Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies - PubMed (original) (raw)

Meta-Analysis

. 2012 Nov;35(11):2215-25.

doi: 10.2337/dc12-0438. Epub 2012 Jul 26.

Lars C Stene, Johnny Ludvigsson, Joachim Rosenbauer, Ondrej Cinek, Jannet Svensson, Francisco Perez-Bravo, Anjum Memon, Suely G Gimeno, Emma J K Wadsworth, Elsa S Strotmeyer, Michael J Goldacre, Katja Radon, Lee-Ming Chuang, Roger C Parslow, Amanda Chetwynd, Kyriaki Karavanaki, Girts Brigis, Paolo Pozzilli, Brone Urbonaite, Edith Schober, Gabriele Devoti, Sandra Sipetic, Geir Joner, Constantin Ionescu-Tirgoviste, Carine E de Beaufort, Kirsten Harrild, Victoria Benson, Erkki Savilahti, Anne-Louise Ponsonby, Mona Salem, Samira Rabiei, Chris C Patterson

Affiliations

Meta-Analysis

Breast-feeding and childhood-onset type 1 diabetes: a pooled analysis of individual participant data from 43 observational studies

Chris R Cardwell et al. Diabetes Care. 2012 Nov.

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.

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Figures

Figure 1

Figure 1

Pooled analysis of association between (nonexclusive) breast-feeding and childhood-onset type 1 diabetes in studies investigating ∼2 weeks (nonexclusive) breast-feeding and studies investigating any measure of breast-feeding.

Figure 2

Figure 2

Pooled analysis of association between exclusive breast-feeding and childhood-onset type 1 diabetes in studies investigating ∼2 weeks exclusive breast-feeding and studies investigating any measure of exclusive breast-feeding.

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