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Appendices

Appendix 1. CENTRAL search strategy

All MeSH terms exploded

#1 MeSH descriptor: (Infant)

#2 neonat*:ti,ab,kw

#3 infant*:ti,ab,kw

#4 newborn*:ti,ab,kw

#5 pediatric*:ti,ab,kw

#6 paediatric*:ti,ab,kw

#7 #1 or #2 or #3 or #4 or #5 or #6

#8 MeSH descriptor: [Fatty Acids, Unsaturated]

#9 MeSH descriptor: [Fatty Acids, Omega‐3]

#10 MeSH descriptor: [Fatty Acids, Omega‐6]

#11 MeSH descriptor: [Dietary Fats, Unsaturated]

#12 MeSH descriptor: [Linolenic Acids]

#13 MeSH descriptor: [Linoleic Acids]

#14 MeSH descriptor: [Docosahexaenoic Acids]

#15 MeSH descriptor: [Eicosapentaenoic Acid]

#16 pufa:ti,ab,kw

#17 polyunsaturated*:ti,ab,kw

#18 omega‐3:ti,ab,kw

#19 omega‐6:ti,ab,kw

#20 linolenic*:ti,ab,kw

#21 linoleic*:ti,ab,kw

#22 docosahexaenoic*:ti,ab,kw

#23 eicosapentaenoic*:ti,ab,kw

#24 #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23

#25 #7 and #24=1079 records

Appendix 2. MEDLINE search strategy

All MeSH terms exploded

1. infant$.mp

2. infant.me

3. newborn$.mp

4. neonat$.mp

5. pediatric$.mp

6. paediatric$.mp

7. #1 OR #2 OR #3 OR #4 OR #5 OR #6

8. PUFA.mp

9. polyunsaturated$.mp

10. fatty acids, unsaturated.me

11. dietary fats, unsaturated.me

12. omega‐3.mp

13. fatty acids, omega‐3.me

14. omega‐6.mp

15. fatty acids, omega‐6.me

16. linolenic$.mp

17. linolenic acids.me

18. linoleic$.mp

19. linoleic acid.me

20. docosahexaenoic$.mp

21. docosahexaenoic acids.me

22. eicosapentaenoic$.mp

23. eicosapentaenoic acid.me

24. #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #22 OR #23

25. #7 AND #24

26. limit 25 to 'randomised controlled trial'=875 records

Appendix 3. EMBASE search strategy

All MeSH terms exploded

1. infant$.mp

2. newborn$.mp

3. neonat$.mp

4. pediatric$.mp

5. paediatric$.mp

6. exp pediatrics

7. #1 OR #2 OR #3 OR #4 OR #5 OR #6

8. PUFA.mp

9. polyunsaturated$.mp

10. exp polyunsaturated fatty acid

11. exp unsaturated fatty acid

12. omega‐3.mp

13. exp omega 3 fatty acid

14. omega‐6.mp

15. exp omega 6 fatty acid

16. linolenic$.mp

17.exp linolenic acid

18. linoleic$.mp

19.exp linoleic acid

20. docosahexaenoic$.mp

21. exp docosahexaenoic acid

22. eicosapentaenoic$.mp

23. exp icosapentaenoic acid

24. exp fish oil

25. #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24

26. #7 AND #25

27. limit 41 to 'randomised controlled trial'

Appendix 4. Risk of bias tool

1. Sequence generation (checking for possible selection bias)

For each included study, we described the method used to generate the allocation sequence in sufficient detail to allow an assessment of whether it should produce comparable groups. We assessed the method as:

  • low risk (any truly random process, e.g. random number table; computer random number generator);

  • high risk (any non‐random process, e.g. odd or even date of birth; hospital or clinic record number);

  • unclear risk.

2. Allocation concealment (checking for possible selection bias)

For each included study, we described the method used to conceal the allocation sequence in sufficient detail and determined whether intervention allocation could have been foreseen in advance of, or during recruitment, or changed after assignment.

We assessed the methods as:

  • low risk (e.g. telephone or central randomisation; consecutively numbered sealed opaque envelopes);

  • high risk (open random allocation; unsealed or non‐opaque envelopes, alternation; date of birth);

  • unclear risk.

3. Blinding of participants and personnel (checking for possible performance bias)

For each included study, we described the methods used, if any, to blind study participants and personnel from knowledge of which intervention a participant received. We judged studies to be at low risk of bias if they were blinded, or if we judged that the lack of blinding could not have affected the results.

