婴幼儿喂养方式与子代糖尿病结局：系统综述。
Infant milk-feeding practices and diabetes outcomes in offspring: a systematic review.
机构信息
Panum Group, Bethesda, MD.
USDA, Food and Nutrition Service, Alexandria, VA.
出版信息
Am J Clin Nutr. 2019 Mar 1;109(Suppl_7):817S-837S. doi: 10.1093/ajcn/nqy311.
BACKGROUND
During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations.
OBJECTIVES
The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) feeding a lower versus higher intensity of human milk to mixed-fed infants with type 1 and type 2 diabetes in offspring.
METHODS
The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980-March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence.
RESULTS
The 4 systematic reviews included 21, 37, 18, and 1 articles, respectively. Observational evidence suggests that never versus ever feeding human milk (limited evidence) and shorter versus longer durations of any (moderate evidence) and exclusive (limited evidence) human milk feeding are associated with higher type 1 diabetes risk. Insufficient evidence examined type 2 diabetes. Limited evidence suggests that the durations of any and exclusive human milk feeding are not associated with intermediate outcomes (e.g., fasting glucose, insulin resistance) during childhood.
CONCLUSIONS
Limited to moderate evidence suggests that feeding less or no human milk is associated with higher risk of type 1 diabetes in offspring. Limited evidence suggests no associations between the durations of any and exclusive human milk feeding and intermediate diabetes outcomes in children. Additional research is needed on infant milk-feeding practices and type 2 diabetes and intermediate outcomes in US populations, which may have distinct metabolic risk.
背景
在美国农业部和卫生与公众服务部发起的“怀孕与出生至 24 个月项目”中，对这些人群的饮食与健康相关证据进行了评估。
目的
这些系统评价旨在检验以下方面的关系：1）从未用母乳喂养与曾用母乳喂养；2）任何母乳喂养持续时间更短与更长；3）纯母乳喂养持续时间更短与更长；4）混合喂养婴儿中用母乳喂养程度更低与更高与 1 型和 2 型糖尿病在后代中的关系。
方法
营养证据系统评价团队与外部专家合作开展了系统评价。我们在 CINAHL、 Cochrane、Embase 和 PubMed 中检索了 1980 年 1 月至 2016 年 3 月发表的文章，根据预定标准对结果进行了双屏幕筛选，从每个纳入的研究中提取数据并评估其偏倚风险，对证据进行定性综合，制定结论陈述，并对证据强度进行分级。
结果
这 4 项系统评价分别纳入了 21 篇、37 篇、18 篇和 1 篇文章。观察性证据表明，从未用母乳喂养（证据有限）和任何母乳喂养（中等证据）和纯母乳喂养（证据有限）持续时间更短与 1 型糖尿病风险更高相关。关于 2 型糖尿病，证据不足。有限的证据表明，任何母乳喂养和纯母乳喂养的持续时间与儿童期的中间结局（如空腹血糖、胰岛素抵抗）无关。
结论
有限至中等证据表明，用较少或不用人乳喂养与后代患 1 型糖尿病的风险更高相关。有限的证据表明，任何母乳喂养和纯母乳喂养的持续时间与儿童的中间糖尿病结局无关。需要进一步研究美国人群中婴儿喂养方式与 2 型糖尿病和中间结局之间的关系，这些人群可能具有不同的代谢风险。
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