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Review
. 2015 Feb;18(3):500-20.
doi: 10.1017/S1368980014000500. Epub 2014 May 1.

Breast-feeding and Helicobacter pylori infection: systematic review and meta-analysis

Helena Carreira  1 , Ana Bastos  1 , Bárbara Peleteiro  1 , Nuno Lunet  1
Affiliations
Review

Breast-feeding and Helicobacter pylori infection: systematic review and meta-analysis

Helena Carreira et al. Public Health Nutr. 2015 Feb.

Abstract

Objective: To quantify the association between breast-feeding and Helicobacter pylori infection, among children and adolescents.

Design: We searched MEDLINE™ and Scopus™ up to January 2013. Summary relative risk estimates (RR) and 95 % confidence intervals were computed through the DerSimonian and Laird method. Heterogeneity was quantified using the I² statistic.

Setting: Twenty-seven countries/regions; four low-income, thirteen middle-income and ten high-income countries/regions.

Subjects: Studies involving samples of children and adolescents, aged 0 to 19 years.

Results: We identified thirty-eight eligible studies, which is nearly twice the number included in a previous meta-analysis on this topic. Fifteen studies compared ever v. never breast-fed subjects; the summary RR was 0·87 (95% CI 0·57, 1·32; I²=34·4%) in middle-income and 0·85 (95% CI 0·54, 1·34; I²=79·1%) in high-income settings. The effect of breast-feeding for ≥4-6 months was assessed in ten studies from middle-income (summary RR=0·66; 95% CI 0·44, 0·98; I²=65·7%) and two from high-income countries (summary RR=1·56; 95% CI 0·57, 4·26; I²=68·3%). Two studies assessed the effect of exclusive breast-feeding until 6 months (OR=0·91; 95% CI 0·61, 1·34 and OR=1·71; 95% CI 0·66, 4·47, respectively).

Conclusions: Our results suggest a protective effect of breast-feeding in economically less developed settings. However, further research is needed, with a finer assessment of the exposure to breast-feeding and careful control for confounding, before definite conclusions can be reached.

Keywords: Adolescent; Breast-feeding; Child; Helicobacter pylori.

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Figures

Fig. 1
Fig. 1
Systematic review flowchart according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement( 17 ). *Four studies( 27 , 32 , 35 , 50 ) provided data to quantify the association between both having been breast-fed and having been breast-fed for 4–6 months and Helicobacter pylori infection
Fig. 2
Fig. 2
Meta-analyses of studies evaluating the association between ever being breast-fed and Helicobacter pylori infection. Relative risk (RR) estimates and 95 % confidence intervals of H. pylori infection according to economic development of the countries where the investigations were conducted( 19 ). For each study, the black diamond indicates the best estimate, the size of the grey square indicates the study’s weight in the analysis (weights are from random-effects analysis) and the horizontal line represents the 95 % CI. The centre of the open diamond indicates the summary estimate of the RR and its width represents the 95 % CI of the summary RR estimate. General abbreviations: SES, socio-economic status; Prev., prevalence (%); HP+, H. pylori-infected; BF, breast-feeding; NA, not available. Abbreviations for countries: BRA, Brazil; TWN, Taiwan, Republic of China; CZE, Czech Republic; DEU, Germany; EGY, Egypt; GBR, United Kingdom; IRL, Ireland; IRN, Islamic Republic of Iran; ITA, Italy; PER, Peru; TUR, Turkey. Abbreviations for tests: SA, test based on the detection of stool antigens; SI, test based on serum immunology; UBT, urea breath test. *In the World Bank statistics, Taiwan, Republic of China, is not listed as a separate country. However, for most indicators, Taiwan’s data are not added to the data for China, but it is added to the world aggregate and the high-income countries aggregate. Therefore, Taiwan was included along with other high-income settings
Fig. 3
Fig. 3
Funnel plot of studies evaluating the association between breast-feeding and Helicobacter pylori infection: (a) ever breast-feeding v. never; (b) breast-feeding for 4–6 months v. less than that. Studies were plotted with their relative risk (RR) estimate on the x-axis (log scale) and the corresponding standard error of the RR along the y-axis; pseudo 95 % confidence limits are represented by dashed lines
Fig. 4
Fig. 4
Meta-analyses of studies evaluating the association between the duration of breast-feeding (<4–6 months v. >4–6 months) and Helicobacter pylori infection. Relative risk (RR) estimates and 95 % confidence intervals of H. pylori infection according to economic development of the countries where the investigations were conducted( 19 ). For each study, the black diamond indicates the best estimate, the size of the grey square indicates the study’s weight in the analysis (weights are from random-effects analysis) and the horizontal line represents the 95 % CI. The centre of the open diamond indicates the summary estimate of the RR and its width represents the 95 % CI of the summary RR estimate. General abbreviations: SES, socio-economic status; Prev., prevalence (%); HP+, H. pylori-infected; BF, breast-feeding; NA, not available. Abbreviations for countries: BRA, Brazil; CMR, Cameroon; DEU, Germany; IRN, Islamic Republic of Iran; IRS, Israel; MEX, Mexico; TUR, Turkey; VNM, Vietnam. Abbreviations for tests: SA, test based on the detection of stool antigens; SI, test based on serum immunology; UBT, urea breath test. *Study comparing those who were breast-fed for more than 6 months with those breast-fed for less than 2 months. A sensitivity analysis excluding this study yielded an overall RR estimate of 0·80 (95 % CI 0·54, 1·19; I 2=65·8 %)
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