Kull Inger, Almqvist Catarina, Lilja Gunnar, Pershagen Göran, Wickman Magnus
Department of Occupational and Environmental Health, Stockholm County Council, Sweden.
J Allergy Clin Immunol. 2004 Oct;114(4):755-60. doi: 10.1016/j.jaci.2004.07.036.
The evidence for a preventive effect of breast-feeding on asthma and other allergic diseases in childhood is inconclusive.
The aim of this study was to investigate the effect of breast-feeding on asthma and sensitization to airborne allergens among children up to 4 years of age.
A birth cohort of 4089 children was followed. Exposure data were collected at 2 months and 1 year of age. The total dose of breast milk was estimated by combining periods of exclusive and partial breast-feeding. Outcomes data were collected at 1, 2, and 4 years of age. The response rate at 4 years was 90%, and 73% participated in a clinical investigation, including blood sampling for analysis of specific IgE and lung function testing. Children with onset of wheeze during lactation (n=217) were excluded in some of the analyses to avoid disease-related modification of exposure.
Exclusive breast-feeding for 4 months or more reduced the risk of asthma at the age of 4 years (odds ratio [OR], 0.72; 95% CI, 0.53-0.97), irrespective of sensitization to common airborne allergens ( P=.72). Excluding children with wheeze during lactation tended to strengthen the risk estimate (OR, 0.64; 95% CI, 0.46-0.88). A duration of 3 months or more of partial breast-feeding seemed to offer additional protection; exclusive breast-feeding for 3 to 4 months combined with partial breast-feeding for 3 months or more resulted in an OR of 0.44 (95% CI, 0.21-0.87). The effects tended to be stronger in children without heredity for allergy ( P interaction=.36).
Breast-feeding reduces the risk of asthma during the first 4 years of life.
母乳喂养对儿童哮喘及其他过敏性疾病的预防作用证据尚无定论。
本研究旨在调查母乳喂养对4岁以下儿童哮喘及对空气传播变应原致敏的影响。
对4089名儿童的出生队列进行随访。在2个月和1岁时收集暴露数据。通过将纯母乳喂养和部分母乳喂养的时间段相结合来估算母乳总量。在1岁、2岁和4岁时收集结局数据。4岁时的应答率为90%，73%的儿童参与了临床调查，包括采集血样分析特异性IgE和进行肺功能测试。在一些分析中排除了哺乳期出现喘息的儿童（n = 217），以避免疾病相关的暴露改变。
纯母乳喂养4个月或更长时间可降低4岁时患哮喘的风险（比值比[OR]，0.72；95%可信区间[CI]，0.53 - 0.97），与对常见空气传播变应原的致敏情况无关（P = 0.72）。排除哺乳期喘息儿童倾向于强化风险估计值（OR，0.64；95%CI，0.46 - 0.88）。部分母乳喂养3个月或更长时间似乎可提供额外保护；纯母乳喂养3至4个月并结合部分母乳喂养3个月或更长时间，OR为0.44（95%CI，0.21 - 0.87）。在无过敏遗传的儿童中，这种作用往往更强（P交互作用 = 0.36）。
母乳喂养可降低生命最初4年患哮喘的风险。
