Mahalanabis D
Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
BMJ. 1991 Aug 31;303(6801):493-6. doi: 10.1136/bmj.303.6801.493.
To determine the effect of breast feeding on the risk of xerophthalmia in children aged 6 months to 3 years attending a diarrhoea treatment centre in Bangladesh.
Case-control study based on stratified analysis (Mantel-Haenszel) and multivariate analysis (logistic regression) of data from a treatment centre based surveillance system.
A large diarrhoea treatment centre in Dhaka, Bangladesh.
2687 children aged 6 months to 3 years representing a 4% systematic sample of all children in this age group treated yearly at the centre over three consecutive years. 66 of the children were cases of xerophthalmia (that is, they had Bitot's spots or corneal lesions or night blindness or night blindness plus conjunctival xerosis or any combination of these) and the remaining 2621 did not have signs or symptoms of vitamin A deficiency. This second group served as controls.
Xerophthalmia and breast fed at onset of diarrhoea or presentation.
The odds ratio relating breast feeding to vitamin A deficiency after adjustment for a large number of confounding variables (0.26 (95% confidence interval 0.14 to 0.49); p less than 0.001) reflected a 74% reduction in the risk of vitamin A deficiency among breast fed children. The estimated reduction of risk did not decline with age, and some 49% of children aged 24-35 months were still being breast fed. The odds ratio relating breast feeding to xerophthalmia in the third year of life (0.35 (95% confidence interval 0.35 to 0.86) reflected a 65% reduced risk of vitamin A deficiency. Other important risk factors or prognostic indicators for xerophthalmia as identified by multivariate analysis were recent measles, prolonged diarrhoea, severe protein energy malnutrition, and poor socioeconomic state.
These results indicate that breast feeding was associated with a substantial reduction of the risk of vitamin A deficiency extending to the third year of life and support the recommendation that mothers in developing countries should be advised to breast feed for as long as possible.
确定母乳喂养对孟加拉国一家腹泻治疗中心6个月至3岁儿童患干眼病风险的影响。
基于对来自一个治疗中心监测系统的数据进行分层分析（曼特尔-亨塞尔法）和多变量分析（逻辑回归）的病例对照研究。
孟加拉国达卡的一家大型腹泻治疗中心。
2687名6个月至3岁的儿童，代表该年龄组每年在该中心接受治疗的所有儿童的4%系统抽样。连续三年。其中66名儿童患有干眼病（即他们有毕脱斑或角膜病变或夜盲症或夜盲症加结膜干燥或这些情况的任何组合），其余2621名儿童没有维生素A缺乏的体征或症状。第二组作为对照。
腹泻发作或就诊时的干眼病和母乳喂养情况。
在对大量混杂变量进行调整后，母乳喂养与维生素A缺乏的比值比为0.26（95%置信区间0.14至0.49）；p<0.001），这表明母乳喂养儿童患维生素A缺乏症的风险降低了74%。估计的风险降低率并不随年龄增长而下降，约49%的24至35个月大的儿童仍在接受母乳喂养。在生命的第三年，母乳喂养与干眼病的比值比为0.35（95%置信区间0.17至0.86），这表明维生素A缺乏症的风险降低了65%。多变量分析确定的其他干眼病重要风险因素或预后指标包括近期麻疹、长期腹泻、严重蛋白质能量营养不良和社会经济状况差。
这些结果表明，母乳喂养与维生素A缺乏风险的大幅降低有关，这种降低一直持续到生命的第三年，并支持建议发展中国家的母亲应尽可能长时间进行母乳喂养。
