Annals of Epidemiology 24 (2014) 267e272

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Annals of Epidemiology
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Original article

Breastfeeding and risk of atopic dermatitis up to the age 42 months:
a birth cohort study in Japan
Jun Ito MD a, b, Takeo Fujiwara PhD a, b, *
a
Department of Social Medicine, National Research Institute for Child Health and Development, Setagaya-ku, Tokyo, Japan
b
Division of Developmental Social Medicine, Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: The purpose of this study was to investigate the association between breastfeeding and atopic
Received 29 July 2013 dermatitis (AD) up to the age 42 months.
Accepted 14 November 2013 Methods: Data from a nationally representative population-based birth cohort study in Japan were used
Available online 21 November 2013
(N ¼ 38,757). Feeding pattern and breastfeeding duration were investigated via questionnaires when
infants were aged 6 months. Physician-diagnosed AD during the previous 1 year was ascertained via
Keywords:
questionnaires when the children were aged 18, 30, and 42 months. The associations between feeding
Breastfeeding
patterns or breastfeeding duration and physician-diagnosed AD from the age 6 to 42 months, categorized
Infant formula
Atopic dermatitis
by AD status (no history of AD, episodic AD, and persistent AD), were analyzed using ordered logistic
Allergy regression adjusted for covariates.
Cohort study Results: Breastfeeding was positively associated with AD, with dose-response association (P for trend <
.001). Exclusively breastfed infants were 1.26 times more likely to have AD (95% confidence interval, 1.12
e1.41) than infants fed formula alone. Furthermore, children with a longer breastfeeding duration were
also significantly more likely to have AD (P for trend < .001).
Conclusions: Breastfeeding is associated with an increased risk of AD up to the age 42 months. Further
study is needed to elucidate the mechanism underlying the association between breastfeeding and AD.
Ó 2014 Elsevier Inc. All rights reserved.

Introduction criteria included nonreliance on prolonged maternal recall, strict
diagnostic criteria, severity of outcome, assessment of effect in
Atopic dermatitis (AD) is one of the most common chronic skin children at high risk, and adequate statistical power. No studies
disorders among infants and young children, which is character- have completely fulfilled these standards thus far [16]. Further-
ized by itchy skin with eczematous changes [1]. The association more, the location of the study may be relevant. Studies in Finland,
between breastfeeding and AD has been studied for more than 70 Denmark, New Zealand, or Japandcountries in which people eat
years [2], but the results have been controversial. Although some relatively large quantities of fishdshowed a positive association
epidemiology studies including meta-analysis [3] showed that between breastfeeding and AD using a prospective study design
breastfeeding had a protective effect on AD [4e6], other studies [8e10,17], suggesting that the contents of the breast milk may be
suggested that breastfeeding increased the risk of AD [7e9] or that associated with the risk of AD.
there was no relationship [10e12]. These differences may stem The Longitudinal Survey of Babies in the 21st century is a
from differences in study design, the definitions of exposure and nationwide large birth cohort study implemented by the Ministry
outcome, sample size, or adjustment for confounders [13e15]. of Health, Labour, and Welfare in Japan. It investigated feeding
Kramer [14] proposed 12 criteria to assess study designs addressing patterns and breastfeeding duration for infants at the age 6 months,
the relationship between breastfeeding and atopic disease. Those and physician-diagnosed AD during the previous 1 year was
queried for children at the age 18, 30, and 42 months. Using the
Author contribution: Dr J.I. analyzed the data and wrote the first draft. Dr T.F. data, the association between breastfeeding and AD can be inves-
conceived the study design, acquired data, and finalized the manuscript. tigated by adopting a prospective design with sufficient statistical
Conflict of interest statement: The authors have no conflicts of interest to disclose. power. The purpose of the present study was, therefore, to inves-
* Corresponding author. Department of Social Medicine, National Research
tigate the association between breastfeeding and the duration of
Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-
8535, Japan. Tel./fax: þ81-3-3417-2647. breastfeeding on the development of AD in young children from the
E-mail address: fujiwara-tk@ncchd.go.jp (T. Fujiwara). age 6 to 42 months in Japan.
