Literature review for - Flourish Paediatrics

Reference Akobeng 2006 Arch Dis Child Barclay 2009 J Pediatrics
Type of study
SLR Meta analysis
Coeliac Disease
SLR Meta analysis
Crohn’s Disease and Ulcerative colitis
Level of evidence II (aetiology) II (aetiology)
Definition of
breastfeeding
Ever breastfed, Never Breastfed, Duration of Ever
Breastfed
Breastfeeding was only defined in 3 of the 8 studies
Intervention
Ever breastfed Vs never breastfed
Comparator
N 1131 cases 3493 controls 1542 cases 2620 controls
Population/study
information
Quality
Results
Six Case control studies
P
All the six included studies were graded ‘‘B’’
Effect of breastfeeding at the time of gluten introduction
on development of CD.
OR= 0.48 (0.40, 0.59)
Increasing duration of breastfeeding is associated with a
reduced risk of coeliac disease
Eight Case control studies
P
All the eight included studies were graded ‘‘B’’
Breastmilk exposure had a significant protective effect
(OR, 0.69; 95% CI, 0.51-0.94; P = .02) in developing
early-onset IBD. A non-significant difference was
demonstrated for ulcerative colitis and Crohn's disease
individually (OR, 0.72; 95% CI, 0.51-1.02; P = .06;
OR, 0.64; 95% CI, 0.38-1.07; P = .09, respectively)
Effect on risk Reduced risk Reduced risk in breastfed infants
Clinical importance 1 1
Clinical relevance 1 1
Generalisability Y Y
Applicability Y Y
References used in body of evidence table: (Akobeng, Ramanan et al. 2006; Barclay, Russell et al. 2009)
One additional study has been published since this review (Gearry, Richardson et al. 2010). This is an additional case-control study from NZ
with 638 prevalent Crohn's disease and 653 prevalent ulcerative colitis cases. A protective effect for breastfeeding was found in this study. The
authors recommend further research on a duration-response protective association.
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