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The Relationship between Breast-feeding and the Prevalence of Asthma Yousuke Takemura, MD, PhD Associate Professor Dept. of Family and Community Medicine Mie University School of Medicine Japan. Yousuke Takemura,

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The Relationship between Breast-feeding and the Prevalence of AsthmaYousuke Takemura, MD, PhDAssociate ProfessorDept. of Family and Community MedicineMie University School of MedicineJapan


Yousuke Takemura,

MD, PhDAssociate ProfessorDepartment of Family and Community MedicineMie University School of Medicine2-174 Edobashi, Tsu, Mie 514-8507JAPAN


Y. Takemura et al.



There is growing evidence that asthma is becoming more commonin the western countries.

Because treatment of asthma is somewhat difficult, prophylaxes have been sought.

Y. Takemura et al.

many risk factors for asthma age gender parental smoking and family history of asthma
Many risk factors for asthma:age, gender, parental smoking, and family history of asthma

Y. Takemura et al.


Many studies on the role of breast-feeding in the prevention of childhood asthma:

1. Positive association2. No association3. Negative association

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Many of these studies were based on relatively small sample population, and did not adjust for confounding factors sufficiently. The present study examines the relationship between breast-feeding and ‘ever having asthma’ by population based case-control studyin Japan.

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Materials and MethodsStudy Population33 public elementary schools (grades 1 – 6)15 public junior high schools (grades 1 – 3)25,767 subjects responded to the questionnaire among 28,848 students.(the response rate = 89.3%)

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Measurementthe American Thoracic Society and Division of Lung Diseases, National Heart, Lung, and Blood Institute (ATS-DLD) questionnairefor children (Japanese version)The reliability and validity of the ATS-DLD questionnaire to identify children with asthma has been well established.

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Asthma: “yes” response to all of the following questions

(1) Has your child ever had an attack of

wheezing that has caused him/her to be short

of breath?

(2) Has your child had such an attack twice or


(3) Has a physician ever informed you that

your child has asthma? and

(4) If so, at that time, did your child have

shortness of breath with wheezing?

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Feeding patterns from the age of 1 to 3 months“breast-feeding only”, “mixed”, or “artificial feeding”

Parental smoking: Having mother or father who smoked one or more cigarettes per day

Parental history of asthma: Subjects whose mother or father had ever been treated for asthma

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Statistical AnalysisThe characteristics of subjects with or without asthma: the chi-squared test or Student’s t-testTo control for confounding factors such as age, gender, parental smoking, and parental history of asthma:multiple logistic regression analysis Dose-response relationship:test of trend

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Y. Takemura et al.



Y. Takemura et al.


The mechanism of the unfavorable effect of breast-feeding on asthma1. Fat soluble chemicals accumulating in breast milk 2. Sensitization through breast milk

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Fat soluble chemicals in breast milk:

If this mechanism is correct, children higher in the birth order would be more likely to have asthma. However, additional adjustment for birth order did not affect the association between asthma and breast feeding

(adjusted odds ratio: 1.212; 95 percent confidence interval: 1.057, 1.389; p < 0.01).

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Sensitization through breast milk:

Foreign protein antigens can be transmitted in breast milk. These antigens may provoke hypersensitivity. In fact, a study showed that this type of sensitization was seen in 10 percents of breast fed infants.

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Advantage 1. The large number of subjects2. Several aspects of homogeneity3. Adjustment for confounding

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Parental recall

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the small number of the reference

Although the reference is prefer to large number, we used artificial milk users as the reference since we would like to know the effects of ‘any exposure to breast-milk’ vs none on the prevalence of asthma.

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duration of breast-feeding

We used three months as cut-off point of duration of breast-feeding since several studies used three months as the criteria of the duration.

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ConclusionBreast-feeding in infancy might be related to the higher prevalence of asthma during pre-adolescence.

Y. Takemura et al.