1047-2797/$ e see front matter Ó 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.annepidem.2013.11.007

2001. respectively. “formula only. We the second. Ito. she was included in the category of naires were mailed in 2002 and 2003 to all subjects who partici.925 responded Non-respondents Non-respondents N = 2.559 subjects responded (92. Flow chart of study participants. 3rd. “partial breastfeeding. 2001 using the birth record duration was obtained in the first survey. Because the study was based on an anonymous public use data set with no identifiable Study sample information on the survey questionnaire.” All infants were also cate- mailed in 2004 to all subjects who participated in the second or the gorized into four groups according to the duration of breastfeeding: third survey (N ¼ 45.” If she answered that she had given only colostrum or had 47.268 J. 1.943 3rd survey Non-respondents 42.015 responded Non-respondents N = 3. Labour. during which 43.699) Multiple births (N = 795) 38. 1e2. 3e5.812 responded N = 942 Non-respondents N = 2. The total number of respondents was feeding.812 subjects responded. she was included in the category of months. Atopic dermatitis feeding and AD up to the age 42 months. Because this study focused on breast.” or “exclusive breastfeeding. subjects without record of breastfeeding status (n ¼ 308) and those who did not answer the Information regarding doctor-diagnosed AD was obtained in question about AD in every survey (n ¼ 1720) were excluded.559 responded Lack of breastfeeding status (N = 308) Lack of atopic dermatitis status all the 2nd. or 6þ months.8%). 2001 Non-respondents N = 6.560 1st survey 47. and Welfare from 2001 to 2004.757 (Fig. she was included in the category of “exclusive breast- tionnaire to the Ministry. formula. Questionnaires were mailed to all subjects when about the duration of breastfeeding and formula feeding for the the infants were aged 6 months. third. 93. The data used for this study were taken from the Longitudinal Survey of Babies in the 21st century conducted by the Japanese Feeding pattern and breastfeeding duration Ministry of Health. If the mother answered that she had not given any have agreed to participate in the study if they returned the ques. and July 10–17. if the mother answered that she had given pated in the first survey when the children were aged 18 and 30 both breast milk and formula.090 2nd survey 43.” “partial breast- responding to the first survey). Participants were asked list (N ¼ 53. The subjects were considered to past 6 months. and July 10e17.” Thus. and fourth survey using the following question: further excluded multiple births (n ¼ 832). The study sample included all infants born in Japan during the periods Information regarding feeding pattern and breastfeeding of January 10e17.4% and 91. we categorized the feeding pattern respectively (response rates. Fujiwara / Annals of Epidemiology 24 (2014) 267e272 Methods sample size for this study was 38. not given any breast milk. Therefore. The second and the third question. 87. The fourth questionnaires were feeding.575 babies born in Japan during January 10–17.” Finally. 1). of those during the first 6 months of life as “formula only. 2001. T. the final “Has your child seen a doctor for AD or eczema treatment in the last Eligibility: 53. and 4th survey (N = 1.195 4th survey 41.015 (response rate. this study has been exempted from ethical review. . and 41.260 N = 1.1%.757 were analyzed Fig.925 and 42.072) when the children were aged 42 months never.2% of those responding to the second or third survey).575).

and model 3 adjusted for the child’s demographics. respectively) Confounders than infants fed formula alone.001.60) than infants fed formula alone.. Similarly.4%). Fujiwara / Annals of Epidemiology 24 (2014) 267e272 269 12 months?” If participants answered “yes” in the second. episodic. have AD up to the age 42 months compared with formula-fed Furthermore. Analyses respectively). 1.. The OR was lower if the breastfeeding duration was shorter (OR. Therefore. P for trend also demonstrated significance for both questionnaire response) during the age 6e12 months (N ¼ 31. and maternal anxi.38) than infants fed averaged using data from all the four surveys. the shown in Table 2. whether the infant was living with but P for trend remains significant (P < .35 times more likely to have AD (95% CI.001). and 2217 (5. young children breastfed exclu- In total. 27. 1. exclusive the age 18 months in most cases) and occurrence of AD after the breastfeeding and a breastfeeding duration of 6þ months were age 18 months. Model 1 adjusted for the child’s demographics (sex. living with grandparents. Details of the dis. the number of siblings at birth. 1. version 12 (Stata Corp. we use three Before sensitivity analysis.57) than infants fed formula breastfeeding would prevent further exacerbation of allergic alone.24 for models 2 and 3. was categorized on the basis of AD persistence (i. is shown in working status at 6 months postpartum. after adjusting for the child’s de- mographics.322) feeding pattern and breastfeeding duration. model 2 adjusted for the child’s de. Furthermore. which was not possible due to lack of information on parental maternal anxiety during child rearing. respectively. based on significant..001 for both). and gestational age Further adjustment for family demographics and lifestyle (model were obtained from their birth records. if participants answered “no” in all three surveys.0%. respectively).33 times symptoms were more likely breastfed by mothers who believe more likely to have AD (95% CI.03 for 3e5 months and 1e2 months. prospective large birth cohort study in Japan.07e1.24 times more likely to persistent and episodic AD up to the age 42 months. breastfeeding duration and AD at the age 18e42 months using or- dered logistic regression because breastfeeding is finished after the age 18 months in most cases. TX). 