ISBN:978 92 4 150612 0
Background: Several studies suggest that breastfeeding has clear short-term benefits, particularly reducing morbidity and mortality due to infectious diseases in childhood. These benefits have been reported in low and middle income and in high-income countries.
Objective and methods: This systematic review and meta-analysis was aimed at assessing the effect of breastfeeding on respiratory infections and diarrheal disease in childhood. Search strategy Two independent literature searches were carried out, comprising the MEDLINE (1966 to December 2011) and Scientific Citation Index databases. Selection criteria We selected observational and randomized studies, published in English, French, Spanish or Portuguese that evaluated the associations between breastfeeding and diarrhoea or respiratory infections outcomes in children younger than 5 years of age. Studies that did not use an internal comparison group were excluded from the meta-analyses. The type of categorization of breastfeeding varied by study, but in all of them it was possible to compare a group with more intense breastfeeding practices with another with less intense breastfeeding. (e.g., ever versus never breastfed; breastfed for x months versus breastfed for less than x months, exclusively versus partially or not breastfed, etc.). Two reviewers using a standardized protocol independently evaluated the manuscripts; any disagreements were solved by consensus. Heterogeneity among studies was assessed with the Q-test and I-square. Because heterogeneity was evident for all outcomes, random-effects models were used throughout. We identified 15 studies that provided 18 estimates on the effect of breastfeeding on diarrhoea morbidity among children < 5 years. More intense breastfeeding practices were associated with a pooled relative risk of diarrhoea incidence of 0.69 (95% confidence interval: 0.58; 0.82) compared to less intense breastfeeding. Among infants aged ≤ 6 months, we obtained 49 estimates from 23 studies, with a corresponding pooled relative risk 0.37 (95% confidence interval: 0.27; 0.50). We also identified 11 studies that evaluated children aged > 6 months, among whom the pooled relative risk was 0.46 (95% confidence interval: 0.28; 0.78). Breastfeeding also decreased the risk of hospitalization from diarrhoea [pooled relative risk: 0.28 (95% confidence interval: 0.16; 0.50) and diarrhoea mortality [pooled relative risk: 0.23 (95% confidence interval: 0.13; 0.42)]. Furthermore, we identified three randomized trials of breastfeeding promotion; diarrhoea morbidity was lower in the group receiving the intervention [pooled relative risk: 0.69 (95% confidence interval: 0.49; 0.96)].
We identified 18 studies that provided 22 estimates on the effect of breastfeeding on any respiratory infection outcome for any subgroup of under-five children, and 16 studies that restricted the analysis to infants aged ≤ 6 months. Breastfeeding reduced the risk of hospitalization for respiratory infection by 57% [pooled relative risk: 0.43 (95% confidence interval: 0.33; 0.55)], and this protective effect did not change with age. Studies that compared breastfed with non-breastfed children reported the highest protective effect [pooled relative risk: 0.33 (95% confidence interval: 0.24; 0.46)] against hospitalization for respiratory infection. Mortality from lower respiratory tract infections was also reduced among breastfed children [pooled relative risk: 0.30 (95% confidence interval: 0.16; 0.56)]. Furthermore, breastfeeding also reduced the prevalence or incidence of lower respiratory tract infection [pooled relative risk: 0.68 (95% confidence interval: 0.60; 0.77)].
Because nearly all studies included in the analyses are observational, we were not able to completely rule out the possibility that the beneficial effect of breastfeeding was due to self-selection of breastfeeding mothers or residual confounding. Nevertheless, we identified three randomized trials in which breastfeeding promotion reduced the risk of diarrhoea.
Conclusion: The available evidence suggests that breastfeeding reduces the risk of diarrhoea and respiratory infection. All effects were statistically significant, and for most outcomes the magnitude of the effects were large. Protection was observed both in low income and high income countries. Read More
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