In the current study, 2 groups of breastfed and formula- or mixed-fed infants were compared for H. pylori infection during the first 6 months of their lives. At the age of 1 month, there was no positive case in the 2 groups, and at the age of 6 months, there was no statistically significant difference in the incidence of H. pylori infection between the 2 groups (P = 0.302).
In a study by Okuda et al., in Japan, it was shown that longer duration of breastfeeding can decrease the incidence of H. pylori infection in early childhood (12). Also, in a study in Shiraz, Iran, it was concluded that the incidence of H. pylori infection in exclusively breastfed infants was significantly lower than that of infants with other feeding regimens (16). In a case-control study by Children’s medical center, it was shown that breastfeeding during the first 6 months of life resulted in lower H. pylori colonization, decrease in duration of symptoms, and less severe gastritis (17). In a Turkish-American study, breastfeeding was discussed as an important protective factor for H. pylori infection (18, 19). In a systematic review by Klein et al. it was suggested that breast milk protects against H. pylori infection (20). In a study by Soltani et al. in Sanandaj, Iran, there was no difference in H. pylori infection between the breastfed and non-breastfed infants (11). Also, in a study in Brazil, there was no significant difference in the incidence of H. pylori infection between the breastfed and never breastfed infants (13). In a study in Germany, the incidence of H. pylori infection was higher in breastfed infants than non-breastfed ones (15). In the current study, similar to the studies in Brazil and Sanandaj, there was no statistically significant difference between the incidence of H. pylori infection in breastfed and formula-fed infants, which may be due to the role of other factors in the acquisition of H. pylori infection in infants.
A cross sectional study by Klein et al. in Peru showed a high prevalence of H. pylori infection in infants (71.4%) and lower prevalence in1-4-year-old children (49.4%) (21). A retrospective serological study by Blecker et al. in a developed country showed that a small portion of the population acquired H. pylori infection (< 1%) during the 1st year of life (22). Acquisition of H. pylori infection usually occurs during the first 5 years of life (23). In Sanandaj study by Soltani et al. there was a statistically significant correlation between age and H. pylori infection (11). In Brazil and Turkey studies, the prevalence of H. pylori infection showed an increase with age increase (13, 18). In a study by Monajemzadeh et al. in Children’s medical center, there was also a statistically significant correlation between breastfeeding and age among children infected with H. pylori (17). In a study by Konno et al. the peak age for acquisition of H. pylori infection was 1 - 5 years and transmission of H. pylori from mother to the child was suggested as the most probable cause of intrafamilial spread (14). In the current study, there was no significant correlation between gestational age and H. pylori positivity (P = 0.306).
In a study in Children’s medical center, there was no statistically significant difference in gender between H. pylori positive and H. pylori negative cases (17) that was in agreement with the findings of similar studies (11, 14), but in the current study, the prevalence of H. pylori infection was significantly higher in female infants(74% vs. 26%) (P = 0.012); although the number of female and male infants in the study was almost equal (51% vs. 49%).
About relationship between H. pylori infection and type of delivery, previous studies reported no evidence, but in the current study, although in 74% of H. pylori positive cases of the 2 groups the delivery method was cesarean section (C/S), the association was not statistically significant (P = 0.941) and it can be attributed to the higher rate of C/S than normal vaginal delivery (NVD) in both groups (74.5% vs. 25.5%).
About the relationship between the place of keeping infants and mothers’ H. pylori infection, there was no statistically significant difference (P = 0.154) (P = 0.122).
There was no significant correlation between H. pylori infection and infantile colic in the current study (P = 0.539). A study in Egypt showed significant correlation between H. pylori infection and symptoms of infantile colic (24).
No significant correlation was observed between H. pylori infection and gastroesophageal reflux disease (GERD) among the studied infants (P = 0.655), which was according to the outcomes of the study by Emiroglu et al. (25). In a study by Abdollahi et al. the possibility of protective effects of H. pylori against GERD in children was discussed (26).
Data were also analyzed using the logistic regression model, but no statistically significant correlation was observed.
The Mantel-Hanzel test was performed to find a relationship between mother’s serologically H. pylori positive and infants H. pylori infection at the age of 6 months in each of the 2 groups. It was observed that out of 37 mothers with serologically positive H. pylori in the breastfed group, 8 infants (22%) were also H. pylori positive at the age of 6 months; in the mixed-fed group, out of 29 mothers who were serologically H. pylori positive, 10 infants (34%) were H. pylori positive at the age of 6 months and the difference between the groups was not statistically significant (P = 0.727). It meant that the incidence of infantile H. pylori infection at the age of 6 months was similar in the 2 groups.
4.1. Conclusions
According to the results of the current study, breastfeeding does not protect against H. pylori infection and also does not increase the risk of acquisition.
4.2. Limitations
As Breastfeeding research center and Imam Khomeini hospital complex are the national referral centers for high risk pregnancies, a lot of cases were excluded from the current study and the study was continued with 2 groups of 54 and 48 infants.
It was a cohort of a limited number of infants and the results may not be generalized to the total population; more studies are needed to evaluate the effect of breastfeeding on the incidence of H. pylori infection.
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