2. Ito. 1. not shown). and 3). 1402 (3. With respect to crude association. plus SES (parental education young children without allergic symptoms from the age 6 to 18 and household income). the OR of breastfeeding duration during the first 6 ety during child rearing. In addition. we found months of life.e. the infant was categorized as having “Persistent income were associated with AD status (Table 1). third. Our study meets 11 of 12 criteria sug- 62. birth between young children with and without allergic symptoms from weight. using a Results nationwide. Furthermore. J. birth weight. Table 4). 8679 (22. and gestational age).11e1.861 (71. the age 6 to 18 months with respect to the distribution of feeding mographics plus family demographics and lifestyle (parental age.001 for both). and 1. 1. which (OR of 6 months breastfeeding: 1.26 for models 2 and 3. that is. maternal education. Both ORs symptoms [15.13e1.. (model 1). we focused on subjects without allergic were slightly attenuated in model 2 and model 3 but remained symptoms (physician-diagnosed AD or bronchial asthma. age. respectively. respectively) compared with infants with no history of AD gested by Kramer [14]. parental smoking habits.18]). derived from ordered logistic regression.18 times significantly more likely to have AD (95% confidence interval [CI].26 or 1. including parental sive breastfeeding. Further adjustment for family demographics and Ordered logistic regression was used to investigate associations lifestyle (model 2) and SES (model 3) attenuated the point estimate between feeding pattern or breastfeeding duration and AD. and maternal anxiety during child to be breastfed and for a longer duration (P ¼ . Exclusive and partially breastfed infants were infant was categorized as having “no history of AD.51. after adjustment for For sensitivity analysis to avoid the bidirectional association covariates measured in this study (model 1.7% and 55. We then confirmed that exclusively duration and AD were also investigated using ordered logistic breastfed infants were 1. maternal work status. The associations between breastfeeding months) was performed.7%) of young children. after adjustment for covariates (model 1. More specifically. and average household and fourth surveys. further sensitivity analysis (i. formula alone after adjustment for the children’s demographics tribution of these confounders are shown in Table 1. but P for trend remains significant (P < .13 and 1. Family demographics and 2) and SES (model 3) attenuated the point estimate (OR of exclu- lifestyle were investigated in the first survey. yielding a strong dose-response association (P for trend < . we investigated the association models. Socioeconomic status (SES) variables months of life and the development of AD from the age 6 to 42 were obtained from the first survey.” If participants answered “yes” once or twice among the three The odds ratio (OR) of feeding pattern during the first 6 months surveys. with allergic symptoms from the age 6 to 18 months are more likely number of siblings at birth. older siblings. More than half of the children were breastfed for 6 positive associations between breastfeeding (terminated before months or more.g. population-based.35 and 1.” 1. regression. whether living with grandparents. although there was one unmet criterion. sex. among children children were exclusively. maternal age. 1.6%) and 8787 (22.001). young children with allergic young children breastfed for at least 6 months were 1. the infant was categorized as having “Episodic AD.13e1. .7%) of young children had sively or for at least 6 months were 1. respectively). respectively). or persistent).33 and 1. and from the second Table 3. Table 5). grandparents.” of life with respect to having AD from the age 6 to 42 months is Furthermore. (21. partially. between breastfeeding and AD (e. AD. The P for trend demonstrated significance (P < .31.001 and P < . Household income was times more likely to have AD (95% CI. All analyses were performed using Discussion STATA SE statistical package. suggesting a dose- and investigated the association between feeding pattern or response association (P < . Infants who were breastfed for at least 6 months were 1. including the maternal months. College Sta- tion. suggesting that reverse causation (to have AD / more likely present among infants with persistent AD (26. allergic history. no history.30 and 1. T.001 in models 1. or not breastfed for the first 6 without allergic symptoms from the age 6 to 18 months. data rearing). with respect to parental education.0% and breastfeeding) is unlikely.32 survey. We discovered that breastfeeding for 6 months of life is asso- ciated with an increased risk of AD up to the age 42 months. paternal smoking habits. paternal education.9%). among family demographics and lifestyle. the assessment of effects in children at high risk of AD. Data regarding a child’s sex.21e1.e. For the multivariate analysis.3%. pattern and breastfeeding duration and found that young children parental smoking habits.

