title: Population response to change in infant feeding guidelines for allergy prevention.
abstract: BACKGROUND
  It is unknown whether population infant feeding practices have changed since recently revised Australian allergy guidelines removed recommendations to delay allergenic solids.
  
  
  OBJECTIVE
  We sought to determine whether updated 2008 guidelines were associated with changes in feeding practice and to determine whether sociodemographic factors influenced this response.
  
  
  METHODS
  In a population-based, cross-sectional study (HealthNuts) of 5276 infants recruited between 2007 and 2011 in Melbourne, Australia, parents reported on infant feeding practices. Multinomial logistic regression was used to investigate the associations between recruitment year and feeding practices and whether these associations were modified by sociodemographic factors.
  
  
  RESULTS
  Compared with participants recruited in 2007-2009, those recruited in 2009-2011 were more likely to introduce solids at age 4 months (adjusted multinomial odds ratio [aMOR], 1.21; 95% CI, 1.02-1.45; P = .032) and less likely to introduce solids at age 6 months (aMOR, 0.80; 95% CI, 0.69-0.92; P = .002), egg after 6 months (aMOR, 0.82; 95% CI, 0.71-0.94; P = .004), and peanut after 12 months (aMOR, 0.70; 95% CI, 0.49-0.98; P = .037). Although parents recruited in 2009-2011 were less likely to formula feed (aMOR, 0.84; 95% CI, 0.72-0.98; P = .023), formula-fed infants were more likely to be given a partially hydrolyzed formula (aMOR, 1.37; 95% CI, 1.12-1.70; P = .003). These changes were significantly stronger among families with a higher socioeconomic status and those without a family history of allergies.
  
  
  CONCLUSIONS
  Updated national allergy guidelines are associated with reduced delay in introduction of solids, egg, and peanut and an increase in partially hydrolyzed formula use among formula-fed infants. Higher socioeconomic status and absence of family history of allergies were associated with better uptake of feeding guidelines.
authors.affiliation: Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Dean
authors.initials: D
authors.lastname: Tey
authors.affiliation: Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; University of Manchester, Manchester, United Kingdom. Electronic address: katie.allen@rch.org.au.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Allen
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Peters
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Koplin
authors.affiliation: Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Mimi L K
authors.initials: ML
authors.lastname: Tang
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia.
authors.forename: Lyle C
authors.initials: LC
authors.lastname: Gurrin
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Ponsonby
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Lowe
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
authors.affiliation: Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, Australia.
authors.forename: Shyamali C
authors.initials: SC
authors.lastname: Dharmage
mesh_terms: D000485:Allergens / Q000276:immunology; D000818:Animals; D010367:Arachis / Q000276:immunology; D001315:Australia; D004531:Eggs; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data*; D008297:Male; D008892:Milk / Q000276:immunology; D018673:Nutrition Policy; D033542:Pandalidae / Q000276:immunology; D010290:Parents; D015995:Prevalence; D031685:Sesamum / Q000276:immunology; D012758:Shellfish; D012882:Skin Tests; D012923:Social Class
chemical_list: D000485:Allergens
keywords: Adjusted multinomial odds ratio; Food allergy; MOR; Multinomial odds ratio; aMOR; egg; family history; formula; guidelines; infant feeding; peanut; solids; weaning