Rights statement: © 2012 by the American Diabetes Association.
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Breast-Feeding and Childhood-Onset Type 1 Diabetes
T2 - A pooled analysis of individual participant data from 43 observational studies
AU - Cardwell, Chris R
AU - Stene, Lars C
AU - Ludvigsson, Johnny
AU - Rosenbauer, Joachim
AU - Cinek, Ondrej
AU - Svensson, Jannet
AU - Perez-Bravo, Francisco
AU - Memon, Anjum
AU - Gimeno, Suely G
AU - Wadsworth, Emma J K
AU - Strotmeyer, Elsa S
AU - Goldacre, Michael J
AU - Radon, Katja
AU - Chuang, Lee-Ming
AU - Parslow, Roger C
AU - Chetwynd, Amanda
AU - Karavanaki, Kyriaki
AU - Brigis, Girts
AU - Pozzilli, Paolo
AU - Urbonaite, Brone
AU - Schober, Edith
AU - Devoti, Gabriele
AU - Sipetic, Sandra
AU - Joner, Geir
AU - Ionescu-Tirgoviste, Constantin
AU - de Beaufort, Carine E
AU - Harrild, Kirsten
AU - Benson, Victoria
AU - Savilahti, Erkki
AU - Ponsonby, Anne-Louise
AU - Salem, Mona
AU - Rabiei, Samira
AU - Patterson, Chris C
N1 - © 2012 by the American Diabetes Association.
PY - 2012/11
Y1 - 2012/11
N2 - 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 METHODSRelevant 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.RESULTSData 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.CONCLUSIONThe 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.
AB - 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 METHODSRelevant 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.RESULTSData 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.CONCLUSIONThe 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.
U2 - 10.2337/dc12-0438
DO - 10.2337/dc12-0438
M3 - Journal article
C2 - 22837371
VL - 35
SP - 2215
EP - 2225
JO - Diabetes Care
JF - Diabetes Care
SN - 1935-5548
IS - 11
ER -