Breastfeeding and Childhood Leukemia Incidence A Meta-analysis and Systematic Review
Breastfeeding and Childhood Leukemia Incidence A Meta-analysis and Systematic Review
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DOI：
10.1001/jamapediatrics.2015.1025
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发表时间：
2015-06-01
期刊：
影响因子：
26.1
通讯作者：
Keinan-Boker, Lital
中科院分区：
文献类型：
--
作者：
Amitay, Efrat L.;Keinan-Boker, Lital
儿童癌症是发达国家儿童和青少年死亡的主要原因，发病率每年增加0.9%。白血病约占所有儿童癌症的30%，但其病因尚不清楚。目的对母乳喂养与儿童白血病相关性的现有科学证据进行荟萃分析。对1960年1月至2014年12月期间发表的研究母乳喂养与儿童白血病之间关系的文章进行了全面检索，检索时间为PubMed、Cochrane图书馆和Scopus（检索时间为2014年7月和12月），并辅以人工检索参考文献列表。研究选择纳入meta分析的研究必须是病例对照研究；将母乳喂养作为可测量的暴露，并将白血病作为可测量的结果；包括以月为单位的母乳喂养持续时间数据；并发表在同行评议的期刊上，并提供英文全文。资料提取与综合检索确定了25项相关研究，其中18项符合所有纳入标准。在这18项研究中未发现发表偏倚或异质性。每个符合纳入标准的研究的质量使用纽卡斯尔-渥太华量表进行评估。采用StatsDirect统计程序中的随机效应模型对原始数据进行多元荟萃分析。主要结局和指标：无母乳喂养或短时间母乳喂养与儿童白血病发病率的关系。结果：所有18项研究的荟萃分析表明，与不母乳喂养或较短母乳喂养相比，任何母乳喂养6个月或更长时间的儿童白血病风险降低19%（优势比为0.81；95% CI为0.73-0.89）。一项独立的对15项研究的荟萃分析表明，曾经母乳喂养与从未母乳喂养相比，儿童白血病的风险降低11%（优势比0.89;95% CI, 0.84-0.94），尽管不同研究对从未母乳喂养的定义不同。18项研究的所有亚组荟萃分析都显示出类似的关联。根据目前的荟萃分析结果，14%至19%的儿童白血病病例可以通过母乳喂养6个月或更长时间来预防。结论和相关性母乳喂养是一种容易获得、低成本的公共卫生措施。这项荟萃分析包括了之前关于该主题的荟萃分析中没有提到的研究，它表明，提倡母乳喂养6个月或更长时间可能有助于降低儿童白血病的发病率，除了对儿童和母亲的其他健康益处之外。
IMPORTANCE Childhood cancer is a leading cause of mortality among children and adolescents in the developed world and the incidence increases by 0.9% each year. Leukemia accounts for about 30% of all childhood cancer but its etiology is still mostly unknown.OBJECTIVE To conduct a meta-analysis of available scientific evidence on the association between breastfeeding and childhood leukemia.DATA SOURCES A thorough search for articles published between January 1960 and December 2014 researching the association between breastfeeding and childhood leukemia was conducted on PubMed, the Cochrane Library, and Scopus (performed in July and December 2014), supplemented by manual searches of reference lists.STUDY SELECTION To be included in the meta-analyses, studies had to be case control; include breastfeeding as a measured exposure and leukemia as a measured outcome; include data on breastfeeding duration in months; and be published in a peer-reviewed journal with full text available in English.DATA EXTRACTION AND SYNTHESIS The search identified 25 relevant studies, 18 of which met all inclusion criteria. No publication bias or heterogeneity among these 18 studies were detected. The quality of each study that met the inclusion criteria was assessed using the Newcastle-Ottawa Scale. Multiple meta-analyses were conducted using the random effect model on raw data in the StatsDirect statistical program.MAIN OUTCOMES AND MEASURES No or short duration of breastfeeding and the incidence of childhood leukemia.RESULTS The meta-analysis of all 18 studies indicated that compared with no or shorter breastfeeding, any breastfeeding for 6 months or longer was associated with a 19% lower risk for childhood leukemia (odds ratio, 0.81; 95% CI, 0.73-0.89). A separate meta-analysis of 15 studies indicated that ever breastfed compared with never breastfed was associated with an 11% lower risk for childhood leukemia (odds ratio, 0.89; 95% CI, 0.84-0.94), although the definition of never breastfed differed between studies. All meta-analyses of subgroups of the 18 studies showed similar associations. Based on current meta-analyses results, 14% to 19% of all childhood leukemia cases may be prevented by breastfeeding for 6 months or more.CONCLUSIONS AND RELEVANCE Breastfeeding is a highly accessible, low-cost public health measure. This meta-analysis that included studies not featured in previous meta-analyses on the subject indicates that promoting breastfeeding for 6 months or more may help lower childhood leukemia incidence, in addition to its other health benefits for children and mothers.