Original ArticlesEffect of breast-feeding on the development of atopic dermatitis during the first 3 years of life—results from the GINI-birth cohort study☆
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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2022, Clinics in DermatologyCitation Excerpt :This beneficial effect was limited to children with a first-degree relative with AD and was not seen in the general population. Similar outcomes were also reported from the German Infant Nutritional Intervention (GINI) Program, which showed a protective effect of exclusive breastfeeding for 4 months compared with a diet of conventional cow's milk formula.30-32 A meta-analysis in 2009 (21 studies with 27 study populations) did not find substantial evidence to support the protective effect of a minimum of 3 months of exclusive breastfeeding in AD in children with or without a strong family history of AD (odds ratio [OR]: 0.78, 95% confidence interval [CI] 0.58-1.05).33
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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.