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Kintossou AK, Blanco-Lopez J, Iguacel I, Pisanu S, Almeida CCB, Steliarova-Foucher E, Sierens C, Gunter MJ, Ladas EJ, Barr RD, Van Herck K, Kozlakidis Z, Huybrechts I. Early Life Nutrition Factors and Risk of Acute Leukemia in Children: Systematic Review and Meta-Analysis. Nutrients 2023; 15:3775. [PMID: 37686807 PMCID: PMC10489830 DOI: 10.3390/nu15173775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Acute leukemia commonly occurs in young children with peak incidence at the age of 2-5 years. However, the etiology is still unclear and many preventable risk factors still deserve to be reviewed. The focus of this systematic review and meta-analysis is to summarize the evidence concerning early life nourishment (breastfeeding, early life diet), neonatal vitamin K administration and the risk of acute leukemia. All epidemiological studies published up to June 2023 and assessing diet-related risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science), with no limits on publication year or language. A total of 38 studies (37 case-control studies and 1 study with pooled analysis) were included. The published risk estimates were combined into a meta-analysis using the Generic Inverse Variance method. The current evidence shows that breastfeeding (yes vs. no) has a protective effect against acute lymphoblastic leukemia (odds ratio = 0.85; 95% CI, 0.76-0.94). Evidence related to the role of other studied factors (foods and supplements) is inconclusive. Further research into the potential role of diet in early life and the risk of acute leukemia is needed to develop prevention strategies at population level. Review Registration: PROSPERO registration no. CRD42019128937.
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Affiliation(s)
- Ambroise Kouame Kintossou
- International Agency for Research on Cancer, 69007 Lyon, France; (A.K.K.); (E.S.-F.); (Z.K.); (I.H.)
- Biobank, Pasteur Institute of Côte d’Ivoire, Abidjan 01 BP 490, Côte d’Ivoire
| | - Jessica Blanco-Lopez
- International Agency for Research on Cancer, 69007 Lyon, France; (A.K.K.); (E.S.-F.); (Z.K.); (I.H.)
| | - Isabel Iguacel
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Silvia Pisanu
- Section of Microbiology and Virology, Department of Biomedical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | | | - Eva Steliarova-Foucher
- International Agency for Research on Cancer, 69007 Lyon, France; (A.K.K.); (E.S.-F.); (Z.K.); (I.H.)
| | - Ciska Sierens
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (C.S.); (K.V.H.)
| | - Marc J. Gunter
- Faculty of Medicine, School of Public Health, Imperial College London, London SW7 2AZ, UK;
| | - Elena J. Ladas
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Ronald D. Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, ON L8S 4L7, Canada;
| | - Koen Van Herck
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium; (C.S.); (K.V.H.)
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, 69007 Lyon, France; (A.K.K.); (E.S.-F.); (Z.K.); (I.H.)
| | - Inge Huybrechts
- International Agency for Research on Cancer, 69007 Lyon, France; (A.K.K.); (E.S.-F.); (Z.K.); (I.H.)
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Gong QQ, Quan DD, Guo C, Zhang C, Zhang ZJ. Association between maternal breastfeeding and risk of systemic neoplasms of offspring. Ital J Pediatr 2022; 48:98. [PMID: 35710389 PMCID: PMC9205047 DOI: 10.1186/s13052-022-01292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breastfeeding might prevent childhood cancer by stimulating the immune system. Methods The following databases, including PubMed, Embase, and Cochrane Library, were searched from inception to January 10, 2021. Results In dose-dependent manner, there was a statistically significant inverse association between any breastfeeding and the incidence of childhood cancer. There was no evidence that breastfeeding was inversely related to childhood cancer of the skeletal, reproductive, or sensory systems. However, breastfeeding was inversely associated with the incidence of hematological malignancies and cancers of the nervous and urinary systems. Among hematological malignancies, the relationship was significant for acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML), but not for acute non-lymphocytic leukemia (ANLL), Hodgkin’s lymphoma (HL), or non-HL. Conclusions The evidences demonstrated that breastfeeding have a potential protective role in preventing selective childhood cancer growth, especially for ALL, AML, cancer of nervous and urinary systems. This study recommended that breastfeeding be extended for as long as possible or maintained for at least 6 months to prevent selective childhood cancer growth. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01292-9.
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Affiliation(s)
- Qin-Qin Gong
- Center of Women's Health Sciences, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Dan-Dan Quan
- Department of Obstetrics and Gynecology, The People's Hospital of China Three Gorges University, The First Hospital of Yichang, Yichang, 443000, China
| | - Chong Guo
- Department of Gynaecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, South Renmin Road, Shiyan, 442000, China.
| | - Zhi-Jun Zhang
- Center for Reproductive Medicine, Taihe Hospital, Hubei University of Medicine, No.32, South Renmin Road, Shiyan, 442000, China.
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Marron M, Brackmann LK, Schwarz H, Hummel-Bartenschlager W, Zahnreich S, Galetzka D, Schmitt I, Grad C, Drees P, Hopf J, Mirsch J, Scholz-Kreisel P, Kaatsch P, Poplawski A, Hess M, Binder H, Hankeln T, Blettner M, Schmidberger H. Identification of Genetic Predispositions Related to Ionizing Radiation in Primary Human Skin Fibroblasts From Survivors of Childhood and Second Primary Cancer as Well as Cancer-Free Controls: Protocol for the Nested Case-Control Study KiKme. JMIR Res Protoc 2021; 10:e32395. [PMID: 34762066 PMCID: PMC8663494 DOI: 10.2196/32395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an interaction between radiation, genetic, and other risk factors is presumed to influence cancer development. OBJECTIVE Therefore, the population-based, nested case-control study KiKme aims to identify differences in genetic predisposition and radiation response between childhood cancer survivors with and without SPNs as well as cancer-free controls. METHODS We conducted a population-based, nested case-control study KiKme. Besides questionnaire information, skin biopsies and saliva samples are available. By measuring individual reactions to different exposures to radiation (eg, 0.05 and 2 Gray) in normal somatic cells of the same person, our design enables us to create several exposure scenarios for the same person simultaneously and measure several different molecular markers (eg, DNA, messenger RNA, long noncoding RNA, copy number variation). RESULTS Since 2013, 101 of 247 invited SPN patients, 340 of 1729 invited FPN patients, and 150 of 246 invited cancer-free controls were recruited and matched by age and sex. Childhood cancer patients were additionally matched by tumor morphology, year of diagnosis, and age at diagnosis. Participants reported on lifestyle, socioeconomical, and anthropometric factors, as well as on medical radiation history, health, and family history of diseases (n=556). Primary human fibroblasts from skin biopsies of the participants were cultivated (n=499) and cryopreserved (n=3886). DNA was extracted from fibroblasts (n=488) and saliva (n=510). CONCLUSIONS This molecular-epidemiological study is the first to combine observational epidemiological research with standardized experimental components in primary human skin fibroblasts to identify genetic predispositions related to ionizing radiation in childhood and SPNs. In the future, fibroblasts of the participants will be used for standardized irradiation experiments, which will inform analysis of the case-control study and vice versa. Differences between participants will be identified using several molecular markers. With its innovative combination of experimental and observational components, this new study will provide valuable data to forward research on radiation-related risk factors in childhood cancer and SPNs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32395.
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Affiliation(s)
- Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Iris Schmitt
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Grad
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johannes Hopf
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Moritz Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Petrick L, Imani P, Perttula K, Yano Y, Whitehead T, Metayer C, Schiffman C, Dolios G, Dudoit S, Rappaport S. Untargeted metabolomics of newborn dried blood spots reveals sex-specific associations with pediatric acute myeloid leukemia. Leuk Res 2021; 106:106585. [PMID: 33971561 PMCID: PMC8275155 DOI: 10.1016/j.leukres.2021.106585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
The etiology of pediatric acute myeloid leukemia (AML) is largely unknown, but evidence for mutations in utero and long latency periods suggests that environmental factors play a role. Therefore, we used untargeted metabolomics of archived newborn dried blood spots (DBS) to investigate neonatal exposures as potential causal risk factors for AML. Untargeted metabolomics profiling was performed on DBS punches from 48 pediatric patients with AML and 46 healthy controls as part of the California Childhood Leukemia Study (CCLS). Because sex disparities are suggested by differences in AML incidence rates, metabolite features associated with AML were identified in analyses stratified by sex. There was no overlap between the 16 predictors of AML in females and 15 predictors in males, suggesting that neonatal metabolomic profiles of pediatric AML risk are sex-specific. In females, four predictors of AML were putatively annotated as ceramides, a class of metabolites that has been linked with cancer cell proliferation. In females, two metabolite predictors of AML were strongly correlated with breastfeeding duration, indicating a possible biological link between this putative protective risk factor and childhood leukemia. In males, a heterogeneous metabolite profile of AML predictors was observed. Replication with larger participant numbers is required to validate findings.
