Exclusive breastfeeding may be a protective factor in individuals with familial multiple sclerosis. A population registry-based case-control study

Aleksa Jovanovic; Tatjana Pekmezovic; Sarlota Mesaros; Ivana Novakovic; Borut Peterlin; Nikola Veselinovic; Olivera Tamas; Jovana Ivanovic; Gorica Maric; Marko Andabaka; Nikola Momcilovic; Jelena Drulovic

doi:10.1016/j.msard.2023.105392

Exclusive breastfeeding may be a protective factor in individuals with familial multiple sclerosis. A population registry-based case-control study

Mult Scler Relat Disord. 2024 Feb:82:105392. doi: 10.1016/j.msard.2023.105392. Epub 2023 Dec 19.

Affiliations

¹ Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ Institute of Medical Genetics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁴ Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia.
⁵ Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia.
⁶ Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: drulovicjelena@gmail.com.

PMID: 38159366
DOI: 10.1016/j.msard.2023.105392

Abstract

Background: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system, which most likely results from the interplay between environmental and genetic factors. The aim of our study was to assess the effect of breastfeeding on the risk of developing familial multiple sclerosis (fMS) in persons with positive MS history, being the first such investigation performed in fMS cohort.

Methods: A case-control study based on the Belgrade population MS Registry was conducted. Cases for the sporadic MS (sMS) control group were randomly selected from the Registry, and matched with individuals with fMS at a ratio of 1:1. Spouses of the persons with fMS were included as a healthy control (HC) group. A specific questionnaire that was previously validated was used to obtain the data. To evaluate risk factors associated with breastfeeding for fMS occurrence compared with sMS and HC, multinomial regression analysis was performed to compute the relative risk ratios (RRR) along with 95% confidence intervals (95% CI). The analysis was afterwards repeated, stratified by sex. Both models were adjusted for potential confounding factors.

Results: A total of 393 participants were included in our case-control study, 131 per group. There were more individuals who were exclusively breastfed longer than six months in the sMS group compared to fMS group (RRR 2.01, 95% CI 1.22-3.32). After stratification by sex, exclusive breastfeeding was shown to be a protective factor for fMS only in male population, for individuals breastfed ≥4 months. The results of both the main and stratified analysis remained robust after adjustment.

Conclusion: Our study findings indicate that breastfeeding reduces the risk of MS in infants with family history of the disease, although this protective effect may be limited to the male population. Further investigation into the differences in risk factors between fMS and sMS is warranted to gain a more comprehensive understanding of the disease.

Keywords: Breastfeeding; Case–control study; Epidemiology; Familial occurrence; Multiple sclerosis.

MeSH terms

Breast Feeding*
Case-Control Studies
Female
Humans
Infant
Male
Multiple Sclerosis* / epidemiology
Multiple Sclerosis* / genetics
Protective Factors
Registries