We assessed the methods as:

  • low risk, high risk or unclear risk for participants;

  • low risk, high risk or unclear risk for personnel.

4. Blinding of outcome assessment (checking for possible detection bias)

For each included study, we described the methods used, if any, to blind outcome assessors from knowledge of which intervention a participant received. We judged studies to be at low risk of bias if they were blinded, or if we judged that the lack of blinding could not have affected the results.

We assessed the methods as:

  • low risk, high risk or unclear risk for blinding of outcome assessors.

5. Incomplete outcome data (checking for possible attrition bias through withdrawals, drop‐outs, protocol deviations)

For each included study and for each outcome or class of outcomes, we described the completeness of data including attrition and exclusions from the analysis. We stated whether attrition and exclusions were reported, the numbers included in the analysis at each stage (compared with the total randomised participants), reasons for attrition or exclusion where reported, and whether missing data were balanced across groups or were related to outcomes.

Where sufficient information was reported or could be supplied by the trial authors, we included missing data in the analyses. We assessed the methods as:

  • low risk (< 10% missing data);

  • high risk;

  • unclear risk.

6. Outcome reporting bias

For each included study, we assessed the possibility of selective outcome reporting bias by assessing the reported methodology in the trial publication and, when necessary, compared with the entry in the clinical trial registries, the original trial protocols, or both obtained by contacting study authors.

We assessed the methods as:

  • low risk (where it was clear that all of the study's prespecified outcomes and all expected outcomes of interest to the review were reported);

  • high risk (where not all the study's prespecified outcomes were reported; one or more reported primary outcomes were not prespecified; outcomes of interest were reported incompletely and so could not be used; study did not include results of a key outcome that would have been expected to have been reported);

  • unclear risk.

7. Other sources of bias

For each included study, we described any important concern we had about other possible sources of bias. We assessed whether each study was free of other problems that could put it at risk of bias. We assessed the methods as:

  • low risk;

  • high risk;

  • unclear risk.

Overall risk of bias

We made explicit judgements about whether studies were at high risk of bias, according to the criteria given in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). With reference to 1. to 7. above, we assessed the likely magnitude and direction of the bias and whether we considered it was likely to impact on the findings. We explored the impact of the level of bias through undertaking sensitivity analyses ‐ see Sensitivity analysis.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Higher versus lower PUFA intake, Outcome 1 All allergic disease.
Figuras y tablas -
Analysis 1.1

Comparison 1 Higher versus lower PUFA intake, Outcome 1 All allergic disease.

Comparison 1 Higher versus lower PUFA intake, Outcome 2 Asthma.
Figuras y tablas -
Analysis 1.2

Comparison 1 Higher versus lower PUFA intake, Outcome 2 Asthma.

Comparison 1 Higher versus lower PUFA intake, Outcome 3 Dermatitis/eczema.
Figuras y tablas -
Analysis 1.3

Comparison 1 Higher versus lower PUFA intake, Outcome 3 Dermatitis/eczema.

Comparison 1 Higher versus lower PUFA intake, Outcome 4 Allergic rhinitis.
Figuras y tablas -
Analysis 1.4

Comparison 1 Higher versus lower PUFA intake, Outcome 4 Allergic rhinitis.

Comparison 1 Higher versus lower PUFA intake, Outcome 5 Food allergy.
Figuras y tablas -
Analysis 1.5

Comparison 1 Higher versus lower PUFA intake, Outcome 5 Food allergy.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 1 All allergic disease ‐ infant incidence.
Figuras y tablas -
Analysis 2.1

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 1 All allergic disease ‐ infant incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 2 All allergic disease ‐ childhood incidence.
Figuras y tablas -
Analysis 2.2

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 2 All allergic disease ‐ childhood incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 3 All allergic disease ‐ childhood prevalence.
Figuras y tablas -
Analysis 2.3

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 3 All allergic disease ‐ childhood prevalence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 4 Asthma ‐ infant incidence.
Figuras y tablas -
Analysis 2.4

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 4 Asthma ‐ infant incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 5 Asthma ‐ childhood incidence.
Figuras y tablas -
Analysis 2.5

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 5 Asthma ‐ childhood incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 6 Asthma ‐ childhood prevalence.
Figuras y tablas -
Analysis 2.6

