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Breastfeeding and Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary
Maria A Quigley1, Claire Carson1, Yvonne Kelly2
1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Insights
Breastfeeding duration is linked to reduced wheezing risk in young children, particularly for early transient wheeze. However, this association diminishes with age and varies by wheezing phenotype.
Area of Science:
- Pediatric respiratory health
- Epidemiology
- Childhood development
Background:
- Systematic reviews indicate breastfeeding may lower asthma risk, but findings are inconsistent.
- Heterogeneity in existing research necessitates further investigation into breastfeeding's impact on childhood wheezing.
- Understanding age-specific associations is crucial for public health recommendations.
Purpose of the Study:
- To examine the relationship between breastfeeding duration and wheezing across different childhood ages.
- To investigate the association between breastfeeding and longitudinal wheezing phenotypes (early transient, late onset, persistent).
- To identify how age and wheezing patterns influence the breastfeeding-wheezing association.
Main Methods:
- Utilized data from the UK Millennium Cohort Study (n=10,126 children).
- Analyzed breastfeeding duration against wheezing at ages 9 months, 3, 5, 7, and 11 years.
- Defined and analyzed longitudinal wheezing phenotypes: early transient, late onset, and persistent.
Main Results:
- The association between breastfeeding and wheezing significantly varied by child's age (P=0.0003).
- Breastfeeding for 6-9 months showed reduced wheezing odds at younger ages (9 months to 5 years) but less effect at 7 and 11 years.
- A dose-response relationship was observed between breastfeeding duration and early transient wheeze, but not for other phenotypes.
Conclusions:
- The protective effect of breastfeeding against wheezing is age-dependent.
- Breastfeeding duration is strongly associated with a reduced risk of early transient wheeze.
- Findings highlight the importance of considering age and wheezing phenotype when evaluating breastfeeding's respiratory benefits.
Abstract:
Systematic reviews suggest that breastfeeding is associated with a lower risk of asthma, although marked heterogeneity exists. Using UK Millennium Cohort Study data (n = 10,126 children, born 2000-2002), we examined the association between breastfeeding duration and wheezing in the previous year, first for each age group separately (ages 9 months, 3 years, 5 years, 7 years, and 11 years) and then in terms of a longitudinal wheezing phenotype: "early transient" (wheezing any time up to age 5 years but not thereafter), "late onset" (any time from age 7 years but not beforehand), and "persistent" (any time up to age 5 years and any time from age 7 years). The association between breastfeeding and wheeze varied by age (2-sided P for interaction = 0.0003). For example, breastfeeding for 6-9 months was associated with lower odds of wheezing at ages 9 months, 3 years, and 5 years but less so at ages 7 years and 11 years (adjusted odds ratios = 0.73, 0.78, 0.79, 0.84, 1.06, respectively). There was a strong dose-response relationship for breastfeeding per month and early transient wheeze (adjusted odds ratio for linear trend = 0.961, 95% confidence interval: 0.942, 0.980) but no clear trend for late-onset or persistent wheeze. Our results identified heterogeneity in the association between breastfeeding and wheezing according to age at wheezing and wheezing phenotype.
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