TY - JOUR
TI - Breast-feeding and childhood-onset type 1 diabetes: A pooled analysis of individual participant data from 43 observational studies
AU - Cardwell, C.R.
AU - Stene, L.C.
AU - Ludvigsson, J.
AU - Rosenbauer, J.
AU - Cinek, O.
AU - Svensson, J.
AU - Perez-Bravo, F.
AU - Memon, A.
AU - Gimeno, S.G.
AU - Wadsworth, E.J.K.
AU - Strotmeyer, E.S.
AU - Goldacre, M.J.
AU - Radon, K.
AU - Chuang, L.-M.
AU - Parslow, R.C.
AU - Chetwynd, A.
AU - Karavanaki, K.
AU - Brigis, G.
AU - Pozzilli, P.
AU - Urbonaite, B.
AU - Schober, E.
AU - Devoti, G.
AU - Sipetic, S.
AU - Joner, G.
AU - Ionescu-Tirgoviste, C.
AU - De Beaufort, C.E.
AU - Harrild, K.
AU - Benson, V.
AU - Savilahti, E.
AU - Ponsonby, A.-L.
AU - Salem, M.
AU - Rabiei, S.
AU - Patterson, C.C.
JO - DIABETES CARE
PY - 2012
VL - 35
TODO - 11
SP - 2215-2225
PB - 
SN - 0149-5992
TODO - 10.2337/dc12-0438
TODO - adolescent;  adult;  article;  birth weight;  breast feeding;  child;  child health care;  clinical assessment;  controlled study;  data analysis;  disease association;  human;  infant;  insulin dependent diabetes mellitus;  major clinical study;  maternal age;  maternal diabetes mellitus;  observational study;  onset age;  preschool child;  risk assessment;  risk factor;  risk reduction;  school child, Adolescent;  Breast Feeding;  Child;  Child, Preschool;  Diabetes Mellitus, Type 1;  Female;  Humans;  Male
TODO - 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. © 2012 by the American Diabetes Association.
ER -