3) Some college 11. 22.0 12.0e7.4) 2þ 3943 (13.5) .8) 602 (6.568.2) 260 (18.9) 7494 (85.1) 426 (30.3) 6244 (71.1) Maternal age (when the child was aged 6 mo) <30 12.6) 40þ 3129 (11.5e5.5) 319 (22.123 (95.1) 317 (3.7) 2110 (24.8) 568 (40.818 (58.2) 976 (11.4) 4860 (55.0) 432 (30.2) <.9) 2994 (34.01 Yes 17.7) 1205 (86.001 2.5) 427 (4.658 (54. with childcare leave 2892 (10.8) Older siblings 0 14. Because the previous prospective study in Japan [9] was based and AD.8) 85 (6.03 30e39 15.1) 5. Fujiwara / Annals of Epidemiology 24 (2014) 267e272 Table 1 Characteristics of study population (N ¼ 38. and fourth survey).3) Maternal anxiety during child rearing (when the child was aged 6 mo) Scarcely not 11.3) Maternal work status (when the child was aged 6 mo) Not working 21.358 (36.5) 3759 (42.2) 58 (4.4) Living with grandparents (when the child was aged 6 mo) No 22.1) 593 (42.7) Paternal education <High school 2174 (7.6) Collegeþ 10.9) 5217 (59.5) 553 (40.9) 82 (0.132 (91.03 Yes 6212 (21.3) 828 (60.7) 4134 (47.6) <.0) 933 (10.2) 2637 (30.1) 969 (69.4) 149 (10.6%)y P (c2 test) n (%) n (%) n (%) Feeding pattern Formula only 1715 (6. second.3) 6983 (79.15 2500e4000 26.070 (74.643 (51.8) 200 (14.530 (54.1) 3028 (34.5) 451 (32.9) 137 (9.2) 1303 (92.11 37e42 27.5 2505 (8.7) 3254 (37.168 (49.7) 819 (9.6) Father’s smoking habits (when the child was aged 6 mo) No 10.3) .7) 544 (39.7) 3098 (35.9) 69 (4.3) 553 (39.001 Some 15.416 (43.7) 42þ 246 (0.925 (48.659 (38.9) 135 (9.001 High school 11. 73.3) .270 (39.4) .9) 69 (4.001 1e2 5484 (19.0) 838 (59.001 Female 13.717 (55.3) 4653 (53. 3.2) 201 (14.7) Average income per year (the first.5) .7) 1449 (16.1) <.2) * Episodic AD cases were defined as those diagnosed with AD at least once from the age 6 to 42 mo.3) Sex Male 14.9) 79 (5.162 (39.52 30e39 16.7) <.0) 8386 (95. although the point estimate of OR was positive and similar .6) 135 (9.7) Other 2752 (9.1) 606 (6.8) 1114 (12. they concluded a null association between breastfeeding [9].01 Full-time work.09 Yes 4285 (15.7) 200 (14.0) 5280 (60.205 (21.1) 3648 (41.9) 40 (2.3) 794 (56.9) 10þ 1542 (5.1) .270 J.4) <.7) 153 (10.1%).6) 246 (17. y Persistent AD cases were defined as those diagnosed with AD every year from the age 6 to 42 mo.7) 1029 (11.1) 873 (62.0) Breastfeeding duration (mo) Never 1715 (6.9) Collegeþ 3899 (13.0) Some college 4439 (15.8) 611 (43.1) 14 (1.4) 835 (59.8) 98 (7.9) 5169 (59.0) Gestational age (wk) <37 1181 (4.7%) Episodic AD (n ¼ 8787.5) 87 (6.3) Birth weight (g) <2500 2100 (7.0) 3431 (39.7) . million yen <2.457 (36.0) 809 (57.5 9444 (33.7) 586 (6.2) 7.8) Maternal education <High school 1396 (4.030 (42. T.20] and prospective design (76.8) 3420 (39.095 (38.8) 1407 (16.0) 5206 (60.5) 8096 (92.2) 169 (12.6) Mother’s smoking habits (when the child was aged 6 mo) No 24.4) 595 (6.9) 15 (1.3) 3e5 5652 (19.5) 6þ 15.7) 3829 (43.648 (72.9) 4000þ 329 (1.2) 1474 (16.0) 364 (26.9) 370 (4.5) 1341 (95.0) 433 (4.3) .757) Characteristics No history of AD (n ¼ 28. The present study is consistent with the findings from Japan on a relatively small sample size (N ¼ 763) and a low follow-up rate that used cross-sectional design [19.2) Full-time work.3) 189 (13.5e10 3047 (10.5) 576 (41.8) Very much 1750 (6.0) 649 (46.845 (41.001 High school 11. without childcare leave 1546 (5.0) 433 (4.4) 477 (34.6) 4485 (51.6) 3188 (36.6) 6484 (74.5) 529 (38.8) .8) 1600 (18.001 Partial breastfeeding 20.002 1 10.9) <.154 (84.2) 168 (1.7) 1804 (20.5) 1083 (77.356 (78.417 (62.6) 46 (3.1) 1254 (14.6) 40þ 622 (2.2) 95 (1.1) Exclusive breastfeeding 6. Ito.7%)* Persistent AD (n ¼ 1402.9) <.9) Paternal age (when the child was aged 6 mo) <30 8621 (30.5) 994 (71.4) 480 (5.

