Abate Biruk Beletew, Tusa Biruk Shalmeno, Sendekie Ashenafi Kibret, Araya Freweyni Gebreegziabher, Bizuayehu Molla Azmeraw, Walle Getachew Tesfaw, Kitaw Tegene Atamenta, Tilahun Befkad Derese, Alamaw Addis Wondmagegn, Zemariam Alemu Birara, Kassaw Amare, Kassie Ayelign Mengesha, Yilak Gizachew, Bizuneh Fassikaw Kebede, Dachew Berihun
School of Population Health, Curtin University, Perth, WA, Australia.
College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
Int Breastfeed J. 2025 Mar 25;20(1):18. doi: 10.1186/s13006-025-00712-w.
Despite numerous reviews examining the impact of exclusive breastfeeding on preventing childhood pneumonia and asthma, a comprehensive and up-to-date synthesis is lacking. This umbrella review aims to consolidate the current evidence on the link between non-exclusive breastfeeding and the risk of pneumonia and asthma in under-five children.
A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar to identify systematic review and meta-analysis (SRM) studies evaluating the effect of exclusive breastfeeding on preventing childhood pneumonia and asthma globally. The latest search was conducted on January 25/2025. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews Two (AMSTAR-2) tool. A weighted inverse variance random-effects model was employed to generate pooled estimates. Summary effect estimates were expressed using odds ratios (OR) with 95% confidence intervals (CI). We evaluated the quality of evidence for each association using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, categorising it as convincing (class I), highly suggestive (class II), suggestive (class III), and weak (class IV).
Twelve SRMs, including 270 primary studies with over ten million participants, were analysed. The random-effects model revealed a highly suggestive association between non-exclusive breastfeeding and an increase in the risk of pneumonia (OR 2.34; 95% CI 1.89, 2.78, GRADE: highly suggestive). Similarly, there was highly suggestive evidence that non-exclusive breastfeeding was associated with a 29% higher risk of childhood asthma (OR 1.21; 95% CI 1.07, 1.34, GRADE: highly suggestive).
Our results highlighted that non-exclusive breastfeeding is associated with an increased risk of pneumonia and asthma in under-five children. These findings emphasise the critical role of exclusive breastfeeding in reducing the risk of respiratory health issues, highlighting the need for policies and initiatives that promote breastfeeding as a key strategy for improving children's health outcomes.
尽管有大量综述探讨了纯母乳喂养对预防儿童肺炎和哮喘的影响，但仍缺乏全面且最新的综合分析。本伞状综述旨在整合当前关于非纯母乳喂养与五岁以下儿童肺炎和哮喘风险之间联系的证据。
在PubMed、Embase、Scopus、Web of Science、Cochrane系统评价数据库和谷歌学术上进行了全面检索，以识别评估全球范围内纯母乳喂养对预防儿童肺炎和哮喘效果的系统评价和荟萃分析（SRM）研究。最近一次检索于2025年1月25日进行。使用多重系统评价评估工具二（AMSTAR - 2）对纳入研究的质量进行评估。采用加权逆方差随机效应模型生成合并估计值。汇总效应估计值用比值比（OR）及95%置信区间（CI）表示。我们使用推荐分级、评估、制定与评价（GRADE）框架评估每种关联的证据质量，将其分类为确凿（I类）、高度提示（II类）、提示（III类）和薄弱（IV类）。
分析了12项SRM，包括270项涉及超过1000万参与者的原始研究。随机效应模型显示，非纯母乳喂养与肺炎风险增加之间存在高度提示性关联（OR 2.34；95% CI 1.89，2.78，GRADE：高度提示）。同样，有高度提示性证据表明，非纯母乳喂养与儿童哮喘风险高29%相关（OR 1.21；95% CI 1.07，1.34，GRADE：高度提示）。
我们的结果强调，非纯母乳喂养与五岁以下儿童肺炎和哮喘风险增加有关。这些发现强调了纯母乳喂养在降低呼吸健康问题风险方面的关键作用，凸显了将促进母乳喂养作为改善儿童健康结局的关键策略的政策和倡议的必要性。
