To the Editor.—
Having read with interest the article by Udall and colleagues1 suggesting a preventive effect of breast milk against severe liver disease in α1-antitrypsin (α1-AT) deficiency, I should like to report the findings of a Swedish prospective study of children with the protease inhibitor Z genetic variant (PiZ) α1-AT deficiency.2
Between 1972 and 1974, approximately 200,000 Swedish infants were screened for α1-AT deficiency. Of the 122 PiZ children identified, 14 had neonatal cholestasis, and another eight had minimal abnormalities in levels of serum bilirubin and hepatic enzyme activity, and hepatosplenomegaly; the remaining 100 PiZ children had no clinical signs of liver disease, although about a third of them had increased serum concentrations of γ-glutamyl transpeptidase (S-GT).2In most cases, feeding records were kept at local child welfare clinics for the first six months of life; feeding histories
Sveger T. Breast-feeding, α1-Antitrypsin Deficiency, and Liver Disease? JAMA. 1985;254(21):3036. doi:10.1001/jama.1985.03360210050021
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