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Association of Infant Breastfeeding and Juvenile Spondyloarthritis: A Case-Control Study
Katelyn H Baggett1, Timothy G Brandon1, Rui Xiao2
1K.H. Baggett, BSc, T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology and Clinical Futures at the Children's Hospital of Philadelphia.
Insights
Exclusive breastfeeding for over six months was linked to a reduced risk of developing juvenile spondyloarthritis (JSpA). However, breastfeeding duration did not significantly impact JSpA disease activity at presentation.
Area of Science:
- Pediatrics
- Immunology
- Microbiome Research
Background:
- Juvenile spondyloarthritis (JSpA) has a complex cause.
- Breastfeeding may offer protection in similar conditions.
- Understanding early-life factors is crucial for JSpA prevention and management.
Purpose of the Study:
- To investigate the association between breastfeeding and the development of JSpA.
- To determine if breastfeeding influences JSpA disease activity at presentation.
Main Methods:
- A retrospective case-control study compared children with JSpA to matched controls.
- Logistic regression analyzed infant factors, including nutrition and delivery mode, for JSpA development.
- Linear regression assessed JSpA disease activity in relation to breastfeeding, delivery mode, and antibiotic exposure.
Main Results:
- Exclusive breastfeeding for over six months was significantly associated with a lower likelihood of developing JSpA (OR 0.47).
- Vaginal delivery was linked to lower JSpA disease activity scores (B = -0.65).
- Breastfeeding duration did not significantly correlate with JSpA Disease Activity Index (JSpADA6) scores.
Conclusions:
- Infant factors, potentially influencing the microbiome, may play a role in JSpA occurrence.
- Early-life nutrition, specifically breastfeeding, could be a modifiable factor in JSpA development.
- Further research into the gut microbiome's role in JSpA is warranted.
Objective:
Given the multifactorial pathogenesis of juvenile spondyloarthritis (JSpA) and evidence of a protective effect in phenotypically similar diseases, we aimed to test whether breastfeeding is associated with the development and disease activity of JSpA.
Methods:
This single-center retrospective case-control study included children with JSpA and age- and sex-matched controls with a 1:1 ratio. Univariable and multivariable conditional logistic regression modeling for matched pairs was used to test the association of infant factors with the development of JSpA, including infant nutrition and form of delivery. Linear regression was used to assess the association of JSpA disease activity (JSpA Disease Activity Index with 6 elements [JSpADA6]) at presentation with breastfeeding exposure, form of delivery, and antibiotic exposure.
Results:
For the 195 case-control matched pairs, the mean age was 13.0 years and 47.7% were female. For breastfeeding, 88.7% of controls and 69.2% of JSpA cases were exposed to breastfeeding of any duration, respectively (P < 0.001). In the multivariable model, exclusive breastfeeding > 6 months was independently and significantly associated with a lower chance of JSpA development (odds ratio 0.47, 95% CI 0.30-0.72; P < 0.001). The median JSpADA6 was not significantly associated with breastfeeding for > 6 months. However, vaginal delivery was significantly associated with a lower JSpADA6 (B = -0.65, 95% CI -1.13 to -0.17; P = 0.008).
Conclusion:
This study suggests that infant factors that affect the microbiome may be associated with the occurrence and disease activity of JSpA at presentation.
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