Abstract：
Objective: The aim of this study was to test the hypothesis that the duration of breastfeeding in infancy reduces the risk of childhood leukemia or lymphoma, and modifies the risk of developing functional gastrointestinal disorders (FGIDs). Subjects and Methods: This case-control study involved the recruitment of children with lymphoid malignancy and functional gastrointestinal symptoms with healthy children as controls. Focused questionnaires were used to collect data on breastfeeding history and other key risk factors. Univariate and multivariate analyses were undertaken. Results: Of the 334 children with lymphoid malignancy, 65% were male. The control group included 334 age- and sex-matched participants. Most (n = 189; 56.6%) of the children with leukemia were <10 years of age. Differences between cases and controls included the duration of breastfeeding (p < 0.0001), mean birthweight (p < 0.001), maternal age (p < 0.001), paternal age (p < 0.001), birth order (p < 0.001), mean number of children (p < 0.001), BMI percentile (p = 0.042), and maternal smoking (p = 0.012). Breastfeeding duration of up to 6 months\' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for acute lymphoblastic leukemia (OR = 3.43, 95% confidence interval [CI] 2.37-4.98; p < 0.001), Hodgkin\'s lymphoma (OR = 1.58, 95% CI: 0.88-2.84, p = 0.120), Non-Hodgkin\'s lymphoma (OR = 2.14, 95% CI: 1.25-3.65, p = 0.005), and overall (OR = 1.95, 95% CI: 1.40-2.71, p < 0.001). Cases also differed from controls with regard to FGIDs, such as stomach ache (p < 0.001), dyspepsia (p < 0.001), early satiety (p = 0.017), bowel satisfaction (p < 0.001), bloating (p < 0.001), nausea (p = 0.005), vomiting (p = 0.039), constipation (p = 0.003), diarrhea (p = 0.010), gastrointestinal canal congestion (p =0.039), muscle aches pains (p = 0.008), fecal incontinence (p = 0.021), and indigestion (p = 0.003). A multivariate stepwise regression analysis revealed that maternal smoking (p < 0.001), formula feeding (p < 0.001), duration of breastfeeding (p < 0.001), birth order (p = 0.002), mother\'s age (p = 0.004) and the child\'s birthweight (p = 0.009) were predictors for leukemia. Further analysis showed that dyspepsia (p < 0.001), gastrointestinal tract canal congestion (p < 0.001), constipation (p = 0.009), diarrhea (p = 0.013), bowel satisfaction (p = 0.021), bloating (p = 0.022), duration of breastfeeding (p < 0.001), and stomach ache (p = 0.025) were significant predictors for developing FGID symptoms after adjusting for age, gender, and other confounding variables. Conclusion: This study confirmed that breastfeeding has some effect on reducing possible risk of childhood lymphoma and leukemia and FGID symptoms compared with healthy control children.
摘要：
目的：这项研究的目的是检验以下假设：婴儿期母乳喂养的持续时间可降低儿童白血病或淋巴瘤的风险，并改变发生功能性胃肠病（FGIDs）的风险。受试者和方法：这项病例对照研究涉及招募患有淋巴恶性肿瘤和功能性胃肠道症状的儿童，以健康儿童为对照。使用集中问卷收集有关母乳喂养史和其他关键危险因素的数据。进行单变量和多变量分析。结果：在334例淋巴恶性肿瘤患儿中，65%为男性。对照组包括334名年龄和性别匹配的参与者。大多数（n=189;56.6％）的白血病儿童年龄<10岁。病例和对照组之间的差异包括母乳喂养的持续时间（p<0.0001），平均出生体重（p<0.001），产妇年龄（p<0.001），父亲年龄（p<0.001），出生顺序（p<0.001），平均儿童人数（p<0.001），BMI百分位数（p=0.042），和母亲吸烟（p=0.012）。母乳喂养持续时间长达6个月，与6个月以上的喂养相比，与急性淋巴细胞白血病的比值比（OR）增加相关（OR=3.43，95％置信区间[CI]2.37-4.98；p<0.001），霍奇金淋巴瘤(OR=1.58,95%CI:0.88-2.84,p=0.120),非霍奇金淋巴瘤（OR=2.14，95％CI：1.25-3.65，p=0.005），和总体（OR=1.95，95%CI：1.40-2.71，p<0.001）。病例在FGID方面也与对照组不同，如胃痛（p<0.001），消化不良（p<0.001），早期饱腹感（p=0.017），肠满意度（p<0.001），腹胀（p<0.001），恶心（p=0.005），呕吐（p=0.039），便秘（p=0.003），腹泻（p=0.010），胃肠道充血（p=0.039），肌肉酸痛（p=0.008），大便失禁（p=0.021），消化不良（p=0.003）。多变量逐步回归分析显示，母亲吸烟(p<0.001)，配方喂养（p<0.001），母乳喂养持续时间（p<0.001），出生顺序（p=0.002），母亲的年龄（p=0.004）和孩子的出生体重（p=0.009）是白血病的预测因子。进一步的分析表明，消化不良（p<0.001），胃肠道充血（p<0.001），便秘（p=0.009），腹泻（p=0.013），肠满意度（p=0.021），腹胀（p=0.022），母乳喂养持续时间（p<0.001），和胃痛（p=0.025）是调整年龄后发生FGID症状的重要预测因子，性别,和其他混杂变量。结论：这项研究证实，与健康对照儿童相比，母乳喂养对降低儿童淋巴瘤和白血病以及FGID症状的可能风险具有一定作用。
