Breastfeeding and Chronic Disease in Childhood and Adolescence

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Extensive biological and epidemiologic research has documented compelling benefits for breastfed infants. Human milk provides nutrients and energy for rapid growth and development, protective factors against infection, and biochemical messages that enhance the development of the gastrointestinal tract and host defense.

The remarkable antimicrobial and immunomodulating effects of human milk described elsewhere in this issue contribute to health during the period the infant is breastfeeding. This article examines the hypothesis that breastfeeding may have long-term protective effects against chronic disease in children. Alternatively, artificial feeding, or the absence of breastfeeding, may increase the risk for chronic disease. Many studies have found the incidence and duration of breastfeeding to be lower among children with chronic disease than among children without chronic disease. The purposes of this article are to review the literature on whether artificial feeding carries an increased risk for certain chronic diseases, to explore the possible explanations for reported findings, and to suggest a reasonable approach at this time for pediatricians in clinical practice.

The literature reporting investigations of the association between infant feeding practices and chronic disease has expanded dramatically since 1984 when Borch-Johnsen and colleagues reported that the risk of type 1 diabetes, or insulin-dependent diabetes mellitus (IDDM), was higher among children who were not breastfed for at least 3 months.17 Since the publication of this first article tying infant feeding to IDDM, more than 100 articles examining this hypothesis have been published. In addition, other studies have considered whether artificial feeding increases the risk for celiac disease, inflammatory bowel disease, childhood cancer, atopic disease,64 multiple sclerosis,85 Henoch-Schönlein's purpura,84 obesity,109 and cardiovascular disease.87 Some of these chronic diseases are more difficult to study than IDDM because they are rare or because their etiologies are complex and poorly understood. Thus, IDDM has a highly developed literature, but childhood cancer has a meager one, and the rare condition Henoch-Schönlein purpura has only a single article.84 IDDM, celiac disease, childhood cancer, and inflammatory bowel disease will be covered in this article.

Section snippets

TYPE I DIABETES MELLITUS

The risk for developing IDDM in childhood may be influenced by infant feeding practices. A large scientific literature that includes ecological studies, animal experiments, human case-control studies, and an ongoing randomized controlled trial in children suggests an association between artificial feeding in the first 3 to 6 months of life and the later development of IDDM. Many studies have explored biological mechanisms, particularly the hypothesis that early exposure to intact cow's milk

CELIAC DISEASE

Studies addressing the possibility that celiac disease is prevented or delayed by breastfeeding11, 20, 31, 40, 41, 54 have noted: (1) a decreased incidence among those who were breastfeeding when gluten was introduced; (2) longer breastfeeding duration among those without celiac disease; (3) a delayed onset of disease among those who breastfed for longer durations; and (4) a later introduction of dietary gluten among breastfeeders.

Celiac disease is an autoimmune enteropathy resulting from two

CHILDHOOD CANCER

Childhood cancer is in fact many different diseases, the causes of which are still poorly understood. Genetics, as well as environmental factors such as ionizing radiation, electromagnetic field radiation, chemical toxins, infection, prenatal factors, and dietary factors, have been established or considered as possible risk factors for various cancers.89 More than 10 studies have explored the possibility of an association with infant feeding,27, 44, 96, 98 some studying all cancers in

INFLAMMATORY BOWEL DISEASE

Twelve case-control studies conducted since 1961 were identified through MEDLINE for review in this article.* These studies examined the possible influence of infant feeding patterns on risk for inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. As a group the studies included geographically and ethnically diverse populations in Europe, North America, and Japan. Some studied both ulcerative

PERSPECTIVES ON COUNSELING

In 1994, the American Academy of Pediatrics (AAP) Work Group on Cow's Milk Protein and Diabetes Mellitus published a statement summarizing research on the possible causal relationship between infant feeding and IDDM.6 Their recommendations included the following: (1) Pediatricians should strongly endorse breastfeeding as the primary source of infant nutrition; and (2) “In families with a strong history of IDDM, particularly if a sibling has diabetes, breast-feeding and avoidance of commercially

References (113)

  • C. Magnani et al.

    Infant feeding and childhood cancer

    Lancet

    (1988)
  • G. Nigro et al.

    Breast-feeding and insulin-dependent diabetes mellitus [letter]

    Lancet

    (1985)
  • A. Rigas et al.

    Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood

    Ann Epidemiol

    (1993)
  • U. Samuelsson et al.

    Breast-feeding seems to play a marginal role in the prevention of insulin-dependent diabetes mellitus

    Diabetes Res Clin Practice

    (1993)
  • F.W. Scott

    Cow milk and insulin-dependent diabetes mellitus: Is there a relationship?

    Am J Clin Nutr

    (1990)
  • E.D. Acheson et al.

    Early weaning in the aetiology of ulcerative colitis: A study of feeding in infancy in cases and controls

    Br Med J

    (1961)
  • H.K. Akerblom et al.

    Putative environmental factors in type 1 diabetes

    Diabetes Metab Rev

    (1998)
  • H.K. Akerblom et al.

