Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study

Annika Klopp; Lorena Vehling; Allan B Becker; Padmaja Subbarao; Piushkumar J Mandhane; Stuart E Turvey; Diana L Lefebvre; Malcolm R Sears; CHILD Study Investigators; Meghan B Azad

doi:10.1016/j.jpeds.2017.07.012

Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study

J Pediatr. 2017 Nov:190:192-199.e2. doi: 10.1016/j.jpeds.2017.07.012.

Authors

Collaborators

CHILD Study Investigators:
Denise Daley⁷, Frances Silverman⁸, Kent Hayglass⁹, Michael Kobor⁷, Stuart Turvey⁷, Tobias Kollmann⁷, Jeff Brook⁸, Clare Ramsey⁹, Joseph Macri¹⁰, Andrew Sandford⁷, Peter Pare⁷, Scott Tebbutt⁷, Michael Brauer⁷, Judah Denburg¹⁰, Michael Cyr¹⁰, Anita Kozyrskyj¹¹, Allan Becker⁹, Edith Chen¹², Greg Miller¹², Tim Takaro¹³, Felix Ratjen¹⁴, Hartmut Grasemann¹⁴, Sharon Dell¹⁴, Teresa To¹⁴, Theo Moraes¹⁴, Padmaja Subbarao¹⁴, Linn Holness⁸, A Dean Befus¹¹, Piushkumar Mandhane¹¹, Catherine Laprise¹⁵, James Scott⁸, Richard Hegele¹⁴, Wendy Lou⁸, Sonia Anand¹⁰, Malcolm Sears¹⁰, Elinor Simons⁹, Meghan Azad⁹, Thomas Eiwegger¹⁴, Qingling Duan¹⁶, Perry Hystad¹⁷, Jeremy Scott¹⁸

Affiliations

¹ Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
³ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
⁴ Department of Pediatrics Child and Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁶ Canadian Healthy Infant Longitudinal Development Study (investigators listed in acknowledgements).
⁷ University of British Columbia, Vancouver, British Columbia, Canada.
⁸ University of Toronto, Toronto, Ontario, Canada.
⁹ University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁰ McMaster University, Hamilton, Ontario, Canada.
¹¹ University of Alberta, Edmonton, Alberta, Canada.
¹² Northwestern University, Chicago, IL.
¹³ Simon Fraser University, Burnaby, British Columbia, Canada.
¹⁴ University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁵ Queens University, Kingston, Ontario, Canada.
¹⁶ University of Quebec at Chicoutimi, Chicoutimi, Quebec, Canada.
¹⁷ Oregon State University, Seattle, WA.
¹⁸ Lakehead University, Thunder Bay, Ontario, Canada.
¹⁹ Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: [email protected].

PMID: 29144244
DOI: 10.1016/j.jpeds.2017.07.012

Abstract

Objective: To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk.

Study design: We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals.

Results: At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections.

Conclusions: Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.

Keywords: asthma; breastfeeding; pumped breast milk.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Asthma / etiology*
Asthma / prevention & control
Breast Feeding*
Breast Milk Expression
Canada
Child, Preschool
Female
Humans
Infant
Infant Formula / adverse effects*
Infant, Newborn
Logistic Models
Longitudinal Studies
Male
Prospective Studies
Protective Factors
Risk Factors