and gestational age. maternal smoking habit.35 (1.21e1. especially among children on AD [4e6].24]. paternal age.33 (1.09 (0. precluding a fish intake during pregnancy was associated with AD and asthma longer protective effect of breastfeeding on AD.14 (0. breast- Another study also discovered positive association between feeding may affect the balance of gut flora.19e1. in Denmark [10].95) [9].33 (1.00e1. Fish contains polychlorinated biphenyls (PCBs).42)* 1. Another observa- in infants [22].01e1. * P < . we add formation regarding infections at the age 6 months.13e1.27. and average household income.001 breastfeeding P for trend <. living with grandparent(s).001 <.95e1.41)y breastfeeding breastfeeding Exclusive 1.3% up to the age 42 infant does not fully develop mature immune response mecha- months) is similar to that of the previous study in Japan [9] (18.03 (0.322) Feeding pattern Model 1 Model 2 Model 3 Feeding pattern Model 1 Model 2 Model 3 OR (95% CI) OR (95% CI) OR (95% CI) Formula only Reference Reference Reference OR (95% CI) OR (95% CI) OR (95% CI) Partial 1. Previous may be a risk factor for AD because it reduces the effect of exposure studies ascertaining AD prevalence use the ISAAC questionnaire to bacteria or endotoxins [29] on the immune system. paternal age.08e1.07e1.15 (0. * P < . and gestational age.13e1.55)y P for trend <.001 P for trend <.10 (0.16) 1. Model 3: adjusted for variables used in postpartum.11 (1.89e1. although there were differences in the later childhood. paternal education.41)* 1.27].31)* 1. model 2 plus maternal education.24 (1. birth weight. maternal work status at 6 mo model 2 plus maternal education.92e1. Model 2: adjusted for variables used in model 1 plus maternal age.91e1. a longer follow-up study re- levels than formula-fed infants [25].12) 1e2 1.85e1. assessed at 12 months [4].26 (1. such that the Table 5 Table 3 ORs for breastfeeding duration with respect to AD from the age 18 to 42 mo among ORs for breastfeeding duration during the first 6 mo with respect to AD from the age children without allergic symptoms from the age 6 to 18 mo using logistic regression 6 to 42 mo using ordered logistic regression analysis (N ¼ 38.05e1. Model 2: smoking habit.47)* 1.98e1. Other studies have reported a protective effect of breastfeeding ation between breastfeeding and AD. birth weight.08e1.20 (1. In addition.001 <. First. independent effect of breastfeeding on AD. it is not to the literature that the association between breastfeeding and possible to adjust for infection at the age 6 months to confirm an AD is generalizable in Japan.11e1.13 (0. and gestational age. older siblings.99 (0. living with grandparent(s).001 <. and tional study reported that a protective effect of breastfeeding on PCBs are transferred to human milk [23.49)y 1. Several limitations need to be addressed.757) without allergic symptoms from the age 6 to 18 mo using logistic regression (N ¼ 31.24) 1. older siblings.03 (0.36) Exclusive 1. older siblings. Because we have adjusted for the number of sib- follow-up period and diagnostic criteria (our study used physician lings as a proxy of the hygiene situation in the house and the diagnosis. older siblings. adjusted for variables used in model 1 plus maternal age. Model 2: adjusted for variables used in model 1 plus maternal age.32 (1. and in a case-control study in New date the mechanism underlying how breastfeeding is associated Zealand [8]. 