternal milk’:ab,ti AND [english]/lim AND [humans]/lim AND [1980-2015]/py OR ‘breast feeding’/exp OR breastfeed*:ab,ti OR ‘breast feed’:ab,ti OR ‘breast feeding’:ab,ti OR breastfed:ab,ti OR ‘breast fed’:ab,ti OR feeding NEAR/3 breast AND [english]/lim AND [humans]/lim AND [1980-2015]/py
    Using Citation manager to filter out title key words:
    NOT (aids AND “Acquired Immunodeficiency Syndrome”) OR hiv OR HIV/AIDS OR human immunodefic* OR Acquired Immunodefic* OR “low birth weight” OR lbw OR vlbw OR elbw OR pcb OR pcbs OR Polychlorinated Biphenyl* OR Polychlorobiphenyl Compound* OR dioxin* OR (breast AND (tumor* OR tumour* OR cancer* OR carcinoma* OR disease*)) OR preterm OR premature

CINAHL

  • Date searched: Dec 8, 2015
  • Search Terms:
    (MH “Breast Feeding+” OR breast-fed OR “breast fed” OR breastfeeding OR breast feeding OR breast-fed) OR MH “Milk, Human” OR “Human Milk” OR “Breast Milk” OR Breastmilk OR breast-milk OR ((maternal OR mother*) n3 milk) OR (MH “Bottle Feeding”) OR “bottle feeding” OR (bottle n3 feed*) OR bottle-feeding OR bottle-feedings OR “bottle fed” OR “bottle-fed”)
    Using Citation manager to filter out title key words:
    NOT (aids AND “Acquired Immunodeficiency Syndrome”) OR hiv OR HIV/AIDS OR human immunodefic* OR Acquired Immunodefic* OR “low birth weight” OR lbw OR vlbw OR elbw OR pcb OR pcbs OR Polychlorinated Biphenyl* OR Polychlorobiphenyl Compound* OR dioxin* OR (breast AND (tumor* OR tumour* OR cancer* OR carcinoma* OR disease*)) OR preterm OR premature

Cochrane

  • Date searched: Dec 8, 2015
  • Search Terms:
    “Breast Feeding”OR breast-fed OR “breast fed” OR breastfeeding OR “breast feeding” OR “breast feed” OR “breast feeds” OR breast-feed OR breast-feeds OR (breast NEAR/3 feed*) OR “human milk” OR “breast milk” OR breastmilk OR “mother’s milk” OR “maternal milk” OR ((mother* OR maternal OR donor* OR donate*) NEAR/3 milk) OR “Bottle feeding” OR “bottle feedings” OR “bottle-feeding” OR “bottle-feedings” OR (bottle NEAR/3 feed*)
    Using Citation manager to filter out title key words:
    NOT (aids AND “Acquired Immunodeficiency Syndrome”) OR hiv OR HIV/AIDS OR human immunodefic* OR Acquired Immunodefic* OR “low birth weight” OR lbw OR vlbw OR elbw OR pcb OR pcbs OR Polychlorinated Biphenyl* OR Polychlorobiphenyl Compound* OR dioxin* OR (breast AND (tumor* OR tumour* OR cancer* OR carcinoma* OR disease*)) OR preterm OR premature
This flow chart illustrates the literature search and screening results for articles examining the relationship between infant milk-feeding practices, including feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and several outcomes, including food allergies, allergic rhinitis, atopic dermatitis, and asthma. The literature search yielded 31,335 articles. During title and abstract screening, 28,537 articles were screened out. During full-text screening, 2,606 articles were screened out. During the hand search, 17 additional articles were identified to include. In total, 0 articles were included in the systematic review on the relationship between feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma.

Figure 2

Flow chart of literature search and screening results.

This flow chart illustrates the literature search and screening results for articles examining the relationship between infant milk-feeding practices, including feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants, and several outcomes, including food allergies, allergic rhinitis, atopic dermatitis, and asthma. The results of the electronic database searches were screened independently by two NESR analysts in a step-wise manner by reviewing titles and abstracts, and then full text articles to determine which articles met the criteria for inclusion. A manual search was done to ascertain articles not identified through the electronic database search. The systematic review on feeding a lower versus higher intensity, proportion, or amount of human milk to mixed-fed infants and food allergies, allergic rhinitis, atopic dermatitis, and asthma included 0 articles.

Table 2. Excluded articles.

Table 2

Excluded articles. The table below lists the full-text articles excluded with at least one reason for exclusion, and may not reflect all possible reasons.

Footnotes

7

U.S. Food and Drug Administration. Version 19 December 2013. Internet: https://www​.fda.gov/Food​/GuidanceRegulation​/GuidanceDocumentsRegulatoryInformation​/InfantFormula/ucm136118​.htm#manufacture (accessed March 23, 2018).

8

Food and Agriculture Organization of the United Nations. World Health Organization. Codex Alimentarius. International Food Standards. Standard for infant formula and formulas for special medical purposes intended for infants. Codex Stan 72-1981. 2007.

9

Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Taussig L, Martinez FD. Peak flow variability, methacholine responsiveness and atopy as markers for detecting different wheezing phenotypes in childhood. Thorax 1997;52(11):946–52. [PMC free article: PMC1758449] [PubMed: 9487341]

10

In 1980 the Infant Formula Act was passed, and December 2015 was when the literature search occurred

11

U.S. Food and Drug Administration. Version 19 December 2013. Internet: https://www​.fda.gov/Food​/GuidanceRegulation​/GuidanceDocumentsRegulatoryInformation​/InfantFormula/ucm136118​.htm#manufacture (accessed March 23, 2018).

12

Food and Agriculture Organization of the United Nations. World Health Organization. Codex Alimentarius. International Food Standards. Standard for infant formula and formulas for special medical purposes intended for infants. Codex Stan 72-1981. 2007.

13

United Nations Development Programme. Human Development Report 2014. Sustaining Human Progress: Reducing Vulnerabilities and Building Resilience. New York, 2014.

14

Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Taussig L, Martinez FD. Peak flow variability, methacholine responsiveness and atopy as markers for detecting different wheezing phenotypes in childhood. Thorax 1997;52(11):946–52. [PMC free article: PMC1758449] [PubMed: 9487341]

Copyright Notice

The contents of this document may be used and reprinted without permission. Endorsements by NESR, NGAD, CNPP, FNS, or USDA of derivative products developed from this work may not be stated or implied.

Bookshelf ID: NBK580362
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