Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis

Koret School of Veterinary Medicine, the Hebrew University of Jerusalem, Rehovot, Israel.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 12/2004; 80(5):1342-52.
Source: PubMed

ABSTRACT It has long been believed that breastfeeding provides protection against ulcerative colitis and Crohn disease. Studies designated to test this hypothesis were conducted without reaching conclusive results.
The aim of this meta-analysis was to examine the role of breastfeeding in preventing inflammatory bowel disease and to summarize the evidence gathered about this subject.
A meta-analysis was performed on 17 relevant articles that were found by using MEDLINE, EMBASE, the Internet, and articles' references. The publications were fully reviewed and divided, on the basis of their quality, into 3 groups.
Studies showed heterogeneous results. The pooled odds ratios of all the 17 reviewed studies, calculated according to the random-effects model, were 0.67 (95% CI: 0.52, 0.86) for Crohn disease and 0.77 (0.61, 0.96) for ulcerative colitis. However, only 4 studies for Crohn disease and 4 for ulcerative colitis were eventually included in the highest quality group. In this group, the pooled odds ratio was 0.45 (0.26, 0.79) for Crohn disease and 0.56 (0.38, 0.81) for ulcerative colitis.
The results of this meta-analysis support the hypothesis that breastfeeding is associated with lower risks of Crohn disease and ulcerative colitis. However, because only a few studies were graded to be of high quality, we suggest that further research, conducted with good methodology and large sample sizes, should be carried out to strengthen the validity of these observations.

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Available from: Eyal Klement, Sep 26, 2015
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    • "Breastfeeding is another possible dietary factor that may be influential in IBD development. A recent meta-analysis analyzed 17 studies addressing the hypothesis that breastfeeding is a protective factor against IBD noted that the limited data supports the hypothesis that breastfeeding confers protection, however larger more well organized studies are needed (33). Developed countries likely have easier access to infant formulas, and as such may be a factor in rising rates of IBD in the Western world. "
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    ABSTRACT: Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory disorder of the gastrointestinal tract associated with significant morbidity. While IBD occurs in genetically susceptible individuals, the etiology is multifactorial, involving environmental influences, intestinal dysbiosis, and altered immune responses. The rising incidence of IBD in industrialized countries and the emergence of IBD in countries with traditionally low prevalence underscore the importance of environmental influences in the pathobiology of the disease. Moreover the high incidence of IBD observed in the South Asian immigrant population in the United Kingdom and Canada further supports the influence of environmental factors.
    Frontiers in Pediatrics 11/2013; 1:34. DOI:10.3389/fped.2013.00034
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    • "A meta-analysis of 14 case control studies found that breast feeding had a protective effect on the development of UC (OR 0.61, 95% CI 0.44–0.84), but not on CD.39 A second systematic review and meta-analysis published in also found a significant protective effect (OR 0.69, 95% CI 0.51–0.94) "
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    ABSTRACT: Inflammatory bowel diseases (IBD), including both Crohn's disease and ulcerative colitis, are disorders of chronic inflammation of the gastrointestinal tract marked by episodes of relapse and remission. Over the past several decades, advances have been made in understanding the epidemiology of IBD. The incidence and prevalence of both Crohn's disease and ulcerative colitis have been increasing worldwide across pediatric and adult populations. As IBD is thought to be related to a combination of individual genetic susceptibility, environmental triggers, and alterations in the gut microbiome that stimulate an inflammatory response, understanding the potentially modifiable environmental risk factors associated with the development or the course of IBD could impact disease rates or management in the future. Current hypotheses as to the development of IBD are reviewed, as are a host of environmental cofactors that have been investigated as both protective and inciting factors for IBD onset. Such environmental factors include breast feeding, gastrointestinal infections, urban versus rural lifestyle, medication exposures, stress, smoking, and diet. The role of these factors in disease course is also reviewed. Looking forward, there is still much to be learned about the etiology of IBD and how specific environmental exposures intimately impact the development of disease and also the potential for relapse.
    Clinical Epidemiology 07/2013; 5(1):237-47. DOI:10.2147/CLEP.S33961
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    • "There are also some studies which could not confirm the positive association between breastfeeding and subsequent development of UC (Koletzko et al., 1989). In 2004, a systematic review and meta-analysis reported a significant protective effect of breastfeeding against both CD and UC (Klement et al., 2004). The role of breastfeeding in the development of childhood onset IBD (<16 years of age) was assessed in the meta-analysis by Barclay et al. "
    Ulcerative Colitis - Treatments, Special Populations and the Future, 11/2011; , ISBN: 978-953-307-739-0
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