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 6 Asthma ‐ childhood prevalence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 7 Dermatitis/eczema ‐ infant incidence.
Figuras y tablas -
Analysis 2.7

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 7 Dermatitis/eczema ‐ infant incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 8 Dermatitis/eczema ‐ childhood incidence.
Figuras y tablas -
Analysis 2.8

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 8 Dermatitis/eczema ‐ childhood incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.
Figuras y tablas -
Analysis 2.9

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 10 Allergic rhinitis ‐ infant incidence.
Figuras y tablas -
Analysis 2.10

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 10 Allergic rhinitis ‐ infant incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 11 Allergic rhinitis ‐ childhood prevalence.
Figuras y tablas -
Analysis 2.11

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 11 Allergic rhinitis ‐ childhood prevalence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 12 Food allergy ‐ infant incidence.
Figuras y tablas -
Analysis 2.12

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 12 Food allergy ‐ infant incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 13 Food allergy ‐ childhood incidence.
Figuras y tablas -
Analysis 2.13

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 13 Food allergy ‐ childhood incidence.

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 14 Food allergy ‐ childhood prevalence.
Figuras y tablas -
Analysis 2.14

Comparison 2 Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother, Outcome 14 Food allergy ‐ childhood prevalence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 1 All allergic disease ‐ infant incidence.
Figuras y tablas -
Analysis 3.1

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 1 All allergic disease ‐ infant incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 2 All allergic disease ‐ childhood incidence.
Figuras y tablas -
Analysis 3.2

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 2 All allergic disease ‐ childhood incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 3 All allergic disease ‐ childhood prevalence.
Figuras y tablas -
Analysis 3.3

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 3 All allergic disease ‐ childhood prevalence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 4 Asthma ‐ infant incidence.
Figuras y tablas -
Analysis 3.4

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 4 Asthma ‐ infant incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 5 Asthma ‐ childhood incidence.
Figuras y tablas -
Analysis 3.5

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 5 Asthma ‐ childhood incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 6 Asthma ‐ childhood prevalence.
Figuras y tablas -
Analysis 3.6

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 6 Asthma ‐ childhood prevalence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 7 Dermatitis/eczema ‐ infant incidence.
Figuras y tablas -
Analysis 3.7

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 7 Dermatitis/eczema ‐ infant incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 8 Dermatitis/eczema ‐ childhood incidence.
Figuras y tablas -
Analysis 3.8

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 8 Dermatitis/eczema ‐ childhood incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.
Figuras y tablas -
Analysis 3.9

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 10 Allergic rhinitis ‐ infant incidence.
Figuras y tablas -
Analysis 3.10

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 10 Allergic rhinitis ‐ infant incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 11 Allergic rhinitis ‐ childhood prevalence.
Figuras y tablas -
Analysis 3.11

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 11 Allergic rhinitis ‐ childhood prevalence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 12 Food allergy ‐ infant incidence.
Figuras y tablas -
Analysis 3.12

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 12 Food allergy ‐ infant incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 13 Food allergy ‐ childhood incidence.
Figuras y tablas -
Analysis 3.13

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 13 Food allergy ‐ childhood incidence.

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 14 Food allergy ‐ childhood prevalence.
Figuras y tablas -
Analysis 3.14

Comparison 3 Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation, Outcome 14 Food allergy ‐ childhood prevalence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 1 All allergic disease ‐ infant incidence.
Figuras y tablas -
Analysis 4.1

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 1 All allergic disease ‐ infant incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 2 All allergic disease ‐ childhood incidence.
Figuras y tablas -
Analysis 4.2

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 2 All allergic disease ‐ childhood incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 3 All allergic disease ‐ childhood prevalence.
Figuras y tablas -
Analysis 4.3

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 3 All allergic disease ‐ childhood prevalence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 4 Asthma ‐ infant incidence.
Figuras y tablas -
Analysis 4.4

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 4 Asthma ‐ infant incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 5 Asthma ‐ childhood incidence.
Figuras y tablas -
Analysis 4.5

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 5 Asthma ‐ childhood incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 6 Asthma ‐ childhood prevalence.
Figuras y tablas -
Analysis 4.6

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 6 Asthma ‐ childhood prevalence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 7 Dermatitis/eczema ‐ infant incidence.
Figuras y tablas -
Analysis 4.7

