BACKGROUND: Allergic diseases are the leading causes of chronic illness in children and young adults in the UK. AIM: To undertake a comprehensive review of the evidence on the effect of breastfeeding (BF) duration and timing of solid food introduction (SFI), on the risk of wheeze, atopic dermatitis, rhino-conjunctivitis, food allergy, allergic sensitisation and measures of lung function or bronchial hyper-responsiveness. METHODS: We carried out a systematic review following the PRISMA guidelines (International Prospective Register of Systematic Reviews [PROSPERO] CRD42013003802). We included intervention, cohort, case-control and cross-sectional studies. Following literature searches (July 2013), study eligibility, data extraction and risk of bias assessments were conducted independently by two investigators. Random effects meta-analyses were used to pool results. Five levels of comparison of total or exclusive BF duration were used to assess disease risk in children at age 0-4 yrs, 5-15 yrs or 15+yrs: 'never vs ever','>1-2 months vs. <1-2 months', '>3-4 months vs. <3-4 months', '>5-7 months vs. <5-7 months', and '>8-12 months vs. <8- 12 months'. Exclusive BF (EBF; BF without formula or solid food supplementation) was categorised as '>0-2 months vs. <0- 2 months', '>3-4 months vs. <3-4 months' and '>5+ months vs. <5+ months', and SFI as '>3-4 months vs. <3-4 months'. Publication bias was assessed using Egger's asymmetry test. RESULTS: Of 16,289 identified studies, 564 met the inclusion criteria and were eligible for analysis. We found reduced risk of wheezing in children aged 5-14 yrs with longer BF or EBF duration, which was dose-dependent, but there was evidence of publication bias (BF and odds of recurrent wheezing P = 0.007). Similar results were found for recurrent wheeze at age 5-14 yrs but not in other ages. Measures of lung function were also increased with increased BF or EBF duration. We found no evidence that BF duration influences other allergic outcomes, and no evidence that timing of SFI influences any of the outcomes assessed. CONCLUSION: Longer breastfeeding duration may protect against wheezing later in childhood. Any effect is likely to be through effects on lung function rather than allergic sensitisation. Other allergic outcomes do not appear to be influenced by breastfeeding duration.
BACKGROUND: There is uncertainty about the influence of diet during pregnancy and infancy on a child's immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease.
METHODS AND FINDINGS: Two authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease. We identified 260 original studies (964,143 participants) of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies (542,672 participants) of other maternal or infant dietary exposures, including 80 trials of maternal (n = 26), infant (n = 32), or combined (n = 22) interventions. Risk of bias was high in 125 (48%) milk feeding studies and 44 (25%) studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with nonpathogenic micro-organisms (probiotics) during late pregnancy and lactation may reduce risk of eczema (Risk Ratio [RR] 0.78; 95% CI 0.68-0.90; I2 = 61%; Absolute Risk Reduction 44 cases per 1,000; 95% CI 20-64), and 6 trials suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitisation to egg (RR 0.69, 95% CI 0.53-0.90; I2 = 15%; Absolute Risk Reduction 31 cases per 1,000; 95% CI 10-47). GRADE certainty of these findings was moderate. We found weaker support for the hypotheses that breastfeeding promotion reduces risk of eczema during infancy (1 intervention trial), that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus (28 observational studies), and that probiotics reduce risk of allergic sensitisation to cow's milk (9 intervention trials), where GRADE certainty of findings was low. We did not find that other dietary exposures-including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake-influence risk of allergic or autoimmune disease. For many dietary exposures, data were inconclusive or inconsistent, such that we were unable to exclude the possibility of important beneficial or harmful effects. In this comprehensive systematic review, we were not able to include more recent observational studies or verify data via direct contact with authors, and we did not evaluate measures of food diversity during infancy.
CONCLUSIONS: Our findings support a relationship between maternal diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce risk of eczema and allergic sensitisation to food, respectively.
Allergic diseases are the leading causes of chronic illness in children and young adults in the UK.
AIM:
To undertake a comprehensive review of the evidence on the effect of breastfeeding (BF) duration and timing of solid food introduction (SFI), on the risk of wheeze, atopic dermatitis, rhino-conjunctivitis, food allergy, allergic sensitisation and measures of lung function or bronchial hyper-responsiveness.
METHODS:
We carried out a systematic review following the PRISMA guidelines (International Prospective Register of Systematic Reviews [PROSPERO] CRD42013003802). We included intervention, cohort, case-control and cross-sectional studies. Following literature searches (July 2013), study eligibility, data extraction and risk of bias assessments were conducted independently by two investigators. Random effects meta-analyses were used to pool results. Five levels of comparison of total or exclusive BF duration were used to assess disease risk in children at age 0-4 yrs, 5-15 yrs or 15+yrs: 'never vs ever','>1-2 months vs. <1-2 months', '>3-4 months vs. <3-4 months', '>5-7 months vs. <5-7 months', and '>8-12 months vs. <8- 12 months'. Exclusive BF (EBF; BF without formula or solid food supplementation) was categorised as '>0-2 months vs. <0- 2 months', '>3-4 months vs. <3-4 months' and '>5+ months vs. <5+ months', and SFI as '>3-4 months vs. <3-4 months'. Publication bias was assessed using Egger's asymmetry test.
RESULTS:
Of 16,289 identified studies, 564 met the inclusion criteria and were eligible for analysis. We found reduced risk of wheezing in children aged 5-14 yrs with longer BF or EBF duration, which was dose-dependent, but there was evidence of publication bias (BF and odds of recurrent wheezing P = 0.007). Similar results were found for recurrent wheeze at age 5-14 yrs but not in other ages. Measures of lung function were also increased with increased BF or EBF duration. We found no evidence that BF duration influences other allergic outcomes, and no evidence that timing of SFI influences any of the outcomes assessed.
CONCLUSION:
Longer breastfeeding duration may protect against wheezing later in childhood. Any effect is likely to be through effects on lung function rather than allergic sensitisation. Other allergic outcomes do not appear to be influenced by breastfeeding duration.
