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Li M, Wang C, Wang J, Du J, Li G. Breastfeeding and Lung Function of Children: A Systematic Review and Meta-Analysis. J Paediatr Child Health 2025. [PMID: 39807749 DOI: 10.1111/jpc.16771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/18/2024] [Accepted: 12/29/2024] [Indexed: 01/16/2025]
Abstract
AIM To evaluate the associations between breastfeeding and lung function among children without known respiratory diseases and to determine the effects of breastfeeding on spirometry. METHODS A systematic search of PubMed, Embase and Cochrane was performed from their inception to 11 Oct 2023 (PROSPERO identifier: CRD42023471664). Observational studies (cohort or cross-sectional or case-control design) and randomised controlled trials (RCTs) were searched. A random-effects model meta-analysis was used to estimate the effect size if significant heterogeneity was detected (p < 0.05 or I2 > 50%); Otherwise, the fixed-effects model was applied. RESULTS In total, 13 observational studies with 18 152 children were included in the qualitative synthesis, and five studies with 5305 children were included in the meta-analysis. Compared to children who were never breastfed, those who were breastfed had better FEV1 (β: 19.34 mL; 95% CI: 6.05, 32.64; p = 0.004) and PEF (β: 87.50 mL/s; 95% CI: 27.43, 147.58; p = 0.004). A similar trend was observed for FVC (β: 17.45 mL; 95% CI: -0.43, 35.33; p = 0.06). Furthermore, compared to children breastfed for less than three to four months, those breastfed for three to four months or more had better FEV1 (β: 19.86 mL; 95% CI: 4.21, 35.51; p = 0.01), FVC (β: 31.90 mL; 95% CI: 7.87, 55.93; p = 0.009) and PEF (β: 75.68 mL/s; 95% CI: 24.40, 126.97; p = 0.004). CONCLUSION This systematic review and meta-analysis revealed associations between breastfeeding and improved lung function in children aged 6-16 years. Further high-quality evidence is needed.
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Affiliation(s)
- Ming Li
- School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Chao Wang
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jiamin Wang
- School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Jing Du
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Gang Li
- School of Public Health, China Medical University, Shenyang, Liaoning, China
- Institute of Statistics and Information, Beijing Center for Disease Prevention and Control, Beijing, China
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Libuda L, Filipiak-Pittroff B, Standl M, Schikowski T, von Berg A, Koletzko S, Bauer CP, Heinrich J, Berdel D, Gappa M. Full Breastfeeding and Allergic Diseases-Long-Term Protection or Rebound Effects? Nutrients 2023; 15:2780. [PMID: 37375684 DOI: 10.3390/nu15122780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
A previous follow-up of the GINIplus study showed that breastfeeding could protect against early eczema. However, effects diminished in adolescence, possibly indicating a "rebound effect" in breastfed children after initial protection. We evaluated the role of early eczema until three years of age on allergies until young adulthood and assessed whether early eczema modifies the association between breastfeeding and allergies. Data from GINIplus until 20-years of age (N = 4058) were considered. Information on atopic eczema, asthma, and rhinitis was based on reported physician's diagnoses. Adjusted Odds Ratios (aOR) were modelled by using generalized estimating equations. Early eczema was associated with eczema (aORs = 3.2-14.4), asthma (aORs = 2.2-2.7), and rhinitis (aORs = 1.2-2.7) until young adulthood. For eczema, this association decreased with age (p-for-interaction = 0.002-0.006). Longitudinal models did not show associations between breastfeeding and the respective allergies from 5 to 20 years of age. Moreover, early eczema generally did not modify the association between milk feeding and allergies except for rhinitis in participants without family history of atopy. Early eczema strongly predicts allergies until young adulthood. While preventive effects of full breastfeeding on eczema in infants with family history of atopy does not persist until young adulthood, the hypothesis of a rebound effect after initial protection cannot be confirmed.
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Affiliation(s)
- Lars Libuda
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, Warburger Straße 100, 33098 Paderborn, Germany
- Children's Hospital, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany
| | - Birgit Filipiak-Pittroff
- Children's Hospital, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany
- Formerly Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 81377 Munich, Germany
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany
| | - Andrea von Berg
- Formerly Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, 80337 Munich, Germany
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, 80804 Munich, Germany
| | - Joachim Heinrich
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 81377 Munich, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia
| | - Dietrich Berdel
- Formerly Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany
| | - Monika Gappa
- Children's Hospital, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany
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Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. Cardiometabolic effects of breastfeeding on infants of diabetic mothers. World J Diabetes 2023; 14:617-631. [PMID: 37273257 PMCID: PMC10236993 DOI: 10.4239/wjd.v14.i5.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants. It may protect infants against many metabolic diseases, predominantly obesity and type 2 diabetes. Diabetes mellitus (DM) is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood. Breastfeeding protects against infant mortality and diseases, such as necrotizing enterocolitis, diarrhoea, respiratory infections, viral and bacterial infection, eczema, allergic rhinitis, asthma, food allergies, malocclusion, dental caries, Crohn's disease, and ulcerative colitis. It also protects against obesity and insulin resistance and increases intelligence and mental development. Gestational diabetes has short and long-term impacts on infants of diabetic mothers (IDM). Breast milk composition changes in mothers with gestational diabetes.
AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.
METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15, 2022, in this review.
RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms. Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM. Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term, the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.
CONCLUSION We need more comprehensive research to prove these effects. Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding, every effort should be made to encourage them to breastfeed.
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Affiliation(s)
- Reem Elbeltagi
- Department of Medicine, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Bahrain
- Department of Microbiology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
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Grenville J, Granell R, Dodd J. Lung function and cognitive ability in children: a UK birth cohort study. BMJ Open Respir Res 2023; 10:10/1/e001528. [PMID: 37130649 PMCID: PMC10163472 DOI: 10.1136/bmjresp-2022-001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Decreased adult lung function is associated with subsequent impairment in cognition. A similar relationship in early life could be of great policy importance, since childhood cognitive ability determines key adult outcomes, including socioeconomic status and mortality. We aimed to expand the very limited data available on this relationship in children, and hypothesised that reduced lung function would be longitudinally associated with decreased cognitive ability. METHODS Lung function was measured at age 8 (forced expiratory volume in one second (FEV1), forced vital capacity (FVC); % predicted), and cognitive ability was measured at ages 8 (Wechsler Intelligence Scale for Children, third edition) and 15 (Wechsler Abbreviated Scale of Intelligence), in the Avon Longitudinal Study of Parents and Children. Potential confounders were identified as preterm birth, birth weight, breastfeeding duration, prenatal maternal smoking, childhood environmental tobacco smoke exposure, socioeconomic status and prenatal/childhood air pollution exposure. Univariable and multivariable linear models (n range=2332-6672) were fitted to assess the cross-sectional and longitudinal associations of lung function with cognitive ability, and change in cognitive ability between ages 8 and 15. RESULTS In univariate analyses, both FEV1 and FVC at age 8 were associated with cognitive ability at both ages, but after adjustment, only FVC was associated with full-scale IQ (FSIQ) at ages 8 (β=0.09 (95% CI 0.05 to 0.12; p<0.001)) and 15 (β=0.06 (0.03 to 0.10; p=0.001)). We did not find evidence of an association between either lung function parameter and interval change in standardised FSIQ. DISCUSSION Reduced FVC, but not FEV1, is independently associated with decreased cognitive ability in children. This low-magnitude association attenuates between ages 8 and 15, while no association is evident with longitudinal change in cognitive ability. Our results support a link between FVC and cognition across the life course, possibly due to shared genetic or environmental risk, rather than causation.
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Affiliation(s)
- Jack Grenville
- Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - James Dodd
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
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Alotiby AA. The role of breastfeeding as a protective factor against the development of the immune-mediated diseases: A systematic review. Front Pediatr 2023; 11:1086999. [PMID: 36873649 PMCID: PMC9981158 DOI: 10.3389/fped.2023.1086999] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Breast milk is rich in nutrients and immunological factors capable of protecting infants against various immunological diseases and disorders. The current systematic review has been framed with the objective of studying the role of breastfeeding as a protective factor against the development of immune-mediated diseases. METHODS The database and website searches were performed using PubMed, PubMed Central, Nature, Springer, Nature, Web of Science, and Elsevier. The studies were scrutinized based on the nature of participants and the nature of disease considered. The search was restricted to infants with immune-mediated diseases such as diabetes mellitus, allergic conditions, diarrhoea, and rheumatoid arthritis. RESULTS We have included 28 studies, out of which seven deal with diabetes mellitus, two rheumatoid arthritis, five studies about Celiac Disease, twelve studies about allergic/ asthma/wheezing conditions and one study on each of the following diseases: neonatal lupus erythematosus and colitis. DISCUSSION Based on our analysis, breastfeeding in association with the considered diseases was found to be positive. Breastfeeding is involved as protective factor against various diseases. The role of breastfeeding in the prevention of diabetes mellitus has been found to be significantly higher than for other diseases.
