Lactancia materna y riesgo de cancer infantil

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Lactancia materna y riesgo de cáncer infantil. Reseña de la evidencia
Breastfeeding and risk of childhood cancer. Summary of the Evidence

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Lactancia materna y riesgo de cancer infantil

  1. 1. Lactancia materna ―XL CONGRESO MÉDICO NACIONAL― y riesgo de cáncer pediátrico―RESEÑA DE LA EVIDENCIA― 29-30-31 octubre 2009
  2. 2. Lactancia materna y riesgo de cáncer pediátrico 1. Efecto de la lactancia materna en la morbilidad infantil.Dr. Frank Cajina Gómez 2. Efecto de la lactancia materna en la mortalidad infantil. 3. Efecto de la lactancia materna en el desarrollo intelectual y motor. 4. Efecto de la lactancia materna en las enfermedades crónicas. 5. Efecto de la lactancia materna en la salud materna. 6. Beneficios económicos de la lactancia materna. 7. Bibliografía y Cuadros. Junio 2002
  3. 3. Lactancia materna y riesgo de cáncer pediátricoDr. Frank Cajina Gómez
  4. 4. Lactancia materna y riesgo de cáncer pediátrico Children who are artificially fed or breastfed for only 6 months or less, are at an increased risk of developing cancer before age 15. The risk of artificially fed children was 1-8 times that of long-term breastfed children, and the risk for short term feeders was 1-9 times that of long term breast feeders.Dr. Frank Cajina Gómez Davis, MK. Infant Feeding and Childhood Cancer. The Lancet 1988 August ;332 (8607):365-368. Los niños que son alimentados artificialmente o amamantados por sólo 6 me- ses o menos, están en un riesgo aumentado de desarrollar cáncer antes de los 15 años de edad. El riesgo de los niños alimentados artificialmente fue de 1-8 veces que los amamantados a largo plazo, y el riesgo para los alimentados a corto plazo fue de 1-9 veces que los alimentados con pecho a largo plazo. Greaves MF. Speculations on the cause of childhood acute lymphoblastic leukemia. Leukemia 1988; 2: 120–125.
  5. 5. Dr. Frank Cajina Gómez
  6. 6. Dr. Frank Cajina Gómez EVIDENCIA RESEÑA DE LA
  7. 7. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y cáncer infantil. Autores, Métodos Resultados significativos Conclusión año y lugar Mathur GP, Between April 1991 The duration of total breast feeding was Estos resultados sugieren que la et al (1993 and June 1992 in significantly longer for controls than cases (10 LM tiene un efecto protector May) India, physicians months vs. 8 months; p .05). The difference compared data on between mean duration of exclusive breast contra el cáncer infantil. Además, Kanpur, 99 childhood feeding between cases and controls was estos indican que la LME India. cancer cases with significant (4.6 months vs. 3.2 months; p .001). proporciona efectos inmunológicos data on 90 sex, Controls were more likely to have undergone a más beneficiosos que la LM age, and hospital longer duration of total breast feeding and matched controls to exclusive breast feeding than were lymphoma complementada con la examine the cases (10 months vs. 6.15 months; p .01 and 4.6 alimentación artificial. La alta tasa relationship months vs. 3 months; p .001, respectively). 58% of LME en la India puede explicar la between duration of lymphoma cases had non-Hodgkins lymphoma. baja incidencia de cáncer infantil total breast feeding When the researchers compared other cancer and exclusive groups and controls, no significant difference (p.ej, alrededor de 6/100,000 vs. breast feeding and between the 2 groups existed in respect to total 18/100,000 en Israel). childhood cancer. breast feeding and exclusive breast feeding Mathur GP, Gupta N, Mathur S, Gupta V, Pradhan S, Dwivedi JN, Tripathi BN, Kushwaha KP, Sathy N, Modi UJ, et al. Breastfeeding and childhood cancer. Indian Pediatr. 1993 May;30(5):651-7.
