伞状评价母乳喂养对儿童健康结局的影响

Impact of breastfeeding on child health outcomes:an umbrella review

目的对母乳喂养影响儿童健康结局的系统研究或荟萃分析进行伞状评价,分析母乳喂养与多种儿童健康结局的相关性。方法检索中国知网、万方数据、维普中文数据库、PubMed、Web of Science、the Cochrane Library、Embase等数据库,筛选其中关于母乳喂养影响儿童健康结局的系统研究或荟萃分析,检索时间为建库至2023年6月30日。使用改良版系统评价方法学质量评价工具(a measurement tool to assess systematic reviews version 2,AMSTAR 2)评估研究质量,由两名研究人员独立筛选文献并提取结局资料进行分析。结果纳入21篇荟萃分析,通过AMSTAR-2方法学工具评价发现共有4份中质量,6份低质量和11份极低质量研究。共报告了24项与儿童健康相关的结局指标,母乳喂养与18项指标显著相关,其中营养状况、心理状况、齿龈健康、过敏、炎症、癌症风险、心肺健康等指标均呈显著改善的趋势,但是小于1个月的母乳喂养可能会导致儿童肥胖。结论母乳喂养可以显著改善大部分儿童健康指标,但是也要注意到短期母乳喂养导致儿童肥胖的风险。该伞状评价纳入的荟萃分析的方法学质量和证据质量有待提升,同时部分指标与母乳喂养之间潜在的剂量依赖关系有待进一步验证。

Objective To conduct an umbrella review of systematic reviews or meta-analyses on the effects of breastfeeding on child health outcomes,and to analyze the associations between breastfeeding and various child health-related outcomes.Methods Databases such as CNKI,Wanfang Data,VIP Chinese Database,PubMed,Web of Science,the Cochrane Library,and Embase were searched for systematic reviews or meta-analyses on the effects of breastfeeding on child health outcomes from inception to June 30,2023.The qualities of the studies were assessed using a measurement tool to assess systematic reviews version 2(AMSTAR 2).Two researchers independently screened the literatures and extracted outcome data for the analysis.Results A total of 21 meta-analyses were enrolled in this review,and the methodological quality evaluation by AMSTAR-2 tool found that there were 4 moderate-quality,6 low-quality,and 11 very low-quality studies.A total of 24 child health-related outcome indicators were reported,and breastfeeding was significantly associated with 18 indicators like nutritional status,psychological status,gingival health,allergy,inflammation,cancer risk,cardiopulmonary health,etc.,all showing a significant improvement trend.However,breastfeeding for less than one month might lead to childhood obesity.Conclusion Breastfeeding can significantly improve most of the child health indicators,but attention should also be paid to the risk of childhood obesity caused by short-term breastfeeding.The methodological quality and evidence quality of the meta-analyses enrolled in this umbrella review need to be improved,and the potential dose-dependent relationship between some indicators and breastfeeding needs to be further verified.