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Affiliation(s)
- Amna A Alotiby
- Department of Hematology and Immunology, Faculty of Medicine Umm Al-Qura University, Makkah, Saudi Arabia
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Perikleous EP, Fouzas S, Michailidou M, Patsourou A, Tsalkidis D, Steiropoulos P, Nena E, Chatzimichael A, Paraskakis E. Association between History of Prolonged Exclusive Breast-Feeding and the Lung Function Indices in Childhood. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1708. [PMID: 36360436 PMCID: PMC9688515 DOI: 10.3390/children9111708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 09/29/2023]
Abstract
Although the propitious effects of breastfeeding on children's health are indisputable, the impact of exclusive breastfeeding on the lung function later in life remains controversial. Our objective was to explore the possible associations between breastfeeding and the lung function of children who were exclusively breastfed for an extensive period of time. This was a cross-sectional study of children who were exclusively breastfed for more than 12 months. Demographics and anthropometric data were collected; the body mass index (BMI), % body fat, and % central obesity were calculated; and all the participants underwent standard spirometry with reversibility testing. The relationship between breastfeeding duration and spirometric parameters was assessed by Spearman's correlation and multivariable regression, after adjustment for other confounders. Forty-six children (21 boys), aged 9.2 ± 2.4 years, with a reported breastfeeding duration of 27.5 ± 12.5 months (range 12-60 months) were included; 13% were overweight (none were obese) and 21.7% had central obesity. The average FEV1 was 104.7 ± 10.4% and the average FEF25-75 was 107.9 ± 13.3%. The duration of exclusive breastfeeding was positively correlated with FEF25-75% (r = 0.422, p = 0.003). Multivariable linear regression analysis confirmed the above finding (beta coefficient 0.478, p = 0.002), independently of age, overweight, and central obesity. No correlation was noted between the duration of breastfeeding and other spirometric parameters. In addition to its favorable impact on the metabolic profile, prolonged exclusive breastfeeding seems to exert a propitious effect on the function of smaller airways throughout childhood.
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Affiliation(s)
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University Hospital of Patras, 26504 Patras, Greece
| | | | - Anna Patsourou
- Medical School, Democritus University of Thrace, 691 00 Alexandroupolis, Greece
| | - Dimos Tsalkidis
- Medical School, Democritus University of Thrace, 691 00 Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 691 00 Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, 691 00 Alexandroupolis, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, Medical School, Democritus University of Thrace, 691 00 Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Pediatric Respiratory Unit, Pediatric Department, University of Crete, 700 13 Heraklion, Greece
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Perikleous E, Fouzas S, Karageorgiou A, Steiropoulos P, Nena E, Chatzimichael A, Tsalkidis A, Paraskakis E. Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis. World J Clin Pediatr 2021; 10:168-176. [PMID: 34868893 PMCID: PMC8603642 DOI: 10.5409/wjcp.v10.i6.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants.
AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.
METHODS In this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated.
RESULTS A total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy.
CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.
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Affiliation(s)
- Evanthia Perikleous
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, University Hospital of Patras, University of Patras, Patra 26504, Greece
| | - Athina Karageorgiou
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Aggelos Tsalkidis
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, Heraklion 71500, Greece
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Xue M, Dehaas E, Chaudhary N, O'Byrne P, Satia I, Kurmi OP. Breastfeeding and risk of childhood asthma: a systematic review and meta-analysis. ERJ Open Res 2021; 7:00504-2021. [PMID: 34912884 PMCID: PMC8666625 DOI: 10.1183/23120541.00504-2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate the relationship between breastfeeding and the development of paediatric asthma. METHODS A systematic review and meta-analysis was conducted with MEDLINE, Embase, CINAHL and ProQuest Nursing and Allied Health source databases. Retrospective/prospective cohorts in children aged <18 years with breastfeeding exposure reported were included. The primary outcome was a diagnosis of asthma by a physician or using a guideline-based criterion. A secondary outcome was asthma severity. RESULTS 42 studies met inclusion criteria. 37 studies reported the primary outcome of physician-/guideline-diagnosed asthma, and five studies reported effects on asthma severity. Children with longer duration/more breastfeeding compared to shorter duration/less breastfeeding have a lower risk of asthma (OR 0.84, 95% CI 0.75-0.93; I2 = 62.4%). Similarly, a lower risk of asthma was found in children who had more exclusive breastfeeding versus less exclusive breastfeeding (OR 0.81, 95% CI 0.72-0.91; I2=44%). Further stratified analysis of different age groups demonstrated a lower risk of asthma in the 0-2-years age group (OR 0.73, 95% CI 0.63-0.83) and the 3-6-years age group (OR 0.69, 95% CI 0.55-0.87); there was no statistically significant effect on the ≥7-years age group. CONCLUSION The findings suggest that the duration and exclusivity of breastfeeding are associated with a lower risk of asthma in children aged <7 years.