  8. 8. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y riesgo de leucemia aguda infantil. Autores, Métodos Resultados significativos Conclusión año y lugar Shu XO, et Data from a After adjustment for potentially Aunque promover ni apoya fuerte ni al. (1995 population-based confounding variables, a slight, although refuta la hipótesis del estudio, estos Feb) case-control study non-significant, reduction in risk of Peoples of childhood cancer lymphoma was observed among children datos sugieren que si la LM reduce Republic of in Shanghai, who were breastfed as infants versus realmente el riesgo de linfoma, su efecto China including 82 those who were not (odds ratio [OR] = protector entre niños chinos es lymphoma cases 0.69; 95% CI: 0.3-1.7). The reduction was probablemente modesto en la magnitud and 159 acute somewhat greater for children who had leukaemia cases been breastfed longer and appeared to y concentración en ciertos subgrupos and their age- and pertain primarily to Hodgkins disease and definidos por la prolongación de la LM, sex-matched to cases diagnosed before the age of 6 la edad del diagnóstico y el subtipo community years. As expected, there was no histológico del cáncer. controls, were reduction in risk of acute leukaemia analysed. associated with breastfeeding. Shu XO, Clemens J, Zheng W, Ying DM, Ji BT, Jin F. Infant breastfeeding and the risk of childhood lymphoma and leukaemia. Int J Epidemiol. 1995 Feb;24(1):27-32.
  9. 9. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y riesgo de leucemia aguda infantil. Autores, Métodos Resultados significativos Conclusión año y lugar Shu XO, et A total of 1744 Ever having breast-fed was found to be En este estudio, la LM estuvo asociada con un al. (1999 children with associated with a 21% reduction in risk riesgo reducido de leucemia aguda infantil. Oct) ALL and 1879 of childhood acute leukemias (odds ratio Minneapoli matched [OR] for all types combined = 0.79; 95% De ser confirmado en estudios s, USA. control confidence interval [CI] = 0.70-0.91). A epidemiológicos adicionales, nuestros subjects, aged reduction in risk was seen separately for hallazgos sugieren que el futuro 1-14 years, and AML (OR = 0.77; 95% CI = 0.57-1.03) epidemiológico y los esfuerzos 456 children and ALL (OR = 0.80; 95% CI = 0.69- with AML and 0.93). The inverse associations were experimentales debieran ser dirigidos a la 539 matched stronger with longer duration of breast- investigación de los efectos antiinfeciosos y/o control feeding for total ALL and AML; for M0, inmunoestimuladores o inmunomoduladores subjects, aged M1, and M2 morphologic subtypes of de la LM en la leucomogénesis en niños. 1-17 years. AML; and for early pre-B-cell ALL. ALL: acute lymphoblastic leukemia. AML: acute myeloid leukemia Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD, Reaman GH, Robison LL. Breast-feeding and risk of childhood acute leukemia. J Natl Cancer Inst. 1999 Oct 20;91(20):1765-72.
  10. 10. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIA Lactancia materna prolongada yDr. Frank Cajina Gómez protección contra leucemia y linfomas infantiles. Autores, Métodos Resultados significativos Conclusión año y lugar Bener A, et A case-control The median duration of breast-feeding among patients was La duración de la LM por más al. (2001 study significantly shorter than among controls, 7 (range 0-23) and de 6 meses puede proteger Jan) United comprising 117 10 (range 0-20) months, respectively (P<0.0001). Breast- Arab patients, aged feeding of 0-6 months duration, when compared with feeding contra leucemia aguda y Emirates. 2-14 years, with of longer than 6 months, was associated with increased odds linfomas infantiles. ALL, HL and ratios (OR) for ALL (OR=2.47, 95% confidence interval (CI) NHL, as well as 1.17-5.25), HL (OR=3.75, 95% CI 0.80-18.69), NHL 117 controls (OR=4.06, 95% CI 0.82-22.59), and overall (OR=2.79, 95% CI matched for 1.54-5.05). In multivariate analysis, breast-feeding duration age, sex and continues to be an independent predictor of lymphoid ethnicity. malignancies (P=0.015). ALL: acute lymphoblastic leukemia. HL: Hodgkins lymphoma NHL: non-Hodgkins lymphoma Bener A, Denic S, Galadari S. Longer breast-feeding and protection against childhood leukaemia and lymphomas. Eur J Cancer. 2001 Jan;37(2):234-8.
