Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood
Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood
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DOI：
10.1136/thorax.56.3.192
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发表时间：
2001-03
期刊：
影响因子：
10
通讯作者：
A. Wright;C. Holberg;L. Taussig;F. D. Martinez
中科院分区：
文献类型：
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作者：
A. Wright;C. Holberg;L. Taussig;F. D. Martinez
婴儿喂养与儿童哮喘之间的关系存在争议。这项研究验证了母乳喂养和儿童哮喘之间的关系因母亲哮喘的存在而改变的假设。方法健康非选择新生儿（n=1246）在出生时纳入。哮喘定义为6、9、11或13年时医生诊断的哮喘加上102份问卷中报告的哮喘症状。在出生后的前13年中，通过问卷调查报告了7个年龄段的反复喘息（过去一年中有104次发作）。纯母乳喂养的持续时间基于前瞻性医生报告或18个月时完成的父母问卷调查。特应性通过6岁时的皮肤试验反应进行评估。结果母乳喂养、哮喘和喘息之间的关系因母亲是否患有哮喘和儿童的特应性而异。在调整混杂因素后，如果母亲患有哮喘，则如果他们完全母乳喂养，则其儿童患哮喘的可能性显著更高（OR 8.7，95%CI 3.4至22.2）。这种关系仅在特应性儿童中明显，并在调整混杂因素后持续存在。相反，喘息复发与母乳喂养之间的关系是年龄依赖性的。在出生后的前2年，无论母亲是否患有哮喘或特应性，纯母乳喂养与喘息复发率显著降低相关（OR 0.45，95%CI 0.2 - 0.9）。从6岁开始，纯母乳喂养与反复喘息的患病率无关，除了母亲患有哮喘的儿童，其喘息的比值比更高（OR 5.7，95%CI 2.3至14.1），特别是如果儿童是特应性的。结论母乳喂养与哮喘或反复喘息的关系因儿童年龄和母亲是否患有哮喘和特应性而异。虽然母乳喂养与预防生命早期反复喘息有关，但从6岁开始，母乳喂养与哮喘和反复喘息的风险增加有关，但仅适用于母亲患有哮喘的特应性儿童。
BACKGROUND The relationship between infant feeding and childhood asthma is controversial. This study tested the hypothesis that the relation between breast feeding and childhood asthma is altered by the presence of maternal asthma. METHODS Healthy non-selected newborn infants (n=1246) were enrolled at birth. Asthma was defined as a physician diagnosis of asthma plus asthma symptoms reported on ⩾2 questionnaires at 6, 9, 11 or 13 years. Recurrent wheeze (⩾4 episodes in the past year) was reported by questionnaire at seven ages in the first 13 years of life. Duration of exclusive breast feeding was based on prospective physician reports or parental questionnaires completed at 18 months. Atopy was assessed by skin test responses at the age of 6 years. RESULTS The relationship between breast feeding, asthma, and wheeze differed with the presence or absence of maternal asthma and atopy in the child. After adjusting for confounders, children with asthmatic mothers were significantly more likely to have asthma if they had been exclusively breast fed (OR 8.7, 95% CI 3.4 to 22.2). This relationship was only evident for atopic children and persisted after adjusting for confounders. In contrast, the relation between recurrent wheeze and breast feeding was age dependent. In the first 2 years of life exclusive breast feeding was associated with significantly lower rates of recurrent wheeze (OR 0.45, 95% CI 0.2 to 0.9), regardless of the presence or absence of maternal asthma or atopy in the child. Beginning at the age of 6 years, exclusive breast feeding was unrelated to prevalence of recurrent wheeze, except for children with asthmatic mothers in whom it was associated with a higher odds ratio for wheeze (OR 5.7, 95% CI 2.3 to 14.1), especially if the child was atopic. CONCLUSION The relationship between breast feeding and asthma or recurrent wheeze varies with the age of the child and the presence or absence of maternal asthma and atopy in the child. While associated with protection against recurrent wheeze early in life, breast feeding is associated with an increased risk of asthma and recurrent wheeze beginning at the age of 6 years, but only for atopic children with asthmatic mothers.