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 7 Dermatitis/eczema ‐ infant incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 8 Dermatitis/eczema ‐ childhood incidence.
Figuras y tablas -
Analysis 4.8

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 8 Dermatitis/eczema ‐ childhood incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.
Figuras y tablas -
Analysis 4.9

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 10 Allergic rhinitis ‐ infant incidence.
Figuras y tablas -
Analysis 4.10

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 10 Allergic rhinitis ‐ infant incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 11 Allergic rhinitis ‐ childhood prevalence.
Figuras y tablas -
Analysis 4.11

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 11 Allergic rhinitis ‐ childhood prevalence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 12 Food allergy ‐ infant incidence.
Figuras y tablas -
Analysis 4.12

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 12 Food allergy ‐ infant incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 13 Food allergy ‐ childhood incidence.
Figuras y tablas -
Analysis 4.13

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 13 Food allergy ‐ childhood incidence.

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 14 Food allergy ‐ childhood prevalence.
Figuras y tablas -
Analysis 4.14

Comparison 4 Higher versus lower PUFA intake: subgrouped by method of infant feeding, Outcome 14 Food allergy ‐ childhood prevalence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 1 All allergic disease ‐ infant incidence.
Figuras y tablas -
Analysis 5.1

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 1 All allergic disease ‐ infant incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 2 All allergic disease ‐ childhood incidence.
Figuras y tablas -
Analysis 5.2

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 2 All allergic disease ‐ childhood incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 3 All allergic disease ‐ childhood prevalence.
Figuras y tablas -
Analysis 5.3

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 3 All allergic disease ‐ childhood prevalence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 4 Asthma ‐ infant incidence.
Figuras y tablas -
Analysis 5.4

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 4 Asthma ‐ infant incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 5 Asthma ‐ childhood incidence.
Figuras y tablas -
Analysis 5.5

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 5 Asthma ‐ childhood incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 6 Asthma ‐ childhood prevalence.
Figuras y tablas -
Analysis 5.6

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 6 Asthma ‐ childhood prevalence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 7 Dermatitis/eczema ‐ infant incidence.
Figuras y tablas -
Analysis 5.7

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 7 Dermatitis/eczema ‐ infant incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 8 Dermatitis/eczema ‐ childhood incidence.
Figuras y tablas -
Analysis 5.8

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 8 Dermatitis/eczema ‐ childhood incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.
Figuras y tablas -
Analysis 5.9

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 10 Allergic rhinitis ‐ infant incidence.
Figuras y tablas -
Analysis 5.10

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 10 Allergic rhinitis ‐ infant incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 11 Allergic rhinitis ‐ childhood prevalence.
Figuras y tablas -
Analysis 5.11

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 11 Allergic rhinitis ‐ childhood prevalence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 12 Food allergy ‐ infant incidence.
Figuras y tablas -
Analysis 5.12

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 12 Food allergy ‐ infant incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 13 Food allergy ‐ childhood incidence.
Figuras y tablas -
Analysis 5.13

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 13 Food allergy ‐ childhood incidence.

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 14 Food allergy ‐ childhood prevalence.
Figuras y tablas -
Analysis 5.14

Comparison 5 Higher versus lower PUFA intake: subgrouped by infant heredity for allergy, Outcome 14 Food allergy ‐ childhood prevalence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 1 All allergic disease ‐ infant incidence.
Figuras y tablas -
Analysis 6.1

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 1 All allergic disease ‐ infant incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 2 All allergic disease ‐ childhood incidence.
Figuras y tablas -
Analysis 6.2

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 2 All allergic disease ‐ childhood incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 3 All allergic disease ‐ childhood prevalence.
Figuras y tablas -
Analysis 6.3

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 3 All allergic disease ‐ childhood prevalence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 4 Asthma ‐ infant incidence.
Figuras y tablas -
Analysis 6.4

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 4 Asthma ‐ infant incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 5 Asthma ‐ childhood incidence.
Figuras y tablas -
Analysis 6.5

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 5 Asthma ‐ childhood incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 6 Asthma ‐ childhood prevalence.
Figuras y tablas -
Analysis 6.6

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 6 Asthma ‐ childhood prevalence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 7 Dermatitis/eczema ‐ infant incidence.
Figuras y tablas -
Analysis 6.7

