Systematic review with meta-analysis: breastfeeding and the risk of Crohn's disease and ulcerative colitis

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d1388269e177">Background</h5> <p id="P1">Breastfeeding is a modifiable factor that may influence development of inflammatory bowel diseases. However, literature on this has been inconsistent and not accounted for heterogeneity in populations and exposure. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d1388269e182">Aims</h5> <p id="P2">We conducted a meta-analysis to examine the association between breastfeeding in infancy and risk of Crohn’s disease and ulcerative colitis. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d1388269e187">Methods</h5> <p id="P3">A systematic search of Medline/PubMed and Embase was performed for full-text, English-language literature through November 2016. Studies were included if they described breastfeeding in infancy in patients with Crohn’s disease or ulcerative colitis, and healthy controls. Data were pooled using a random effects model for analysis. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d1388269e192">Results</h5> <p id="P4">A total of 35 studies were included in the final analysis, comprising 7,536 individuals with Crohn’s disease, 7,353 with ulcerative colitis, and 330,222 controls. Ever being breastfed was associated with a lower risk of Crohn’s disease (OR 0.71, 95% CI 0.59 – 0.85) and ulcerative colitis (OR 0.78, 95% CI 0.67 – 0.91). While this inverse association was observed in all ethnicity groups, the magnitude of protection was significantly greater among Asians (OR 0.31, 95% CI 0.20 – 0.48) compared to Caucasians (OR 0.78, 95% CI 0.66 – 0.93) (p=0.0001) in Crohn’s disease. Breastfeeding duration showed a dose-dependent association, with strongest decrease in risk when breastfed for at least 12 months for Crohn’s disease (OR 0.20, 95% CI 0.08 – 0.50) and ulcerative colitis (OR 0.21, 95% CI 0.10 – 0.43) as compared to 3 or 6 months. </p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d1388269e197">Conclusions</h5> <p id="P5">Breastfeeding in infancy protects against the development of Crohn’s disease and ulcerative colitis. </p> </div>

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Most cited references 52

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Inflammatory bowel disease.

Clara Abraham, Judy H Cho, Peter Moses (2009)

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Aleksandar D. Kostic, Ramnik Xavier, Dirk Gevers (2014)

Studies of the roles of microbial communities in the development of inflammatory bowel disease (IBD) have reached an important milestone. A decade of genome-wide association studies and other genetic analyses have linked IBD with loci that implicate an aberrant immune response to the intestinal microbiota. More recently, profiling studies of the intestinal microbiome have associated the pathogenesis of IBD with characteristic shifts in the composition of the intestinal microbiota, reinforcing the view that IBD results from altered interactions between intestinal microbes and the mucosal immune system. Enhanced technologies can increase our understanding of the interactions between the host and its resident microbiota and their respective roles in IBD from both a large-scale pathway view and at the metabolic level. We review important microbiome studies of patients with IBD and describe what we have learned about the mechanisms of intestinal microbiota dysfunction. We describe the recent progress in microbiome research from exploratory 16S-based studies, reporting associations of specific organisms with a disease, to more recent studies that have taken a more nuanced view, addressing the function of the microbiota by metagenomic and metabolomic methods. Finally, we propose study designs and methodologies for future investigations of the microbiome in patients with inflammatory gut and autoimmune diseases in general. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.

Siew C. Ng, Whitney Tang, Jessica Y. L. Ching … (2013)

Inflammatory bowel diseases (IBD) are becoming more common in Asia, but epidemiologic data are lacking. The Asia-Pacific Crohn's and Colitis Epidemiology Study aimed to determine the incidence and phenotype of IBD in 8 countries across Asia and in Australia. We performed a prospective, population-based study of IBD incidence in predefined catchment areas, collecting data for 1 year, starting on April 1, 2011. New cases were ascertained from multiple overlapping sources and entered into a Web-based database. Cases were confirmed using standard criteria. Local endoscopy, pathology, and pharmacy records were searched to ensure completeness of case capture. We identified 419 new cases of IBD (232 of ulcerative colitis [UC], 166 of Crohn's disease [CD], and 21 IBD-undetermined). The crude annual overall incidence values per 100,000 individuals were 1.37 for IBD in Asia (95% confidence interval: 1.25-1.51; 0.76 for UC, 0.54 for CD, and 0.07 for IBD-undetermined) and 23.67 in Australia (95% confidence interval: 18.46-29.85; 7.33 for UC, 14.00 for CD, and 2.33 for IBD-undetermined). China had the highest incidence of IBD in Asia (3.44 per 100,000 individuals). The ratios of UC to CD were 2.0 in Asia and 0.5 in Australia. Median time from symptom onset to diagnosis was 5.5 months (interquartile range, 1.4-15 months). Complicated CD (stricturing, penetrating, or perianal disease) was more common in Asia than Australia (52% vs 24%; P = .001), and a family history of IBD was less common in Asia (3% vs 17%; P < .001). We performed a large-scale population-based study and found that although the incidence of IBD varies throughout Asia, it is still lower than in the West. IBD can be as severe or more severe in Asia than in the West. The emergence of IBD in Asia will result in the need for specific health care resources, and offers a unique opportunity to study etiologic factors in developing nations. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.