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Affiliation(s)
- Lauren Petrick
- The Institute of Exposomics Research, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA.
| | - Partow Imani
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kelsi Perttula
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA; Department of Health Sciences, California State University East Bay, Hayward, CA, 94542, USA
| | - Yukiko Yano
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Todd Whitehead
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Catherine Metayer
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Courtney Schiffman
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Georgia Dolios
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sandrine Dudoit
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA; Department of Statistics, University of California, Berkeley, CA, 94720, USA
| | - Stephen Rappaport
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California, Berkeley, CA, 94720, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, 94720, USA
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Su Q, Sun X, Zhu L, Yan Q, Zheng P, Mao Y, Ye D. Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. BMC Med 2021; 19:90. [PMID: 33845843 PMCID: PMC8042913 DOI: 10.1186/s12916-021-01950-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer. METHODS A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out. RESULTS Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65-0.91) and 0.77 (95% CI 0.63-0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (P non-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62-0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44-0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44-0.83). However, no associations of breastfeeding with risk of other cancers were found. CONCLUSIONS Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.
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Affiliation(s)
- Qing Su
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Xiaohui Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Liwen Zhu
- Department of Hematology and Oncology, Children's hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Qin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Peiwen Zheng
- Department of Medical Adiministration, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yingying Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China.
| | - Ding Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China.
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Marron M, Brackmann LK, Kuhse P, Christianson L, Langner I, Haug U, Ahrens W. Vaccination and the Risk of Childhood Cancer-A Systematic Review and Meta-Analysis. Front Oncol 2021; 10:610843. [PMID: 33552984 PMCID: PMC7862764 DOI: 10.3389/fonc.2020.610843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Infections may play a role in the etiology of childhood cancer and immunizations may be protective because vaccinations stimulate the immune system. Observational studies reported inconsistent associations between vaccination and risk of childhood cancer. Since a synthesis of the evidence is lacking, we conducted a meta-analysis stratified by histological and site-specific cancer. METHODS We performed a systematic review (CRD42020148579) following PRISMA guidelines and searched for literature in MEDLINE, Embase, and the Science Citation Index databases. We identified in three literature databases 7,594 different articles of which 35 met the inclusion criteria allowing for 27 analyses of 11 cancer outcomes after exposure to nine different types of vaccinations. We calculated summary odds ratios (ORs) and 95% confidence intervals (CIs) using random effects models. RESULTS We observed four inverse associations between childhood leukemia and certain vaccines as well as the number of vaccinations: OR 0.49 (95% CI = 0.32 to 0.74) for leukemia death after bacillus Calmette-Guérin vaccination; OR 0.76 (95% CI = 0.65 to 0.90) for acute lymphoblastic leukemia after Haemophilus influenzae type b vaccination; OR 0.57 (95% CI = 0.36 to 0.88) for leukemia; and OR 0.62 (95% CI = 0.46 to 0.85) for acute lymphoblastic leukemia after three or more vaccinations of any type. All other conducted analyses did not show any associations. DISCUSSION The results are consistent with the hypothesis that vaccinations reduce the risk of childhood leukemia. However, the robustness and validity of these results is limited due to the small number, substantial heterogeneity, and methodological limitations of available studies.
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Affiliation(s)
- Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Pia Kuhse
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Library, Bremen, Germany
| | - Ingo Langner
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Clinical Epidemiology, Bremen, Germany
| | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Clinical Epidemiology, Bremen, Germany
- University of Bremen, Faculty of Human and Health Sciences, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Department Epidemiological Methods and Etiological Research, Bremen, Germany
- University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany
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Güngör D, Nadaud P, Dreibelbis C, LaPergola CC, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and childhood leukemia: a systematic review. Am J Clin Nutr 2019; 109:757S-771S. [PMID: 30982871 PMCID: PMC6500929 DOI: 10.1093/ajcn/nqy306] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) feeding a lower versus higher intensity of human milk to mixed-fed infants with acute childhood leukemia, generally, and acute lymphoblastic leukemia, specifically. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980 to March 2016, dual-screened the results using predetermined criteria, extracted data from and assessed risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS We included 24 articles from case-control or retrospective studies. Limited evidence suggests that never feeding human milk versus 1) ever feeding human milk and 2) feeding human milk for durations ≥6 mo are associated with a slightly higher risk of acute childhood leukemia, whereas evidence comparing never feeding human milk with feeding human milk for durations <6 mo is mixed. Limited evidence suggests that, among infants fed human milk, a shorter versus longer duration of human milk feeding is associated with a slightly higher risk of acute childhood leukemia. None of the included articles examined exclusive human milk feeding or the intensity of human milk fed to mixed-fed infants. CONCLUSIONS Feeding human milk for short durations or not at all may be associated with slightly higher acute childhood leukemia risk. The evidence could be strengthened with access to broadly generalizable prospective samples; therefore, we recommend linking surveillance systems that collect infant feeding and childhood cancer data.
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Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA,Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Abstract
In this Review, I present evidence supporting a multifactorial causation of childhood acute lymphoblastic leukaemia (ALL), a major subtype of paediatric cancer. ALL evolves in two discrete steps. First, in utero initiation by fusion gene formation or hyperdiploidy generates a covert, pre-leukaemic clone. Second, in a small fraction of these cases, the postnatal acquisition of secondary genetic changes (primarily V(D)J recombination-activating protein (RAG) and activation-induced cytidine deaminase (AID)-driven copy number alterations in the case of ETS translocation variant 6 (ETV6)-runt-related transcription factor 1 (RUNX1)+ ALL) drives conversion to overt leukaemia. Epidemiological and modelling studies endorse a dual role for common infections. Microbial exposures earlier in life are protective but, in their absence, later infections trigger the critical secondary mutations. Risk is further modified by inherited genetics, chance and, probably, diet. Childhood ALL can be viewed as a paradoxical consequence of progress in modern societies, where behavioural changes have restrained early microbial exposure. This engenders an evolutionary mismatch between historical adaptations of the immune system and contemporary lifestyles. Childhood ALL may be a preventable cancer.
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Affiliation(s)
- Mel Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
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9
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Abstract
The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.
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Affiliation(s)
- A MacDonald
- Dietetic Department, Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, England
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10
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Amitay EL, Dubnov Raz G, Keinan-Boker L. Breastfeeding, Other Early Life Exposures and Childhood Leukemia and Lymphoma. Nutr Cancer 2016; 68:968-77. [PMID: 27352124 DOI: 10.1080/01635581.2016.1190020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Childhood cancer incidence increases and although rare, it is a leading cause of mortality. Leukemia and lymphoma comprise 40% of all cancers in children but little is known of their etiology. In this study, we examined the associations of breastfeeding and other early life exposures with childhood leukemia and lymphoma. A population-based case-control study carried out in 2011-2013 comprised mothers of 190 incidents (2005-2013) of leukemia/lymphoma cases aged 1-19 yr at diagnosis and 384 population-based controls. Interviews based on a computerized structured questionnaire were conducted with the mothers. Multivariate logistic regression models adjusted for potential confounders assessed the association between breastfeeding patterns and childhood leukemia/lymphoma. Ever breastfeeding category was associated with a 64% decreased risk for childhood leukemia/lymphoma lsqb;odds ratio (OR) = 0.36, 95% confidence interval (CI): 0.22, 0.60lrqb; and similar trends, with a dose-response effect, were observed for any breastfeeding (exclusive and/or partial) category for 6, 12, and 18+ mo. Other infant exposures associated with cancer risk were child iron supplementation (OR = 0.39, 95% CI: 0.26, 0.59), pet ownership (OR = 0.50, 95% CI: 0.33, 0.78), paternal smoking (OR = 1.93, 95% CI: 1.18, 3.15), and having older siblings (OR = 1.18, 95% CI: 1.05, 1.33). Breastfeeding-a controllable and modifiable exposure-is inversely associated with risk for childhood leukemia and lymphoma with a dose-response effect.
