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Prospective study of breast-feeding in relation to wheeze, atopy, and bronchial hyperresponsiveness in the Avon Longitudinal Study of Parents and Children (ALSPAC)

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Background

Breast-feeding clearly protects against early wheezing, but recent data suggest that it might increase later risk of atopic disease and asthma.

Objective

We sought to examine the relationship between breast-feeding and later asthma and allergy outcomes by using data from the Avon Longitudinal Study of Parents and Children, a large birth cohort in the United Kingdom.

Methods

We used adjusted logistic regression models to evaluate the association between breast-feeding and atopy at age 7 years, bronchial responsiveness to methacholine at age 8 years, and wheeze at ages 3 and 7½ years. Bayesian methods were used to assess the possibility of bias caused by an influence of early wheezing on the duration of breast-feeding, as well as selection bias.

Results

Breast-feeding was protective for wheeze in the first 3 years of life (odds ratio [OR] of 0.80 [95% CI, 0.70-0.90] for ≥6 months relative to never) but not wheeze (OR, 0.98; 95% CI, 0.79-1.22), atopy (OR, 1.12; 95% CI, 0.92-1.35), or bronchial hyperresponsiveness (OR, 1.07; 95% CI, 0.82-1.40) at ages 7 to 8 years. Bayesian models adjusting for the longer duration of breast-feeding among children with wheezing in early infancy produced virtually identical results.

Conclusions

We did not find consistent evidence for either a deleterious effect or a protective effect of breast-feeding on later risk of allergic disease in a large prospective birth cohort of children with objective outcome measures and extensive data on potential confounders and effect modifiers. Neither reverse causation nor loss to follow-up appears to have materially biased our results.

Section snippets

ALSPAC study

We used data from the ALSPAC study (http://www.alspac.bris.ac.uk), which has been described in detail elsewhere.14 Additional information is available in the Online Repository at www.jacionline.org. Ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee and the Local Research Ethics Committees. The core ALSPAC sample consists of 14,541 pregnancies resulting in a cohort of 14,062 live births. Of these, 13,988 children were alive at 1 year of age. For reasons of

Results

Approximately 25% of the children in the ALSPAC cohort were never breast-fed, 25% were breast-fed for at least 6 months, and approximately 8.5% were exclusively breast-fed for at least 4 months (see Table E1). Participation in the clinic visits at age 7 years for skin prick testing and age 8 years for bronchial responsiveness testing was higher among children who had been breast-fed, had older siblings, had less postnatal exposure to environmental tobacco smoke, or had mothers who were older,

Discussion

In this large prospective study with objective outcome measures at ages 7 and 8 years and extensive data on potential confounders and effect modifiers, we found no evidence that breast-feeding increased the risk of later wheeze, asthma diagnosis, atopy, or BHR. We found no evidence of deleterious effects of breast-feeding either in the dataset as a whole or in subsets defined by parental atopy, child atopy, sex, family size, various combinations of these factors, or other risk factors in these

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    The UK Medical Research Council, the Wellcome Trust, and the University of Bristol provide core support for ALSPAC. The analysis was supported by the Division of Intramural Research, National Institute of Environmental Health Sciences, USA.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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