  11. 11. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y neuroblastoma, EEUU y Canadá. Autores, Métodos Resultados significativos Conclusión año y lugar Daniels JL, Maternal reports of breast- Children with neuroblastoma were La LM estuvo asociada inversamente et al. (2002 feeding were compared less likely to have breast-fed than con neuroblastoma y debería ser Jun) USA y among 393 children six control children (odds ratio (OR) = Canada. months or older who had 0.6; 95% confidence interval (CI) = promocionada entre las madres neuroblastoma and were 0.5-0.9). The association between sanas. La investigación adicional identified through the breast-feeding and neuroblastoma sobre los posibles mecanismos de de Childrens Cancer Group and increased with breast-feeding esta asociación deberían the Pediatric Oncology Group duration (0-3 months OR = 0.7, CI = and 376 age-matched case- 0.4-1.0; 13+ months OR = 0.5, CI = garantizarse. control study. 0.3-0.9). Daniels JL, Olshan AF, Pollock BH, Shah NR, Stram DO. Breast-feeding and neuroblastoma, USA and Canada. Cancer Causes Control. 2002 Jun;13(5):401-5.
  12. 12. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y el riesgo de leucemia infantil: un meta-análisis. Autores, Métodos Resultados significativos Conclusión año y lugar Kwan ML, A fixed effects model was A significant, negative Este meta-análisis mostró que tanto la LM a et al. (2004 employed to association was observed corto plazo como a largo plazo redujo el Nov-Dec) systematically combine between long-term the results of 14 case- breastfeeding and both ALL risk riesgo de ALL y AML infantil, sugiriendo que California, control studies addressing (odds ratio [OR]=0.76; 95% el efecto protector de la LM no pude USA. the effect of short-term (< confidence interval [CI] 0.68, limitarse a ALL como se suponía antes. La or = 6 months) and long- 0.84) and AML risk (OR=0.85; tendencia potencial introducida por tasas term (>6 months) 95% CI 0.73, 0.98). Short-term breastfeeding on the risk breastfeeding was similarly de participación diferentes para casos y of childhood ALL and/or protective for ALL and AML. control muestra que la diferencia en el SES AML. Subgroup analyses Results for studies that adjusted puede minimizarse implementando of studies that did and did and did not adjust for SES were estudios de casos y controles más grandes not adjust for SES were not significantly different from also performed. the results for the 14 studies comparando el SES, basados en la combined. población. ALL: acute lymphoblastic leukemia. AML: acute myeloid leukemia SES: socioeconomic status Kwan ML, Buffler PA, Abrams B, Kiley VA. Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep. 2004 Nov-Dec;119(6):521-35.
  13. 13. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIA Revisión de estudios de casos yDr. Frank Cajina Gómez controles relacionados con la LM y reducción del riesgo de leucemia infantil. Autores, Métodos Resultados significativos Conclusión año y lugar Guise JM, We sought studies providing data We reviewed 111 citations to identify Hay pocos estudios de alta calidad que regarding the association of 32 potentially eligible full-text articles. et al. (2005 breastfeeding and occurrence of Of the 10 studies reviewed, only 4 were examinan el potencial de un efecto Nov) childhood leukemia. Studies were sufficient to provide at least fair-quality protector de la LM para la leucemia Oregon, identified by using Medline, HHS evidence regarding the association Blueprint for Action on between maternal breastfeeding and infantil. Además, los pocos estudios que USA. Breastfeeding, US Department of childhood leukemia. Studies conflicted existen discrepan en cuanto a la Health and Human Services Office regarding the protective effect of on Womens Health, Cochrane breastfeeding on childhood leukemia. asociación. Se estima que los EEUU Database of Systematic Reviews, In the 2 largest and highest quality gastan 1.4 billones de dólares National Centre for Reviews and studies, breastfeeding was associated Dissemination, reference lists, and with a significant risk reduction in one anualmente para el tratamiento de la national experts. Methodologic study with longer breastfeeding leucemia infantil. Los pacientes, los quality was evaluated for each duration, reflecting greater protection, study by using criteria from the US and a nonsignificant but suggestive clínicos, y los creadores de política no Preventive Services Task Force difference in the other. Taken together, tienen los datos que ellos necesitan para and the National Health Service half of the studies associated Centre for Reviews and breastfeeding with a lower risk of acute tomar decisiones en cuanto a esta Dissemination. lymphocytic leukemia. medida preventiva potencial importante. Guise JM, Austin D, Morris CD. Review of case-control studies related to breastfeeding and reduced risk of childhood leukemia. Pediatrics. 2005 Nov;116(5):e724-31.
