前人哺乳,后人防癌!哺乳喂养可降低后代多种癌症发生风险!

2022-06-23 MedSci原创 MedSci原创

 Ital J Pediatr:孕产妇母乳喂养与后代全身性肿瘤风险的关系。

在发达国家和发展中国家,与儿童癌症相关的发病率和死亡率正在急剧上升。最常见的儿童癌症包括急性白血病(占26.3%),尤其是急性淋巴细胞白血病(ALL)、中枢神经系统肿瘤(17.6%)和淋巴瘤(占所有癌症的14.6%)。

母乳喂养是新生儿的主要食物,新生儿几乎满足所有基本需求,以满足生长发育的要求。近年来,用配方奶喂养婴儿已成为一种普遍现象;然而,配方奶粉的成分与母乳喂养的成分不同。母乳喂养含有配方奶粉中没有的成分,包括激素和活性肽,对新生儿期和婴儿期的发育起着至关重要的作用。

目前的研究都没有提到母乳喂养和其他全身性疾病以及母乳喂养对儿童癌症的影响。此外,在以前的研究中,母乳喂养模式(或配方奶粉)与儿童癌症风险之间的明确关联尚未得到详细探讨。世界卫生组织(WHO)建议,母乳喂养对健康有额外的益处,可延续到成年期,并建议将母乳喂养维持2年或更长时间。关于母乳喂养的持续时间,研究人员之间存在争议,尚未达成共识。本次荟萃分析是旨在全面探索母乳喂养与儿童癌症的关联。本次分析最终纳入46项研究。

母乳喂养是否影响儿童癌症的发病率

35项研究探讨了母乳喂养是否影响儿童癌症的发病率。与从未母乳喂养的儿童相比,与儿童癌症相比,母乳喂养的比值比为0.83(95%CI,0.75-0.92)(图2),这表明曾经接受过母乳喂养与儿童癌症发病率的显着降低有关。

母乳喂养模式

关于各种母乳喂养方式,纯母乳喂养和非纯母乳喂养在儿童癌症发病率方面没有显著差异(OR = 0.82,95%CI,0.66-1.02)(图3和表1)。然而,其他母乳喂养模式和儿童癌症的发病率(混合与非混合母乳喂养(OR = 0.95,95%CI,0.91-1.00)和配方奶喂养与非配方奶喂养(OR = 1.38,95%CI,1.00-1.92))显示出显著差异。混合母乳喂养与配方奶粉(OR = 0.75,95%CI,0.53-1.07),纯母乳喂养与配方奶(OR = 0.54,95%CI,0.23-1.25)以及纯母乳喂养与混合(OR = 1.01,95%CI,0.92-1.10)的比较显示儿童癌症发病率没有显著差异。

母乳喂养的持续时间

研究人员观察到母乳喂养持续时间与癌症风险之间的非线性剂量反应关系(非线性P<0.01)。癌症的风险与母乳喂养的持续时间成反比:随着母乳喂养持续时间的增加,癌症的几率显着降低(图4)。

根据母乳喂养持续时间分组,纯母乳喂养在第1、6和12个月设临界点。表1表明母乳喂养的持续时间与癌症的发病率显著相关,特别是对于长期母乳喂养(≥1个月 vs.<1个月(OR = 0.75,95%CI,0.63-0.89),≥6个月 vs.<6个月(OR = 0.82,95%CI,0.74-0.90)。然而,在母乳喂养12个月(≥12个月 vs.<12个月)之间的比较中,没有观察到差异(OR = 0.82,95%CI:0.65-1.04)。

关于6个月的纯母乳喂养,纳入了4项研究。各组间儿童癌症发病率无显著差异(≥6个月 vs. <6个月,OR = 0.98 95%CI,0.75–1.28)。与混合母乳喂养相比,没有6-12个月和≥12个月纯母乳喂养的儿童癌症发病率数据,但有0-6个月纯母乳喂养与混合母乳喂养的比较(OR = 0.92,95%CI,0.78-1.08)。

不同的儿童癌症

血液系统恶性肿瘤

无论母乳喂养方式和母乳喂养时间长短都与血液系统恶性肿瘤风险降低有关(OR = 0.82,95%CI,0.71-0.94)(图5)。

还对白血病(ALL,AML和ANLL)和淋巴瘤(HL和NHL)进行了单独的亚组分析。对于白血病,有19项研究表明任何母乳喂养与白血病风险之间存在统计学上显著的负相关关系(OR = 0.89,95%CI,0.82-0.97)。根据白血病亚组分析,急性淋巴细胞白血病的比值比为0.85(95%CI,0.82-0.97),表明母乳喂养对急性淋巴细胞白血病有保护作用。只有3项研究包含AML亚组分析(OR = 0.79,95%CI,0.66–0.94),AML与儿童癌症发病率之间存在显着关系。对于ANLL,纳入了3项研究,任何母乳喂养与ANLL风险之间没有关联(OR = 1.10,95%CI,0.68-1.80)

淋巴瘤的亚组分析包括5项研究(OR = 0.93, 95%CI, 0.79–1.09)。研究发现,母乳喂养对HL或NHL的风险没有显著的保护作用(分别为OR=0.89, 95%CI,0.68-1.15;OR=0.96、95% CI,0.79–1.17) 表1

其他儿童癌症

本次分析还收集了有关母乳喂养与其他疾病系统关系的数据。项研究探讨了母乳喂养与神经系统疾病发病率的关系,在母乳喂养与神经系统疾病关系的亚组分析中观察到统计学意义(OR = 0.72,95%CI,0.54-0.96)。然而,研究了母乳喂养对骨骼癌,泌尿,生殖等系统癌症发病率的影响,没有研究提到呼吸系统,消化系统或内分泌系统。根据获得的数据,其他几个系统(骨骼:OR = 0.85,95%CI,0.62-1.16,生殖:OR = 1.11,95%CI,0.73-1.67,感觉:OR = 0.77,95%CI,0.39-1.50)的儿童癌症发病率结果没有统计学意义;泌尿系统例外(OR = 0.69,95%CI,0.51-0.92)(表​1)。

证据表明,母乳喂养在预防选择性儿童癌症生长方面具有潜在的保护作用,特别是对于ALL,AML,神经和泌尿系统癌症。这项研究建议尽可能延长母乳喂养或维持至少6个月,以防止儿童癌症发生。

 

原文来源:

Gong QQ, Quan DD, Guo C, Zhang C, Zhang ZJ. Association between maternal breastfeeding and risk of systemic neoplasms of offspring. Ital J Pediatr. 2022;48:98. Published 2022 Jun 16. doi:10.1186/s13052-022-01292-9.

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    2022-07-05 zwddoctor

    接受过母乳喂养与儿童癌症发病率的显着降低有关。

    0

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    2022-06-23 jeanqiuqiu
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