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 7 Dermatitis/eczema ‐ infant incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 8 Dermatitis/eczema ‐ childhood incidence.
Figuras y tablas -
Analysis 6.8

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 8 Dermatitis/eczema ‐ childhood incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.
Figuras y tablas -
Analysis 6.9

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 9 Dermatitis/eczema ‐ childhood prevalence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 10 Allergic rhinitis ‐ infant incidence.
Figuras y tablas -
Analysis 6.10

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 10 Allergic rhinitis ‐ infant incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 11 Allergic rhinitis ‐ childhood prevalence.
Figuras y tablas -
Analysis 6.11

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 11 Allergic rhinitis ‐ childhood prevalence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 12 Food allergy ‐ infant incidence.
Figuras y tablas -
Analysis 6.12

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 12 Food allergy ‐ infant incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 13 Food allergy ‐ childhood incidence.
Figuras y tablas -
Analysis 6.13

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 13 Food allergy ‐ childhood incidence.

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 14 Food allergy ‐ childhood prevalence.
Figuras y tablas -
Analysis 6.14

Comparison 6 Higher versus lower PUFA intake: subgrouped by gestational age at birth, Outcome 14 Food allergy ‐ childhood prevalence.

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 1 Asthma.
Figuras y tablas -
Analysis 7.1

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 1 Asthma.

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 2 Dermatitis/eczema.
Figuras y tablas -
Analysis 7.2

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 2 Dermatitis/eczema.

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 3 Allergic rhinitis.
Figuras y tablas -
Analysis 7.3

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 3 Allergic rhinitis.

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 4 Food allergy.
Figuras y tablas -
Analysis 7.4

Comparison 7 Higher versus lower PUFA intake: sensitivity analysis, Outcome 4 Food allergy.

Summary of findings for the main comparison. Higher versus lower PUFA intake for the prevention of allergy ‐ infant incidence

Higher versus lower PUFA intake for the prevention of allergy ‐ infant incidence

Patient or population: infants
Settings: hospital or community
Intervention: higher versus lower PUFA intake

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Lower PUFA intake

Higher PUFA intake

All allergic disease ‐ infant incidence
Follow‐up: 1 years

Study population

RR 0.96
(0.73 to 1.26)

323
(1 study)

⊕⊝⊝⊝
very low1,2,3

395 per 1000

379 per 1000
(289 to 498)

Moderate

395 per 1000

379 per 1000
(288 to 498)

Asthma ‐ infant incidence
Follow‐up: 2 years

Study population

RR 1.04
(0.8 to 1.35)

1162
(3 studies)

⊕⊕⊝⊝
low4,5

160 per 1000

167 per 1000
(128 to 217)

Moderate

124 per 1000

129 per 1000
(99 to 167)

Dermatitis/eczema ‐ infant incidence
Follow‐up: 2 years

Study population

RR 0.93
(0.82 to 1.06)

1906
(7 studies)

⊕⊝⊝⊝
very low3,4,5

326 per 1000

303 per 1000
(267 to 346)

Moderate

323 per 1000

300 per 1000
(265 to 342)

Allergic rhinitis ‐ infant incidence
Follow‐up: 2 years

Study population

RR 0.47
(0.23 to 0.96)

594
(2 studies)

⊕⊝⊝⊝
very low3,4,5,6

74 per 1000

35 per 1000
(17 to 71)

Moderate

58 per 1000

27 per 1000
(13 to 56)

Food allergy ‐ infant incidence
Follow‐up: 2 years

Study population

RR 0.81
(0.56 to 1.19)

915
(3 studies)

⊕⊝⊝⊝
very low3,4,5,7

118 per 1000

95 per 1000
(66 to 140)

Moderate

150 per 1000

121 per 1000
(84 to 179)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PUFA: polyunsaturated fatty acid; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Losses to follow‐up
2 Reported by single study only.
3 Wide confidence intervals.
4 Single high quality study.
5 Reported by a minority of studies.
6 Single study reported an effect.
7 Substantial heterogeneity.