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Affiliation(s)
- Efrat Lev Amitay
- a School of Public Health , University of Haifa , Haifa , Israel
| | - Gal Dubnov Raz
- b Exercise, Lifestyle and Nutrition Clinic , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat Gan , Israel.,c Israel Center for Disease Control , Ministry of Health , Ramat Gan , Israel
| | - Lital Keinan-Boker
- c Israel Center for Disease Control , Ministry of Health , Ramat Gan , Israel.,d School of Public Health , Faculty of Social Welfare and Health Sciences, University of Haifa , Haifa , Israel
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11
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Mortazavi H, Tashvighi M, Azizian M, Khalighi HR, Sabour S, Movahhedian A, Baharvand M. Evaluation of Relationship Between Demographics and Dental Status in a Defined Group of Iranian Paediatric Patients Undergoing Cancer Therapy. J Clin Diagn Res 2015; 9:ZC80-3. [PMID: 26501019 DOI: 10.7860/jcdr/2015/11976.6521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 07/14/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Cancer is a major cause of death in children under 15 years of age. AIMS This study aimed to evaluate relationship between demographics and dental status in a defined group of Iranian paediatric patients undergoing cancer therapy. SETTINGS AND DESIGN This cross-sectional study was accomplished on 161 subjects age ranging 8-12 years. There were 76 cancerous patients hospitalized at Mahak Hospital (one of the major children's cancer centers in Tehran) as the study group and 85 healthy children attending at Dental School, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 2012 to 2013. MATERIALS AND METHODS Demographics were gathered by using data-form. Oral examination and DMFT Index were used to describe teeth status in all teeth and in the first permanent molars. According to Becker's definition, "D" stands for untreated decayed teeth, "M" indicates missing teeth, and "F" shows Filled teeth. It is noteworthy that full coverage crowns are considered as "F" in this Index. STATISTICAL ANALYSIS Chi-square, Mann-Whitney U, Student's t-tests and Logistic Regression were used for data analysis. RESULTS The most frequent type of cancer was acute lymphoblastic/lymphocytic leukemia (33.3%). Patients were significantly shorter than controls (p=0.03), and their fathers and mothers were of lower educational achievement (p=0.01, p= 0.001). Although DMFT of all dentition showed significantly higher score in cancerous children (p=0.001), DMFT of four first permanent molars (left, right, upper, and lower) was borderline significantly higher in patients (p= 0.06). Moreover, frequency of cancer was borderline significantly higher in children with lower birth order (p= 0.05). According to Logistic Regression, in as much as patients grew elder 1 year, DMFT index increased 1.5 units. CONCLUSION Patients under cancer therapy were shorter than healthy ones, and their parents were of lower educational levels. In addition, their teeth status was poorer than controls.
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Affiliation(s)
- Hamed Mortazavi
- Associate Professor, Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Maryam Tashvighi
- Assistant Professor, Department of Hematology and Oncology, Medical School. Azad University , Qom, Iran
| | | | - Hamid Reza Khalighi
- Assistant Professor, Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Siamak Sabour
- Associate Professor, Department of Clinical Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Amir Movahhedian
- Dental Student, Department of Oral Medicine, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Maryam Baharvand
- Associate Professor, Department of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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12
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Greenop KR, Bailey HD, Miller M, Scott RJ, Attia J, Ashton LJ, Downie P, Armstrong BK, Milne E. Breastfeeding and nutrition to 2 years of age and risk of childhood acute lymphoblastic leukemia and brain tumors. Nutr Cancer 2015; 67:431-41. [PMID: 25646650 DOI: 10.1080/01635581.2015.998839] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute lymphoblastic leukemia (ALL) and childhood brain tumors (CBT) are 2 of the most common forms of childhood cancer, but little is known of their etiology. In 2 nationwide case-control studies we investigated whether breastfeeding, age of food introduction, or early diet are associated with the risk of these cancers. Cases aged 0-14 years were identified from Australian pediatric oncology units between 2003 and 2007 (ALL) and 2005 and 2010 (CBT) and population-based controls through nationwide random-digit dialing. Mothers completed questionnaires giving details of infant feeding up to the age of 2 yr. Data from 322 ALL cases, 679 ALL controls, 299 CBT cases, and 733 CBT controls were analysed using unconditional logistic regression. Breastfeeding was associated with a reduced risk of ALL [odds ratio (OR) = 0.52, 95% confidence interval (CI): 0.32, 0.84), regardless of duration. Introduction of artificial formula within 14 days of birth was positively associated with ALL (OR = 1.57, 95% CI: 1.03, 2.37), as was exclusive formula feeding to 6 mo (OR = 1.81, 95% CI: 1.07, 3.05). No associations were seen between breastfeeding or formula use and risk of CBT. Our results suggest that breastfeeding and delayed introduction of artificial formula may reduce the risk of ALL but not CBT.
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Affiliation(s)
- Kathryn R Greenop
- a Telethon Kids Institute , University of Western Australia , Perth , Western Australia , Australia
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13
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Maia RDRP, Wünsch Filho V. Infection and childhood leukemia: review of evidence. Rev Saude Publica 2014; 47:1172-85. [PMID: 24626555 PMCID: PMC4206105 DOI: 10.1590/s0034-8910.2013047004753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze studies that evaluated the role of infections as well as indirect
measures of exposure to infection in the risk of childhood leukemia,
particularly acute lymphoblastic leukemia. METHODS A search in Medline, Lilacs, and SciELO scientific publication databases
initially using the descriptors "childhood leukemia" and "infection" and
later searching for the words "childhood leukemia" and "maternal infection
or disease" or "breastfeeding" or "daycare attendance" or "vaccination"
resulted in 62 publications that met the following inclusion criteria:
subject aged ≤ 15 years; specific analysis of cases diagnosed with acute
lymphoblastic leukemia or total leukemia; exposure assessment of mothers' or
infants' to infections (or proxy of infection), and risk of leukemia. RESULTS Overall, 23 studies that assessed infections in children support the
hypothesis that occurrence of infection during early childhood reduces the
risk of leukemia, but there are disagreements within and between studies.
The evaluation of exposure to infection by indirect measures showed evidence
of reduced risk of leukemia associated mainly with daycare attendance. More
than 50.0% of the 16 studies that assessed maternal exposure to infection
observed increased risk of leukemia associated with episodes of influenza,
pneumonia, chickenpox, herpes zoster, lower genital tract infection, skin
disease, sexually transmitted diseases, Epstein-Barr virus, and
Helicobacter pylori. CONCLUSIONS Although no specific infectious agent has been identified, scientific
evidence suggests that exposure to infections has some effect on childhood
leukemia etiology.
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Wang KL, Liu CL, Zhuang Y, Qu HY. Breastfeeding and the risk of childhood Hodgkin lymphoma: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2014; 14:4733-7. [PMID: 24083735 DOI: 10.7314/apjcp.2013.14.8.4733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Numerous observational epidemiological studies have evaluated associations between breastfeeding and the risk of childhood Hodgkin lymphoma; however, the existing results are inconsistent. We therefore conducted a systematic review and meta-analysis. METHODS Medical literature was searched in the Pubmed and Embase databases to identify all English-language relevant studies up to April 10, 2013. Reference lists were thereafter hand-searched for additional articles. Studies that reported relative risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were included. This meta-analysis was conducted in accordance with the guidelines for the meta-analysis of observational studies in epidemiology. RESULTS We finally included 10 case-control studies in our meta-analysis, involving 1,618 childhood Hodgkin lymphoma cases and 8,181 controls. Overall, we did found a borderline significant association between breastfeeding and reduced risk of childhood Hodgkin lymphoma comparing ever breastfed children to never breastfed children (pooled OR =0.79; 95%CI, 0.58-1.08; P=0.13), with limited evidence for between-study heterogeneity (P =0.12, I2 = 35.70%). CONCLUSION There is limited evidence for an inverse association between breastfeeding and risk of childhood Hodgkin lymphoma.
