Please use this identifier to cite or link to this item: http://repositorio.unifesp.br/handle/11600/35441
Title: Breast-Feeding and Childhood-Onset Type 1 Diabetes A pooled analysis of individual participant data from 43 observational studies
Authors: Cardwell, Chris R.
Stene, Lars C.
Ludvigsson, Johnny
Rosenbauer, Joachim
Cinek, Ondrej
Svensson, Jannet
Perez-Bravo, Francisco
Memon, Anjum
Gimeno, Suely Godoy Agostinho [UNIFESP]
Wadsworth, Emma J. K.
Strotmeyer, Elsa S.
Goldacre, Michael J.
Radon, Katja
Chuang, Lee-Ming
Parslow, Roger C.
Chetwynd, Amanda
Karavanaki, Kyriaki
Brigis, Girts
Pozzilli, Paolo
Urbonaite, Brone
Schober, Edith
Devoti, Gabriele
Sipetic, Sandra
Joner, Geir
Ionescu-Tirgoviste, Constantin
Beaufort, Carine E. de
Harrild, Kirsten
Benson, Victoria
Savilahti, Erkki
Ponsonby, Anne-Louise
Salem, Mona
Rabiei, Samira
Patterson, Chris C.
Queens Univ Belfast
Norwegian Inst Publ Hlth
Oslo Univ Hosp
Linkoping Univ Hosp
Univ Dusseldorf
Charles Univ Prague
Univ Hosp Motol
Herlev Univ Hosp
Univ Chile
Brighton & Sussex Med Sch & NHS Brighton & Hove
Universidade Federal de São Paulo (UNIFESP)
Cardiff Univ
Univ Pittsburgh
Univ Oxford
Hosp Ludwig Maximilian Univ Munich
Natl Taiwan Univ Hosp
Univ Leeds
Univ Lancaster
Univ Athens
Riga Stradins Univ
Univ Campus Biomed
Lithuanian Univ Hlth Sci
Med Univ Vienna
Univ Salento
Univ Belgrade
Univ Oslo
N Paulescu Inst Diabet
Clin Pediat Luxembourg
Univ Aberdeen
Univ Helsinki
Royal Childrens Hosp
Ain Shams Univ
Shahid Beheshti Univ Med Sci & Hlth Serv
Issue Date: 1-Nov-2012
Publisher: Amer Diabetes Assoc
Citation: Diabetes Care. Alexandria: Amer Diabetes Assoc, v. 35, n. 11, p. 2215-2225, 2012.
Abstract: OBJECTIVE-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.RESEARCH DESIGN and METHODS-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.RESULTS-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 (I-2 = 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 (I-2 = 0%). Adjustments for potential confounders altered these estimates very little.CONCLUSIONS-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. Diabetes Care 35: 2215-2225, 2012
URI: http://repositorio.unifesp.br/handle/11600/35441
ISSN: 0149-5992
Other Identifiers: http://dx.doi.org/10.2337/dc12-0438
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