Breast-feeding and childhood-onset type 1 diabetes : A pooled analysis of individual participant data from 43 observational studies
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Date
2012-11
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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 (I 2 = 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 (I 2 = 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.
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Keywords
3.2 Clinical medicine, 3.3 Health sciences, 1.1. Scientific article indexed in Web of Science and/or Scopus database, Internal Medicine, Endocrinology, Diabetes and Metabolism, Advanced and Specialised Nursing, SDG 3 - Good Health and Well-being
Citation
Cardwell, C R, Stene, L C, Ludvigsson, J, Rosenbauer, J, Cinek, O, Svensson, J, Perez-Bravo, F, Memon, A, Gimeno, S G, Wadsworth, E J K, Strotmeyer, E S, Goldacre, M J, Radon, K, Chuang, L M, Parslow, R C, Chetwynd, A, Karavanaki, K, Brigis, G, Pozzilli, P, Urbonaite, B, Schober, E, Devoti, G, Sipetic, S, Joner, G, Ionescu-Tirgoviste, C, De Beaufort, C E, Harrild, K, Benson, V, Savilahti, E, Ponsonby, A L, Salem, M, Rabiei, S & Patterson, C C 2012, 'Breast-feeding and childhood-onset type 1 diabetes : A pooled analysis of individual participant data from 43 observational studies', Diabetes Care, vol. 35, no. 11, pp. 2215-2225. https://doi.org/10.2337/dc12-0438