Figuras y tablas -
Summary of findings for the main comparison. Higher versus lower PUFA intake for the prevention of allergy ‐ infant incidence
Summary of findings 2. Higher versus lower PUFA intake for the prevention of allergy ‐ childhood incidence

Higher versus lower PUFA intake for the prevention of allergy ‐ childhood incidence

Patient or population: infants
Settings: hospital or community
Intervention: higher versus lower PUFA intake

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Lower PUFA intake

Higher PUFA intake

All allergic disease ‐ childhood incidence
Follow‐up: 3 years

Study population

RR 0.69
(0.47 to 1.02)

154
(2 studies)

⊕⊝⊝⊝
very low1,2,3,4

519 per 1000

358 per 1000
(244 to 529)

Moderate

483 per 1000

333 per 1000
(227 to 493)

Asthma ‐ childhood incidence
Follow‐up: 3 years

Study population

RR 0.45
(0.2 to 1.02)

89
(1 study)

⊕⊝⊝⊝
very low1,3,5

353 per 1000

159 per 1000
(71 to 360)

Moderate

353 per 1000

159 per 1000
(71 to 360)

Dermatitis/eczema ‐ childhood incidence
Follow‐up: 3 years

Study population

RR 0.65
(0.34 to 1.24)

154
(2 studies)

⊕⊝⊝⊝
very low1,3,4

266 per 1000

173 per 1000
(90 to 330)

Moderate

238 per 1000

155 per 1000
(81 to 295)

Food allergy ‐ childhood incidence
Follow‐up: 3 years

Study population

RR 2.27
(0.25 to 20.68)

65
(1 study)

⊕⊝⊝⊝
very low1,3,5

36 per 1000

81 per 1000
(9 to 739)

Moderate

36 per 1000

82 per 1000
(9 to 744)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PUFA: polyunsaturated fatty acid; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Very high losses to follow‐up.
2 Moderate heterogeneity.
3 Wide confidence intervals.
4 Minority of studies reported outcome.
5 Reported by single study.

Figuras y tablas -
Summary of findings 2. Higher versus lower PUFA intake for the prevention of allergy ‐ childhood incidence
Summary of findings 3. Higher versus lower PUFA intake for the prevention of allergy ‐ Childhood prevalence

Higher versus lower PUFA intake for the prevention of allergy ‐ childhood prevalence

Patient or population: infants
Settings: hospital or community
Intervention: higher versus lower PUFA intake

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Lower PUFA intake

Higher PUFA intake

All allergic disease ‐ childhood prevalence
Follow‐up: 3 years

Study population

RR 0.98
(0.81 to 1.19)

633
(2 studies)

⊕⊝⊝⊝
very low1,2,3

394 per 1000

386 per 1000
(319 to 469)

Moderate

372 per 1000

365 per 1000
(301 to 443)

Asthma ‐ childhood prevalence
Follow‐up: 3 years

Study population

RR 1.12
(0.82 to 1.53)

635
(2 studies)

⊕⊝⊝⊝
very low1,3,4,5

188 per 1000

210 per 1000
(154 to 287)

Moderate

164 per 1000

184 per 1000
(134 to 251)

Dermatitis/eczema ‐ childhood prevalence
Follow‐up: 3 years

Study population

RR 0.81
(0.59 to 1.09)

635
(2 studies)

⊕⊝⊝⊝
very low1,2,3

229 per 1000

186 per 1000
(135 to 250)

Moderate

219 per 1000

177 per 1000
(129 to 239)

Allergic rhinitis ‐ childhood prevalence
Follow‐up: 3 years

Study population

RR 1.02
(0.83 to 1.25)

635
(2 studies)

⊕⊝⊝⊝
very low1,2,3

331 per 1000

338 per 1000
(275 to 414)

Moderate

220 per 1000

224 per 1000
(183 to 275)

Food allergy ‐ childhood prevalence
Follow‐up: 3 years

Study population

RR 0.27
(0.06 to 1.19)

119
(1 study)

⊕⊝⊝⊝
very low2,4

138 per 1000

37 per 1000
(8 to 165)

Moderate

139 per 1000

38 per 1000
(8 to 165)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PUFA: polyunsaturated fatty acid; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Losses to follow‐up > 10%.
2 Wide confidence intervals.
3 Reported by a minority of studies.
4 Reported by single study.
5 Very high losses to follow‐up.

