Infants and toddlers are dropping acid: Do commercial infant and toddler foods cause epithelial injury and predispose to the development of food allergy?

Abstract

Background:

Food intake in early life plays an important role in providing nutrients and setting the child up for lifelong eating habits. One aspect of early‐life foods that has been ignored is the role of the pH, on the development of oesophageal inflammation. The acidic environment within the oesophageal lumen has been linked to oesophageal inflammation and barrier injury, relating to oesophageal diseases such as EoE and GORD. We noticed an increase in the incidence of both EoE and GORD alongside an increase in the sales of infant/toddler foods, commonly containing fruit or citric acids to create a preservative free option.

Method:

We measured the pH of commercially available infant/toddler/toddler foods; pouches, infant/toddler jars and infant formula and compared to home‐made foods. We considered a pH of <4 as likely to cause oesophageal/epithelial damage.

Results:

29 of 60 tested commercially available infant and toddler feeds and bottles in Australian supermarkets were found to have a pH less than 4. This was infrequent with home‐prepared foods where the pH was less than 4 in 2 of the 8 foods. In particular, products containing apple puree and citric acid were acidification factors.

Conclusion:

Many commercially available infant/toddler foods have the capacity to induce epithelial injury due to its low pH. This has implications that require further investigation for the pathogenesis and also for the prevention and treatment of oesophageal diseases. Epithelial barrier integrity and inflammation has become a recent focus in the aetiology of allergic diseases; which are also dramatically increasing in the last few decades.