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Affiliation(s)
- Ke-Lai Wang
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China E-mail :
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15
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Crouch S, Lightfoot T, Simpson J, Smith A, Ansell P, Roman E. Infectious illness in children subsequently diagnosed with acute lymphoblastic leukemia: modeling the trends from birth to diagnosis. Am J Epidemiol 2012; 176:402-8. [PMID: 22899827 DOI: 10.1093/aje/kws180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although there is increasing evidence that immune dysregulation in children who develop acute lymphoblastic leukemia (ALL) is detectable from birth, debate about the role of infectious exposures in infancy continues. With the aim of quantifying children's infectious exposures, investigators have used a number of infection exposure proxies, but there is a lack of consistency in findings, with some markers indicating increased ALL risks and others decreased risks, the disparity being evident both within and between studies. Accordingly, the authors conducted an in-depth analysis of key infection exposure proxies used in the United Kingdom Childhood Cancer Study, a national population-based case-control study conducted over the period 1991-1996, which combined data from medical records, parental interview, and population census. This longitudinal approach revealed the marked deterioration in immune response that emerged around 5 months prior to ALL diagnosis and confirmed that infectious diagnoses in the first year of life were significantly increased (P < 0.05) in children who developed leukemia between 2 and 14 years of age, as well as in those who had birth orders >1, were not breastfed, lived in deprived areas, or were diagnosed with eczema. By contrast, no association between infectious illness and preschool activity was detected, the lower infection levels among controls whose mothers reported attendance contributing to a significantly reduced ALL odds ratio.
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Affiliation(s)
- Simon Crouch
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, United Kingdom.
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16
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17
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Abstract
The acute leukaemias account for about 30% of all malignancy seen in childhood across the Western world. A peak incidence of precursor B cell ALL has emerged as socio-economic conditions have improved in countries worldwide. From twin studies and the use of neonatal blood spots it has been possible to back track the first initiating genetic events within critical haemopoietic cells to foetal development in utero for most precursor B cell ALL and some cases of AML. These events may occur as part of normal foetal development. Whether other factors (environmental or constitutional) are involved to increase the chance of these first genetic changes happening is unclear. For some leukaemias (e.g. infant MLL positive ALL) the first event appears adequate to create a malignant clone but for the majority of ALL and AML further 'genetic' changes are required, probably postnatal. Many environmental factors have been proposed as causative for leukaemia but only ionising irradiation and certain chemicals, e.g. benzene and cytotoxics (alkylators and topoisomerase II inhibitors) have been confirmed and then principally for acute myeloid leukaemia. It appears increasingly likely that delayed, dysregulated responses to 'common' infectious agents play a major part in the conversion of pre-leukaemic clones into overt precursor B cell ALL, the most common form of childhood leukaemia. Constitutional polymorphic alleleic variants in immune response genes (especially the HLA Class II proteins) and cytokines may play a role in determining the type of immune response. High penetrance germ-line mutations are involved in only about 5% of childhood leukaemias (more in AML than ALL). There is little evidence to support any role of viral transformation in causation, unlike in animals. Other environmental factors for which some evidence exists include non-ionising electromagnetic radiation and electric fields, although their mode of action in leukaemogenesis remains unclear. There is no single cause for childhood leukaemia and for most individuals a combination of factors appears to be necessary; all involving gene-environment interactions. To date few clear preventative measures have emerged, except the complete avoidance of first trimester X-rays in pregnancy; a healthy diet with adequate oral folic acid intake both preconception and early in pregnancy; and the early exposure of children to other children outside the home to facilitate stimulation and maturation of the natural immune system. Here then are clear echoes of the "hygiene hypothesis" regarding the initiation of allergies, autoimmune disease and type I diabetes mellitus in children and young people.
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18
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zur Hausen H. Childhood leukemias and other hematopoietic malignancies: Interdependence between an infectious event and chromosomal modifications. Int J Cancer 2009; 125:1764-70. [DOI: 10.1002/ijc.24365] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries. Breastfeed Med 2009; 4 Suppl 1:S17-30. [PMID: 19827919 DOI: 10.1089/bfm.2009.0050] [Citation(s) in RCA: 297] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This article summarizes the Agency for Healthcare Research and Quality's evidence report on the effects of breastfeeding on term infant and maternal health outcomes in developed countries. EVIDENCE REPORT DATA SOURCES Medline, CINAHL, Cochrane Library, bibliographies of selected reviews, and suggestions from domain experts were surveyed. Searches were limited to English-language publications. EVIDENCE REPORT REVIEW METHODS Eligible comparisons examined the association between differential exposure to breastfeeding and health outcomes. We assessed 15 infant and six maternal outcomes. For four outcomes, we also updated previously published systematic reviews. For the rest of the outcomes, we either summarized previous systematic reviews or conducted new systematic reviews; randomized and non-randomized comparative trials, prospective cohorts, and case-control studies were included. Adjusted estimates were extracted from non-experimental designs. The studies were graded for methodological quality. We did not draw conclusions from poor quality studies. EVIDENCE REPORT RESULTS We screened over 9,000 abstracts. Thirty-two primary studies on term infant health outcomes, 43 primary studies on maternal health outcomes, and 28 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. A history of breastfeeding was associated with a reduction in the risk of acute otitis media, nonspecific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, and sudden infant death syndrome. There was no relationship between breastfeeding in term infants and cognitive performance. There were insufficient good quality data to address the relationship between breastfeeding and cardiovascular diseases and infant mortality. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or no breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-prepregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear. EVIDENCE REPORT CONCLUSIONS A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers. Future research would benefit from clearer selection criteria, definitions of breastfeeding exposure, and adjustment for potential confounders. Matched designs such as sibling analysis may provide a method to control for hereditary and household factors that are important in certain outcomes.
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Affiliation(s)
- Stanley Ip
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center Evidence-Based Practice Center, 800 Washington Street, Boston, MA 02111, USA.
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20
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Abstract
This review considers recent studies regarding the role of environmental factors in the etiology of childhood leukemia and lymphoma. Potential environmental risk factors identified for childhood leukemia include exposure to magnetic fields of more than 0.4 micro Tessla, exposure to pesticides, solvents, benzene and other hydrocarbons, maternal alcohol consumption (but only for certain genotypes), contaminated drinking water, infections, and high birth weight. The finding of space-time clustering and seasonal variation also supports a role for infections. There is little evidence linking childhood leukemia with lifetime exposure to ionizing radiation although fetal exposures to X-rays are associated with increased risk. Breast-feeding, consumption of fresh fruit and vegetables and having allergies all appear to be protective. Burkitt lymphoma (BL) is confined to areas of the world where malaria is endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a co-factor. Environmental risk factors suggested for other types of non-Hodgkin lymphoma (NHL) include exposure to ionizing radiation (both lifetime and antenatal), pesticides, and, in utero exposure to cigarette smoke, benzene and nitrogen dioxide (via the mother). Hodgkin lymphoma (HL) is especially associated with higher levels of socioeconomic deprivation, but breast-feeding seems to confer lower risk. This is consistent with an infection or immune-response mediated etiology for HL.
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Affiliation(s)
- Richard J Q McNally
- School of Clinical Medical Sciences, Child Health, University of Newcastle Upon Tyne, UK.
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21
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Ribeiro KB, Buffler PA, Metayer C. Socioeconomic status and childhood acute lymphocytic leukemia incidence in São Paulo, Brazil. Int J Cancer 2008; 123:1907-12. [DOI: 10.1002/ijc.23738] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Infections in early life and childhood leukaemia risk: a UK case-control study of general practitioner records. Br J Cancer 2008; 99:1529-33. [PMID: 18827817 PMCID: PMC2579698 DOI: 10.1038/sj.bjc.6604696] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We investigated infections in early life (diagnosed in general practice) and subsequent risk of childhood leukaemia in the UK General Practice Research Database (GPRD). All children born at GPRD practices and subsequently diagnosed with leukaemia were identified as cases and were individually matched (on year of birth, sex and practice) to up to 20 controls. The final analysis included 162 leukaemia cases and 2215 matched controls. Conditional logistic regression demonstrated no evidence that children with one or more recorded infection in the first year of life had a reduced risk of leukaemia (OR=1.05, 95%CI 0.69, 1.59; P=0.83) or acute lymphoblastic leukaemia (ALL; OR=1.05, 95%CI 0.64–1.74; P=0.84). Our study provides no support for the Greaves hypothesis, which proposes that reduced or delayed exposure to infections in early life increases the risk of childhood ALL.