Figuras y tablas -
Summary of findings 3. Higher versus lower PUFA intake for the prevention of allergy ‐ Childhood prevalence
Comparison 1. Higher versus lower PUFA intake

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Infant incidence

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

1.2 Childhood incidence

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.47, 1.02]

1.3 Childhood prevalence

2

633

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.19]

2 Asthma Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Infant incidence

3

1162

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.80, 1.35]

2.2 Childhood incidence

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

2.3 Childhood prevalence

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

3 Dermatitis/eczema Show forest plot

9

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Infant incidence

7

1906

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.82, 1.06]

3.2 Childhood incidence

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.34, 1.24]

3.3 Childhood prevalence

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.09]

4 Allergic rhinitis Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Infant incidence

2

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.23, 0.96]

4.2 Childhood prevalence

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.25]

5 Food allergy Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Infant incidence

3

915

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.56, 1.19]

5.2 Childhood incidence

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

5.3 Childhood prevalence

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 1. Higher versus lower PUFA intake
Comparison 2. Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease ‐ infant incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Infant supplementation

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

2 All allergic disease ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Infant supplementation

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.34, 0.92]

2.2 Maternal supplementation

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.51, 1.91]

3 All allergic disease ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Infant supplementation

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.83, 1.25]

3.2 Maternal supplementation

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.44, 1.38]

4 Asthma ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Infant supplementation

1

554

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.78, 1.81]

4.2 Maternal supplementation

2

608

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.69, 1.33]

5 Asthma ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Infant supplementation

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

6 Asthma ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Infant supplementation

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.82, 1.57]

6.2 Maternal supplementation

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.41, 2.72]

7 Dermatitis/eczema ‐ infant incidence Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Infant supplementation

5

1245

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.11]

7.2 Maternal supplementation

3

661

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.68, 1.15]

8 Dermatitis/eczema ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Infant supplementation

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.25, 1.20]

8.2 Maternal supplementation

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.28, 3.20]

9 Dermatitis/eczema ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Infant supplementation

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.62, 1.18]

9.2 Maternal supplementation

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.23, 1.36]

10 Allergic rhinitis ‐ infant incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Maternal supplementation

2

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.23, 0.96]

11 Allergic rhinitis ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Infant supplementation

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.83, 1.25]

11.2 Maternal supplementation

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.18, 8.26]

12 Food allergy ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Infant supplementation

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.47, 1.42]

12.2 Maternal supplementation

2

592

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.48, 1.37]

13 Food allergy ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Maternal supplementation

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

14 Food allergy ‐ childhood prevalence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 Maternal supplementation

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 2. Higher versus lower PUFA intake: subgrouped by supplementation of infant versus supplementation of mother
Comparison 3. Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease ‐ infant incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 n‐3 supplementation

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

2 All allergic disease ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 n‐3 supplementation

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.47, 1.02]

3 All allergic disease ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 n‐3 supplementation

2

633

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.19]

4 Asthma ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 n‐3 supplementation

3

1162

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.80, 1.35]

5 Asthma ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 n‐3 supplementation

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

6 Asthma ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 n‐3 supplementation

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

7 Dermatitis/eczema ‐ infant incidence Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 n‐3 supplementation

5

1657

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.09]

7.2 n‐6 supplementation

2

249

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.59, 1.23]

8 Dermatitis/eczema ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 n‐3 supplementation

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.34, 1.24]

9 Dermatitis/eczema ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 n‐3 supplementation

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.09]

10 Allergic rhinitis ‐ infant incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 n‐3 supplementation

2

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.23, 0.96]

11 Allergic rhinitis ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 n‐3 supplementation

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.25]

12 Food allergy ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 n‐3 supplementation

3

915

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.56, 1.19]

13 Food allergy ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 n‐3 supplementation

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

14 Food allergy ‐ childhood prevalence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 n‐3 supplementation

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 3. Higher versus lower PUFA intake: subgrouped by n‐3 versus n‐6 supplementation
Comparison 4. Higher versus lower PUFA intake: subgrouped by method of infant feeding

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease ‐ infant incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Human milk fed infants

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

2 All allergic disease ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Human milk fed infants

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.51, 1.91]

2.2 Formula fed infants

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.34, 0.92]

3 All allergic disease ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Human milk fed infants

2

633

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.19]

4 Asthma ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5 Asthma ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Formula fed infants

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

6 Asthma ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Human milk fed infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

7 Dermatitis/eczema ‐ infant incidence Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Human milk fed infants

6

1715

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.82, 1.09]

7.2 Formula fed infants

2

191

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.57, 1.23]

