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Relationship of infant feeding to recurrent wheezing at age 6 years
A L Wright1, C J Holberg, L M Taussig
1Department of Pediatrics, University of Arizona, Tucson, USA.
Insights
Breast-feeding is linked to reduced recurrent wheezing in nonatopic children by age 6. This protective effect of infant feeding persists regardless of early respiratory illnesses.
Area of Science:
- Pediatric respiratory health
- Infant nutrition
- Allergy and immunology
Background:
- Recurrent wheezing in childhood is a significant health concern.
- The influence of infant feeding practices on long-term respiratory outcomes requires further investigation.
- Understanding risk factors for childhood wheezing is crucial for prevention strategies.
Purpose of the Study:
- To examine the association between infant feeding methods and the occurrence of recurrent wheezing at age 6 years.
- To determine if a history of lower respiratory tract illnesses modifies the relationship between infant feeding and wheezing.
- To identify potential protective factors against childhood recurrent wheeze.
Main Methods:
- A prospective, longitudinal study followed 988 healthy infants from birth to 6 years.
- Infant feeding data were collected prospectively; recurrent wheezing was assessed via parental questionnaire at age 6.
- Children's atopic status was determined by skin prick tests; early lower respiratory tract illnesses were clinically diagnosed.
Main Results:
- Nonatopic children who were breast-fed had significantly lower rates of recurrent wheezing at age 6 (3.1% vs. 9.7%, P < .01).
- This association between breast-feeding and reduced wheezing was observed in nonatopic children irrespective of early wheezing illnesses.
- In multivariate analysis, non-breast-fed nonatopic children had threefold increased odds of recurrent wheezing (OR, 3.03; 95% CI, 1.06-8.69).
Conclusions:
- Infant breast-feeding is associated with a decreased incidence of recurrent wheezing at age 6 in nonatopic children.
- The protective effect of breast-feeding on recurrent wheezing is independent of early-life lower respiratory tract illnesses.
- Promoting breast-feeding may be a strategy to reduce the burden of recurrent wheezing in susceptible nonatopic children.
Objectives:
To investigate the relationship of infant feeding to recurrent wheezing at age 6 years and to assess whether this relationship is altered by a history of wheezing lower respiratory tract illnesses.
Design:
Prospective, longitudinal study of healthy infants followed up from birth to 6 years of age.
Setting:
Nonselected health maintenance organization population in Tucson, Arizona.
Participants:
There were 1246 healthy infants enrolled at birth, 988 of whom had data on both infant feeding and wheezing at age 6 years.
Interventions:
None.
Main Outcome Measures:
Recurrent wheeze (four or more episodes in the past year) was assessed by a questionnaire that was completed by parents when the children were 6 years old. Children were classified by atopic status on the basis of skin prick tests.
Results:
Breast-feeding information was collected prospectively, and lower respiratory tract illnesses in the first 3 years of life were diagnosed by the pediatrician. Being breast-fed was associated with lower rates of recurrent wheeze at age 6 years (3.1% vs 9.7%, P < .01) for nonatopic children; this relationship was not significant for atopic children. The relationship of breast-feeding with recurrent wheeze was apparent among nonatopic children both with and without a wheezing lower respiratory tract illness in the first 6 months of life. When potential confounders, including early wheezing lower respiratory tract illness, were included in a multivariate model, nonatopic children who had not been breast-fed had three times the odds of wheezing recurrently (odds ratio, 3.03; confidence interval, 1.06 to 8.69). Eleven percent of recurrent wheeze among nonatopic children could be attributed to not breast-feeding.
Conclusions:
Recurrent wheeze at age 6 years is less common among nonatopic children who were breast-fed as infants. This effect is independent of whether the child wheezed with a lower respiratory tract illness in the first 6 months of life.