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23
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Wolf JS, Li G, Varadhachary A, Petrak K, Schneyer M, Li D, Ongkasuwan J, Zhang X, Taylor RJ, Strome SE, O'Malley BW. Oral lactoferrin results in T cell-dependent tumor inhibition of head and neck squamous cell carcinoma in vivo. Clin Cancer Res 2007; 13:1601-10. [PMID: 17332307 PMCID: PMC1810394 DOI: 10.1158/1078-0432.ccr-06-2008] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Human lactoferrin is a naturally occurring glycoprotein that inhibits cancer growth. Our purpose was to evaluate recombinant human lactoferrin as a chemotherapeutic agent against head and neck squamous cell carcinoma. EXPERIMENTAL DESIGN Controlled experiments both in vitro and in the murine model evaluating both the effect and mechanism of lactoferrin on cancer growth. RESULTS In both human and murine cell lines, lactoferrin induced dose-dependent growth inhibition. Using flow cytometric analysis, lactoferrin was shown to induce G(1)-G(0) growth arrest. This arrest seemed to be modulated by down-regulation of cyclin D1. In the in vitro model, luminex data revealed that lactoferrin inhibited cellular release of proinflammatory and prometastatic cytokines, including interleukin-8, interleukin-6, granulocyte macrophage colony-stimulating factor, and tumor necrosis factor-alpha. Lactoferrin up-regulated the cellular activation of nuclear factor-kappaB within 4 h of cellular exposure. In C3h/HeJ mice implanted with SCCVII tumors, orally delivered lactoferrin inhibited tumor growth by 75% compared with control mice. Immunohistochemical analysis of harvested tumors revealed up to 20-fold increases of lymphocytes within treated animals. When mice were depleted of CD3(+) cells, all lactoferrin-induced tumor inhibition was abrogated. CONCLUSION We conclude that human recombinant lactoferrin can inhibit the growth of head and neck squamous cell carcinoma via direct cellular inhibition as well as systemically via immunomodulation. Our data support the study of human lactoferrin as an immunomodulatory compound with therapeutic potential.
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Affiliation(s)
- Jeffrey S Wolf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Harding NJ, Birch JM, Hepworth SJ, McKinney PA. Breastfeeding and risk of childhood CNS tumours. Br J Cancer 2007; 96:815-7. [PMID: 17339892 PMCID: PMC2360067 DOI: 10.1038/sj.bjc.6603638] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 01/23/2007] [Accepted: 01/24/2007] [Indexed: 11/29/2022] Open
Abstract
We investigated infant feeding habits in relation to risk of childhood central nervous system tumours among 633 cases in the UK Childhood Cancer Study (UKCCS). No significant effect of breastfeeding was detected overall (odds ratio 1.01, confidence interval: 0.85-1.21) nor in any morphological subgroup. Similarly, no effect for the duration of breastfeeding or any other feeding practices was observed.
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Affiliation(s)
- N J Harding
- Paediatric Epidemiology Group, 30-32 Hyde Terrace, University of Leeds, Leeds, UK.
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25
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Schack-Nielsen L, Michaelsen KF. Advances in our understanding of the biology of human milk and its effects on the offspring. J Nutr 2007; 137:503S-510S. [PMID: 17237337 DOI: 10.1093/jn/137.2.503s] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is an intense interest in the effects of breast-feeding on the offspring and in understanding the mechanisms behind these effects. More than 50 papers are published monthly on topics such as the influence of breast-feeding on aspects of growth, immune-related effects, mental development, and noncommunicable diseases. Most breast-feeding data are observational; confounding can be difficult to rule out because some maternal factors are associated with both breast-feeding and infant outcomes (e.g., obesity and mental development). The most important short-term immunological benefit of breast-feeding is the protection against infectious diseases. There is also some evidence of lower prevalence of inflammatory bowel diseases, childhood cancers, and type I diabetes in breast-fed infants, suggesting that breast-feeding influences the development of the infant's own immune system. One of the most consistent findings of breast-feeding is a positive effect on later intelligence tests with a few test points advantage for breast-fed infants. In the last few years, several systematic reviews and meta-analyses have examined the effect of breast-feeding on noncommunicable diseases. There seems to be a small protective effect against later overweight and obesity. Blood pressure and blood cholesterol seem to be slightly lower in breast-fed infants; however, the few studies examining breast-feeding and the risk of coronary heart disease in later life did not find an association. Recent data have suggested that breast-feeding can program the insulin-like growth factor-I axis, as 3 studies found that breast-fed infants are taller as adults.
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Affiliation(s)
- Lene Schack-Nielsen
- Department of Human Nutrition, Faculty of Life Science, University of Copenhagen, DK-1958, Frederiksberg C, Denmark
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26
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Saddlemire S, Olshan AF, Daniels JL, Breslow NE, Bunin GR, Ross JA. Breast-feeding and Wilms tumor: a report from the Children's Oncology Group. Cancer Causes Control 2006; 17:687-93. [PMID: 16633916 DOI: 10.1007/s10552-005-0508-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 12/20/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous research has shown that breast-feeding offers many nutritional benefits to children including protection against infection and possibly a decreased risk of childhood cancer. We investigated the association between breast-feeding and Wilms tumor, a childhood kidney tumor. METHODS We used data from a large case-control study in the United States and Canada. Cases were children under age 16 years who were diagnosed with Wilms tumor from 1999 to 2002 and were participating in the National Wilms Tumor Study. Controls were identified by random-digit dialing and were age and region matched to cases. Mothers of 501 cases and 480 controls provided information on breast-feeding by telephone interviews. RESULTS Breast-feeding was associated with a reduced risk of Wilms tumor [adjusted odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5-0.9]. Longer duration did not provide any additional reduction in risk. When stratified by maternal education, breast-feeding lowered risk among children whose mothers had less than a college education (OR = 0.6; 95% CI = 0.4-0.8) but not for mothers who had a college degree or more (OR = 1.1; 95% CI = 0.6-1.9). CONCLUSIONS The results of this study are suggestive of an association between breast-feeding and Wilms tumor, but further research is needed to confirm this relationship.
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Affiliation(s)
- Stephanie Saddlemire
- Department of Epidemiology, University of North Carolina, CB#7435, Chapel Hill, NC, 27599-7435, USA.
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27
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Smith A, Roman E, Simpson J, Ansell P, Fear NT, Eden T. Childhood leukaemia and socioeconomic status: fact or artefact? A report from the United Kingdom childhood cancer study (UKCCS). Int J Epidemiol 2006; 35:1504-13. [PMID: 16945940 DOI: 10.1093/ije/dyl193] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is widely believed that children of high socioeconomic status (SES) are more likely than those of low SES to develop acute lymphoblastic leukaemia (ALL). Such observations have led to wide-ranging speculations about the potential aetiological role of factors associated with affluence and modernization. METHODS Children (0-14 years) newly diagnosed with cancer in the UK between 1991 and 1996 were ascertained via a rapid hospital-based case finding system (n = 4430, of which 1578 were ALL). Children without cancer (controls) were randomly selected from primary care population registries for comparative purposes (n = 7763). Area-based deprivation scores were assigned as markers of SES at two time points - birth and diagnosis. An individual-based marker of SES - social class - was assigned using father's occupation as recorded on the child's birth certificate. RESULTS No differences in area-based measures of deprivation were observed between cases and controls at time of diagnosis, either for all cancers combined [n = 4430, odds ratio (OR) = 1.00 (95% confidence intervals (CI) 0.98-1.01)] or for ALL alone (n = 1578 OR = 0.99, 95%CI 0.96-1.01). Findings were similar at time of birth (all cancers, OR = 0.99 95%CI 0.98-1.01, ALL OR = 0.98, 95%CI 0.96-1.00). In addition, no case-control differences were observed when an individual-based measure of SES - social class - based on father's occupation at time of birth was used. CONCLUSIONS The comprehensive nature of the data, coupled with complete case-ascertainment and representative population-based controls suggests that SES in the UK is not a determinant of ALL in children. We believe the small effects reported for SES in some past studies may be artefactual.
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Affiliation(s)
- Alex Smith
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, York YO10 5DD, UK.
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28
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Evenhouse E, Reilly S. Improved estimates of the benefits of breastfeeding using sibling comparisons to reduce selection bias. Health Serv Res 2006; 40:1781-802. [PMID: 16336548 PMCID: PMC1361236 DOI: 10.1111/j.1475-6773.2005.00453.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Better measurement of the health and cognitive benefits of breastfeeding by using sibling comparisons to reduce sample selection bias. DATA We use data on the breastfeeding history, physical and emotional health, academic performance, cognitive ability, and demographic characteristics of 16,903 adolescents from the first (1994) wave of the National Longitudinal Study of Adolescent Health. The sample includes 2,734 sibling pairs. STUDY DESIGN We examine the relationship between breastfeeding history and 15 indicators of physical health, emotional health, and cognitive ability, using ordinary least squares and logit regression. For each indicator, we estimate, in addition to the usual between-family model, a within-family model to see whether differences in siblings' outcomes are associated with differences in the siblings' breastfeeding histories. PRINCIPAL FINDINGS Nearly all of the correlations found in the between-family model become statistically insignificant in the within-family model. The notable exception is a persistent positive correlation between breastfeeding and cognitive ability. These findings hold whether breastfeeding is measured in terms of duration or as a Yes/No variable. CONCLUSIONS This study provides persuasive evidence of a causal connection between breastfeeding and intelligence. However, it also suggests that nonexperimental studies of breastfeeding overstate some of its other long-term benefits, even if controls are included for race, ethnicity, income, and education.