  14. 14. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna y cáncer infantil: una RS con meta-análisis. Autores, Métodos Resultados significativos Conclusión año y lugar Martin RM, We undertook a Forty-nine publications were potentially relevant; Haber sido amamantado está asociado systematic review of of these, 26 provided odds ratio estimates for at et al. (2005 published studies least one childhood cancer outcome and were inversamente con ALL, HL y Dec) Bristol, investigating the included in metaanalyses. Overall, 92% of the neuroblastoma en la infancia, pero las United association between studies were case-control studies, 85% relied on breast-feeding and long-term recall of feeding history, only 8% explicaciones no causales son posibles. Kingdom. childhood cancers using examined breast-feeding exclusivity and control Incluso de ser causal, la importancia Medline (1966 to June response rates were under 80% in over half. 2004), supple-mented Metaanalyses suggested lower risks associated para la salud pública de estas with auto alerts and with having been breast-fed of 9% (95% CI = 2- asociaciones puede ser pequeña. manual searches. 16%) for ALL, 24% (3-40%) for HL and 41% (22- Analyses are based on 56%) for neuroblastoma, with little between-study Nuestras estimaciones sugieren que el odds ratios for specific heterogeneity. The estimates for HL and aumento de la LM de un 50% a un 100% cancers among those neuroblastoma, however, were driven by single ever breast-fed studies. There was little evidence that breast- prevendría en la mayor parte el 5% de compared with those feeding was associated with acute casos de leucemia aguda y linfoma never breast-fed, pooled nonlymphoblastic leukemia, NHL, central nervous using random-effects system cancers, malignant germ cell tumors, infantiles. models. juvenile bone tumors, or other solid cancers. ALL: acute lymphoblastic leukemia. HL: Hodgkins lymphoma. NHL: non-Hodgkins lymphoma Martin RM, Gunnell D, Owen CG, Smith GD. Breast-feeding and childhood cancer: A systematic review with metaanalysis. Int J Cancer. 2005 Dec 20;117(6):1020-31.
  15. 15. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIA Duración de la lactancia maternaDr. Frank Cajina Gómez y leucemia aguda y linfoma infantiles en una muestra de niños turcos. Autores, Métodos Resultados significativos Conclusión año y lugar Altinkaynak We investigated this The median duration of breast-feeding among patients was Nuestras conclusiones S, et al. issue in a case-control shorter than that of controls (10 vs 12 months). Patients with sugieren que la LM por (2006 May) study comprising 137 ALL and AML had shorter mean breast-feeding duration patients, aged 1 to 16 compared with healthy children (P = 0.001 and P < 0.001, más de 6 meses es Erzurum, years, with acute respectively). The shortest mean breast-feeding duration protectora contra Turkey lymphocytic leukemia was noted in the children with AML. Breast-feeding for a malignidades linfoides (ALL), acute myeloid duration of 0 to 6 months, when compared with feeding of en la infancia, leukemia (AML), longer than 6 months, was associated with increased odds Hodgkin or non-Hodgkin ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (CI) especialmente para lymphoma, in addition to = 1.17-5.10], AML (OR = 6.67, 95% CI = 1.32-33.69), AML y ALL. 146 controls matched for Hodgkin lymphoma (OR = 3.33, 95% CI = 0.60-18.54), non- age and sex. Hodgkin lymphoma (OR = 1.90, 95% CI = 0.68-5.34) and overall (OR = 2.54, 95% CI = 1.51-4.26). AML: acute myeloid leukemia ALL: acute lymphoblastic leukemia. Altinkaynak S, Selimoglu MA, Turgut A, Kilicaslan B, Ertekin V. Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children. J Pediatr Gastroenterol Nutr. 2006 May;42(5):568-72.