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Affiliation(s)
- Mike Xue
- Dept of Family Medicine, Queen's University, Kingston, Canada
| | - Emily Dehaas
- Dept of Medicine, University of Toronto, Toronto, Canada
| | - Nagendra Chaudhary
- Dept of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Paul O'Byrne
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Imran Satia
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Om P. Kurmi
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
- Faculty Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Dzhambov AM, Lercher P, Rüdisser J, Browning MHEM, Markevych I. Allergic symptoms in association with naturalness, greenness, and greyness: A cross-sectional study in schoolchildren in the Alps. ENVIRONMENTAL RESEARCH 2021; 198:110456. [PMID: 33188758 DOI: 10.1016/j.envres.2020.110456] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Greenness may protect from or contribute to allergy risk by influencing air pollution and human-microbe interactions. However, existing research on the issue is heterogeneous and produced conflicting results. Less in known about the effects of greyness. This study investigated the association between different characteristics of residential and school environment and allergic symptoms in schoolchildren. METHODS The present cross-sectional survey was undertaken in 2004/2005 among 1251 schoolchildren (8-12 years old) in several alpine valleys in Austria and Italy. Children's mothers completed a questionnaire that asked about allergic symptoms (International Study of Asthma and Allergies in Childhood questionnaire), sociodemographic information, lifestyle, perinatal data, and housing conditions. We constructed four aggregate outcome variables: current asthma symptoms, ever asthma symptoms, ever allergic rhinitis (AR) symptoms, and ever eczema symptoms. We employed well-known greenness and greyness exposure indicators (Normalized Difference Vegetation Index, tree canopy cover, agricultural cover, imperviousness cover, and industrial cover), as well as an alternative naturalness index (Distance to Nature, D2N). Adjusted logistic regressions were used to explore associations between each exposure-outcome pair. Air pollution (NO2), traffic noise and time spent outdoors were tested as potential mediators in causal mediation analysis. RESULTS Decrease in naturalness in a 500-m buffer around the home was associated with higher prevalence of AR symptoms. Associations with asthma symptoms were in the same direction but marginally significant. Residential NDVI and tree cover were marginally associated with lower prevalence of asthma and AR symptoms. Having a domestic garden was associated with lower prevalence of asthma symptoms. School greenness in a 100-m buffer was associated with lower prevalence of AR symptoms. Residential greyness was associated with higher prevalence of AR and asthma symptoms. We observed stronger associations for greenness and greyness in non-movers and in children without a family history of allergies. Mediation by NO2 and time spent outdoors was present in some of the exposure-outcome pairs. CONCLUSIONS Schoolchildren residing in places with lower naturalness and higher greyness may be more likely to have allergic rhinitis and possibly asthma. Considering more comprehensive indicators than greenness and greyness and conducting research in children without a family history of allergic diseases may be key to better understanding who can profit from natural landscapes.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
| | - Peter Lercher
- Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | | | - Matthew H E M Browning
- Department of Parks , Recreation, and Tourism Management, Clemson University, Clemson, USA
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
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Abstract
PURPOSE OF REVIEW To perform a nonsystematic review of the literature on the role of breastfeeding as primary prevention tool for allergic diseases. RECENT FINDINGS Human milk contains vast amounts of biologically active components that have a significant impact on the development of the gut microbiota. Exclusively breastfed infants show a different microbiota, with a predominance of Bifidobacterium species in their intestines.The mechanisms underlying the antiallergic effects of human milk are most probably complex, as human milk contains not only nutritional substances but also functional molecules including polysaccharides, cytokines, proteins, and other components which can produce an epigenetic modulation of the innate and adaptive immune responses of the infant in very early life. SUMMARY Currently, there is not sufficient strong evidence to guarantee its effectiveness in allergy prevention and therefore the main international scientific societies still do not count it among the recognized primary prevention strategies of allergy.
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Affiliation(s)
- Maurizio Mennini
- Multifactorial and Systemic Diseases Research Area, Predictive and Preventive Medicine Research Unit, Division of Allergy Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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van Meel ER, Saharan G, Jaddoe VW, de Jongste JC, Reiss IK, Tiemeier H, El Marroun H, Duijts L. Parental psychological distress during pregnancy and the risk of childhood lower lung function and asthma: a population-based prospective cohort study. Thorax 2020; 75:1074-1081. [PMID: 33046570 PMCID: PMC7677473 DOI: 10.1136/thoraxjnl-2019-214099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Background Although maternal psychological distress during pregnancy is associated with increased risks of respiratory morbidity in preschool children, it is unknown whether this association persists into later childhood. Objective To examine the association between parental psychological distress during pregnancy and lung function and asthma in children of school age. Methods This study of 4231 children was embedded in a population-based prospective cohort. Parental psychological