Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants
Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants
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DOI：
10.1016/j.jaci.2010.01.026
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发表时间：
2010-04-01
影响因子：
14.2
通讯作者：
Bisgaard, Hans
中科院分区：
文献类型：
--
作者：
Giwercman, Charlotte;Halkjaer, Liselotte B.;Bisgaard, Hans
背景：建议母乳喂养来预防湿疹、哮喘和过敏，特别是在高危家庭中，但最近的研究引起了人们的担忧，认为母乳喂养可能无法保护儿童，甚至可能会增加风险。然而，疾病风险、疾病表现、生活方式和母乳喂养的选择是相互关联的，因此，分析真正的因果效应提出了许多方法学挑战。 目的：首先，在高危临床出生队列中评估纯母乳喂养持续时间对生命头 2 年内湿疹和喘息性疾病发生的影响。其次，评估母乳脂肪酸成分对母乳喂养风险的影响。方法：我们研究了哥本哈根儿童哮喘研究 (COPSAC) 出生队列中 411 名婴儿出生后头两年的疾病发展情况，这些婴儿的母亲有哮喘病史。我们分析了疾病发病前母乳喂养持续时间对疾病风险的影响，避免了与疾病相关的暴露改变（反向因果关系）的影响。测量母乳中的多不饱和脂肪酸。 结果：根据人口统计学、聚丝蛋白变异、父母湿疹和家中宠物调整后，母乳喂养显着增加湿疹风险（N = 306；相对风险，2.09；95% CI 1.15-3.80；P=.016），但降低了喘息发作的风险（相对风险，0.67；95% CI 0.48-0.96；P =.021）和严重喘息恶化（相对风险，0.16；95% CI 0.03-1.01；P=.051）。母乳的脂肪酸组成与湿疹或喘息的风险之间没有关联。结论：随着母乳喂养时间的延长，婴儿患湿疹的风险增加。相反，喘息障碍和严重喘息恶化的风险降低了。母乳的脂肪酸成分对湿疹或喘息性疾病的风险没有显着影响。 （过敏临床免疫杂志 2010 年；125：866-71。）
Background: Breast-feeding is recommended for the prevention of eczema, asthma, and allergy, particularly in high-risk families, but recent studies have raised concern that this may not protect children and may even increase the risk. However, disease risk, disease manifestation, lifestyle, and the choice to breast-feed are interrelated, and therefore, analyzing true causal effects presents a number of methodologic challenges.Objective: First, to assess the effect from duration of exclusive breast-feeding on the development of eczema and wheezy disorders during the first 2 years of life in a high-risk clinical birth cohort. Second, to assess any influence from the fatty acid composition of mother's milk on the risk from breast-feeding.Methods: We studied disease development during the first two years of life of the 411 infants from the Copenhagen Study on Asthma in Childhood (COPSAC) birth cohort, born to mothers with a history of asthma. We analyzed the effect from duration of breast-feeding before disease onset on the disease risk, avoiding the effect from disease-related modification of exposure (inverse causation). Polyunsaturated fatty acids were measured in breast milk.Results: Breast-feeding significantly increased the risk of eczema adjusted for demographics, filaggrin variants, parents' eczema, and pets at home (N = 306; relative risk, 2.09; 95% CI 1.15-3.80; P=.016) but reduced the risk of wheezy episodes (relative risk, 0.67; 95% CI 0.48-0.96; P =.021) and of severe wheezy exacerbation (relative risk, 0.16; 95% CI 0.03-1.01; P=.051). There was no association between the fatty acid composition of mother's milk and the risk of eczema or wheeze.Conclusion: The risk of eczema was increased in infants with increasing duration of breast-feeding. In contrast, the risk of wheezy disorder and severe wheezy exacerbations was reduced. There were no significant effects from the fatty acid composition of the breast milk on risk of eczema or wheezy disorders. (J Allergy Clin Immunol 2010;125:866-71.)