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A matched case-control study of breastfeeding and other factors in pediatric Crohn’s disease

Theresa A. Mikhailov, Melissa A. Christensen, Sylvia E. Furner

Background: The incidence of inflammatory bowel disease (IBD) in children and adolescents has increased over the last 40 years. This increase is due primarily to the rise in Crohn’s disease (CD). The pathogenesis of CD remains uncertain but is thought to involve both environmental and genetic factors. We conducted this matched case-control of children diagnosed with CD to determine if CD in children is associated with breastfeeding in infancy.

Methods: We matched sibling controls to unrelated cases by age and sex. We obtained demographic and clinical data from the medical records and questionnaires. We analyzed data by McNemar’s test, t-test, the non-zero correlation test, and conditional logistic regression analysis.

Results: The association between breastfeeding and CD was protective but not significant [ψ= 0.63 (0.31– 1.30) n=152, McNemar’s χ2= 1.58, p=0.21]. There was no significant trend in development of CD based on duration of breastfeeding. Breastfeeding [dichotomous ψ= 0.61 (0.27–1.38) m=76 pairs] and [ordinal ψ= 0.80 (0.27–2.41), 0.40 (0.11–1.43), 0.62 (0.24–1.58) for < 3 months, 3–6 months, and > 6 months, respectively, vs. none] was protective in the development of CD controlling for family history of CD and of ulcerative colitis (UC), diarrhea, hospitalization, and any illness other than diarrhea in infancy, maternal age, and any smoke exposure. Any smoke exposure was a statistically significant risk factor for CD with an odds ratio greater than 2.

Conclusion: We found no association between breastfeeding in infancy and CD in children but a consistent association between any smoke exposure and CD in children.