distress was assessed by the Brief Symptom Inventory during and 3 years after pregnancy, and in mothers also at 2 and 6 months after pregnancy. At age 10 years, lung function was obtained by spirometry and asthma by questionnaire. Results The prevalence of asthma was 5.9%. Maternal overall psychological distress during pregnancy was associated with a lower forced vital capacity (FVC) (z-score difference −0.10 (95% CI −0.20 to –0.01) per 1-unit increase), maternal depressive symptoms during pregnancy with a lower forced expiratory volume in the first second (FEV1) and FVC (−0.13 (95% CI −0.24 to –0.01) and −0.13 (95% CI −0.24 to –0.02) when using clinical cut-offs) in their children. All maternal psychological distress measures during pregnancy were associated with an increased risk of asthma (range OR: 1.46 (95% CI 1.12 to 1.90) to 1.91 (95% CI 1.26 to 2.91)). Additional adjustment for paternal psychological distress during pregnancy and parental psychological distress after pregnancy did not materially change the associations. Paternal psychological distress during pregnancy was not associated with childhood respiratory morbidity. Conclusion Maternal, but not paternal, psychological distress during pregnancy is associated with an increased risk of asthma and partly lower lung function in children. This suggests intrauterine programming for the risk of later-life respiratory disease.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gautam Saharan
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent Wv Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irwin Km Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Social and Behavioural Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Hanan El Marroun
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus Medical Center, Rotterdam, The Netherlands .,Department of Pediatrics, Division of Neonatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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12
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The Interplay Between Eczema and Breastfeeding Practices May Hide Breastfeeding's Protective Effect on Childhood Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:862-871.e5. [PMID: 32949808 DOI: 10.1016/j.jaip.2020.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Longer duration of breastfeeding may be protective against asthma. However, early manifestations of allergic disease, such as eczema, are risk factors for asthma and can influence the duration of breastfeeding, and hence, may bias observable associations. OBJECTIVE To examine the relationship between breastfeeding ever and duration and the development of asthma and allergic asthma phenotypes, stratified by a diagnosis of eczema during or after the breastfeeding period. METHODS A total of 3663 children participated in the 6-year-old follow-up of the HealthNuts study, a population-based, longitudinal study of allergic diseases in Australia. At age 1 year, breastfeeding and eczema data were collected and at age 6 years, information on wheeze, medication use, and parental report of doctor-diagnosed asthma were obtained, both via questionnaire. Skin prick test responses to food and aeroallergens at age 6 years further distinguished asthmatic children into allergic and nonallergic phenotypes. RESULTS Breastfeeding initiation was not associated with current asthma at age 6 years (adjusted odds ratio, 0.76; 95% CI, 0.45-1.29) when compared with never breastfeeding. Results were similar for length of exclusiveness and overall duration of breastfeeding, and allergic and nonallergic asthma phenotypes. However, increased duration of breastfeeding among children without eczema in infancy was associated with reduced odds of asthma (per month increase, adjusted odds ratio, 0.98; 95% CI, 0.95-1.0; P = .05), which equates to 0.86 (95% CI, 0.74-1.0) reduced odds of asthma for a 6-month increase in breastfeeding. This association was not apparent in children who were diagnosed with eczema during breastfeeding (adjusted odds ratio, 1.03; 95% CI, 0.98-1.08; P = .3). CONCLUSIONS Longer duration of breastfeeding was associated with a reduced odds of asthma among children without eczema in the first year of life; this association was masked before stratification by eczema in infancy. Future studies examining breastfeeding practices and the risk of allergic outcomes in later childhood need to consider the presence of early-life allergic manifestations impacting on breastfeeding behavior.
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13
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Decrue F, Gorlanova O, Usemann J, Frey U. Lung functional development and asthma trajectories. Semin Immunopathol 2020; 42:17-27. [PMID: 31989229 DOI: 10.1007/s00281-020-00784-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023]
Abstract
Early life environmental risk factors are associated with chronic respiratory morbidity in child- and adulthood. A possible mechanism for this sustained effect is their influence on early life lung functional growth and development, a susceptible phase of rapid lung growth with increased plasticity. We summarize evidence of hereditary and environmental ante-, peri-, and early postnatal factors on lung functional development, such as air pollution, tobacco exposure, nutrition, intrauterine growth retardation, prematurity, early life infections, microbiome, and allergies and their effect on lung functional trajectories. While some of the factors (e.g., prematurity) directly impair lung growth, the influence of many environmental factors is mediated through inflammatory processes (e.g., recurrent infections or oxidative stress). The timing and nature of these influences and their impact result in degrees of impaired maximal lung functional capacity in early adulthood; and they potentially impact future long-term respiratory morbidity such as chronic asthma or chronic obstructive airway disease (COPD). We discuss possibilities to prevent or modify such early abnormal lung functional growth trajectories and the need for future studies and prevention programs.