  16. 16. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIA Lactancia materna y turmor de Wilms:Dr. Frank Cajina Gómez un informe del Grupo de Oncología Pediátrica Autores, Métodos Resultados significativos Conclusión año y lugar COG, Sadd- We used data from a large case- Breast-feeding was associated with a Los resultados de este estudio lemire S, et control study in the United States reduced risk of Wilms tumor [adjusted son sugestivos de una al. (2006 and Canada. Cases were children odds ratio (OR) = 0.7; 95% Jun) North under age 16 years who were confidence interval (CI) = 0.5-0.9]. asociación entre LM y una Carolina, diagnosed with Wilms tumor from Longer duration did not provide any reducción en el riesgo de tumor USA 1999 to 2002 and were participating additional reduction in risk. When de Wilms, pero la investigación in the National Wilms Tumor Study. stratified by maternal education, adicional es necesaria para Controls were identified by random- breast-feeding lowered risk among digit dialing and were age and children whose mothers had less than confirmar esta relación. region matched to cases. Mothers of a college education (OR = 0.6; 95% 501 cases and 480 controls CI = 0.4-0.8) but not for mothers who provided information on breast- had a college degree or more (OR = feeding by telephone interviews. 1.1; 95% CI = 0.6-1.9). Childrens Oncology Group, Saddlemire S, Olshan AF, Daniels JL, Breslow NE, Bunin GR, Ross JA. Breast-feeding and Wilms tumor: a report from the Childrens Oncology Group. Cancer Causes Control. 2006 Jun;17(5):687-93.
  17. 17. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Relación entre lactancia materna y leucemia infantil. Un meta-análisis. Autores, Métodos Resultados significativos Conclusión año y lugar AHRQ We identified four systematic We used a random-effects model to combine Se concluye que existe Publication reviews or meta-analyses that SES-adjusted odds ratios of ALL in relation to asociación entre una No 07-E007. examined the relationship short-term (≤ 6 months) and long-term (> 6 (April 2007) between breastfeeding and months) breastfeeding from UKCCS103, historia de lactancia USA childhood leukemia. We have CCG107study, and Dockerty 1999 (Table 17). materna de una duración elected to describe in details only Rosenbaum 2000 was excluded from mínima de 6 meses y una the Guise 2005 systematic review the analysis because the duration of reducción en el riesgo de and Kwan 2004meta-analysis breastfeeding was not reported. The results from because they superseded the our meta-analysis suggest that long-term ALL y AML. Beral 2001 meta-analysis and breastfeeding is associated with a reduction in Davis 1998 systematic review. the risk of ALL (OR 0.80; 95%CI 0.71 - 0.91). acute lymphocytic leukemia (ALL) acute myelogenous leukemia (AML) Evidence Report/Technology Assessment. Number 153. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Relationship between Childhood Leukemia and Breastfeeding. Agency for Healthcare Research and Quality U.S. Department of Health and Human Services and Tufts-New England Medical Center Evidence- Based Practice Center Boston, Massachusetts. AHRQ Publication No. 07-E007. April 2007.