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Affiliation(s)
- Eirik Evenhouse
- Department of Economics, Mills College, Oakland, CA 94613, USA
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Petridou E, Andrie E, Dessypris N, Dikalioti SK, Trichopoulos D. Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece). Cancer Causes Control 2006; 17:209-15. [PMID: 16425099 DOI: 10.1007/s10552-005-0409-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 09/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To estimate the incidence and epidemiological profile of childhood (0-14 years) Hodgkin's lymphoma in Greece derived by the network of childhood Hematology-Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period. METHODS Seventy-one of these cases were individually age and gender matched to an equal number of controls. RESULTS The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0-4; 6.3 for those 5-9 and 13.9 for those 10-14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin's lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4-30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4-14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2-25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6-42.8). CONCLUSIONS Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir.
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Affiliation(s)
- E Petridou
- Department of Hygiene and Epidemiology, Athens University Medical School, 75 Mikras Asias str., Goudi Athens, 11527, Greece.
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Abstract
Leukemia is the most common cancer to affect children, accounting for approximately a third of all childhood cancers. The major morphological subtypes of leukemia, acute lymphoblastic leukemia (ALL), and acute myeloblastic leukemia (AML), are characterized by chromosomal translocations involving over 200 genes including mixed lineage leukemia (MLL), TEL, and AML1. Chromosomal translocations involving the MLL gene at 11q23 are a common feature of infant acute leukemia, found in up to 80% of all cases, and there is strong evidence that rearrangements involving the MLL gene or the TEL-AML1 gene fusion can originate in utero. As with most other cancers, the mechanism by which leukemia arises is likely to involve gene-environment interactions. Accordingly, it is important to identify exposures that cause DNA damage and induce chromosome breaks which are inadequately repaired, ultimately leading to the initiation and disease progression. Exposures acting before birth and early in life has long been thought to be important determinants of leukemia, and the list of suspected chemical, physical, and biological agents continues to increase. Unfortunately, the evidence regarding the majority of suggested exposures is limited and often contradictory, and there are areas, which clearly warrant further investigation in order to further our understanding of the aetiology of childhood leukemia.
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Affiliation(s)
- Tracy Lightfoot
- Department of Health Sciences, Epidemiology and Genetics Unit, Seebohm Rowntree Building, University of York, York, United Kingdom.
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Schack-Nielsen L, Larnkjaer A, Michaelsen KF. Long Term Effects of Breastfeeding on the Infant and Mother. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2005; 569:16-23. [PMID: 16137101 DOI: 10.1007/1-4020-3535-7_3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is increasing evidence that breastfeeding has long term beneficial effects on the infant. The most important are improved cognitive development, reduced incidence of immune related diseases (e.g. Type-1 diabetes and inflammatory bowel disease), and childhood cancers. A reduced risk of breast cancer in the mother is another important benefit.
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Affiliation(s)
- Lene Schack-Nielsen
- Department of Human Nutrition, The Royal Veterinary and Agric University, Denmark
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Fear NT, Simpson J, Roman E. Childhood Cancer and Social Contact: the Role of Paternal Occupation (United Kingdom)*. Cancer Causes Control 2005; 16:1091-7. [PMID: 16184475 DOI: 10.1007/s10552-005-0402-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 06/02/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the relationship between childhood cancer (particularly leukaemia) and paternal occupational social contact (a proxy for potential exposure to infections) using the UK Childhood Cancer Study. METHODS Using a national population-based case-control study, self-reported occupational data from fathers of 3596 children diagnosed with cancer between 1991 and 1996 under 15 years of age (cases) and fathers of 7011 children without cancer (controls) were analysed. Associations were assessed using odds ratios (OR) calculated by time of exposure (birth, diagnosis), diagnostic group (all cancers, leukaemia, acute lymphoblastic leukaemia (ALL), central nervous system tumours, other cancers), level of occupational social contact (high, medium, low), urban-rural status at diagnosis and occupational title. RESULTS From 371 occupations, 75 (20%) were classified as having high levels of occupational social contact, 31 (8%) as medium and the remaining 265 (71%) as low. No associations were apparent for fathers' occupational social contact overall, for any time period or diagnostic group. OR for leukaemia and high levels of paternal occupational social contact at birth and diagnosis being 1.02 (95% confidence interval (CI) = 0.88-1.18) and 0.91 (95% CI = 0.79-1.06), respectively. Analyses by urban-rural status at diagnosis and by occupational title revealed no notable associations. CONCLUSIONS The analyses of paternal occupational histories do not support the suggested association between high levels of paternal occupational social contact and an increased risk of childhood leukaemia. However, the role of participation bias should not be discounted.
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Affiliation(s)
- Nicola T Fear
- Academic Centre for Defence Mental Health, Institute of Psychiatry, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ , UK.
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Guise JM, Austin D, Morris CD. Review of case-control studies related to breastfeeding and reduced risk of childhood leukemia. Pediatrics 2005; 116:e724-31. [PMID: 16263987 DOI: 10.1542/peds.2005-0636] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To conduct a systematic review to evaluate the evidence for the effect of breastfeeding on the risk of developing childhood leukemia. REVIEW METHODS We sought studies providing data regarding the association of breastfeeding and occurrence of childhood leukemia. Studies were identified by using Medline, HHS Blueprint for Action on Breastfeeding, US Department of Health and Human Services Office on Women's Health, Cochrane Database of Systematic Reviews, National Centre for Reviews and Dissemination, reference lists, and national experts. Methodologic quality was evaluated for each study by using criteria from the US Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination. RESULTS We reviewed 111 citations to identify 32 potentially eligible full-text articles. Of the 10 studies reviewed, only 4 were sufficient to provide at least fair-quality evidence regarding the association between maternal breastfeeding and childhood leukemia. Studies conflicted regarding the protective effect of breastfeeding on childhood leukemia. In the 2 largest and highest quality studies, breastfeeding was associated with a significant risk reduction in one study with longer breastfeeding duration, reflecting greater protection, and a nonsignificant but suggestive difference in the other. Taken together, half of the studies associated breastfeeding with a lower risk of acute lymphocytic leukemia. CONCLUSIONS There are few high-quality studies that examine the potential for a protective effect of breastfeeding for childhood leukemia. Furthermore, the few studies that exist disagree regarding the association. It is estimated that the United States spends 1.4 billion dollars annually on the treatment of childhood leukemia. Patients, clinicians, and policy makers do not have the data that they need to make decisions regarding this important potential preventive measure.
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Affiliation(s)
- Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA.
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Hernández Aguilar MT, Aguayo Maldonado J. La lactancia materna. Cómo promover y apoyar la lactancia materna en la práctica pediátrica. Recomendaciones del Comité de Lactancia de la AEP. An Pediatr (Barc) 2005; 63:340-56. [PMID: 16219255 DOI: 10.1157/13079817] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Kwan ML, Buffler PA, Wiemels JL, Metayer C, Selvin S, Ducore JM, Block G. Breastfeeding patterns and risk of childhood acute lymphoblastic leukaemia. Br J Cancer 2005; 93:379-84. [PMID: 16052219 PMCID: PMC2361562 DOI: 10.1038/sj.bjc.6602706] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 06/06/2005] [Accepted: 06/13/2005] [Indexed: 01/18/2023] Open
Abstract
The risk of childhood acute lymphoblastic leukaemia (ALL) was investigated in relation to breastfeeding patterns in the Northern California Childhood Leukaemia Study. Data collected by self-administered and in-person questionnaires from biological mothers of leukaemia cases (age 0-14 years) in the period 1995-2002 were matched to birth certificate controls on date of birth, sex, Hispanic ethnic status, and maternal race. Ever compared to never breastfeeding was not associated with risk of ALL at ages 1-14 years (odds ratio=0.99; 95% CI=0.64-1.55) and ages 2-5 years (OR=1.49; 95% CI=0.83-2.65). Various measures of breastfeeding duration compared to absence of breastfeeding also had no significant effect on risk. Complimentary feeding characteristics such as type of milk/formula used and age started eating solid foods among breastfed children were not associated with ALL risk. This study provides no evidence that breastfeeding affects the occurrence of childhood ALL.
