Systematic Review: The Role of Breastfeeding in the Development of Pediatric Inflammatory Bowel Disease

Objectives To assess the current evidence for the role of breastfeeding in the development of early onset inflammatory bowel disease (IBD) with a systematic review. Study design An electronic database search was performed (January 1966-January 2008) with keywords related to IBD and breastfeeding, looking specifically for studies that reported outcome in early-onset disease (<16 years of age) and any exposure to breast milk as the variables. Meta-analysis of studies included for review was then performed by using a random effects model, and results were expressed as odds ratios (OR) with 95% CIs. Results A total of 79 articles were identified, 20 of which were found describing breastfeeding in relation to the development of lBD; 8 of these articles included separate early-onset groups. One study did not describe any exposure to breast milk for the early onset group, so 7 studies were included in the meta-analysis. Breast milk exposure had a significant protective effect (OR, 0.69; 95% CI, 0.51-0.94; P = .02) in developing early-onset lBD. A non-significant difference was demonstrated for ulcerative colitis and Crohn's disease individually (OR, 0.72; 95% CI, 0.51-1.02; P = .06; OR, 0.64; 95% CI, 0.38-1.07; P = .09, respectively). Conclusions The current evidence demonstrates a possible protective effect for breast milk in the development of early onset IBD. However, the quality of existing data is generally poor. These findings need to be investigated in well-designed prospective studies. (J Pediatr 2009,155:421-6).