Norris J M, Scott F W
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, 80262, USA.
Epidemiology. 1996 Jan;7(1):87-92. doi: 10.1097/00001648-199601000-00015.
We evaluated the relation between early infant diet and insulin-dependent diabetes risk with a meta-analysis of 17 case-control studies. A summary of all studies indicated a moderate effect for exposure to breast-milk substitutes [odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.18-1.61] and cow's milk-based substitutes (OR = 1.61; 95% CI = 1.31-1.98) before 3 months of age. Fourteen studies relied on retrospectively collected infant diet data based on long-term maternal recall, which may be biased or inaccurate; three studies used existing infant diet records to assess exposure, thus lessening the possibility of recall bias or inaccurate data. The studies using existing records demonstrated little association compared with the studies relying on long-term recall. Studies in which the controls had a participation rate that was more than 20% lower than that of the cases showed a stronger diabetogenic effect of never being breast-fed (OR = 1.58) than studies whose cases and controls had similar participation rates (OR = 1.06). Thus, differences in the participation rates of cases and controls may have biased the results of these studies. This meta-analysis indicates that the weak association between infant diet and risk of diabetes mellitus may have methodologic explanations.
我们通过对17项病例对照研究进行荟萃分析，评估了婴儿早期饮食与胰岛素依赖型糖尿病风险之间的关系。所有研究的总结表明，在3个月龄前接触母乳替代品[比值比（OR）= 1.38；95%置信区间（CI）= 1.18 - 1.61]和以牛奶为基础的替代品（OR = 1.61；95% CI = 1.31 - 1.98）有中等程度的影响。14项研究依赖于基于长期母亲回忆回顾性收集的婴儿饮食数据，这可能存在偏差或不准确；3项研究使用现有的婴儿饮食记录来评估暴露情况，从而降低了回忆偏差或数据不准确的可能性。与依赖长期回忆的研究相比，使用现有记录的研究显示关联较小。与病例和对照参与率相似的研究（OR = 1.06）相比，对照参与率比病例低20%以上的研究显示，从未母乳喂养的致糖尿病作用更强（OR = 1.58）。因此，病例和对照参与率的差异可能使这些研究的结果产生了偏差。这项荟萃分析表明，婴儿饮食与糖尿病风险之间的微弱关联可能有方法学上的解释。