  18. 18. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez Lactancia materna exclusiva y cáncer pediátrico. Autores, Métodos Resultados significativos Conclusión año y lugar Ortega- Maternal reports of full The mean duration of full La LM estuvo asociada inversamente con García JA, breastfeeding, breastfeeding for cases were 8.43 and cáncer pediátrico, la protección aumenta et al (Jan- collected through 11.25 weeks for controls. Cases had Feb 2008) personal interviews been significantly more often bottle-fed con la duración de la lactancia exclusiva. Spain. using the Paediatric than controls (odds ratio (OR) 1.8; Es necesaria la investigación adicional Environmental History, 95% confidence interval (CI) 1.1–2.8). sobre los mecanismos posibles de esta were compared among Cases were significantly less breastfed asociación. Mientras tanto, la LM debe 187 children 6 months for at least 2 months (OR of age or older who 0.5; 95% CI 0.3–0.8), for at least 4 ser promocionada entre las madres. had PC and 187 age- months (OR 0.5; 95% CI 0.3–0.8), and matched control for 24 weeks or more (OR 0.5; 95% CI siblings. 0.2–0.9). Juan A Ortega-García, Josep Ferrís-Tortajada, Alberto M Torres-Cantero, Offie P Soldin, Encarna Pastor Torres, Jose L Fuster-Soler, Blanca Lopez-Ibor and Luis Madero-López. Full breastfeeding and paediatric cancer. J Paediatr Child Health 44 (2008) 10–13.
  19. 19. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIA ¿La lactancia materna prolongadaDr. Frank Cajina Gómez reduce el riesgo de leucemia y linfomas infantiles? Autores, Métodos Resultados significativos Conclusión año y lugar Bener A, et The study group The mean age+/-SD of cases was 5.44+/- 3.29 years and of control subjects El presente estudio confirma comprised of 169 5.51+/-3.62 years. The male/female ratio was 1.73. Overall, the mean al (April patients with acute number of months of breastfeeding in the male patients and controls was 9.1 que una mayor duración de la lymphocytic leukemia 2008) (ALL), Hodgkins (HL) (95% confidence interval [CI] 7.9-10.4) and 12.1 (95% CI 11.0-13.4), LM tiene un efecto protector Qatar. and non-Hodgkins lymphoma (NHL), age respectively (P<0.001), and in the female patients and controls 8.4 (95% CI contra ALL y HL. Los factores =or<15 years, and 6.9-10.1) and 11.5 (95% CI 10.0-13.0), respectively (P<0.01). In 103 ALL adicionales que se encuentran 169 healthy controls, patients, a shorter period of breastfeeding (0-6 months duration), was matched to patients associated with increased odds ratio (OR) for males (OR=3.1, 95% CI 1.4- asociados con un riesgo by age and sex. Mothers of all study 6.8) and females (OR=2.2, 95% CI 0.8-6.32) as compared to breastfeeding elevado de neoplasia linfoide subjects provided longer than 6 months. In 103 ALL patients, 32 HL and 34 NHL patients, there fueron edad y nivel educativo information via were no statistically significant differences in the duration of breastfeeding telephone about the between the male and female patients and their respective controls. In bajos de la madre. Todos estos history of multivariate analysis, statistically significant risk factors for the development factores pueden estar breastfeeding and of childhood lymphoid malignancy were: a shorter duration of breastfeeding, parameters seen as relacionados con un mayor lower age and level of education of mother and higher income, larger size of proxies for viral infection. accommodation and birth order in the family. riesgo de infecciones en la infancia temprana. acute lymphocytic leukemia (ALL); Hodgkins lymphoma (HL) Bener A, Hoffmann GF, Afify Z, Rasul K, Tewfik I. Does prolonged breastfeeding reduce the risk for childhood leukemia and lymphomas? Minerva Pediatr. 2008 Apr;60(2):155-61.
  20. 20. Lactancia materna y riesgo de cáncer pediátrico RESEÑA DE LA EVIDENCIADr. Frank Cajina Gómez July 2009 Childhood cancer. Several studies have examined associations between formula-feeding and childhood leukemia, based on the hypothesis that immunoactive factors in breast milk may prevent viral infections implicated in leukemia pathogenesis. Two meta-analyses found a 1.3-fold higher risk of acute lymphoblastic leukemia among formula-fed children, compared with children who were breast-fed for greater than 6 months. Kwan et al. found a 1.2-fold higher risk of acute myeloid leukemia among formula-fed infants, compared with infants breast-fed ≥6 months.
  21. 21. ―Semana Mundial de la Lactancia Materna 2009―"Lactancia Materna: una respuesta vital en emergencias".

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