TABLE 5.
Evidence examining the relationship between shorter versus longer durations of exclusive human milk feeding and type 1 diabetes in offspring1
| Author and year Country | Study design (study/cohort name where applicable) | Country | Notable sample characteristics | Shorter vs. longer durations of exclusive human milk feeding exposures2 | Significant associations with type 1 diabetes | Nonsignificant associations with type 1 diabetes |
|---|---|---|---|---|---|---|
| Alves 2012 (10) | Case control | Brazil |
n = 123 cases, 123 sibling controls Baseline: mean 9 y Race/ethnicity NR Risk: 100% of sibling controls had a sibling with T1D |
Mean difference in EBF duration in cases vs. controls | –0.9 mo (95% CI: –1.2, –0.6), P < 0.001 | None |
| Esfarjani 2001 (13) | Case control | Iran |
n = 52 cases, 52 controls Baseline: <14 y Race/ethnicity NR Risk: 0% of controls with family history of IDDM |
Mean duration of EBF in cases vs. controls | None | 4.5 mo (SD = 3.1) vs. 4.1 mo (SD = 3.9), NS |
| Frederiksen 2013 (9) | Nested case control3 (DAISY) | USA |
n = 53 cases, 1782 controls Baseline: birth Race/ethnicity: 70.1% non-Hispanic white Risk: 100% at-risk genotype or family history of T1D (first-degree relative) |
Mean EBF duration in cases vs. controls | None | 1.4 mo (SD = 2.0) vs. 1.3 mo (SD = 1.7); T1D HR 0.97 (95% CI: 0.83, 1.14), P = 0.73 |
| Gimeno 1997 (63) | Case control | Brazil |
n = 346 cases, 346 controls Baseline: <18 y Sex NR Race/ethnicity NR |
EBF 0–7 d vs. >60 dEBF 8–60 d vs. > 60 d | IDDM: OR 2.13 (95% CI: 1.28, 3.55)None | NoneIDDM: OR 1.14 (95% CI: 0.82, 1.58) |
| Kostraba 1992 (14) | Case control | USA |
n = 211 cases, 211 controls Baseline: diagnosed <17 y but age at the study NR Race/ethnicity: 26.1% black, 73.9% white |
EBF duration in cases vs. controls | None | In white subsample: 18 wk vs. 13 wk, P = 0.4 In black subsample: 13 wk vs. 27 wk, P = 0.16 |
| Lund-Blix 2015 (41) | Prospective cohort (MIDIA) | Norway |
n = 726 Baseline: birth Race/ethnicity NR Risk: 100% at-risk genotype |
Full BF duration (mo) as a continuous variable | None | T1D by age 7.70 (SD = 1.58) y: HR 0.96 (95% CI: 0.78, 1.18) |
| Full BF 4–5.9 mo vs. <4 mo | None | T1D by age 7.70 (SD = 1.58) y: HR 0.79 (95% CI: 0.32, 1.94) | ||||
| Full BF ≥6 mo vs. <4 mo | None | T1D by age 7.70 (SD = 1.58) y: HR 0.84 (95% CI: 0.26, 2.73) | ||||
| Full BF ≤2 wk vs. >2 wk | None | T1D by age 7.70 (SD = 1.58) y: HR 1.10 (95% CI: 0.36, 3.41) | ||||
| Malcova 2006 (16) | Case control | Czech Republic |
n = 868 cases, 1466 controls Baseline: ≤18 y, median 13 y (IQR: 10, 16) for cases, 12 y (IQR: 9, 15) for controls Race/ethnicity NR |
Introduced to formula or other supplementary feeding at 1–3 mo vs. 4–6 mo | None | T1D: OR 1.11 (95% CI: 0.83, 1.50) |
| Introduced to formula or other supplementary feeding at 7–9 mo vs. 4–6 mo | None | T1D: OR 0.96 (95% CI: 0.69, 1.34) | ||||
| Introduced to formula or other supplementary feeding at ≥ 10 mo vs. 4–6 mo | None | T1D: OR 0.90 (95% CI: 0.49, 1.67) | ||||
| Perez-Bravo 1996 (35) | Case control | Chile |
n = 80 cases, 85 controls Baseline: mean: 15.1 y (SD = 5.6) Race/ethnicity: strata III of the sociogenetic classification (40% indigenous admixture with European genetic pools of mostly Spanish origin) |
Mean EBF duration in cases vs. controls | 21.55 wk (SD = 15.05) vs. 33.95 wk (SD = 20.40), P = 0.01 | None |
| Perez-Bravo 2003 (64) | Case control | Chile |
n = 143 cases, 107 controls Baseline: mean ∼8 y (SD ∼4 y) Race/ethnicity: 100% 2 Hispanic surnames and no Amerindian background |
Mean EBF duration in cases vs. controls | 5.4 mo (SD = 3.5) vs. 7.6 mo (SD = 3.6), P < 0.02 | None |
| Rami 1999 (20) | Case control (EURODIAB ACE) | Austria |
n = 114 cases, 495 controls Baseline: <15 y Race/ethnicity NR |
Median EBF duration in cases vs. controls | None | 2 mo (range: 0–7) vs. 2 mo (range: 0–18), P = 0.40 |
| Sadauskaite-Kuehne 2004 (43) | Case control (Diabetes and Environment around the Baltic Sea) | Sweden, Lithuania |
n = 517 Swedish cases, 286 Lithuanian cases, controls NR (∼2 controls per case) Baseline: 0–15 y Race/ethnicity NR |
EBF ≥5 mo vs. <5 mo | T1D in Swedish subsample ages 5–9 y: OR 0.54 (95% CI: 0.36, 0.81) | NR4 |
