PURPOSE OF THE STUDY.
To evaluate the feasibility of peanut (PN) introduction in infancy and its effects on growth and nutrition.
This study was a planned secondary analysis from the LEAP trial (N Engl J Med. 2015;372:803–813), in which 4- to 11-month-old infants who tolerated PN were advised to eat 6 g of peanut protein per week to age 5 years. The control population included infants who did not tolerate PN during the LEAP trial.
PN consumption was monitored by using a validated questionnaire. Anthropomorphic measurements were taken and 3-day food diaries completed for each study visit. Average daily caloric intake and that of macro- and micronutrients were calculated.
The median age at screening was 7.8 months. Median peanut consumption exceeded 6 g throughout the study. Peanut introduction in infancy did not shorten the duration of breastfeeding. There was no difference between groups in weight, height, BMI, tricep skinfold thickness, or other anthropomorphic measurements. Total caloric intake was the same between groups. The percent of energy from carbohydrates was higher in the avoidance group at all time points, whereas the percent of energy from fat was higher in the PN consumption group, especially in the upper quartiles of consumption. The percent of energy from protein was comparable between groups. Similarly, there were no differences in the intake of sodium, calcium, iron, zinc, or vitamin D.
Early dietary introduction of peanut in high-risk infants who tolerate it has no effect on the duration of breastfeeding, growth, or nutrition.
The landmark LEAP study turned our approach to the early introduction of highly allergenic foods 180° by showing that it decreased children’s risk of developing PN allergy by ∼80%. This extension study demonstrates that early peanut introduction also has no detrimental effects on growth or nutrition. How and to whom should early PN introduction be offered? Infants with severe atopic dermatitis and/or egg allergy should be tested before an observed, in-office challenge per the LEAP protocol is considered. Children without food allergy and with only mild-to-moderate atopic dermatitis are considered to be at low risk for the development of PN allergy. They may have peanut introduction as tolerated at ∼6 months old only after at least 1 other solid is tolerated. Recipes for preparing PN to feed to appropriate infants are available (J Allergy Clin Immunol. 2017;139:29–44).
- Copyright © 2017 by the American Academy of Pediatrics