Pieścik-Lech Małgorzata, Chmielewska Anna, Shamir Raanan, Szajewska Hania
*Department of Paediatrics, The Medical University of Warsaw, Poland †Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
J Pediatr Gastroenterol Nutr. 2017 Mar;64(3):454-459. doi: 10.1097/MPG.0000000000001293.
In addition to genetic background, a number of environmental factors have been claimed to influence the development of type 1 diabetes (T1D), including infant diet.
The aim of the study was to systematically update evidence on the possible relation between early feeding practices and the risk of T1D.
The Cochrane Library, MEDLINE, EMBASE, Web of Science, and CINAHL were searched for studies of any design up to July 2015. MEDLINE and EMBASE were additionally searched in March 2016. The primary outcome measures were the development of T1D or T1D-associated autoimmunity (T1DA).
Nine publications were identified. Breastfeeding at the time of gluten introduction, as compared to gluten introduction after weaning, did not reduce the risk of developing T1DA or T1D. In children at high risk of developing T1D, except for gluten introduction at 3 months or younger age compared with gluten introduction at older than 3 months, which increased the risk of T1DA, the age of gluten introduction in infants had no effect on the risk of developing T1DA.
Current evidence, mainly from observational studies, does not support the claim that early infant feeding practices, such as breastfeeding at gluten introduction or the age of the infant at the time of gluten introduction, may decrease the risk of developing T1D. More robust data are needed from randomized controlled trials.
除遗传背景外,许多环境因素被认为会影响1型糖尿病(T1D)的发病,包括婴儿饮食。
本研究旨在系统更新关于早期喂养方式与T1D风险之间可能关系的证据。
检索Cochrane图书馆、MEDLINE、EMBASE、科学网和CINAHL,查找截至2015年7月的任何设计的研究。2016年3月又对MEDLINE和EMBASE进行了检索。主要结局指标为T1D或T1D相关自身免疫(T1DA)的发生。
共识别出9篇文献。与断奶后引入麸质相比,引入麸质时进行母乳喂养并不能降低发生T1DA或T1D的风险。在有发展为T1D高风险的儿童中,除了3个月及以下引入麸质与3个月以上引入麸质相比会增加T1DA风险外,婴儿引入麸质的年龄对发生T1DA的风险没有影响。
目前主要来自观察性研究的证据不支持早期婴儿喂养方式,如引入麸质时进行母乳喂养或引入麸质时婴儿的年龄,可能降低发生T1D风险的说法。需要随机对照试验提供更有力的数据。