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Eur Respir J. 2009 May;33(5):993-1002. doi: 10.1183/09031936.00075708. Epub 2009 Jan 22.

Effect of breastfeeding on asthma, lung function and bronchial hyperreactivity in ISAAC Phase II.

Collaborators (149)

Björkstén B, Brunekreef B, Cookson W, Strachan D, von Mutius E, Weiland SK, Büchele G, Kleiner A, Nagel G, Rzehak P, Weinmayr G, Weiland SK, Priftanji A, Shkurti A, Simenati J, Grabocka E, Shyti K, Agolli S, Gurakuqi A, Stein RT, de Pereira MU, Jones MH, Pitrez PM, Cooper PJ, Chico M, Chen YZ, Zhong NS, Lei C, Wong G, Riikjärv MA, Annus T, Annesi-Maesano I, Gotua M, Rukhadze M, Abramidze T, Kvachadze I, Karsanidze L, Kiladze M, Dolidze N, Leupold W, Keil U, von Mutius E, Weiland SK, Arthur P, Addo-Yobo E, Gratziou C, Priftis C, Papadopoulou A, Katsardis C, Tsanakas J, Hatziagorou E, Kirvassilis F, Clausen M, Shah JR, Mathur RS, Khubchandani RP, Mantri S, Forastiere F, Di Domenicantonio R, De Sario M, Sammarro S, Pistelli R, Serra MG, Corbo G, Perucci CA, Svabe V, Sebre D, Casno G, Novikova I, Bagrade L, Brunekreef B, Schram D, Doekes G, Jansen-van Vliet PH, Janssen NA, Aarts FJ, de Meer G, Crane J, Wickens K, Barry D, Nystad W, Bolle R, Lund E, El-Sharif N, Nemery B, Barghuthy F, Abu Huij S, Qlebo M, Garrido JB, Ruiz TR, Perales AB, Jiménez YG, Rodriguez JA, de Cabo JM, Maldonado AL, Torres MD, Garcia-Marcos L, Torres AM, Pérez JJ, López AP, Robles SC, Hernandez GG, Gimeno AM, Rodríguez AL, Paredes CL, Gil IG, Suarez-Varela MM, González AL, Montaner AE, Guerola MT, Bråbäck L, Kjellman M, Nilsson L, Mai XM, Sandin A, Saraçlar Y, Kuyucu S, Tuncer A, Saçkesen C, Sumbuloğlu V, Geyik P, Kocabaş C, Strachan D, Kaur B, Aït-Khaled N, Anderson HR, Strachan DP, Cookson W, Williams H, Asher I, Ellwood P, Mitchell E, Stewart A, Crane J, Beasley R, Pearce N, Björkstén B, Brunekreef B, Foliaki S, García-Marcos L, Keil U, von Mutius E, Weiland SK, Lai C, Wong G, Mallol J, Montefort S, Odhiambo J, Robertson C.


The association between breastfeeding and wheezing, lung function and atopy was evaluated in the International Study of Asthma and Allergy in Childhood (ISAAC) Phase II. Cross-sectional studies were performed in 27 centres in 20 countries. Information on disease and exposure factors was collected by parental questionnaires. Data from 54,000 randomly selected school children (aged 8-12 yrs, 31,759 with skin prick testing) and a stratified subsample (n = 4,888) were used for testing the correlation of breastfeeding with bronchial hyperreactivity and lung function. Random effect models for meta-analysis were applied to calculate combined odds ratios (ORs). Any breastfeeding was associated with less wheeze both in affluent (adjusted OR (OR(adj)) 0.87, 95% confidence interval (CI) 0.78-0.97) and nonaffluent countries (OR(adj) 0.80, 95% CI 0.68-0.94). Further analyses revealed that this was true only for nonatopic wheeze in nonaffluent countries (OR(adj) 0.69, 95% CI 0.53-0.90). Breastfeeding was not associated with atopic wheeze and objective measures of allergy in both affluent and nonaffluent countries. In contrast, breastfeeding was associated with higher predicted forced expiratory volume in one second in affluent countries only (mean ratio 1.11, 95% CI 1.02-1.20). Breastfeeding is associated with protection against nonatopic wheeze, which becomes particularly evident in nonaffluent countries. Overall, breastfeeding was not related to any measure of allergy. These findings may explain some of the controversy regarding breastfeeding, since the direction of the association with breastfeeding depends on the predominating wheeze phenotype (e.g. atopic, nonatopic).

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