TY - JOUR
T1 - Breast-feeding and childhood-onset type 1 diabetes
T2 - A pooled analysis of individual participant data from 43 observational studies
AU - Cardwell, Chris R.
AU - Stene, Lars C.
AU - Ludvigsson, Johnny
AU - Rosenbauer, Joachim
AU - Cinek, Ondrej
AU - Svensson, Jannet
AU - Perez-Bravo, Francisco
AU - Memon, Anjum
AU - Gimeno, Suely G.
AU - Wadsworth, Emma J.K.
AU - Strotmeyer, Elsa S.
AU - Goldacre, Michael J.
AU - Radon, Katja
AU - Chuang, Lee Ming
AU - Parslow, Roger C.
AU - Chetwynd, Amanda
AU - Karavanaki, Kyriaki
AU - Brigis, Girts
AU - Pozzilli, Paolo
AU - Urbonaite, Brone
AU - Schober, Edith
AU - Devoti, Gabriele
AU - Sipetic, Sandra
AU - Joner, Geir
AU - Ionescu-Tirgoviste, Constantin
AU - De Beaufort, Carine E.
AU - Harrild, Kirsten
AU - Benson, Victoria
AU - Savilahti, Erkki
AU - Ponsonby, Anne Louise
AU - Salem, Mona
AU - Rabiei, Samira
AU - Patterson, Chris C.
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84868121007&partnerID=8YFLogxK
U2 - 10.2337/dc12-0438
DO - 10.2337/dc12-0438
M3 - Article
C2 - 22837371
AN - SCOPUS:84868121007
SN - 1935-5548
VL - 35
SP - 2215
EP - 2225
JO - Diabetes Care
JF - Diabetes Care
IS - 11
ER -
