Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies.
Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies.
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DOI：
10.2337/dc12-0438
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发表时间：
2012-11
期刊：
影响因子：
16.2
通讯作者：
Patterson CC
中科院分区：
文献类型：
--
作者：
Cardwell CR;Stene LC;Ludvigsson J;Rosenbauer J;Cinek O;Svensson J;Perez-Bravo F;Memon A;Gimeno SG;Wadsworth EJ;Strotmeyer ES;Goldacre MJ;Radon K;Chuang LM;Parslow RC;Chetwynd A;Karavanaki K;Brigis G;Pozzilli P;Urbonaite B;Schober E;Devoti G;Sipetic S;Joner G;Ionescu-Tirgoviste C;de Beaufort CE;Harrild K;Benson V;Savilahti E;Ponsonby AL;Salem M;Rabiei S;Patterson CC
通过对公认的混杂因素进行调整后进行汇总分析，研究母乳喂养或纯母乳喂养的儿童患1型糖尿病的风险是否降低。使用MEDLINE、Web of Science和EMBASE从文献检索中识别相关研究。要求相关研究的作者提供个体参与者数据或进行预先指定的分析。采用荟萃分析技术对联合收割机比值比（OR）进行合并，并研究研究之间的异质性。数据来自43项研究，包括9，874例1型糖尿病患者。总的来说，纯母乳喂养>2周后，糖尿病风险降低（20项研究; OR = 0.75，95%CI 0.64-0.88），纯母乳喂养>3个月后的相关性较弱（30项研究; OR = 0.87，95% CI 0.75-1.00），在（非排他性）母乳喂养>2周（28项研究; OR = 0.93，95%CI 0.81-1.07）或>3个月（29项研究; OR = 0.88，95%CI 0.78-1.00）。这些相关性均存在显著异质性（I2分别为58、76、54和68%）。在偏倚风险较低的研究中，纯母乳喂养>2周后的风险降低仍然存在（12项研究; OR = 0.86，95%CI 0.75-0.99），异质性降低（I2 = 0%）。潜在混杂因素的调整对这些估计值的影响很小。汇总分析表明，纯母乳喂养和1型糖尿病风险之间的保护性关联较弱。然而，这些发现很难解释，因为纳入的研究中存在明显的效应差异和可能的偏倚（特别是回忆偏倚）。
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. 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. 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 (I2 = 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 (I2 = 0%). Adjustments for potential confounders altered these estimates very little. 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.