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Affiliation(s)
- M L Kwan
- Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, CA 94720, USA.
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Martin RM, Holly JMP, Smith GD, Ness AR, Emmett P, Rogers I, Gunnell D. Could associations between breastfeeding and insulin-like growth factors underlie associations of breastfeeding with adult chronic disease? The Avon Longitudinal Study of Parents and Children. Clin Endocrinol (Oxf) 2005; 62:728-37. [PMID: 15943836 DOI: 10.1111/j.1365-2265.2005.02287.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The influence of infant feeding method (breast/formula) on growth factor levels could underlie associations of breastfeeding with childhood growth and risk factors for cardiovascular disease. We investigated associations of having been breastfed with serum IGF-I and IGFBP-3 in childhood. METHODS Prospective birth cohort study (subsample of the Avon Longitudinal Study of Parents and Children, UK) based on 871 children born in 1991/1992 who underwent clinical follow-up and blood tests at age 7-8 years. A total of 488 (56%) children had complete data. RESULTS In children with complete data, the age- and sex-standardized IGF-I levels of those who were partially or exclusively breastfed were 6.1 and 13.8 ng/ml higher, respectively, than those who were never breastfed (increase in IGF-I levels per category of breastfeeding exclusivity: 7.1 ng/ml; 95% CI: 0.3-13.9; P = 0.04). In models also controlling for birthweight, gestational age, mother's age, and socioeconomic and dietary factors, the breastfeeding-IGF-I association was attenuated (regression coefficient: 3.3 ng/ml; -4.2-10.7; P = 0.4); further adjustment for IGFBP-3 made little difference (regression coefficient: 4.1 ng/ml; -2.8-10.9; P = 0.2). There was little evidence for an association between breastfeeding and IGFBP-3 or the molar ratio IGF-I/IGFBP-3. CONCLUSIONS The positive association between breastfeeding and IGF-I could be due to residual confounding or to chance. Nevertheless, the magnitude of the fully adjusted effect estimate and the novelty of the association suggest that larger studies should now be conducted to confirm or refute the hypothesis that variations in IGF-I by infant feeding mode explain associations of breastfeeding with health in later life.
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Affiliation(s)
- Richard M Martin
- Department of Social Medicine, University of Bristol, Bristol, UK.
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Abstract
Breastfeeding is a route of HIV transmission from an HIV-infected mother to her infant. However, breastfeeding is an important pillar of child survival and the ideal way of feeding an infant, as well as providing a unique biological and emotional basis for child development. This chapter will highlight the dilemma created by the risks and benefits of breastfeeding and will discuss factors which increase the risk of HIV transmission during breastfeeding, as well as strategies which could be employed to reduce these risks. The research agenda is very full as many questions still remain unanswered.
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Affiliation(s)
- Anna Coutsoudis
- Department of Paediatrics and Child Health, Room 261, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa.
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Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: A systematic review with metaanalysis. Int J Cancer 2005; 117:1020-31. [PMID: 15986434 DOI: 10.1002/ijc.21274] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It has been suggested that breast milk may play a role in the prevention of certain childhood cancers. We undertook a systematic review of published studies investigating the association between breast-feeding and childhood cancers using Medline (1966 to June 2004), supplemented with auto alerts and manual searches. Analyses are based on odds ratios for specific cancers among those ever breast-fed compared with those never breast-fed, pooled using random-effects models. Forty-nine publications were potentially relevant; of these, 26 provided odds ratio estimates for at least one childhood cancer outcome and were included in metaanalyses. Overall, 92% of the studies were case-control studies, 85% relied on long-term recall of feeding history, only 8% examined breast-feeding exclusivity and control response rates were under 80% in over half. Metaanalyses suggested lower risks associated with having been breast-fed of 9% (95% CI = 2-16%) for acute lymphoblastic leukemia, 24% (3-40%) for Hodgkin's disease and 41% (22-56%) for neuroblastoma, with little between-study heterogeneity. The estimates for Hodgkin's disease and neuroblastoma, however, were driven by single studies. There was little evidence that breast-feeding was associated with acute nonlymphoblastic leukemia, non-Hodgkin's lymphoma, central nervous system cancers, malignant germ cell tumors, juvenile bone tumors, or other solid cancers. In conclusion, ever having been breast-fed is inversely associated with acute lymphoblastic leukemia, Hodgkin's disease and neuroblastoma in childhood, but noncausal explanations are possible. Even if causal, the public health importance of these associations may be small. Our estimates suggest that increasing breast-feeding from 50% to 100% would prevent at most 5% of cases of childhood acute leukemia or lymphoma. (c) 2005 Wiley-Liss, Inc.
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Affiliation(s)
- Richard M Martin
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
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Abstract
There are three current hypotheses concerning infectious mechanisms in the aetiology of childhood leukaemia: exposure in utero or around the time of birth, delayed exposure beyond the first year of life to common infections and unusual population mixing. No specific virus has been definitively linked with childhood leukaemia and there is no evidence to date of viral genomic inclusions within leukaemic cells. The case-control and cohort studies have revealed equivocal results. Maternal infection during pregnancy has been linked with increased risk whilst breast feeding and day care attendance in the first year of life appear to be protective. There is inconclusive evidence from studies on early childhood infectious exposures, vaccination and social mixing. Some supportive evidence for an infectious aetiology is provided by the findings of space-time clustering and seasonal variation. Spatial clustering suggests that higher incidence is confined to specific areas with increased levels of population mixing, particularly in previously isolated populations. Ecological studies have also shown excess incidence with higher population mixing. The marked childhood peak in resource-rich countries and an increased incidence of the childhood peak in acute lymphoblastic leukaemia (ALL) (occurring at ages 2-6 years predominantly with precursor B-cell ALL) is supportive of the concept that reduced early infection may play a role. Genetically determined individual response to infection may be critical in the proliferation of preleukaemic clones as evidenced by the human leucocyte antigen class II polymorphic variant association with precursor B-cell and T-cell ALL.
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Affiliation(s)
- Richard J Q McNally
- Cancer Research UK Paediatric and Familial Cancer Research Group, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, UK.
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40
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Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep 2004; 119:521-35. [PMID: 15504444 PMCID: PMC1497668 DOI: 10.1016/j.phr.2004.09.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The authors used a meta-analytic technique to (1) quantify the evidence of an association between duration of breastfeeding and risk of childhood acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML), (2) assess the influence of socioeconomic status (SES) on any such associations, and (3) discuss the implications of these findings for the evaluation of whether breastfeeding reduces the risk of childhood leukemia. METHODS A fixed effects model was employed to systematically combine the results of 14 case-control studies addressing the effect of short-term (< or = 6 months) and long-term (>6 months) breastfeeding on the risk of childhood ALL and/or AML. Subgroup analyses of studies that did and did not adjust for SES were also performed. RESULTS A significant, negative association was observed between long-term breastfeeding and both ALL risk (odds ratio [OR]=0.76; 95% confidence interval [CI] 0.68, 0.84) and AML risk (OR=0.85; 95% CI 0.73, 0.98). Short-term breastfeeding was similarly protective for ALL and AML. Results for studies that adjusted and did not adjust for SES were not significantly different from the results for the 14 studies combined. CONCLUSIONS This meta-analysis showed that both short-term and long-term breastfeeding reduced the risk of childhood ALL and AML, suggesting that the protective effect of breastfeeding might not be limited to ALL as earlier hypothesized. Potential bias introduced by different participation rates for case and control samples that differed in SES can be minimized by implementing larger case-control studies with SES-matched, population-based controls.
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Affiliation(s)
- Marilyn L Kwan
- Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, CA 94720, USA.
