Breast-Feeding and Childhood-Onset Type 1 Diabetes

Author:

Cardwell Chris R.1,Stene Lars C.23,Ludvigsson Johnny4,Rosenbauer Joachim5,Cinek Ondrej6,Svensson Jannet7,Perez-Bravo Francisco8,Memon Anjum9,Gimeno Suely G.10,Wadsworth Emma J.K.11,Strotmeyer Elsa S.12,Goldacre Michael J.13,Radon Katja14,Chuang Lee-Ming15,Parslow Roger C.16,Chetwynd Amanda17,Karavanaki Kyriaki18,Brigis Girts19,Pozzilli Paolo20,UrbonaitĖ Brone21,Schober Edith22,Devoti Gabriele23,Sipetic Sandra24,Joner Geir2526,Ionescu-Tirgoviste Constantin27,de Beaufort Carine E.28,Harrild Kirsten29,Benson Victoria30,Savilahti Erkki31,Ponsonby Anne-Louise32,Salem Mona33,Rabiei Samira34,Patterson Chris C.1

Affiliation:

1. School of Medicine and Dentistry, Queen’s University Belfast, Belfast, U.K.

2. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

3. Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway

4. Department of Clinical Experimental Medicine, Division of Pediatrics, Linkoping University Hospital, Linkoping, Sweden

5. Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Institute at Duesseldorf University, Duesseldorf, Germany

6. Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Motol, Czech Republic

7. Pediatric Department, Herlev University Hospital, Herlev, Denmark

8. Department of Nutrition, Faculty of Medicine, Laboratory of Nutritional Genomics, University of Chile, Santiago, Chile

9. Division of Primary Care and Public Health, Brighton and Sussex Medical School and NHS Brighton and Hove, Brighton, U.K.

10. Preventive Medicine Department, Federal University of São Paulo, São Paulo, Brazil

11. Cardiff Work Environment Research Centre, Cardiff University, Cardiff, U.K.

12. Department of Epidemiology, Graduate School of Public Health, Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, Pennsylvania

13. Department of Public Health, Oxford University, Oxford, U.K.

14. Institute and Outpatient Clinic for Occupational and Environmental Medicine, Hospital of the Ludwig Maximilian University Munich, Munich, Germany

15. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

16. Paediatric Epidemiology Group, University of Leeds, Leeds, U.K.

17. Mathematics and Statistics Department, Lancaster University, Lancaster, U.K.

18. Second University Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

19. Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia

20. University Campus Bio-Medico, Rome, Italy

21. Institute of Endocrinology of Lithuanian University of Health Science, Kaunas, Lithuania

22. Department of Paediatrics, Medical University of Vienna, Vienna, Austria

23. Department of Social Sciences and Communication, University of Salento, Lecce, Italy

24. School of Medicine, Institute of Epidemiology, Belgrade University, Belgrade, Serbia

25. Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway

26. Department of Paediatrics, Oslo University Hospital, Oslo, Norway

27. Nutrition and Metabolic Diseases Clinic, N. Paulescu Institute of Diabetes, Bucharest, Romania

28. Clinique Pédiatrique Luxembourg, Luxembourg City, Luxembourg

29. Medical Statistics Team, University of Aberdeen, Aberdeen, U.K.

30. Cancer Epidemiology Unit, University of Oxford, Oxford, U.K.

31. Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland

32. Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, Australia

33. Paediatrics Department, Ain Shams University, Cairo, Egypt

34. Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran

Abstract

OBJECTIVE To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders. RESEARCH DESIGN AND METHODS Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies. RESULTS Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64–0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies; OR = 0.87, 95% CI 0.75–1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81–1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78–1.00). These associations were all subject to marked heterogeneity (I2 = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75–0.99), and heterogeneity was reduced (I2 = 0%). Adjustments for potential confounders altered these estimates very little. CONCLUSIONS The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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