Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
Nutrients. 2018 Jul 30;10(8):995. doi: 10.3390/nu10080995.
Breastfeeding has many established health benefits, but its impact on asthma development is uncertain. Breastfeeding appears to have a positive and dose-dependent impact on respiratory health, particularly during early childhood and in high-risk populations; however, the strength and causality of these associations are unclear. It is challenging to compare results across studies due to methodological differences and biological variation. Resolving these inconsistencies will require well-designed, prospective studies that accurately capture asthma diagnoses and infant feeding exposures (including breastfeeding duration, exclusivity, and method of feeding), account for key confounders, evaluate dose effects, and consider effect modification and reverse causality. Mechanistic studies examining human milk bioactives and their impact on lung health and asthma development are beginning to emerge, and these will be important in establishing the causality and mechanistic basis of the observed associations between breastfeeding and asthma. In this review, we summarize current evidence on this topic, identify possible reasons for disagreement across studies, discuss potential mechanisms for a causal association, and provide recommendations for future research.
母乳喂养有许多已确立的健康益处，但它对哮喘发展的影响尚不确定。母乳喂养似乎对呼吸健康有积极的、剂量依赖性的影响，特别是在儿童早期和高危人群中；然而，这些关联的强度和因果关系尚不清楚。由于方法学差异和生物学变异，很难在研究间进行结果比较。解决这些不一致性需要精心设计的前瞻性研究，这些研究要准确捕捉哮喘诊断和婴儿喂养暴露（包括母乳喂养持续时间、排他性和喂养方式），考虑关键混杂因素，评估剂量效应，并考虑效应修饰和反向因果关系。研究人类母乳生物活性及其对肺部健康和哮喘发展影响的机制研究正在兴起，这对于确定母乳喂养与哮喘之间观察到的关联的因果关系和机制基础将是重要的。在这篇综述中，我们总结了这一主题的现有证据，确定了研究间存在分歧的可能原因，讨论了因果关联的潜在机制，并为未来的研究提供了建议。