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41
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Lightfoot TJ, Roman E. Causes of childhood leukaemia and lymphoma. Toxicol Appl Pharmacol 2004; 199:104-17. [PMID: 15313583 DOI: 10.1016/j.taap.2003.12.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Accepted: 12/08/2003] [Indexed: 11/25/2022]
Abstract
Childhood cancer is rare comprising less than 1% of all malignancies diagnosed each year in developed countries. Leukaemia is the commonest form of cancer in children accounting for around a third of all childhood cancer, with acute lymphoblastic leukaemia (ALL) being the most prevalent. Biologically specific subtypes of ALL and acute myeloblastic leukaemia (AML), the other major morphological type of childhood leukaemia, are characterised by chromosomal changes. Whilst over 200 genes have been associated with chromosomal translocations, to date, only MLL, TEL, and AML1 have been linked with childhood leukaemia. Interestingly, there is increasing evidence to support the theory that gene rearrangements such as these may originate in utero. As with many other human diseases, both genetic and environmental factors have been implicated in the aetiology of the disease. Although much has been documented with regard to diet, smoking, alcohol consumption and recreational and prescription drug use during pregnancy, there is no consistent evidence to support a link with any of these factors and childhood leukaemia. However, findings from studies investigating prenatal and early life exposures are often based on small numbers of cases as both the type of cancer and exposure are rare. Furthermore, accurate information relating to past exposures can be difficult to obtain and is often reliant on self-reporting. To further our understanding of the aetiology of childhood leukaemia and lymphoma, there are areas which clearly warrant investigation. These include collection of parental dietary folate data combined with genetic analysis of the folate related genes, in utero exposure to DNA topoisomerase II inhibitors, and the possible effects of assisted reproduction technology on disease susceptibility.
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Affiliation(s)
- Tracy J Lightfoot
- Leukaemia Research Fund Epidemiology and Genetics Unit, Department of Health Sciences, University of York, YO10 5DD, UK.
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Abstract
Breast milk is known to have anti-infective and immunomodulating effects on infants, but its association with childhood cancer has not been well studied. Artificial feeding may affect the immune response in carcinogenesis. In this communication the authors have reviewed different articles describing the association between breast feeding (BF) and subsequent development of childhood hematological malignancy. It appears that BF may have a protective effect on childhood cancer, both the duration of BF as well as the quantity of milk ingested is probably critical to the beneficial immunological effects of BF against childhood cancer if any.
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Affiliation(s)
- A K Tripathy
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Fear NT, Roman E, Ansell P, Simpson J, Day N, Eden OB. Vitamin K and childhood cancer: a report from the United Kingdom Childhood Cancer Study. Br J Cancer 2003; 89:1228-31. [PMID: 14520451 PMCID: PMC2394315 DOI: 10.1038/sj.bjc.6601278] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The relationship between neonatal vitamin K received by the intramuscular (i.m.) route and the development of leukaemia or other cancers was investigated as part of a national case–control study of childhood cancer, using data abstracted from obstetric and neonatal records. The analyses included 2530 children diagnosed with cancer before 15 years of age, 1174 of whom had leukaemia and 4487 control children without cancer. Overall, 39% of cases and 42% of controls had records of i.m. vitamin K administration, while 24% of cases and 22% of controls had no record of whether or not they had received vitamin K. Using subjects who received i.m. vitamin K as the baseline group, our analyses found no association between the administration of i.m. vitamin K and either leukaemia or other cancers as a group. We conclude that there is no convincing evidence that neonatal vitamin K administration, irrespective of the route by which it is given, influences the risk of children developing leukaemia or any other cancer.
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Affiliation(s)
- N T Fear
- Leukaemia Research Fund Epidemiology and Genetics Unit, University of Leeds, Leeds LS2 9JT, UK
| | - E Roman
- Leukaemia Research Fund Epidemiology and Genetics Unit, University of Leeds, Leeds LS2 9JT, UK
- Leukaemia Research Fund Epidemiology and Genetics Unit, University of Leeds, Leeds LS2 9JT, UK. E-mail:
| | - P Ansell
- Leukaemia Research Fund Epidemiology and Genetics Unit, University of Leeds, Leeds LS2 9JT, UK
| | - J Simpson
- Leukaemia Research Fund Epidemiology and Genetics Unit, University of Leeds, Leeds LS2 9JT, UK
| | - N Day
- Strangeways Research Laboratory, The Institute of Public Health, University of Cambridge, Wort's Causeway, Cambridge CB1 8RN, UK
| | - O B Eden
- Academic Unit of Paediatric Oncology, Christie Hospital and Central Manchester and Manchester Children's University Hospitals NHS Trusts, Wilmslow Road, Withington, Manchester M20 4BX, UK
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Abstract
Matched pair analysis relating to 3376 mothers of children who died of cancer 1972-1981 and of healthy control children from the Oxford Survey of Childhood Cancers showed no evidence of protection from breastfeeding for acute lymphocytic leukaemia (OR 1.04, 95% CI 0.86-1.26), for all cancers combined (OR 1.04, 95% CI 0.93-1.15) or for other groupings. Analyses by duration of breastfeeding also failed to support the protective hypothesis.
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Affiliation(s)
- R J Lancashire
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - T Sorahan
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Institute of Occupational Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. E-mail:
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Pang D, McNally R, Birch JM. Parental smoking and childhood cancer: results from the United Kingdom Childhood Cancer Study. Br J Cancer 2003; 88:373-81. [PMID: 12569379 PMCID: PMC2747546 DOI: 10.1038/sj.bjc.6600774] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
There are strong a priori reasons for considering parental smoking behaviour as a risk factor for childhood cancer but case - control studies have found relative risks of mostly only just above one. To investigate this further, self-reported smoking habits in parents of 3838 children with cancer and 7629 control children included in the United Kingdom Childhood Cancer Study (UKCCS) were analysed. Separate analyses were performed for four major groups (leukaemia, lymphoma, central nervous system tumours and other solid tumours) and more detailed diagnostic subgroups by logistic regression. In the four major groups, after adjustment for parental age and deprivation there were nonsignificant trends of increasing risk with number of cigarettes smoked for paternal preconception smoking and nonsignificant trends of decreasing risk for maternal preconception smoking (all P-values for trend >0.05). Among the diagnostic subgroups, a statistically significant increased risk of developing hepatoblastoma was found in children whose mothers smoked preconceptionally (OR=2.68, P=0.02) and strongest (relative to neither parent smoking) for both parents smoking (OR=4.74, P=0.003). This could be a chance result arising from multiple subgroup analysis. Statistically significant negative trends were found for maternal smoking during pregnancy for all diagnoses together (P<0.001) and for most individual groups, but there was evidence of under-reporting of smoking by case mothers. In conclusion, the UKCCS does not provide significant evidence that parental smoking is a risk factor for any of the major groups of childhood cancers.
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Affiliation(s)
- D Pang
- Cancer Research UK, Paediatric and Familial Cancer Research Group, Royal Manchester Children's Hospital, Stancliffe, Hospital Road, Manchester M27 4HA, UK
| | - R McNally
- Cancer Research UK, Paediatric and Familial Cancer Research Group, Royal Manchester Children's Hospital, Stancliffe, Hospital Road, Manchester M27 4HA, UK
| | - J M Birch
- Cancer Research UK, Paediatric and Familial Cancer Research Group, Royal Manchester Children's Hospital, Stancliffe, Hospital Road, Manchester M27 4HA, UK
- Cancer Research UK, Paediatric and Familial Cancer Research Group, Royal Manchester Children's Hospital, Stancliffe, Hospital Road, Manchester M27 4HA, UK. E-mail:
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Law GR, Smith AG, Roman E. The importance of full participation: lessons from a national case-control study. Br J Cancer 2002; 86:350-5. [PMID: 11875698 PMCID: PMC2375226 DOI: 10.1038/sj.bjc.6600092] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2001] [Revised: 11/29/2001] [Accepted: 11/29/2001] [Indexed: 12/03/2022] Open
Abstract
Differential participation between cases and controls can lead to biased estimates of risk. However, the effects of participation are often ignored. We report a detailed analysis of locations of residence for participants and non-participants in a large, national case-control study of childhood cancer in Great Britain, using the 1991 census. The initial selection of 7669 controls, taken from lists of those registered with a General Practitioner, was representative of the British population in respect to an areal-based index of material deprivation. However, parents of controls agreeing to participate were living in more affluent areas than initially selected controls and their matched 3838 cases. The three components of the deprivation index, persons unemployed, households not owning a car or their home were similarly associated with participation. Other census characteristics, such as proportion of flat dwellers and centrally heated households were also associated with control participation. Population density of the local area was not different between participating controls and their matched cases. However, initially selected controls lived in more urban areas than their cases. Such differences are not unique to this study, as they are an inevitable consequence of incomplete participation. The implications of these differences are discussed, in relation to the difficulty this imposes in the interpretation of studies of disease aetiology.
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Affiliation(s)
- G R Law
- Leukaemia Research Fund, Centre for Clinical Epidemiology, 30 Hyde Terrace, University of Leeds, Leeds LS2 9LN, UK.
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