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

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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  • Authors+Show Affiliations

    ,

    School of Medicine and Dentistry, Queen’s University Belfast, Belfast, UK. c.cardwell@qub.ac.uk

    , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

    Source

    Diabetes care 35:11 2012 Nov pg 2215-25

    MeSH

    Adolescent
    Breast Feeding
    Child
    Child, Preschool
    Diabetes Mellitus, Type 1
    Female
    Humans
    Male

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22837371

    Citation

    Cardwell, Chris R., et al. "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, 2012, pp. 2215-25.
    Cardwell CR, Stene LC, Ludvigsson J, et al. Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies. Diabetes Care. 2012;35(11):2215-25.
    Cardwell, C. R., Stene, L. C., Ludvigsson, J., Rosenbauer, J., Cinek, O., Svensson, J., ... 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, 35(11), pp. 2215-25. doi:10.2337/dc12-0438.
    Cardwell CR, et al. Breast-feeding and Childhood-onset Type 1 Diabetes: a Pooled Analysis of Individual Participant Data From 43 Observational Studies. Diabetes Care. 2012;35(11):2215-25. PubMed PMID: 22837371.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Breast-feeding and childhood-onset type 1 diabetes: 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, Y1 - 2012/07/26/ PY - 2012/7/28/entrez PY - 2012/7/28/pubmed PY - 2013/4/18/medline SP - 2215 EP - 25 JF - Diabetes care JO - Diabetes Care VL - 35 IS - 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. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/22837371/full_citation L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=22837371 DB - PRIME DP - Unbound Medicine ER -