title: Early infant multivitamin supplementation is associated with increased risk for food allergy and asthma.
abstract: OBJECTIVE
  Dietary vitamins have potent immunomodulating effects in vitro. Individual vitamins have been shown to skew T cells toward either T-helper 1 or T-helper 2 phenotypic classes, suggesting that they may participate in inflammatory or allergic disease. With the exception of antioxidant protection, there has been little study on the effect of early vitamin supplementation on the subsequent risk for asthma and allergic disease. The objective of this study was to determine whether early vitamin supplementation during infancy affects the risk for asthma and allergic disease during early childhood.
  
  
  METHODS
  Cohort data were analyzed from the National Center for Health Statistics 1988 National Maternal-Infant Health Survey, which followed pregnant women and their newborns, and the 1991 Longitudinal Follow-up of the same patients, which measured health and disease outcomes. Patients were stratified by race and breastfeeding status. Factors that are known to be associated with alteration of risk for asthma or food allergies were identified using univariate logistic regression. Those factors were then analyzed in multivariate logistic regression models. Early vitamin supplementation was defined as vitamin use within the first 6 months.
  
  
  RESULTS
  There were >8000 total patients in the study. The overall incidence of asthma was 10.5% and of food allergy was 4.9%. In univariate analysis, male gender, smoker in the household, child care, prematurity (<37 weeks), being black, no history of breastfeeding, lower income, and lower education were associated with higher risk for asthma. Child care, higher levels of education, income, and history of breastfeeding were associated with a higher risk for food allergies. In multivariate logistic analyses, a history of vitamin use within the first 6 months of life was associated with a higher risk for asthma in black infants (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.04-1.56). Early vitamin use was also associated with a higher risk for food allergies in the exclusively formula-fed population (OR: 1.63; 95% CI: 1.21-2.20). Vitamin use at 3 years of age was associated with increased risk for food allergies but not asthma in both breastfed (OR: 1.62; 95% CI: 1.19-2.21) and exclusively formula-fed infants (OR: 1.39; 95% CI: 1.03-1.88).
  
  
  CONCLUSIONS
  Early vitamin supplementation is associated with increased risk for asthma in black children and food allergies in exclusively formula-fed children. Additional study is warranted to examine which components most strongly contribute to this risk.
authors.affiliation: Department of Pediatrics, Children's National Medical Center, Washington, DC, USA. jdmilner@niaid.nih.gov
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Milner
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Stein
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
mesh_terms: D000704:Analysis of Variance; D001249:Asthma / Q000208:ethnology / Q000209:etiology*; D044383:Black People; D001942:Breast Feeding; D002675:Child, Preschool; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D005512:Food Hypersensitivity / Q000209:etiology*; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D014815:Vitamins / Q000009:adverse effects / Q000276:immunology*
chemical_list: D014815:Vitamins