Timing of introduction of allergenic foods to the infant diet may influence the risk of allergic or autoimmune disease, but the evidence for this has not been comprehensively synthesized. OBJECTIVE To systematically review and meta-analyze evidence that timing of allergenic food introduction during infancy influences risk of allergic or autoimmune disease.

BackgroundThere is uncertainty about the influence of diet during pregnancy and infancy on a child’s immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease.Methods and findingsTwo authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease. We identified 260 original studies (964,143 participants) of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies (542,672 participants) of other maternal or infant dietary exposures, including 80 trials of maternal (n = 26), infant (n = 32), or combined (n = 22) interventions. Risk of bias was high in 125 (48%) milk feeding studies and 44 (25%) studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with nonpathogenic micro-organisms (probiotics) during late pregnancy and lactation may reduce risk of eczema (Risk Ratio [RR] 0.78; 95% CI 0.68–0.90; I2 = 61%; Absolute Risk Reduction 44 cases per 1,000; 95% CI 20–64), and 6 trials suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitisation to egg (RR 0.69, 95% CI 0.53–0.90; I2 = 15%; Absolute Risk Reduction 31 cases per 1,000; 95% CI 10–47). GRADE certainty of these findings was moderate. We found weaker support for the hypotheses that breastfeeding promotion reduces risk of eczema during infancy (1 intervention trial), that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus (28 observational studies), and that probiotics reduce risk of allergic sensitisation to cow’s milk (9 intervention trials), where GRADE certainty of findings was low. We did not find that other dietary exposures—including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake—influence risk of allergic or autoimmune disease. For many dietary exposures, data were inconclusive or inconsistent, such that we were unable to exclude the possibility of important beneficial or harmful effects. In this comprehensive systematic review, we were not able to include more recent observational studies or verify data via direct contact with authors, and we did not evaluate measures of food diversity during infancy.ConclusionsOur findings support a relationship between maternal diet and risk of immune-mediated diseases in the child. Maternal probiotic and ...

ObjeCtiveTo determine whether feeding infants with hydrolysed formula reduces their risk of allergic or autoimmune disease.

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There is need for a quantitative assessment of the importance of glaciohydraulic supercooling for basal ice formation and glacial sediment transfer. We assess the contribution of supercooling to stratified facies basal ice formation at Svı´nafellsj¨okull and Skaftafellsj¨okull, southeast Iceland, both of which experience supercooling. Five stratified basal ice subfacies have previously been identified at Svı´nafellsj¨okull, but their precise origins have not been determined. Analysis of stratified basal ice stable isotope compositions (d 18 O and dD), spatial distribution and physical characteristics demonstrates that two subfacies present at both glaciers are consistent with supercooling. These 'supercool' subfacies account for 42% of stratified facies exposed at Svı´nafellsj¨okull, although estimates at Skaftafellsj¨okull are precluded by limited basal ice exposure. Owing to their high debris contents, supercooling-related facies contribute a debris flux of 4.8 to 9.6 m 3 m À1 a À1 at Svı´nafellsj¨okull (83% of the stratified facies debris flux). Other stratified subfacies, formed by non-supercooling processes, account for 58% of the stratified basal ice at Svı´nafellsj¨okull, but only contribute a debris flux of 1.0 to 2.0 m 3 m À1 a À1 (17% of the stratified facies debris flux). We conclude that supercooling has a significant role in glacial sediment transfer, although in stratified basal ice formation its role is less significant at these locations than has been reported elsewhere.

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