Critical review of the World Health Organization's (WHO) 2007 report on 'evidence of the long-term effects of breastfeeding: systematic reviews and meta-analysis' with respect to obesity
Critical review of the World Health Organization's (WHO) 2007 report on 'evidence of the long-term effects of breastfeeding: systematic reviews and meta-analysis' with respect to obesity
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DOI：
10.1111/j.1467-789x.2008.00504.x
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发表时间：
2008-11-01
期刊：
影响因子：
8.9
通讯作者：
Allison, D. B.
中科院分区：
文献类型：
--
作者：
Cope, M. B.;Allison, D. B.
儿童和成人肥胖已成为一个高度公认的公共卫生问题，越来越需要发现原因和评估预防措施。对肥胖的一个重要的因果影响是母乳喂养（BF）。世界卫生组织（WHO）最近发表了一份关于“母乳喂养长期影响的证据：系统评价和荟萃分析”的报告，并得出结论，“证据表明母乳喂养可能对肥胖症的流行有很小的保护作用。. . [and]母乳喂养的影响不太可能是由于发表偏倚或混淆。在这里，我们通过解决八个问题对WR关于BF和肥胖的部分进行了批判性的概述：Q1：是否有足够的证据得出BF与儿童肥胖率降低有关的结论？问题2：是否有足够的证据表明，BF与母乳喂养的后代成年后肥胖率较低有关？问题3：如果存在这种关联，那么与其他肥胖的因果因素相比，以及与对个体或人群肥胖水平的潜在影响相比，它们的程度如何？问题4：是否有足够的证据表明BF可以降低儿童肥胖的风险？问题5：是否有足够的证据表明BF不会降低儿童肥胖的风险？问题6：是否有足够的证据得出结论，BF导致长期降低肥胖的风险，并持续到成年？问题7：是否有足够的证据得出结论，BF不会导致长期降低肥胖的风险，并持续到成年？问题8：为了解决这些问题，可以做哪些进一步的研究？我们的结论是，虽然BF可能有超出任何假定的预防肥胖的好处，BF的好处很可能超过任何伤害，任何声明，一个强大的，明确的或一致的证据表明，BF因果关系降低超重或肥胖的风险是没有根据的。
Obesity among children and adults has become a highly recognized public health concern and there is an increasing need to discover causes and evaluate preventative measures. One putatively causal influence on obesity is breastfeeding (BF). The World Health Organization (WHO) recently published a report (WR) on 'Evidence of the Long-Term Effects of Breastfeeding: Systematic Reviews and Meta-Analysis' and concluded 'that the evidence suggests that breastfeeding may have a small protective effect [emphasis added] on the prevalence of obesity . . . [and] the effect of breastfeeding was not likely to be due to publication bias or confounding.' Here we provide a critical overview of the WR's section on BF and obesity by addressing eight questions: Q1: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity in children? Q2: Is there sufficient evidence to conclude that BF is associated with lower rates of obesity among breastfed offspring once they reach adulthood? Q3: If there are such associations, what are their magnitudes in comparison with other putatively causal factors and with respect to the potential impact on individual or population levels of obesity? Q4: Is there sufficient evidence to conclude that BF causes a reduction in risk of obesity during childhood? Q5: Is there sufficient evidence to conclude that BF does not cause a reduction in risk of obesity during childhood? Q6: Is there sufficient evidence to conclude that BF causes a long-term reduction in risk of obesity that persists into adulthood? Q7: Is there sufficient evidence to conclude that BF does not cause a long-term reduction in risk of obesity that persists into adulthood? Q8: What further research might be done to address these questions? We conclude that, while BF may have benefits beyond any putative protection against obesity, and benefits of BF most likely outweigh any harms, any statement that a strong, clear or consistent body of evidence shows that BF causally reduces the risk of overweight or obesity is unwarranted at this time.