Comparison of 11 Formulas and Breastfeeding for Atopic Dermatitis and Growth in Pediatric Cow's Milk Protein Allergy: A Systematic Review and Network Meta-Analysis of 23 Randomized Controlled Trials

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-04-03 DOI:10.1111/jebm.70026

Tengfei Li, Qingyong Zheng, Jianguo Xu, Yiyi Li, Mingyue Zhang, Bowa Zhang, Li Zhou, Jinhui Tian

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引用次数: 0

Abstract

Objective

This study aimed to evaluate the effectiveness of various formulas and the ability of breastfeeding with the exclusion of cow milk protein to reduce the Scoring Atopic Dermatitis (SCORAD) index and promote growth in infants with cow milk protein allergy.

Methods

We conducted a systematic search of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure, WanFang Data, Weipu, and the China Biomedical Literature Database. The search period ranged from the inception of each database to December 2023 (with an update until January 15, 2025). We included randomized controlled trials (RCTs) comparing formulas and breastfeeding for cow's milk protein allergy in infants. Two independent reviewers extracted data via standardized methods and assessed the risk of bias via the revised Cochrane risk-of-bias 2.0 tool. We performed a network meta-analysis (NMA) via a Bayesian fixed-effects model in RStudio and assessed the certainty of the evidence via the Confidence in Network Meta-Analysis (CINeMA) online application. The protocol for this NMA was preregistered in PROSPERO (No. CRD42024504707).

Results

This analysis included 23 RCTs involving 1997 children and assessed 12 interventions. Compared with the regular formula, the pectin-thickened amino acid formula (TAAF) might reduce the SCORAD index (−12.49, 95% confidence interval [CI] −20.38 to −4.48, low certainty). At ≤6 months of follow-up, compared with rice-hydrolyzed formula (RHF), breastfeeding might improve the length-for-age Z score (LAZ) (0.47, 95% CI 0.13–0.81, moderate certainty), and breastfeeding (0.39, 95% CI 0.02–0.77, low certainty) and extensively hydrolyzed formula (EHF) with probiotics (0.38, 95% CI 0.00–0.77, low certainty) might respectively improve the weight-for-age Z score (WAZ) and weight-for-length Z score (WLZ). At the 12-month follow-up, EHF might improve the LAZ (0.41, 95% CI 0.11–0.71, low certainty) and WLZ (0.37, 95% CI 0.18–0.56, low certainty) compared with RHF, whereas the amino acid formula (AAF) may improve the WAZ (0.33, 95% CI 0.02–0.63, low certainty).

Conclusions

Low-certainty evidence suggested that TAAF might reduce the SCORAD index. Moderate or low certainty evidence indicated that, at ≤6 months of follow-up, breastfeeding might improve the LAZ and WAZ, whereas EHF with probiotics might improve the WLZ. At the 12-month follow-up, EHF might improve the LAZ and WLZ, whereas AAF might improve the WAZ. However, further high-quality studies would be needed to confirm these findings and assess their safety and cost-effectiveness.

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11种配方奶粉和母乳喂养治疗特应性皮炎和儿童牛奶蛋白过敏生长的比较：23项随机对照试验的系统评价和网络荟萃分析

目的评价不同配方奶粉及不含牛奶蛋白的母乳喂养对降低评分性特应性皮炎（SCORAD）指数、促进牛奶蛋白过敏婴儿生长发育的效果。方法系统检索PubMed、Embase、Web of Science、Cochrane Central Register of Controlled Trials （Central）、ClinicalTrials.gov、中国知识基础设施、万方数据、唯普和中国生物医学文献数据库。搜索周期从每个数据库的开始到2023年12月（更新到2025年1月15日）。我们纳入了比较配方奶粉和母乳喂养对婴儿牛奶蛋白过敏的随机对照试验（rct）。两名独立审稿人通过标准化方法提取数据，并通过修订后的Cochrane风险-偏倚2.0工具评估偏倚风险。我们通过RStudio中的贝叶斯固定效应模型进行了网络元分析（NMA），并通过网络元分析信心（CINeMA）在线应用程序评估了证据的确定性。该NMA的协议已在PROSPERO （No. 6）中预注册。CRD42024504707)。结果本分析纳入23项随机对照试验，涉及1997名儿童，评估了12项干预措施。与常规配方相比，果胶增稠氨基酸配方（TAAF）可降低SCORAD指数（- 12.49,95%可信区间[CI] - 20.38至- 4.48，低确定性）。在≤6个月的随访中，与大米水解配方奶粉（RHF）相比，母乳喂养可提高年龄比体重Z评分（LAZ）（0.47, 95% CI 0.13-0.81，中等确定性），母乳喂养（0.39,95% CI 0.02-0.77，低确定性）和广泛水解配方奶粉（EHF）添加益生菌（0.38,95% CI 0.000 - 0.77，低确定性）可分别提高年龄比体重Z评分（WAZ）和长度比体重Z评分（WLZ）。在12个月的随访中，与RHF相比，EHF可能改善LAZ （0.41, 95% CI 0.11-0.71，低确定性）和WLZ （0.37, 95% CI 0.18-0.56，低确定性），而氨基酸配方（AAF）可能改善WAZ （0.33, 95% CI 0.02-0.63，低确定性）。结论低确定性证据提示TAAF可能降低SCORAD指数。中等或低确定性证据表明，在≤6个月的随访中，母乳喂养可能改善LAZ和WAZ，而EHF加益生菌可能改善WLZ。在12个月的随访中，EHF可能改善LAZ和WLZ，而AAF可能改善WAZ。然而，需要进一步的高质量研究来证实这些发现并评估其安全性和成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.