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Jack Fong, MD
Department of Pediatrics
Danbury Hospital
Danbury, CT 06810
Pat Murphy, RN, IBCLC
Center for Breastfeeding
Danbury Hospital
Danbury, CT 06810
To the Editor.—
We read with interest the article by Moore et al1 regarding atopic dermatitis (AD) in the first 6 months of life. Their conclusions that both prenatal and perinatal factors affect the incidence of AD are intriguing. We think, though, that a more detailed discussion should have been attempted regarding the influence of breastfeeding on the incidence of this condition. The authors only write that "adjustment for infant feeding type at 3 and 6 months ... did not materially alter any of the risk estimates."1(p470)
This conclusion is in contrast to the vast majority of research in the field of infant nutrition. Indeed, there is suggestion in some articles that exclusive breastfeeding may raise the incidence of AD. Miyake et al2 concluded that breastfeeding may be associated with increased incidence of AD, especially among children without a family history of allergy. Similar conclusions were reached by Bergmann et al,3 who suggested that for every month of breastfeeding there is an increased risk of AD. However, these authors (and others) have not addressed other potential causes for AD, which may have modified their statements. For example, Karmaus et al4 investigated the adverse effects of environmental factors and reached the conclusion that for children with high levels of dichlorodiphenyl dichloroethylene, breastfeeding did not have a protective effect against allergic manifestations. They concluded that contaminants may therefore reduce the protective effects of breast milk.
However, numerous studies suggest that breastfeeding does reduce the risk of AD. Gdalevich et al5 performed a meta-analysis of the association between breastfeeding during the first months of life and incidence of AD. They concluded that breastfeeding should be strongly recommended to mothers of infants when there is a family history of atopy as a means of preventing atopic eczema. Similar conclusions were reached by Schoetzau et al,6 who followed 856 exclusively breastfeeding infants and 256 partially breastfeeding or formula-fed infants for 1 year. Kull et al7 followed 4089 Swedish infants up to 2 years and also found protective effects of breastfeeding on the incidence of asthma and AD. Heine et al8 reached a similar conclusion regarding the protective effects of breastfeeding against AD but added that high birth weight and day care attendance increased the risk of AD in the first year of life. In the Moore et al article,1 birth weight was found to be similar between the 2 groups (with and without AD), but day care attendance was not studied.
The data regarding the protective effects of human milk against infections and allergic manifestations are strong if not overwhelming. Thus, to attempt to refute these effects, more thorough and statistically meaningful studies should be performed. Genetic aspects of diseases are currently unmodifiable; feeding methods are modifiable. When considering infant nutrition, the benefits of human milk spread beyond its mere caloric value.
REFERENCES
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