母乳喂养与儿童癌症风险：系统评价和剂量-反应荟萃分析。
Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China.
Department of Hematology and Oncology, Children's hospital of Nanjing Medical University, Nanjing, 210008, China.
出版信息
BMC Med. 2021 Apr 13;19(1):90. doi: 10.1186/s12916-021-01950-5.
BACKGROUND
The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer.
METHODS
A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out.
RESULTS
Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65-0.91) and 0.77 (95% CI 0.63-0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (P non-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62-0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44-0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44-0.83). However, no associations of breastfeeding with risk of other cancers were found.
CONCLUSIONS
Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.
背景
本研究旨在定量总结有关母乳喂养与儿童癌症风险关联的现有证据。
方法
对 PubMed 和 Embase 数据库进行文献检索，以确定从研究开始到 2020 年 7 月 17 日发表的合格观察性研究。通过汇总相对风险（RR）或比值比（OR）估计值及其 95%置信区间（CI）进行分类和剂量-反应荟萃分析。通过荟萃回归和分层分析检测潜在的异质性来源。还进行了敏感性分析和发表偏倚检验。
结果
荟萃分析纳入了 45 篇涉及 475579 人的文章。在 33 项关于母乳喂养与儿童白血病风险之间关联的研究中，汇总的风险估计值分别为 0.77（95%CI，0.65-0.91）和 0.77（95%CI，0.63-0.94），用于曾经与非/偶尔母乳喂养和最长与最短母乳喂养持续时间组。母乳喂养持续时间与儿童白血病风险之间存在明显的非线性剂量-反应关系（P 非线性 <0.001）。母乳喂养持续时间为 9.6 个月时，保护效果最佳（OR，0.66，95%CI 0.62-0.70）。四项研究检验了母乳喂养与儿童神经母细胞瘤风险之间的关联，在曾经母乳喂养与非/偶尔母乳喂养（OR=0.59，95%CI 0.44-0.81）和最长与最短母乳喂养（OR=0.61，95%CI 0.44-0.83）的比较中均观察到一致的显著负相关。然而，没有发现母乳喂养与其他癌症风险之间存在关联。
结论
我们的研究支持母乳喂养对儿童白血病风险具有保护作用，并且提示存在非线性剂量-反应关系。需要进一步的研究来证实母乳喂养与儿童神经母细胞瘤风险之间的关联。
Zotero 插件