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Affiliation(s)
- Fabienne Decrue
- University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Olga Gorlanova
- University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Jakob Usemann
- University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.,Division of Respiratory Medicin, University Children's Hospital Zurich, Zurich, Switzerland
| | - Urs Frey
- University Children's Hospital (UKBB), University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
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14
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Ferrante G, Carta M, Montante C, Notarbartolo V, Corsello G, Giuffrè M. Current Insights on Early Life Nutrition and Prevention of Allergy. Front Pediatr 2020; 8:448. [PMID: 32850557 PMCID: PMC7424002 DOI: 10.3389/fped.2020.00448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/29/2020] [Indexed: 01/01/2023] Open
Abstract
The incidence of allergic diseases in childhood appears to have significantly increased over the last decades. Since environmental factors, including diet, have been thought to play a significant role in the development of these diseases, there is great interest in identifying prevention strategies related to early nutritional interventions. Breastfeeding is critical for the immune development of newborns and infants through immune-modulating properties and it impacts the establishment of a healthy gut microbiota. However, the evidence for a protective role of breastfeeding against the development of food allergy in childhood is controversial, and there is little evidence to support the benefits of an antigen avoidance diet during lactation. Although it is not possible to draw a definitive conclusion about the protective role of breast milk against allergic diseases, exclusive breastfeeding is still recommended throughout the first 6 months of life due to associated health benefits. Furthermore, recommendations regarding complementary feeding in infancy have been significantly modified over the last few decades. Several studies have shown that delayed exposure to allergenic foods does not have a role in allergy prevention and recent guidelines recommend against delaying the introduction of complementary foods after 6 months of age, both in high- and low-risk infants. However, trials investigating this dietary approach have reported equivocal results so far. This review summarizes the available high-quality evidence regarding the efficacy of the principal dietary interventions proposed in early life to prevent allergic diseases in children.
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Affiliation(s)
- Giuliana Ferrante
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
| | - Maurizio Carta
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
| | - Claudio Montante
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
| | - Veronica Notarbartolo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
| | - Giovanni Corsello
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
| | - Mario Giuffrè
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro," Università degli Studi di Palermo, Palermo, Italy
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15
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Looman KIM, Meel ER, Grosserichter‐Wagener C, Vissers FJM, Klingenberg JH, Jong NW, Jongste JC, Pasmans SGMA, Duijts L, Zelm MC, Moll HA. Associations of Th2, Th17, Treg cells, and IgA + memory B cells with atopic disease in children: The Generation R Study. Allergy 2020; 75:178-187. [PMID: 31385614 DOI: 10.1111/all.14010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND New insights into immune cells could contribute to treatment and monitoring of atopic disease. Because nongenetic factors shape the human immune system, we here studied these immune cells in a large cohort with atopic children with adjustment for prenatal and postnatal confounders. METHODS Information on atopic dermatitis, inhalant- and food-allergic sensitization, asthma lung function scores was obtained from 855 10-year-old children within the Generation R cohort. 11-color flow cytometry was performed to determine CD27+ and CD27- IgG+ , IgE+ and IgA+ memory B cells, Th1, Th2, Th17, and Treg-memory cells from venous blood. Associations between any atopic disease, the individual atopic diseases, and immune cell numbers were determined. RESULTS Children with any atopic disease had higher Th2, Treg, Treg-memory, and CD27+ IgA+ memory B-cell numbers compared to children without atopic disease. When studying the individual diseases compared to children without the individual diseases, children with atopic dermatitis, inhalant-, and food-allergic sensitization had higher memory Treg cell numbers 12.3% (95% CI 4.2; 21.0), (11.1% (95% CI 3.0; 19.8), (23.7% (95% CI 7.9; 41.8), respectively. Children with food-allergic sensitization had higher total B and CD27+ IgA+ memory B-cell numbers (15.2% [95% CI 3.2; 28.7], 22.5% [95% CI 3.9; 44.3], respectively). No associations were observed between asthma and B- or T-cell numbers. CONCLUSION Children with any atopic disease and children with inhalant- and food-allergic sensitization or atopic dermatitis had higher circulating memory Treg cells, but not higher IgE+ B-cell numbers. The associations of higher Treg and CD27+ IgA+ B-cell numbers in children with food-allergic sensitization are suggestive of TGF-β-mediated compensation for chronic inflammation.
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Affiliation(s)
- Kirsten I. M. Looman
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Evelien R. Meel
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Epidemiology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | | | - Floor J. M. Vissers
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Janice H. Klingenberg
- Generation R Study Group Erasmus MC, University Medical Center Rotterdam the Netherlands
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Nicolette W. Jong
- Department of Internal Medicine, Division of Allergology Erasmus MC, University Medical Center Rotterdam the Netherlands
| | - Johan C. Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | | | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Pediatrics, Division of Neonatology Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | - Menno C. Zelm
- Department of Immunology and Pathology, Central Clinical School Monash University and Alfred Hospital Melbourne Victoria Australia
| | - Henriëtte A. Moll
- Department of Pediatrics Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam the Netherlands
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16
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Zielinska MA, Hamulka J. Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4181. [PMID: 31671856 PMCID: PMC6862650 DOI: 10.3390/ijerph16214181] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 02/08/2023]
Abstract
Air pollution is a major social, economic, and health problem around the world. Children are particularly susceptible to the negative effects of air pollution due to their immaturity and excessive growth and development. The aims of this narrative review were to: (1) summarize evidence about the protective effects of breastfeeding on the adverse health effects of air pollution exposure, (2) define and describe the potential mechanisms underlying the protective effects of breastfeeding, and (3) examine the potential effects of air pollution on breastmilk composition and lactation. A literature search was conducted using electronic databases. Existing evidence suggests that breastfeeding has a protective effect on adverse outcomes of indoor and outdoor air pollution exposure in respiratory (infections, lung function, asthma symptoms) and immune (allergic, nervous and cardiovascular) systems, as well as under-five mortality in both developing and developed countries. However, some studies reported no protective effect of breastfeeding or even negative effects of breastfeeding for under-five mortality. Several possible mechanisms of the breastfeeding protective effect were proposed, including the beneficial influence of breastfeeding on immune, respiratory, and nervous systems, which are related to the immunomodulatory, anti-inflammatory, anti-oxidant, and neuroprotective properties of breastmilk. Breastmilk components responsible for its protective effect against air pollutants exposure may be long chain polyunsaturated fatty acids (LC PUFA), antioxidant vitamins, carotenoids, flavonoids, immunoglobins, and cytokines, some of which have concentrations that are diet-dependent. However, maternal exposure to air pollution is related to increased breastmilk concentrations of pollutants (e.g., Polycyclic aromatic hydrocarbons (PAHs) or heavy metals in particulate matter (PM)). Nonetheless, environmental studies have confirmed that breastmilk's protective effects outweigh its potential health risk to the infant. Mothers should be encouraged and supported to breastfeed their infants due to its unique health benefits, as well as its limited ecological footprint, which is associated with decreased waste production and the emission of pollutants.
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Affiliation(s)
- Monika A Zielinska
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, 159C Nowoursynowska Street, 02-776 Warsaw, Poland.
| | - Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, 159C Nowoursynowska Street, 02-776 Warsaw, Poland.
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17
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Miliku K, Azad MB. Breastfeeding and the Developmental Origins of Asthma: Current Evidence, Possible Mechanisms, and Future Research Priorities. Nutrients 2018; 10:E995. [PMID: 30061501 PMCID: PMC6115903 DOI: 10.3390/nu10080995] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/14/2018] [Accepted: 07/26/2018] [Indexed: 01/06/2023] Open
Abstract
Breastfeeding has many established health benefits, but its impact on asthma development is uncertain. Breastfeeding appears to have a positive and dose-dependent impact on respiratory health, particularly during early childhood and in high-risk populations; however, the strength and causality of these associations are unclear. It is challenging to compare results across studies due to methodological differences and biological variation. Resolving these inconsistencies will require well-designed, prospective studies that accurately capture asthma diagnoses and infant feeding exposures (including breastfeeding duration, exclusivity, and method of feeding), account for key confounders, evaluate dose effects, and consider effect modification and reverse causality. Mechanistic studies examining human milk bioactives and their impact on lung health and asthma development are beginning to emerge, and these will be important in establishing the causality and mechanistic basis of the observed associations between breastfeeding and asthma. In this review, we summarize current evidence on this topic, identify possible reasons for disagreement across studies, discuss potential mechanisms for a causal association, and provide recommendations for future research.
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Affiliation(s)
- Kozeta Miliku
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
| | - Meghan B Azad
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3E 3P4, Canada.
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18
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Arigliani M, Spinelli AM, Liguoro I, Cogo P. Nutrition and Lung Growth. Nutrients 2018; 10:E919. [PMID: 30021997 PMCID: PMC6073340 DOI: 10.3390/nu10070919] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022] Open
Abstract
Experimental evidence from animal models and epidemiology studies has demonstrated that nutrition affects lung development and may have a lifelong impact on respiratory health. Chronic restriction of nutrients and/or oxygen during pregnancy causes structural changes in the airways and parenchyma that may result in abnormal lung function, which is tracked throughout life. Inadequate nutritional management in very premature infants hampers lung growth and may be a contributing factor in the pathogenesis of bronchopulmonary dysplasia. Recent evidence seems to indicate that infant and childhood malnutrition does not determine lung function impairment even in the presence of reduced lung size due to delayed body growth. This review will focus on the effects of malnutrition occurring at critical time periods such as pregnancy, early life, and childhood, on lung growth and long-term lung function.
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Affiliation(s)
- Michele Arigliani
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Alessandro Mauro Spinelli
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Ilaria Liguoro
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
| | - Paola Cogo
- Department of Medicine, University Hospital of Udine, Piazzale S. Maria Misericordia 1, 33100 Udine, Italy.
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19
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Oppenheimer JJ, Marshall GD. Increasing our knowledge base of asthma. Ann Allergy Asthma Immunol 2018; 119:476-479. [PMID: 29223297 DOI: 10.1016/j.anai.2017.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John J Oppenheimer
- Division of Allergy Immunology, Rutgers-UMDNJ and Pulmonary and Allergy Associates, Summit, New Jersey.
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20
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Lossius AK, Magnus MC, Lunde J, Størdal K. Prospective Cohort Study of Breastfeeding and the Risk of Childhood Asthma. J Pediatr 2018; 195:182-189.e2. [PMID: 29397158 PMCID: PMC5869148 DOI: 10.1016/j.jpeds.2017.11.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/19/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To study whether the duration of breastfeeding and time for introduction of complementary foods was associated with the risk of childhood asthma. STUDY DESIGN We used data from the Norwegian Mother and Child Study, a nationwide prospective cohort study that recruited pregnant women from across Norway between 1999 and 2008. Children with complete data of breastfeeding up to 18 months and current age >7 years were eligible (n = 41 020). Asthma as the primary outcome was defined based on ≥2 dispensed asthma medications at age 7 years registered in the Norwegian Prescription Database. We used log-binomial regression models to obtain crude relative risks (RRs) in the main analysis, and adjusted for selected confounders in multivariable analyses. RESULTS For duration of any breastfeeding, 5.9% of infants breastfed <6 months (adjusted RR [aRR] 1.05, 0.93-1.19) and 4.6% breastfed 6-11 months (aRR 0.96, 0.87-1.07) had dispensed asthma medications at age 7 years compared with 4.6% of infants breastfed ≥12 months (Ptrend .62). Infants still breastfed at 6 months, but introduced to complementary foods <4 months and 4-6 months, had an aRR of 1.15 (0.98-1.36) and 1.09 (0.94-1.27) respectively, compared with infants fully breastfed for 6 months (Ptrend .09). Ages at introduction of solids or formula separately were not significant predictors (Ptrend .16 and .08, respectively). CONCLUSIONS We found no association between duration of breastfeeding or age of introduction to complementary foods and asthma at age 7 years.
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Affiliation(s)
| | - Maria Christine Magnus
- The Norwegian Institute of Public Health, Oslo, Norway,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom,School of social and community medicine, University of Bristol, Bristol, United Kingdom
| | - Jon Lunde
- Ped. dpt, Ostfold Hospital Trust, Norway
| | - Ketil Størdal
- Pediatric Department, Ostfold Hospital Trust, Grålum, Norway; The Norwegian Institute of Public Health, Oslo, Norway.
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21
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Ahmadizar F, Vijverberg SJH, Arets HGM, de Boer A, Garssen J, Kraneveld AD, Maitland-van der Zee AH. Breastfeeding is associated with a decreased risk of childhood asthma exacerbations later in life. Pediatr Allergy Immunol 2017; 28:649-654. [PMID: 28755494 DOI: 10.1111/pai.12760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Breastfeeding has been suggested to influence the risk of asthma and asthma severity in children. However, the conclusions from epidemiologic studies are inconsistent. METHODS We used data from 960 children (aged 4-12 years) using regular asthma medication who participated in the PACMAN study. Breastfeeding exposure was based on questionnaire data and stratified into (i) ever vs never, and (ii) ≥6 vs <6 months duration of breastfeeding. Asthma severity was based on the occurrence of asthma exacerbations in the preceding year and/or poorly controlled asthma symptoms during the last week of study visit. Odds ratios (ORs) were derived from univariate and multivariable logistic regression analyses. RESULTS Breastfeeding was associated with a decreased risk of asthma exacerbations; adjusted (adj.) OR: 0.55 (95% confidence interval [CI]: 0.35-0.87). After stratification for duration of breastfeeding, the adj. ORs were 0.48 (95% CI: 0.27-0.84) for duration <6 months and 0.71 (95% CI: 0.43-1.20) for duration ≥6 months breastfeeding. When we stratified the analysis by family history of asthma, the association between breastfeeding and asthma exacerbations was strong and statistically significant only in children with a positive family history of asthma; adj. OR: 0.34 (95% CI: 0.18-0.66). There was no association between breastfeeding and risk of poor asthma control; adj. OR: 1.04 (95% CI: 0.76-1.41). CONCLUSION In a pediatric population with asthma, children who had been breastfed had a statistically significantly lower risk of asthma exacerbations later in life compared to asthmatic children who had not been breastfed.
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Affiliation(s)
- Fariba Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Susanne J H Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology and Allergology, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Human Milk and Allergic Diseases: An Unsolved Puzzle. Nutrients 2017; 9:nu9080894. [PMID: 28817095 PMCID: PMC5579687 DOI: 10.3390/nu9080894] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
There is conflicting evidence on the protective role of breastfeeding in relation to the development of allergic sensitisation and allergic disease. Studies vary in methodology and definition of outcomes, which lead to considerable heterogeneity. Human milk composition varies both within and between individuals, which may partially explain conflicting data. It is known that human milk composition is very complex and contains variable levels of immune active molecules, oligosaccharides, metabolites, vitamins and other nutrients and microbial content. Existing evidence suggests that modulation of human breast milk composition has potential for preventing allergic diseases in early life. In this review, we discuss associations between breastfeeding/human milk composition and allergy development.
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