Association of Exclusive Breastfeeding with Asthma Risk among Preschool Children: An Analysis of National Health and Nutrition Examination Survey Data, 1999 to 2014

Abstract

Breastmilk contains many important nutrients, anti-inflammatory agents, and immunomodulators. It is the preferred nutrition source for infants. However, the association of the duration of exclusive breastmilk feeding (BMF) with asthma development is unclear. Data on children from the United States who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were obtained. We examined the association between the duration of exclusive BMF and asthma in 6000 children (3 to 6 years old). After calculating the duration of exclusive breastfeeding according to answers to NHANES questionnaires, the estimated duration of exclusive BMF was divided into five categories: never breastfed or BMF for 0 to 2 months after birth; BMF for 2 to 4 months after birth; BMF for 4 to 6 months after birth; and BMF for ≥6 months after birth. The overall prevalence of asthma in children aged 3 to 6 years was approximately 13.9%. The risk of asthma was lower in children with an exclusive BMF duration of 4 to 6 months (aOR, 0.69; 95% CI, 0.48–0.98), after adjustment for potentially confounding factors. Subgroup analysis revealed that children of younger ages (3 to 4 years old) benefited most from the protective effects of exclusive BMF for 4 to 6 months (aOR, 0.47; 95% CI, 0.27, 0.8). We found that exclusive BMF, especially BMF for 4 to 6 months, is associated with a decreased risk of asthma in preschool-age children. The protective effect appeared to be diminished in older children. The potential mechanism needs further investigation.

Full Breastfeeding and Allergic Diseases—Long-Term Protection or Rebound Effects?

“…Two very recent studies using data from large-scale population-based studies, i.e., National Health and Nutrition Examination Survey (NHANES, 833 cases and 5167 controls) [ 21 ] and UK Biobank (7157 cases with childhood-onset asthma and 158,253 controls) [ 22 ], could not yet be considered in the above-mentioned guidelines. Both showed potential protective effects: Breastfed children from the UK Biobank less frequently developed asthma until 12 years of age compared to their counterparts who were not breastfed [ 22 ].…”

“…Both showed potential protective effects: Breastfed children from the UK Biobank less frequently developed asthma until 12 years of age compared to their counterparts who were not breastfed [ 22 ]. The second study showed that in three to six year-old children participating in NHANES who were exclusively breastfed for at least four to six months asthma risk was reduced by 31% compared with children never breastfed [ 21 ]. Interestingly, Chen et al also reported that protective effects seem to diminish in older children [ 21 ].…”

Breastfeeding-Related Health Benefits in Children and Mothers: Vital Organs Perspective

“…This is of particular significance considering that asthma, the highest prevalent chronic non-communicable childhood disease, affects approximately 14% of children worldwide [ 39 ], leading to frequent emergency room visits and school absenteeism, often resulting in lifelong impairments in lung health [ 40 ]. Several investigations have demonstrated that certain HMOs have the ability to directly modulate the immune response by mitigating viral pathogens and modulating the behavior of immune cells within the host [ 41 ]. These findings highlight the potential immunomodulatory properties of HMOs concerning respiratory health.…”

Rethinking breastfeeding management

“…17 Additionally, a duration of breastfeeding of at least 4 months is associated with reduced risk of asthma among children ages 3 to 6 years and reduced risk of urinary tract infections. 18,19 Initiation of breastfeeding may reduce postneonatal mortality by 31% for Black infants. 7 Considerable data confirm that the…”

“…Infants who are exclusively breastfed for more than 4 months have lower risk of overweight and obesity 17. Additionally, a duration of breastfeeding of at least 4 months is associated with reduced risk of asthma among children ages 3 to 6 years and reduced risk of urinary tract infections 18,19. Initiation of breastfeeding may reduce postneonatal mortality by 31% for Black infants 7.…”