| EBF ≥2 mo vs. <2 mo | T1D in Lithuanian subsample ages 5–9 y: OR 0.58 (95% CI: 0.34, 0.99) | NR | ||||
| Samuelsson 1993 (44) | Case control | Sweden |
n = 297 cases, 792 controls Baseline: 0–14 y Sex NR Race/ethnicity NR |
Mean duration of complete BF in cases vs. controls | None | NS (data NR) In subsample age <5 y: 4.50 mo (SD = 0.68) vs. 3.02 mo (SD = 0.47), P = 0.17 In subsample age 5–9 y: 3.18 mo (SD = 0.26) vs. 3.55 mo (SD = 0.25), P = 0.34 In subsample age >10 y: 2.17 mo (SD = 0.16) vs. 2.40 mo (SD = 0.11) |
| Samuelsson 2001 (65) | Case control | Sweden |
n = 297 cases, 736 controls Baseline: 0–14 y Sex NR Race/ethnicity NR |
Mean EBF duration in cases vs. controls | None | 2.5 mo (95% CI: 2.2, 2.7) vs. 2.6 mo (95% CI: 2.5, 2.8) |
| Verge 1994 (48) | Case control | Australia |
n = 217 cases, 258 controls Baseline: 0–15 y, median 9.2 y Race/ethnicity NR |
EBF ≥3 mo vs. EBF <3 mo | IDDM: OR 0.66 (95% CI: 0.45, 0.97) IDDM in subsample age <9.2 y: OR 0.50 (95% CI: 0.28, 0.87) |
IDDM in subsample age ≥9.2 y: OR 0.80 (95% CI: 0.46, 1.39) |
| Virtanen 1991 (49) | Case control (DiMe) | Finland |
n = 103 cases, 103 controls Baseline: 0–6 y Race/ethnicity NR |
Median EBF duration in cases vs. controls | 3 mo vs. 4 mo, P = 0.02 | None |
| EBF ≥1 mo vs. <1 mo | None | IDDM: ∼90% in cases vs. ∼99% in controls, NS | ||||
| EBF ≥2 mo vs. <2 mo | None | IDDM: ∼88% in cases vs. ∼95% in controls, NS | ||||
| EBF ≥3 mo vs. <3 mo | IDDM: OR 0.36 (95% CI: 0.14, 0.93) ∼73% in cases vs. ∼90% in controls, P < 0.05 |
None | ||||
| EBF ≥4 mo vs. <4 mo | IDDM: OR 0.41 (95% CI: 0.21, 0.83) ∼41% in cases vs. ∼61% in controls, P < 0.05 |
None | ||||
| EBF ≥5 mo vs. <5 mo | None | IDDM: OR 0.77 (95% CI: 0.36, 1.64) ∼28% in cases vs. ∼30% in controls, NS |
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| EBF ≥6 mo vs. <6 mo | None | IDDM: ∼15% in cases vs. ∼14% in controls, NS | ||||
| Virtanen 1992 (50) | Case control (DiMe) | Finland |
n = 426 cases, 426 controls Baseline: 7–14 y Race/ethnicity NR |
Median EBF duration in cases vs. controls | 2 mo vs. 2 mo,5P = 0.04 | None |
| EBF ≥1 mo vs. <1 mo | None | IDDM: OR ∼0.8 (95% CI: ∼0.5, ∼1.4) ∼88% in cases vs. ∼90% in controls | ||||
| EBF ≥2 mo vs. <2 mo | IDDM: OR 0.60 (95% CI: 0.41, 0.89) ∼65% in cases vs. ∼75% in controls, P < 0.05 |
None | ||||
| EBF ≥3 mo vs. <3 mo | IDDM: OR 0.63 (95% CI: 0.43, 0.93) ∼41% in cases vs. ∼51% in controls, P < 0.05 |
None | ||||
| EBF ≥4 mo vs. <4 mo | None | IDDM: OR ∼0.7 (95% CI: ∼0.4, ∼1.1) ∼14% in cases vs. ∼20% in controls |
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| EBF ≥5 mo vs. <5 mo | IDDM: ∼7% in cases vs. ∼13% in controls, P < 0.05 | IDDM: OR ∼0.6 (95% CI: ∼0.3, ∼1.2) | ||||
| EBF ≥6 mo vs. <6 mo | None | IDDM: OR ∼0.7 (95% CI: ∼0.3, ∼1.7) ∼4% in cases vs. ∼7% in controls |
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| Wadsworth 1997 (66) | Case control | UK |
n = 218 cases, 324 controls Baseline: <5 y Sex NR Race/ethnicity NR |
First introduction of artificial milk formula 2–6 wk vs. <2 wk | None | T1D: OR 1.42 (95% CI: 0.75, 2.70) |
| First introduction of artificial milk formula 6 wk–4 mo vs. <2 wk | None | T1D: OR 0.71 (95% CI: 0.40, 1.23) | ||||
| First introduction of artificial milk formula >4 mo vs. <2 wk | None | T1D: OR 1.41 (95% CI: 0.70, 2.80) |
1BF, breastfeeding; DAISY, Diabetes Autoimmunity Study in the Young; DiMe; Childhood Diabetes in Finland; EBF, exclusively breastfed; IDDM, insulin-dependent diabetes mellitus; MIDIA, Environmental Triggers of Type 1 Diabetes; NR, not reported; NS, not significant; T1D, type 1 diabetes.
2Exposures, as defined by the authors of the studies included in the body of evidence, which address shorter versus longer durations of exclusive human milk feeding or vice versa
3The authors call the study a prospective cohort; however, the assessment grouped participants by outcome status rather than infant feeding exposure.
4Authors only reported significant associations; information about nonsignificant findings was not reported.
5Although the medians are the same, the authors describe this as significantly shorter EBF duration in cases than controls