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Padhani ZA, Das JK, Siddiqui FA, Salam RA, Lassi ZS, Khan DSA, Abbasi AMA, Keats EC, Soofi S, Black RE, Bhutta ZA. Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis. Nutr Rev 2023; 81:1501-1524. [PMID: 37016953 DOI: 10.1093/nutrit/nuad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood. OBJECTIVE This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants. DATA SOURCES Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews. DATA EXTRACTION Two investigators independently extracted data from the included studies on a standardized data-extraction form. DATA ANALYSIS Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score. CONCLUSION Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020218517.
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Affiliation(s)
- Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jai K Das
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha A Siddiqui
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Ammaar M A Abbasi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sajid Soofi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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Zhang J, Clayton GL, Hansen SN, Olsen A, Lawlor DA, Dahm CC. Maternal Pre-Pregnancy BMI, Offspring Adiposity in Late Childhood, and Age of Weaning: A Causal Mediation Analysis. Nutrients 2023; 15:2970. [PMID: 37447295 DOI: 10.3390/nu15132970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Infant feeding practices have been hypothesized to influence offspring's body mass index (BMI) later in life, and women with overweight or obesity tend to wean their infants earlier than women with healthy BMI. We, therefore, aimed to investigate how much early age of weaning mediated the maternal-offspring adiposity relationship. The study included 4920 mother-child pairs from the Avon Longitudinal Study of Parents and Children birth cohort. G-computation was applied to estimate the natural direct (NDE) and indirect (NIE) effects, via the age of weaning (<3 months, 3 months, >3 months), of maternal pre-pregnancy overweight or obesity on offspring's BMI and fat mass index. The NDE of maternal overweight or obesity on offspring BMI at 17 years old was 2.63 kg/m2 (95% CI: 2.27 to 2.99). The NIE via the age of weaning was 0.02 kg/m2 (95% CI: 0.00 to 0.04), corresponding to 0.8% of the total effect. Similar results were observed for the offspring's fat mass index. The NDE and NIE were similar to the main analyses when we looked at the relationship stratified by breastfeeding status. Our study found a minimal influence of age of weaning on the pathway between maternal and offspring adiposity, indicating the age of weaning may not be a key mediator.
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Affiliation(s)
- Jie Zhang
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Gemma L Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol BS8 2BN, UK
| | | | - Anja Olsen
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - Deborah A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol BS8 2BN, UK
| | - Christina C Dahm
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
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Arora A, Manohar N, Hector D, Bhole S, Hayen A, Eastwood J, Scott JA. Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study. Nutr J 2020; 19:16. [PMID: 32070350 PMCID: PMC7029498 DOI: 10.1186/s12937-020-0528-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids. METHODS Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks. RESULTS The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66). CONCLUSIONS Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.
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Affiliation(s)
- Amit Arora
- School of Health Sciences, Western Sydney University Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145 Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
| | - Narendar Manohar
- School of Health Sciences, Western Sydney University Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Debra Hector
- Cancer Australia, Surry Hills, NSW 2010 Australia
| | - Sameer Bhole
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW 2010 Australia
- Oral Health Alliance, Oral Health Centre, University of Queensland, Brisbane, QLD 4006 Australia
- Metro North Oral Health Services, Stafford, QLD Australia
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - John Eastwood
- Community Paediatrics, Sydney Local Health District, NSW Health, Croydon, Australia
- School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW Australia
- School of Medicine, Griffith University, Gold Coast, QLD Australia
| | - Jane Anne Scott
- School of Public Health, Curtin University, Perth, WA Australia
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Garcia AH, Voortman T, Baena CP, Chowdhurry R, Muka T, Jaspers L, Warnakula S, Tielemans MJ, Troup J, Bramer WM, Franco OH, van den Hooven EH. Maternal weight status, diet, and supplement use as determinants of breastfeeding and complementary feeding: a systematic review and meta-analysis. Nutr Rev 2016; 74:490-516. [PMID: 27330143 DOI: 10.1093/nutrit/nuw016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Infant feeding practices are influenced by maternal factors. OBJECTIVE The aim of this review is to examine the associations between maternal weight status or dietary characteristics and breastfeeding or complementary feeding. DATA SOURCES A systematic literature search of the Embase, Cochrane Library, Google Scholar, MEDLINE, PubMed, and Web of Science databases was performed. STUDY SELECTION Interventional and cohort studies in healthy mothers and infants that reported on maternal weight status, diet, or supplement use were selected. DATA EXTRACTION Outcomes assessed included delayed onset of lactogenesis; initiation, exclusivity, duration, and cessation of breastfeeding; and timing of complementary feeding. DATA ANALYSIS Eighty-one studies were included. Maternal underweight, diet, and supplement use were not associated with infant feeding practices. Obese women had a relative risk of failure to initiate breastfeeding (risk ratio [RR] = 1.23; 95%CI, 1.03-1.47) and a delayed onset of lactogenesis (RR = 2.06; 95%CI, 1.18-3.61). The RR for breastfeeding cessation was 1.11 (95%CI, 1.07-1.15) per increase in category of body mass index. CONCLUSIONS Prevention of obesity in women of reproductive age, as well as counseling of obese women after delivery, could be targeted to improve infant feeding practices.
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Affiliation(s)
- Audry H Garcia
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Trudy Voortman
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - Cristina P Baena
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - Rajiv Chowdhurry
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Taulant Muka
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Loes Jaspers
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Samantha Warnakula
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Myrte J Tielemans
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jenna Troup
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Wichor M Bramer
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Oscar H Franco
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Edith H van den Hooven
- A.H. Garcia, T. Voortman, C.P. Baena, T. Muka, L. Jaspers, M.J. Tielemans, J. Troup, O.H. Franco, and E.H. van den Hooven are with the Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands. C.P. Baena is with the Pontifical Catholic University of Parana, Curitiba, Brazil. R. Chowdhurry and S. Warnakula are with the Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom. W.M. Bramer is with the Medical Library, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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