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STOP-JIA

Some breast milk a day keeps the IVIG away?

By: CARRA | September 13, 2016 | What Caught Our Eye

Perhaps you missed the New York Times article published in October 2015,  “Overselling Breast Feeding” or the firestorm that erupted afterwards. I didn’t. I was up nursing my newborn on our first week home and reading resultant Facebook posts, emails, and even an article one of my friends had written. I stayed pretty silent from my glider and Boppy (a C-shaped nursing pillow), and told myself that I could comfortably keep to the sidelines for this one and let my general peds friends handle the unenviable job of correcting some of the more inflamed and misinformed comments.

But now, two recent articles in rheumatology are part of the library of evidence on the benefits of breastfeeding. Studies from France and Japan show protective effects in Ankylosing Spondylitis (AS) and Kawasaki Disease, respectively. The negative association with AS may not be surprising. If any of the diseases we see have a link to the gut microbiome and diet, it is the HLA-B27 arthritides. Montoya, et al, in May’s Annals of Rheumatic Diseases present a case-control study indicating that breastfeeding may lower the risk of AS.

They found that the odds of having AS compared to sibling controls were half as much in those who were breastfed. The study’s strength lies in the use of intra-family controls; important, as the authors point out, in examining a disease that clearly has a significant genetic component. The glaring limitation is that they had to rely on recall about breastfeeding status and duration for patients, some of whom were as old as 70. Remarkably, they report that only 7 of the 210 cases were not able to give breastfeeding data.

What impressed me even more were the findings in this month’s issue of Pediatrics, which features an article on the potential effects of breastfeeding in reducing the risk of Kawasaki Disease (KD). Yorifuji, et al, performed a very large, nationwide, prospective study in Japan, where there is a relatively high prevalence of KD. And also, apparently, a remarkably high rate of survey participation! Over 88% of the ~44,000 initial questionnaires sent out to families of six month old babies across the country were returned. If you have ever sent out a survey, more so, if you have ever been the parent of a six month old, you understand why this percentage is astounding. Perhaps this has something to do with Japan’s favorable maternity and child care leave laws, but I digress…

Larger than the effect seen with AS, the odds ratio of hospitalization for KD was 0.25 in breastfed and partially breastfed children compared to those who didn’t breastfeed. Moreover, the effect did not change much in models that controlled for multiple child and maternal factors. To put this in context, this effect size is in the same range as the effects of exercise in the prevention of death from cardiovascular disease. The authors suggest that this protection may be due to general “antiinfective” effects of breastfeeding versus the promotion of immune maturity, limiting the risk for dysfunctional inflammatory responses. In a disease that is potentially life threatening and whose treatment and management can be expensive and is not without risk, perhaps this piece of news is reason to raise a glass… or for some moms, a shirt.

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