Case-control studyindependent cross-checkabstract only checked I-INTC-12 standard review
Breastfeeding and appendicitis
Does breast feeding provide protection against acute appendicitis? A case-control study.
Overview
Alves JG et al.. Trop Doct 2008 · PMID 18820196 · DOI 10.1258/td.2008.070404
Children breastfed for longer had appendicitis less often than their siblings in one small study.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test breastfeeding vs appendicitis
- How was the study done?
Sibling case-control
- How many people, animals or samples were studied?
200 cases, 200 siblings
- What was actually found?
Breastfeeding associated with protection
- How large was the observed effect?
not reported in abstract
- What do the results mean in everyday life?
A possible link, not proof.
- What are the study's limitations?
Small; recall; no numbers
- What does it say about Elawady's specific claim?
Weak partial support
- Do the results apply to Germany and Europe?
Low
- What can explicitly not be concluded from this study?
Causation; tonsil/adenoid outcomes
Scientific in-depth review
1. Full reference
- Authors
- Alves JG et al.
- Journal
- Trop Doct
- Year
- 2008
- Identifier
- PMID 18820196 DOI 10.1258/td.2008.070404
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract (PubMed lists non-US government support)
2. Research question
Is breastfeeding associated with lower risk of acute appendicitis in children?
3. Study design and population
- Study design
- Case-control study – Case-control study with sibling controls
- Population
Children with histologically confirmed appendicitis and their siblings
- Country
not stated in abstract
- Period
not stated
- Sample size
200 cases, 200 sibling controls
- Inclusion and exclusion criteria
Histologically confirmed appendicitis; sibling of same sex, age difference up to 3 years
4. Methods and endpoints
- Exposure / intervention
Breastfeeding (>=2 months; >4 months)
- Comparator
Less or no breastfeeding
- Endpoints
Acute appendicitis
- Statistical methods
not reported in abstract
5. Actual results
- Results
Abstract: breastfeeding in at least the first two months of life and for more than four months was associated with protection against acute appendicitis (effect sizes not given in the abstract); two earlier studies reported that children with appendicitis were less likely to have been breastfed.
- Absolute risks
not reported
- Authors' conclusion
Breastfeeding may possibly give protection against appendicitis.
6. Strengths
- Sibling controls reduce family confounding
7. Weaknesses
- Small
- Recall of breastfeeding
- No effect sizes in abstract
- Single setting
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Case-control with recall-based exposure; informal judgement.
9. Assessment of the statistical interpretation
Effect size not available; cannot judge precision.
10. Relevance to the specific claim
Gives limited observational support for a link between infant feeding (less breastfeeding) and appendicitis; it does not show that formula or infant cereal 'causes' appendicitis or that all children are affected.
11. Independent contrary findings
Not reviewed systematically.
12. Transferability to Germany and Europe
Low; non-European small study.
13. Overall methodological judgement
Weak partial support for one element of the claim.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | high |
| Precision of results | low |
| Directness | indirect |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | unknown |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Whether the association is causal and how large it is.