Re: ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? (Cattaneo et al. 2011)

Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis

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.

Do complementary feeding practices predict the later risk of obesity?

PURPOSE OF REVIEW

Obesity is a multifaceted public health problem, which should be addressed with an all-encompassing approach. Recent research has asked questions that link specific infant nutritional risks to childhood obesity. This article brings recent research in the area of complimentary feeding practices to light and summarizes the research on its consequent impact on obesity risk.

RECENT FINDINGS

The article will discuss the current conflicting evidence on the relationship between the timing of introduction of complimentary foods and later obesity risk. It will summarize recent findings on the impact that complimentary feeding has on food preferences, growth and weight gain during the first year of life.

SUMMARY

In industrialized countries complementary feeding has no major impact on obesity. However, there is some evidence that the age at introduction of complementary foods has some effect on growth in infancy and that effects might be more pronounced in formula-fed children. The focus of research should be shifted from the timing of the introduction of complementary feeding to the quality and quantity of foods being offered and their consequent impact on weight gain and obesity risk. More research should be conducted on the relationship of primary nutrition to appetite regulation, satiety and food acceptance.