    Emergence of diabetes associated autoantibodies in the nutritional prevention of IDDM (TRIGR) project [abstract no. 0191]

    Diabetes

    (1999)

  • Supplemental foods for infants

  • Breastfeeding and the use of human milk

    Pediatrics

    (1997)

  • Infant feeding practices and their possible relationship to the etiology of diabetes mellitus

    Pediatrics

    (1994)
  • C.M. Anderson et al.

    Does breast feeding protect against the development of clinical symptoms of celiac disease in children [letter]?

    J Pediatr Gastroenterol Nutr

    (1985)
  • A.F. Andresen

    Gastrointestinal manifestations of food allergy

    Med J Res

    (1925)
  • H. Ascher et al.

    Different features of coeliac disease in two neighboring countries

    Arch Dis Child

    (1993)
  • H. Ascher et al.

    Influence of infant feeding and gluten intake on coeliac disease

    Arch Dis Child

    (1997)
  • S. Auricchio et al.

    Does breast feeding protect against the development of clinical symptoms of celiac disease in children?

    J Pediatr Gastroenterol Nutr

    (1983)
  • O. Bergstrand et al.

    Breast-feeding during infancy in patients who later develop Crohn's disease

    Scand J Gastroenterol

    (1983)
  • K.M. Bernt et al.

    Human milk as a carrier of biochemical messages

    Acta Paediatr Suppl

    (1999)
  • L. Blom et al.

    The Swedish childhood diabetes study: Social and perinatal determinants for diabetes in childhood

    Diabetologia

    (1989)
  • E. Bognetti et al.

    HLA antigens in Italian type 1 diabetic patients: Role of DR3/DR4 antigens and breast feeding in the onset of the disease

    Acta Diabetologia

    (1992)
  • D.N. Challacombe et al.

    Childhood coeliac disease is disappearing [letter]

    Lancet

    (1980)
  • D.N. Challacombe et al.

    Changing infant feeding practices and declining incidence of coeliac disease in West Somerset

    Arch Dis Child

    (1997)
  • G. Corrao et al.

    Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: A nationwide case-control study

    Int J Epidemiol

    (1998)
  • K. Dahl-Jorgensen et al.

    Relationship between cow's milk consumption and incidence of IDDM in childhood

    Diabetes Care

    (1991)
  • G. Dahlquist et al.

    The Swedish Childhood Diabetes Study: A multivariate analysis of risk determinants for diabetes in different age groups

    Diabetologia

    (1991)
  • G. Dahlquist et al.

    An increased level of antibodies to B-lactoglobulin is a risk determinant for early-onset type 1 (insulin-dependent) diabetes mellitus independent of islet cell antibodies and early introduction of cow's milk

    Diabetologia

    (1992)
  • D. Daneman et al.

    Dietary triggers of insulin-dependent diabetes in the BB rat

    Diabetes Res

    (1987)
  • M.K. Davis

    Review of the evidence for an association between infant feeding and childhood cancer

    Int J Cancer Suppl

    (1998)
  • L.C. Duffy et al.

    The effects of infant feeding on rotavirus-induced gastroenteritis: A prospective study

    Am J Public Health

    (1986)
  • R.B. Elliott et al.

    Dietary protein: A trigger of insulin-dependent diabetes in the BB rat?

    Diabetologia

    (1984)
  • K. Falth-Magnusson et al.

    Infant feeding history shows distinct differences between Swedish celiac and reference children

    Pediatr Allergy Immunol

    (1996)
  • P. Fort et al.

    Breast feeding and insulin-dependent diabetes mellitus in children

    J Am Coll Nutr

    (1986)
  • P. Garancini et al.

    Relevance of HLA-DR phenotype and breast feeding status in age heterogeneity at IDDM onset

    Diabetes Care

    (1993)
  • H.C. Gerstein

    Cow's milk exposure and type 1 diabetes mellitus

    Diabetes Care

    (1994)
  • T. Gilat et al.

    Childhood factors in ulcerative colitis and Crohn's Disease: An international study

    Scand J Gastroenterol

    (1987)
  • GimenoS.G. et al.

    IDDM and milk consumption. A case-control study in Sao Paulo, Brazil

    Diabetes Care

    (1997)
  • C. Glatthaar et al.

    Diabetes in Western Australian children: Descriptive epidemiology

    Med J Australia

    (1988)
  • J. Golding et al.

    Factors associated with childhood cancer in a national cohort study

    Brit J of Cancer

    (1990)
  • A.S. Goldman

    The immune system of human milk: Antimicrobial, antiinflammatory and immunomodulating properties

    Pediatr Infect Dis J

    (1993)
  • L. Greco et al.

    The effect of early feeding on the onset of symptoms in celiac disease

    J Pediatr Gastroenterol Nutr

    (1985)

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    Address reprint requests to Margarett K. Davis, MD, MPH Global AIDS Program NCHSTP/CDC Mailstop E-07 1600 Clifton Road Atlanta, GA 30333

    *

    National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

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    Copyright © 2001 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.