Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Inner Mongolia Dairy Technology Research Institute, Hohhot, China; Inner Mongolia Yili Industrial Group, Yili Maternal and Infant Nutrition Institute (YMINI), Beijing, China.
Adv Nutr. 2024 May;15(5):100217. doi: 10.1016/j.advnut.2024.100217. Epub 2024 Apr 4.
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.
尽管部分水解配方（PHF）或完全水解配方（EHF）牛奶蛋白被广泛推荐用于预防过敏性疾病（AD），但与牛奶配方（CMF）或母乳（BM）相比，其疗效的临床研究尚无定论。我们旨在系统评估 PHF 或 EHF 与 CMF 或 BM 相比对儿童 AD（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。我们检索了从成立到 2022 年 10 月 21 日发表的 PubMed、Embase、Cochrane 图书馆和 Web of Science 中的临床试验。我们使用推荐评估、制定与评估（GRADE）方法来评估证据的强度。总体而言，纳入了 24 项试验（10950 名婴儿），其中 17 项专门纳入了高危婴儿。与 CMF 相比，早期给予 EHF 的婴儿在 0-2 岁时患牛奶过敏的风险较低，这一证据的 GRADE 评级为低（相对风险 [RR]：0.62；95%CI：0.39，0.99）。有中等质量证据支持 PHF 和 EHF 分别降低 2 岁以下和 2 岁以上儿童湿疹的风险（RR：0.71；95%CI：0.52，0.96；和 RR：0.79；95%CI：0.67，0.94）。我们还发现了中等系统证据表明，与 CMF 相比，PHF 降低了 0-2 岁儿童喘息的风险（RR：0.50；95%CI：0.29，0.85），但 PHF 和 EHF 增加了与 BM 相比的风险（RR：1.61；95%CI：1.11，2.31；和 RR：1.64；95%CI：1.26，2.14）。PHF 和 EHF 对任何年龄的儿童的其他 AD 均无显著影响。总之，与 CMF 相比，PHF、EHF 对牛奶过敏、湿疹和喘息有不同的预防作用。与 BM 相比，PHF 和 EHF 均可能增加喘息的风险，但不会增加其他 AD 的风险。鉴于大多数试验仅纳入高危婴儿，在尝试任何推广之前，有必要对非高危婴儿进行更多研究。本方案已在 PROSPERO 上注册，注册号为 CRD42022320787。
