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Breastfeeding reduce the risk of Kawasaki disease in a Chinese
population based case-control study
Feifei Si1, Qian Duan2, Yanfeng Yang1*
1Pediatric Cardiovascular Department, Chengdu Women’s and Children’s Central
Hospital, School of Medicine, University of Electronic Science and Technology of
China, Chengdu, China
2 Southwest Jiaotong University, Chengdu, China
Feifei Si, Email:sifeifei211@163.com
Qian Duan, Email: 15882347203@163.com
*The author for correspondence: Yanfeng yang, Email:licole2019@163.com
Abstract
Backgroud: Kawasaki disease (KD) is the leading cause of acquired heart
disease in the pediatric age group in developed countries. But its etiology
is unknown. We assessed whether brestfeeding time can influence risk of
KD.
Methods: We collected feeding, clinical and laboratory details from 200
KD patients and 100 controls. Then we use SPSS to assess the
comparison of the general characteristics of KD patients and control
patients, and the Correlation of BF time with clinical and laboratory of
KD patients.
Results: The haemoglobin level was significantly lower in Kawasaki
disease patients compared with controls (p<0.05). There were no
significant differences between group of KD with coronary artery lesions
(CALs) and group of KD without CALs in age, sex, WBC, platelet, HB,
CRP . However, there were significantly decreased frequencies for the
longer beestfeeding time in KD patients without CALs when compared
with KD patients with CALs (OR=668, 95%CI=0.454-0.984,p=0.041).
Moreover, HB level were positively correlated with brestfeeding time in
patients with KD (r=0.163, p=0.028)
Conclusion: We have shown that breast-feeding is associated with KD
and the CALs. Brestfeeding may reduce the risk or KD with CALs.
Brestfeeding may reduce the risk of KD with CALs.
Kaywords: Kawasaki disease, brestfeeding, coronary artery lesions
Background
Kawasaki disease (KD) is a vasculitis of unknown etiology, which
mainly occurs in infants and young children. The most severe
complications that KD patients experience are coronary artery lesions
(CALs), leading to myocardial ischemia, infarction and sudden death. At
present, KD is the leading cause of acquired heart disease in the pediatric
age group in developed countries[1].
Cause and pathogenesis of KD are unclear. Therefore literature is
replete with multiple factors considered as associations of KD[2]. KD
may occur with an aberrant immune response to some environmental
trigger[3]. Recently researchers found that nutrition during critical
windows in early life can influence and program later cardiometabolic
health[4]. Brestfeeding is the best source of nutrition for infants to
optimize growth and development. The World Health Organization(WHO)
recommends exclusive breastfeeding for the first 6 months of life,
introduction of complementary foods at 6 months of age, and continued
breastfeeding up to 2 years of age and beyond [5].
A Japanese study and a German study already have indicated a
potential protective effect of brestfeeding in KD[6,7]. This suggested that
brestfeeding potentially play a role in the pathogenesis of KD. But there
are few study about the specific association between the brestfeeding and
KD. Therefore, in a retrospective case-control study we investigated the
association and impact of breastfeeding practices and on Laboratory
indexes of KD.
Methods
This investigation was a retrospective analysis. All cases were
performed at a single institution. The study was approved by the Ethics
Committees of Chengdu women’s and Children Central hospital. The
medical records of all patients with a discharge diagnosis of KD admitted
to the Chengdu Women’s and Children’s Central Hospital from
September 2018 to September 2019 were retrospectively reviewed.
We collected 200 KD patients, as controls, 100 healthy children
were selected.
We collected feeding, clinical and laboratory details from each KD
case. All enrolled patients met the criteria proposed by the Japanese
Kawasaki Disease Research Committee[8]. Patients with KD were
divided into 2 groups according to the presence of CAL: patients with
CALs and patients without CALs. CALs were defined as a z score 2.5 in
the right coronary artery or the left anterior descending coronary artery or
the presence of ectasia or aneurysms. Coronary arterial lesion severity
assessment was visualised using echocardiography or coronary artery
angiography along with dilatation and/or evidence of ectasia and
aneurysms. Collection of clinical data were approved by the Chengdu
Women’s and Children Central Hospital.
