Breast-Feeding and Childhood-Onset Type 1 Diabetes A pooled analysis of individual participant data from 43 observational studies
2012 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 35, no 11, 2215-2225 p.Article in journal (Refereed) Published
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. less thanbrgreater than less thanbrgreater thanRESEARCH 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. less thanbrgreater than less thanbrgreater thanRESULTS-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 andgt;2 weeks (20 studies; OR = 0.75, 95% CI 0.64-0.88), the association after exclusive breast-feeding for andgt;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 andgt;2 weeks (28 studies; OR = 0.93, 95% CI 0.81-1.07) or andgt;3 months (29 studies; OR = 0.88, 95% CI 0.78-1.00). These associations were all subject to marked heterogeneity (I-2 = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for andgt;2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75-0.99), and heterogeneity was reduced (I-2 = 0%). Adjustments for potential confounders altered these estimates very little. less thanbrgreater than less thanbrgreater thanCONCLUSIONS-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.
Place, publisher, year, edition, pages
American Diabetes Association , 2012. Vol. 35, no 11, 2215-2225 p.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-86376DOI: 10.2337/dc12-0438ISI: 000311424100023OAI: oai:DiVA.org:liu-86376DiVA: diva2:576894
Funding Agencies|National Institutes of Health|R01-DK-46498R01-DK-42316|Chinese Foundation of Health||Department of Health, Executive Yuan, Republic of China|DOH91-TD1167|Ministry for Science and Technology of the Republic of Serbia|175042|German Research Foundation|HE 234/1-1|Research Council of Norway|148359/330|2012-12-142012-12-142014-10-29