Breast-feeding and childhood-onset type 1 diabetes: A pooled analysis of individual participant data from 43 observational studies

Chris R. Cardwell, Lars C. Stene, Johnny Ludvigsson, Joachim Rosenbauer, Ondrej Cinek, Jannet Svensson, Francisco Perez-Bravo, Anjum Memon, Suely G. Gimeno, Emma J.K. Wadsworth, Elsa S. Strotmeyer, Michael J. Goldacre, Katja Radon, Lee Ming Chuang, Roger C. Parslow, Amanda Chetwynd, Kyriaki Karavanaki, Girts Brigis, Paolo Pozzilli, Brone UrbonaiteEdith Schober, Gabriele Devoti, Sandra Sipetic, Geir Joner, Constantin Ionescu-Tirgoviste, Carine E. De Beaufort, Kirsten Harrild, Victoria Benson, Erkki Savilahti, Anne Louise Ponsonby, Mona Salem, Samira Rabiei, Chris C. Patterson

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)2215-2225
Number of pages11
JournalDiabetes Care
Issue number11
Publication statusPublished - Nov 2012

Field of Science*

  • 3.2 Clinical medicine
  • 3.3 Health sciences

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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