Statistical analyses
Statistical analysis was performed using SPSS version 20 software
(SPSS Inc., Chicago, IL, USA). We presented the data as mean ±
standard deviation (SD) for all values. Statistical significance of the
differences between the continuous variables was evaluated by One-way
analysis of variance (ANOVA) or Kruskal–Wallis ANOVA and Mann –
Whitney U tests. A Pearson ’s test was used to measure associations
between sequential parameters. The association between brestfeeding
time and Kawasaki disease risk was estimated by computing odds ratios
and 95% confidence intervals from a multivariate logistic regression
analysis. A pvalue of <0.05 was considered to be statistically
significant.
Results
As shown in Table 1, platelet count, white blood cell counts,
C-reactive protein were higher in Kawasaki disease patients compared
with controls (p<0.001), whereas haemoglobin level was significantly
lower in Kawasaki disease patients compared with controls (p<0.05).
There were no significant differences between group of KD with
CALs and group of KD without CALs in age, sex, WBC, platelet, HB,
CRP (Table 2). However, there were significantly decreased frequencies
for the longer beestfeeding time in KD patients without CALs when
compared with KD patients with CALs (OR=668, 955CI=0.454-0.984,
p=0.041. Table2). Moreover, as shown in Table 3, HB level were
positively correlated with brestfeeding time in patients with KD (r=0.163,
p=0.028) (Table 3).
Discussion
It is widely accepted that breast-feeding has numerous health
benefits for both the infant and mother[9] . Increasing evidence suggests
that breast-feeding is associated with lower cardiovascular disease
(CVD)risk factors [10 ].It is reported to be the most frequent pediatric
systemic vasculitis globally, and the most important cause of acquired
heart disease among children. There were only few studies about the
association between brest-feeding and Kawasaki disease. Up to now, we
are the first to report the relationship between brestfeeding and the KD
laboratory index.
In addition to standard diagnostic criteria, KD patients may
experience a variety of nonspecific clinical features, such as anemia[11].
Anemia is the most common clinical feature in KD patients and is
thought to have a more prolonged duration of active inflammation[12].
Studies found that hemoglobin is a useful early differentiating feature
between KD shock syndrome from toxic shock syndrome in a pediatric
intensive care unit [13].
In this study, we showed that the HB level was significantly lower in
Kawasaki disease patients, moreover, HB level was positively correlated
with brestfeeding time in patients with KD. Therefore, we hypothesize
that brestfeeding during early life may play a role in in the acute phase of
KD.
Our analysis identified a statistically significant association between
brestfeeding time and an reduced risk of CALs in KD children. It
suggested that the longer brestfeeding time may play a protective factors
in the development of KD CALs.
The authors observed protective effects of breastfeeding on the
development of KD during the period from 6 to 30 months of age in the
country in which KD is most common.
Among other advantages, breastfeeding seems to protect against a
variety of infectious diseases [14] and non-breastfed children have a
higher risk of developing allergies and bronchial asthma later in life [15].
During the perinatal and infancy periods, these and other factors
potentially play a role in the pathogenesis of KD.
The WHO recommends that infants should be fed breast milk
exclusively for the first six months of life. Our study provide further
evidence for the promotion of breast-feeding. A large study from Japan
has indicated that breastfeeding may be protective for KD[16], our data
reinforce the findings.
Our study has limitations. The cross-sectional analysis cannot
determine causality. Further, we were not able to adjust for unmeasured
potential confounders, such as infant feeding patterns or early
introduction of complementary foods. Another major limitation of this
study was its relatively small sample size.
Conclusions
In summary, we have shown that breast-feeding is associated with
KD and the CALs. The results from the present study add to the literature
supporting a beneficial effect of breastfeeding on health-related
parameters.
Acknowledgements The authors would like to thank Muchen Li for the idea of the
research, Yiling Liu and Lingxia Fan who were involved in data collection.
Contributors Feifei Si conceptualised and designed the study, drafted the initial
manuscript. Yanfeng Yang conducted analyses and reviewed and revised the
manuscript for important intellectual content. Qian Duan contributed to interpretation
of data and critically reviewed the manuscript for important intellectual content. All
authors approved the final manuscript as submitted and agree to be accountable for all
aspects of the work.
Funding No funding was used for the creation of this manuscript.
Disclaimer The study sponsors had no role in study design; the collection, analysis
and interpretation of data; the writing of the report or the decision to submit the
manuscript for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval No approval was required by the institutional review board at
Chengdu Women’s and Children Central Hospital.
Availability of data and materials Please contact authors for data requests.
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