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A protective effect of breastfeeding on the progression of non-alcoholic fatty liver disease
  1. V Nobili1,
  2. G Bedogni2,
  3. A Alisi1,
  4. A Pietrobattista1,
  5. A Alterio1,
  6. C Tiribelli2,
  7. C Agostoni3
  1. 1
    Liver Unit, “Bambino Gesù” Children’s Hospital and Research Institute, Rome, Italy
  2. 2
    Liver Research Centre, Basovizza, and Department of Life Sciences, University of Trieste, Trieste, Italy
  3. 3
    Department of Paediatrics, San Paolo Hospital, University of Milan, Milan, Italy
  1. Correspondence to Dr Valerio Nobili, Liver Unit “Bambino Gesù” Children’s Hospital and Research Institute, Via S. Onofrio 4, 00165 Rome, Italy; nobili66{at}


Objective: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease characterised by accumulation of large-droplet fat in hepatocytes with possible progression to inflammation and fibrosis. Breastfeeding has benefits for child health, both during infancy and later in life, reducing the risk of manifestations of the metabolic syndrome. Here we investigated the association between early type of feeding (breastfed versus formula-fed and duration of breastfeeding) and later NAFLD development.

Study design: We investigated 191 young Caucasian children (3–18 years old) with NAFLD consecutively enrolled between January 2003 and September 2007 in our centre. 48% of these children (n = 91) had been breastfed for a median (interquartile range) time of 8 (7) months.

Results: After correction for age, waist circumference, gestational age and neonatal weight, the odds of non-alcoholic steatohepatitis (NASH) (OR 0.04, 95% CI 0.01 to 0.10) and fibrosis (OR 0.32, 95% CI 0.16 to 0.65) were lower in breastfed versus not breastfed infants. Moreover, the odds of NASH (OR 0.70, exact 95% CI 0.001 to 0.87) and fibrosis (OR 0.86, exact 95% CI 0.75 to 0.98) decreased for every month of breastfeeding.

Conclusions: This observational study suggests that earlier feeding habits might affect the clinical expression of NASH from 3 to 18 years later, with an apparent drug-like preventive effect of breastfeeding.

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  • Funding The study was supported by funds from the “Bambino Gesù” Hospital and from the Liver Research Centre via the Italian Liver Foundation.

  • Competing interests None.

  • Ethics approval The study protocol conformed to the Declaration of Helsinki and the recommendations of the Ethics Committee of the “Bambino Gesù” Hospital.

  • Patient consent Parental consent obtained.

  • Contributors Study concept and design: V Nobili, C Agostoni; acquisition of data: A Alisi, A Pietrobattista, A Alterio; analysis and interpretation of data: V Nobili, G Bedogni; drafting of the manuscript: G Bedogni, A Alisi, C Agostoni; critical revision of the manuscript for important intellectual content: V Nobili, C Tiribelli, C Agostoni; statistical analysis: Bedogni G. Dr Nobili had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.