Sears Malcolm R, Greene Justina M, Willan Andrew R, Taylor D Robin, Flannery Erin M, Cowan Jan O, Herbison G Peter, Poulton Richie
Department of Medicine, McMaster University, Ontario, Hamilton, Canada.
Lancet. 2002 Sep 21;360(9337):901-7. doi: 10.1016/S0140-6736(02)11025-7.
Breastfeeding is widely advocated to reduce risk of atopy and asthma, but the evidence for such an effect is conflicting. We aimed to assess long-term outcomes of asthma and atopy related to breastfeeding in a New Zealand birth cohort.
Our cohort consisted of 1037 of 1139 children born in Dunedin, New Zealand, between April, 1972, and March, 1973, and residing in Otago province at age 3 years. Children were assessed every 2-5 years from ages 9 to 26 years with respiratory questionnaires, pulmonary function, bronchial challenge, and allergy skin tests. History of breastfeeding had been independently recorded in early childhood.
504 (49%) of 1037 eligible children were breastfed (4 weeks or longer) and 533 (51%) were not. More children who were breastfed were atopic at all ages from 13 to 21 years to cats (p=0.0001), house dust mites (p=0.0010), and grass pollen (p<0.0001) than those who were not. More children who were breastfed reported current asthma at each assessment between age 9 (p=0.0008) and 26 years (p=0.0008) than those who were not. Breastfeeding effects were not affected by parental history of hayfever or asthma. Multifactor analysis controlling for socioeconomic status, parental smoking, birth order, and use of sheepskin bedding in infancy, showed odds ratios of 1.94 (95% CI 1.42-2.65, p<0.0001) for any allergen positive at age 13 years, 2.40 (1.36-4.26, p=0.0003) for current asthma at 9 years, and 1.83 (1.35-2.47, p<0.0001) for current asthma at 9-26 years by repeated-measures analysis.
Breastfeeding does not protect children against atopy and asthma and may even increase the risk.
母乳喂养被广泛提倡以降低患特应性疾病和哮喘的风险，但关于这种效果的证据相互矛盾。我们旨在评估新西兰一个出生队列中与母乳喂养相关的哮喘和特应性疾病的长期结局。
我们的队列由1972年4月至1973年3月在新西兰达尼丁出生、3岁时居住在奥塔哥省的1139名儿童中的1037名组成。从9岁到26岁，每2至5年对儿童进行一次评估，评估内容包括呼吸问卷、肺功能、支气管激发试验和过敏皮肤试验。母乳喂养史在儿童早期已独立记录。
1037名符合条件的儿童中，504名（49%）进行了母乳喂养（4周或更长时间）。533名（51%）未进行母乳喂养。在13至21岁的所有年龄段，与未进行母乳喂养的儿童相比，进行母乳喂养的儿童对猫（p=0.0001）、屋尘螨（p=0.0010）和草花粉（p<0.0001）的特应性更高。在9岁（p=0.0008）至26岁（p=0.0008）的每次评估中，与未进行母乳喂养的儿童相比，进行母乳喂养的儿童报告患当前哮喘的比例更高。母乳喂养的影响不受父母枯草热或哮喘病史的影响。在控制社会经济地位、父母吸烟、出生顺序和婴儿期使用羊皮褥子的多因素分析中，13岁时对任何过敏原呈阳性的比值比为1.94（95%可信区间1.42-2.65，p<0.0001），9岁时患当前哮喘的比值比为2.40（1.36-4.26，p=0.0003），通过重复测量分析，9至26岁时患当前哮喘的比值比为1.83（1.35-2.47，p<0.0001）。
母乳喂养不能保护儿童免受特应性疾病和哮喘的影响，甚至可能增加风险。
