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Breastfeeding and the prevalence of allergic diseases in schoolchildren: Does reverse causation matter?

Takashi Kusunoki1, Takeshi Morimoto, Ryuta Nishikomori

  • 1Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Shiga, Japan. kusutaka@gamma.ocn.ne.jp

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|January 22, 2010
PubMed

Insights

Breastfeeding appears to reduce the risk of childhood bronchial asthma (BA). However, the observed increased prevalence of atopic dermatitis (AD) and food allergy (FA) linked to breastfeeding is likely due to reverse causation in high-risk infants.

Area of Science:

  • Pediatric Allergy and Immunology
  • Epidemiology
  • Public Health Nutrition

Background:

  • Infants at higher risk for allergic diseases may be breastfed longer, potentially creating a false association.
  • This phenomenon, known as reverse causation, can obscure the true effects of breastfeeding on allergy development.

Purpose of the Study:

  • To investigate the long-term effects of infant feeding practices on the prevalence of allergic diseases at school age.
  • To differentiate between true effects and reverse causation in the breastfeeding-allergy relationship.

Main Methods:

  • A large-scale questionnaire survey of 13,215 parents of schoolchildren aged 7-15 years.
  • Comparison of allergic disease prevalence (bronchial asthma, atopic dermatitis, food allergy) based on infant feeding type: complete breastfeeding, mixed feeding, or artificial feeding.
  • Univariate and multivariate analyses, controlling for known risk factors for allergic diseases.

Main Results:

  • Complete and mixed breastfeeding were associated with a significantly lower prevalence of bronchial asthma (BA) compared to artificial feeding.
  • Univariate analysis showed higher prevalence of atopic dermatitis (AD) and food allergy (FA) with complete breastfeeding.
  • Multivariate analysis, accounting for risk factors, eliminated the apparent promoting effect of breastfeeding on AD and FA, supporting reverse causation.

Conclusions:

  • Breastfeeding demonstrates a clear inhibitory effect on the prevalence of bronchial asthma (BA) at school age.
  • The apparent increased risk of atopic dermatitis (AD) and food allergy (FA) associated with breastfeeding is likely due to reverse causation, not a direct promoting effect.

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