Infant Formulas With Partially or Extensively Hydrolyzed Milk Proteins for the Prevention of Allergic Diseases: A Systematic Review and Meta-Analysis of Clinical Trials

IF 8 1区医学 Q1 NUTRITION & DIETETICS

Advances in Nutrition Pub Date : 2024-04-04 DOI:10.1016/j.advnut.2024.100217

Xiaoxu Li , Tingchao He , Sufang Duan , Jinghong Liang , Gang Feng , Fang Li , Zhenyu Shen , Wenhui Ye , Biao Liu , Bibo Jiang , Yujing Chen , Nan Liu , Ignatius Man-Yau Szeto , Li Cai

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引用次数: 0

Abstract

Despite the widely recommended usage of partially hydrolyzed formula (PHF) or extensively hydrolyzed formula (EHF) of milk protein for preventing allergic diseases (ADs), clinical studies have been inconclusive regarding their efficacy compared with that of cow's milk formula (CMF) or breast milk (BM). We aimed to systematically evaluate the effects of PHF or EHF compared with those of CMF or BM on risk of ADs (cow's milk allergy, allergic rhinitis, eczema, asthma, wheeze, food allergy, and sensitization) in children. We searched PubMed, Embase, Cochrane Library, and Web of Science for clinical trials published from inception to 21 October, 2022. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to grade the strength of evidence. Overall, 24 trials (10,950 infants) were included, 17 of which specifically included high-risk infants. GRADE was low for the evidence that, compared with CMF, infants early fed with EHF had lower risk of cow's milk allergy at age 0–2 y [relative risk (RR): 0.62; 95% CI: 0.39, 0.99]. Moderate evidence supported that PHF and EHF reduced risk of eczema in children aged younger or older than 2 y, respectively (RR: 0.71; 95% CI: 0.52, 0.96; and RR: 0.79; 95% CI: 0.67, 0.94, respectively). We also identified moderate systematic evidence indicating that PHF reduced risk of wheeze at age 0–2 y compared with CMF (RR: 0.50; 95% CI: 0.29, 0.85), but PHF and EHF increased the risk compared with BM (RR: 1.61; 95% CI: 1.11, 2.31; and RR: 1.64; 95% CI: 1.26, 2.14). Neither PHF nor EHF had significant effects on other ADs in children of any age. In conclusion, compared with CMF, PHF, or EHF had different preventive effect on cow's milk allergy, eczema, and wheeze. Compared with BM, both PHF and EHF may increase risk of wheeze but not other ADs. Given that most trials included only high-risk infants, more research on non–high-risk infants is warranted before any generalization is attempted.

This protocol was registered at PROSPERO as CRD42022320787.

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含部分或大量水解牛奶蛋白的婴儿配方奶粉用于预防过敏性疾病：临床试验的系统回顾和元分析

尽管人们广泛推荐使用牛奶蛋白部分水解配方奶粉（PHF）或广泛水解配方奶粉（EHF）来预防过敏性疾病（ADs），但与牛奶配方奶粉（CMF）或母乳（BM）相比，临床研究对其疗效并无定论。我们的目的是系统评估 PHF 或 EHF 与 CMF 或 BM 相比对儿童 ADs（牛奶过敏、过敏性鼻炎、湿疹、哮喘、喘息、食物过敏和致敏）风险的影响。我们在 PubMed、Embase、Cochrane Library 和 Web of Science 中检索了从开始到 2022 年 10 月 21 日发表的临床试验。我们采用建议评估、发展和评价分级法（GRADE）对证据的强度进行了分级。总共纳入了 24 项试验（10,950 名婴儿），其中 17 项试验特别纳入了高风险婴儿。有证据表明，与 CMF 相比，早期喂养 EHF 的婴儿在 0-2 岁时发生牛奶过敏的风险较低[相对风险 (RR)：0.62；95% CI：0.39, 0.99]，该证据的 GRADE 值较低。中度证据支持 PHF 和 EHF 可分别降低 2 岁以下或 2 岁以上儿童患湿疹的风险（RR：0.71；95% CI：0.52，0.96；RR：0.79；95% CI：0.67，0.94）。我们还发现中度系统性证据表明，与 CMF 相比，PHF 可降低 0-2 岁患喘鸣症的风险（RR：0.50；95% CI：0.29，0.85），但与 BM 相比，PHF 和 EHF 会增加患喘鸣症的风险（RR：1.61；95% CI：1.11，2.31；RR：1.64；95% CI：1.26，2.14）。PHF和EHF对任何年龄儿童的其他AD均无明显影响。总之，与CMF相比，PHF或EHF对牛奶过敏、湿疹和喘息有不同的预防效果。与 BM 相比，PHF 和 EHF 可能会增加患喘息的风险，但不会增加其他 ADs 的风险。鉴于大多数试验只纳入了高风险婴儿，因此在试图进行任何推广之前，有必要对非高风险婴儿进行更多的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Nutrition 医学-营养学

CiteScore

17.40

自引率

2.20%

发文量

117

审稿时长

56 days

期刊介绍： Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.

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