Never versus ever feeding human milk and diabetes outcomes in offspring a systematic review
The body of evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available...
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| Corporate Authors: | , |
| Format: | eBook |
| Language: | English |
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Washington, DC
United States Department of Agriculture
April 2019, 2019
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The body of evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence. SUMMARY OF EVIDENCE: 1. Twenty-one articles met the inclusion criteria for this systematic review, including 16 with evidence about type 1 diabetes, 2 with evidence about type 2 diabetes, and 3 with evidence about the intermediate diabetes outcomes fasting glucose, HbA1C, and insulin resistance.2. Evidence about the association between never versus ever feeding human milk and higher risk of type 1 diabetes was limited. Across the 15 independent studies (16 articles) that examined type 1 diabetes, 6 found statistically significant associations. The primary difference between the studies that did and did not report significant associations was statistical power. BACKGROUND: 1. This systematic review was conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.2. The goal of this systematic review was to examine the following question: What is the relationship between never versus ever feeding human milk and diabetes outcomes in offspring?3. This systematic review examines comparisons of infants who were never fed human milk with infants who were ever fed human milk (i.e., any amount of human milk feeding). Human milk feeding was defined as feeding human milk alone or in combination with infant formula and/or complementary foods or beverages such as cow's milk. Human milk was defined as mother's own milk provided at the breast (i.e., nursing) or expressed and fed fresh or after refrigeration or freezing. Donor milk (e.g., banked milk) was not examined in this review. With 1 exception, the statistically significant associations suggested that never versus ever being fed human milk is associated with higher risk of type 1 diabetes. The ability to draw stronger conclusions was primarily limited by insufficient sample sizes, concerns about internal validity such as the potential for confounding, and the retrospective collection of exposure data, which increases the risk of misclassification of the exposure.3. Evidence related to type 2 diabetes and intermediate diabetes outcomes (e.g., fasting glucose, HbA1C, and insulin resistance) was scant Infant formula was defined as commercially-prepared infant formula meeting FDA and/or Codex Alimentarius international food standards.4. This systematic review examines available evidence related to diabetes outcomes in offspring, including fasting glucose, HbA1C, glucose tolerance/insulin resistance, and the incidence and prevalence of prediabetes, type 1 diabetes, and type 2 diabetes. CONCLUSION STATEMENT AND GRADE: 1. Limited evidence from observational studies suggests that never versus ever being fed human milk is associated with higher risk of type 1 diabetes. There is insufficient evidence to determine whether or not there is a relationship between never versus ever feeding human milk and type 2 diabetes, prediabetes, fasting glucose, HbA1c, insulin resistance, and glucose tolerance throughout the lifespan. Grade: Limited - type 1 diabetes; Grade Not Assignable - type 2 diabetes, prediabetes, fasting glucose, HbA1C, insulin resistance, glucose tolerance METHODS: 1. The systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.2. A single literature search was conducted to identify literature for several related systematic reviews that examined infant milk-feeding practices and different outcomes. The search was conducted in CINAHL, Cochrane, Embase, and PubMed, and used a search date range of January 1980 to March 2016. A manual search was done to identify articles that may not have been included in the electronic databases searched.3. Articles were screened independently by 2 NESR analysts to determine which articles met predetermined criteria for inclusion.4. Data from each included article were extracted, risks of bias were assessed, and both were checked for accuracy.5. |
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| Physical Description: | 1 PDF file (210 pages) illustrations |