8 Dermatitis/eczema ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Human milk fed infants

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.28, 3.20]

8.2 Formula fed infants

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.25, 1.20]

9 Dermatitis/eczema ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Human milk fed infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.09]

10 Allergic rhinitis ‐ infant incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Human milk fed infants

2

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.23, 0.96]

11 Allergic rhinitis ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Human milk fed infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.25]

12 Food allergy ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Human milk fed infants

3

915

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.56, 1.19]

13 Food allergy ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Human milk fed infants

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

14 Food allergy ‐ childhood prevalence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 Human milk fed infants

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 4. Higher versus lower PUFA intake: subgrouped by method of infant feeding
Comparison 5. Higher versus lower PUFA intake: subgrouped by infant heredity for allergy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease ‐ infant incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 High risk for allergy

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

2 All allergic disease ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Risk for allergy not selected

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.47, 1.02]

3 All allergic disease ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 High risk for allergy

2

633

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.19]

4 Asthma ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 High risk for allergy

2

673

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.79, 1.71]

4.2 Risk for allergy not selected

1

489

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.66, 1.34]

5 Asthma ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Risk for allergy not selected

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

6 Asthma ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 High risk for allergy

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

7 Dermatitis/eczema ‐ infant incidence Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 High risk for allergy

5

1245

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.81, 1.12]

7.2 Risk for allergy not selected

2

661

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.71, 1.12]

8 Dermatitis/eczema ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Risk for allergy not selected

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.34, 1.24]

9 Dermatitis/eczema ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 High risk for allergy

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.09]

10 Allergic rhinitis ‐ infant incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 High risk for allergy

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.18, 8.26]

10.2 Risk for allergy not selected

1

475

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.18, 0.89]

11 Allergic rhinitis ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 High risk for allergy

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.25]

12 Food allergy ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 High risk for allergy

2

442

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.38, 1.02]

12.2 Risk for allergy not selected

1

473

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.67, 2.31]

13 Food allergy ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Risk for allergy not selected

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

14 Food allergy ‐ childhood prevalence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 High risk for allergy

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 5. Higher versus lower PUFA intake: subgrouped by infant heredity for allergy
Comparison 6. Higher versus lower PUFA intake: subgrouped by gestational age at birth

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All allergic disease ‐ infant incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Term infants

1

323

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.73, 1.26]

2 All allergic disease ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Term infants

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.47, 1.02]

3 All allergic disease ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Term infants

2

633

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.19]

4 Asthma ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Term infants

2

673

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.79, 1.71]

4.2 Preterm infants

1

489

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.66, 1.34]

5 Asthma ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Term infants

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.02]

6 Asthma ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Term infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.82, 1.53]

7 Dermatitis/eczema ‐ infant incidence Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Term infants

6

1422

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.80, 1.07]

7.2 Preterm infants

1

484

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.71, 1.29]

8 Dermatitis/eczema ‐ childhood incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Term infants

2

154

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.34, 1.24]

9 Dermatitis/eczema ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Term infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.59, 1.09]

10 Allergic rhinitis ‐ infant incidence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Term infants

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.18, 8.26]

10.2 Preterm infants

1

475

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.18, 0.89]

11 Allergic rhinitis ‐ childhood prevalence Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 Term infants

2

635

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.83, 1.25]

12 Food allergy ‐ infant incidence Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 Term infants

2

442

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.38, 1.02]

12.2 Preterm infants

1

473

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.67, 2.31]

13 Food allergy ‐ childhood incidence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Term infants

1

65

Risk Ratio (M‐H, Fixed, 95% CI)

2.27 [0.25, 20.68]

14 Food allergy ‐ childhood prevalence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 Term infants

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.06, 1.19]

Figuras y tablas -
Comparison 6. Higher versus lower PUFA intake: subgrouped by gestational age at birth
Comparison 7. Higher versus lower PUFA intake: sensitivity analysis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Asthma Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Infant incidence

1

489

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.66, 1.34]

2 Dermatitis/eczema Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Infant incidence

1

484

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.71, 1.29]

3 Allergic rhinitis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Infant incidence

1

475

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.18, 0.89]

4 Food allergy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Infant incidence

1

473

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.67, 2.31]

Figuras y tablas -
Comparison 7. Higher versus lower PUFA intake: sensitivity analysis