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Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies.
Diabetes Care 2012; 35(11):2215-25DC

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.

Authors+Show Affiliations

School of Medicine and Dentistry, Queen’s University Belfast, Belfast, UK. c.cardwell@qub.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -