Original Articles
Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life—results from the GINI-birth cohort study

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Abstract

Objective

To investigate if exclusive breast-feeding for 4 months is associated with atopic dermatitis during the first 3 years of life.

Study design

Data on 3903 children were taken from yearly parental-administered questionnaires from a birth cohort study in Germany (recruited 1995-1998) comprised of a noninterventional (NI) and an interventional (I) subgroup. Outcomes were physician-diagnosed atopic dermatitis (AD) and itchy rash. Multiple logistic regression was performed for the entire cohort and stratified by family history of allergy and by study group adjusting for a fixed set of risk factors for allergies.

Results

Exclusive breast-feeding (52 % of children) was not associated with higher risk for AD either in the entire cohort (ORadj, 0.95; 95% CI, 0.79-1.14) or if stratified by family history of AD. In the I subgroup, but not in the NI subgroup, exclusive breast-feeding showed a significant protective effect on AD if compared with conventional cow's milk formula (ORadj, 0.64; 95% CI, 0.45-0.90).

Conclusion

These findings do not support the hypothesis that exclusive breast-feeding is a risk factor for development of atopic dermatitis but is protective if compared with conventional cow's milk. Observational studies might not be able to effectively control for selection bias and reverse causation.

Section snippets

Study design and subjects

We used questionnaire data from a birth cohort of healthy term neonates enrolled between 1995 and 1998 in two regions in Germany (urban Munich, rural Wesel).24., 25. This cohort is comprised of two groups.

Group I (interventional) are infants with a family history of allergy participating in an intervention study that is described in detail elsewhere (German Infant Nutritional Intervention Program [GINI]). 26., 15. Briefly, this study was a prospective randomized double-blind trial to

Study population

Of the 5538 infants recruited at birth, 4194 (75.7 %) had completed 3-year questionnaires. Complete data on feeding regimen and physician-diagnosed AD for the first 3 years of life were available for 3903 of these (93.1%). Approximately half (52.0%) of these infants were exclusively breast-fed, whereas 522 (13.4%) were exclusively bottle-fed during the first 4 months. The overall prevalence of physician-diagnosed AD and intermittent itchy rash for at least 6 months were 20.0% and 9.1%

Discussion

In this large birth cohort designed to investigate determinants and the natural course of allergic disease, we did not find evidence that exclusive breast-feeding increases the risk of developing AD during the first 3 years of life. Our study was powerful enough to detect even moderately-sized risk ratios that would be expected according to the literature.2., 22. Moreover, we found a protective effect of exclusive breast-feeding compared with conventional cow's-milk formula in the high-risk I

Conclusion

In this large birth cohort designed to investigate risk factors of allergic diseases, we did not find any evidence that exclusive breast-feeding increases the risk of development of AD. However when a subgroup with blinded randomization of formulae was compared with a conventional cow's-milk formula reference group, exclusive breast-feeding showed a significant protective effect. This effect could not be shown in the observational subgroup. These results suggest that observational studies might

Acknowledgements

We thank the families for participation in the study, the obstetric units to allow the recruitment procedure and the GINI team for excellent work.

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Supported by the Federal Ministry for Education, Science, Research and Technology, Grant No. 01 EE 9401-4 and the Child Health Foundation. Nestlé, Hipp, Milupa, Numico and Mead Johnson provided the study formulas for the intervention study.

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