Impact of peanut consumption in the LEAP Study: Feasibility, growth, and nutrition

Abstract

BACKGROUND Early introduction of peanut is an effective strategy to prevent peanut allergy in high-risk infants; however, feasibility and effects on growth and nutritional intake are unknown. OBJECTIVE To evaluate the feasibility of introducing peanut in infancy and explore effects on growth and nutritional intake up to 60 months of age. METHODS In the Learning Early About Peanut Allergy (LEAP) trial, 640 atopic infants aged 4-11 months were randomly assigned to consume (6g peanut protein/week) or avoid peanut until 60 months of age. Peanut consumption and early feeding practices were assessed by questionnaire. Dietary intake was evaluated with prospective food diaries. Anthropometric measurements were taken at all study visits. RESULTS Peanut was successfully introduced and consumed until 60 months with median peanut protein intake of 7.5g/week (IQR 6.0-9.0) in the consumption group compared to 0g in the avoidance group. Introduction of peanut in breastfeeding infants did not affect the duration of breastfeeding. There were no differences in anthropometric measurements or energy intakes between groups at any visits. Regular peanut consumption led to differences in dietary intakes. Consumers had higher intakes of fat and avoiders had higher carbohydrate intakes; differences were greatest at the upper quartiles of peanut consumption. Protein intakes remained consistent between groups. CONCLUSIONS Introduction of peanut proved feasible in infants at high-risk of peanut allergy and did not affect the duration of breastfeeding nor impact negatively on growth or nutrition. Energy balance was achieved in both groups through variations in intakes from fat and carbohydrate while protein homeostasis was maintained.

Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel

“…However, it should be noted that data from the nutrition analysis of the LEAP cohort [27] indicate that introduction of peanut did not affect the duration or frequency of breast-feeding and did not influence growth or nutrition.Age of peanut introduction: for children with severe eczema, egg allergy, or both, the EP recommends that introduction of solid foods begins at 4–6 months of age, starting with solid food other than peanut, so that the child can demonstrate the ability to consume solid food without evidence of nonspecific signs and symptoms that could be confused with IgE-mediated food allergy. However, it is important to note that infants in the LEAP trial were enrolled between 4 and 11 months of age and benefitted from peanut consumption regardless of age at entry.…”

“…However, it should be noted that data from the nutrition analysis of the LEAP cohort [27] indicate that introduction of peanut did not affect the duration or frequency of breast-feeding and did not influence growth or nutrition.…”

Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–Sponsored Expert Panel

“…Breast-feeding recommendations: the EP recognizes that early introduction of peanut may seem to depart from recommendations for exclusive breast-feeding through 6 months of age [25,26]. However, it should be noted that data from the nutrition analysis of the LEAP cohort [27] indicate that introduction of peanut did not affect the duration or frequency of breastfeeding and did not influence growth or nutrition.…”

Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel

“…However, it should be noted that data from the nutrition analysis of the LEAP cohort 27 indicate that introduction of peanut did not affect the duration or frequency of breastfeeding, and did not influence growth or nutrition.…”