0.6 times higher plasma PCB later onset of AD [5]. A study in Netherland AD was found for the early onset of AD (age < 2 years) but not for a showed that breastfed infants showed 3. breastfeeding may play a role in inducing aged 9e21 years [29].60)y 1.61)y 1.16 (1.25) 1. maternal adjusted for variables used in model 1 plus maternal age. A previous study that reported a protective effect of without allergic heredity.88e1. paternal education.12 (1.02e1.12e1. to our study (OR.35 (1.05. maternal Model 1: adjusted for child’s sex.27) 1.36) 1. maternal and maternal anxiety during child rearing. smoking habit.001.24) Formula only Reference Reference Reference breastfeeding Partial 1.35) 1.57)* 1.97e1. and maternal anxiety during child rearing. and average household income. That is.28 (1.06 (0.13e1. paternal education. whereas previous study [9] used the International Study association remains significant.58)* 1. birth weight. paternal age. where fish consumption is relatively high as in Japan with the development of AD. maternal work status at 6 mo and maternal anxiety during child rearing. model 2 plus maternal education. breastfeeding on the same criteria). the hygiene hypothesis [28] may explain the as. paternal smoking habit. paternal age.83e1. Model 3: adjusted for variables used in smoking habit.001.06 (0.91e1. paternal smoking habit.31) 6þ 1. J. T. misclassification might occur.001 <. paternal smoking habit.001 <.24) 3e5 1.95e1. Further study is needed to eluci- Finland [17]. the hygiene hypothesis is not likely of Asthma and Allergies in Childhood [ISAAC] questionnaire).02 (0. Model 3: adjusted for variables used in and maternal anxiety during child rearing. to explain the association. living with grandparent(s).001 . was assessed as doctor-diagnosed AD (which is not always based sociation between breastfeeding and AD. paternal smoking habit.17e1. However.19e1.757) (N ¼ 31. maternal work status at 6 mo postpartum. [21].001 <. AD through exposure to PCB. living with grandparent(s). .06 (0. Because PCB influence the ported that breastfeeding is no longer protective for AD in subjects immune system [26.30 (1. Ito.18 (1. Furthermore.01. paternal education.00e1.322) Breastfeeding Model 1 Model 2 Model 3 Breastfeeding Model 1 Model 2 Model 3 duration (mo) duration (mo) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Never Reference Reference Reference Never Reference Reference Reference 1e2 1.45)* 1.01.29)* 1. * P < . because AD Alternatively.01. because our study is a larger prospective study. suggesting that maternal fish intake may explain the associ. 1. maternal work status at 6 mo * P < .88e1.35 (1.29 (1.33 (1.52)* P for trend <. 95% CI. y P < .6% nisms such as the shift from Th-2 dominance in infants to Th-1 in up to the age 24 months).001 <. y P < .95e1.27) 1. because we do not have in- Therefore. birth weight.14) 0. and average household income.001 Model 1: adjusted for child’s sex. Model 2: Model 1: adjusted for child’s sex. Model 3: adjusted for variables used in model 2 plus maternal education. and gestational age. the prevalence of AD in the present study (26.13e1.51)y 1. which is associated with breastfeeding and AD among children without atopic heredity in the development of AD [30e32]. Fujiwara / Annals of Epidemiology 24 (2014) 267e272 271 Table 2 Table 4 ORs for breastfeeding patterns during the first 6 mo with respect to AD from the age ORs for feeding pattern with respect to AD from the age 18 to 42 mo among children 6 to 42 mo using ordered logistic regression analysis (N ¼ 38. postpartum. A previous study reported that maternal breastfeeding on AD.001 Model 1: adjusted for child’s sex.20 (1. Furthermore. and average household income.19) 3e5 1. postpartum.38)* 6þ 1.

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