Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
Int J Epidemiol. 2010 Apr;39(2):459-68. doi: 10.1093/ije/dyp333. Epub 2009 Nov 24.
Enterovirus infections are common, although most often sub-clinical. The present purpose was to assess the impact of breastfeeding and other factors on enterovirus infections in infancy.
A prospective observational study was carried out on a population-based cohort of 639 Norwegian infants aged 3-12 months. The outcome was enterovirus RNA measured in monthly stool samples. Data on underlying determinants, such as dietary feeding and household factors, were reported in parental questionnaires. Multivariable logistic regression was performed to allow for common confounders. Statistical analyses were performed by GLLAMM using Stata 9.2, which corrects for subject-specific random effects.
The prevalence of enterovirus in stools was 11.1% (475/4279). Risk of enterovirus infection decreased with increasing number of daily breastfeeds; the effect was most pronounced at the age of 3 months [odds ratio (OR), 0.85; 95% confidence interval (CI) 0.8-0.9, P < 0.001], gradually declining thereafter, reaching no effect at 11 months. Increased risk was associated with having one or more sibling(s) (OR 1.89; 95% CI 1.2-3.0), particularly if they attended daycare (OR 2.46; 95% CI 1.4-4.2), and with increasing exposure to other children (OR 1.04; 95% CI 1.0-1.1). There was a tendency towards higher prevalence of infection when a household's drinking water came from a well, and a protective effect of owning a dog or cat.
Several factors may modify the risk for enterovirus infections in the first year of life. This study supports the protective effect of breastfeeding. The protection decreased with age and increased with dose of ingested milk.
肠病毒感染很常见，尽管大多数情况下是亚临床感染。本研究旨在评估母乳喂养和其他因素对婴儿期肠病毒感染的影响。
对 639 名年龄在 3-12 个月的挪威婴儿进行了一项基于人群的前瞻性观察研究。研究结果是通过每月粪便样本中检测到的肠病毒 RNA 来衡量的。父母调查问卷中报告了潜在决定因素的数据，如饮食喂养和家庭因素。多变量逻辑回归用于考虑常见的混杂因素。统计分析采用 Stata 9.2 中的 GLLAMM 进行，该方法纠正了个体特定的随机效应。
粪便中肠病毒的检出率为 11.1%（475/4279）。肠病毒感染的风险随着每日母乳喂养次数的增加而降低；这种影响在 3 个月时最为明显[比值比（OR），0.85；95%置信区间（CI）0.8-0.9，P < 0.001]，此后逐渐下降，11 个月时无影响。与有一个或多个兄弟姐妹（OR 1.89；95% CI 1.2-3.0）相关，尤其是如果他们上日托（OR 2.46；95% CI 1.4-4.2），且与接触其他儿童的机会增加（OR 1.04；95% CI 1.0-1.1）相关。如果家庭的饮用水来自井水，则感染的患病率有上升趋势，养宠物狗或宠物猫有保护作用。
有几个因素可能会改变婴儿期第一年肠病毒感染的风险。本研究支持母乳喂养的保护作用。这种保护作用随着年龄的增长而降低，随着摄入的牛奶量的增加而增加。
