Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life

Lactobacillus-derived indole derivatives ameliorate intestinal barrier damage in rat pups with complementary food administration

The consumption of complementary foods can bring about diarrhea and intestinal barrier dysfunction in infants. In this study, three different Lactobacillus strains combined with L-tryptophan (Trp) were administered to rat pups with complementary foods. Complementary food feeding caused inflammatory cell infiltration, crypt structure irregularity and goblet cell reduction in the colon tissues of the rat pups. However, the oral administration of Trp combined with Lactiplantibacillus plantarum DPUL-S164 or Limosilactobacillus reuteri DPUL-M94 significantly restored the pathological changes in the colon tissues and inhibited the expression of pro-inflammatory cytokines in the colon and ileum of the rat pups. M94 or S164 combined with Trp intervention could promote the expression of cell differentiation genes and tight junction proteins, and restore the intestinal barrier damage caused by complementary foods in rat pups by activating the aryl hydrocarbon receptors (AhR) and nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. In addition, the indole-3-lactic acid (ILA), indole-3-propionic acid (IPA), or indole-3-carbaldehyde (I3C) level in the cecal contents of the rat pups increased after intervention of Trp combined with S164 or M94, which may account for the amelioration of intestinal barrier damage in rat pups administered with complementary foods. Furthermore, S164 or M94 combined with Trp intervention up-regulated the relative abundance of f_Lactobacillaceae, f_Akkermansiaceae, g_Lactobacillus, and g_Akkermansia in the intestinal tract of the rat pups. In conclusion, S164 or M94 combined with Trp intervention can ameliorate complementary food-induced intestinal barrier damage and gut flora disorder in rat pups by producing ILA, IPA, or I3C, which are AhR ligands.

Complementary Feeding: Tradition, Innovation and Pitfalls

According to WHO, "complementary feeding (CF) is the process starting when breast milk alone or infant formula alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast human milk or a breastmilk substitute". CF is one of the most important "critical and sensitive periods" in human life: indeed, timing and approaches to solid foods introduction in an infant's nutrition are of utmost importance as potential epigenetic factors from infancy to adulthood. CF is also deeply influenced by each country and single-family traditions, culture, and beliefs. The aim of our narrative review is to analyze traditional CF practices, including innovative and alternative ones that emerged in the last decades, such as baby-led weaning or plant-based weaning, and to evaluate their effects on the risk of developing non-communicable diseases. Moreover, we will discuss pitfalls and misunderstandings that pediatricians frequently have to face when dealing with complementary feeding. Health care professionals must not have prejudices against parents' wishes or traditions about CF; rather, they should support and educate them in case of any alternative CF choice, always pursuing the infant's adequate growth, neuro- and taste development, and the achievement of correct eating behavior as the primary goal.

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.

Mothers' feeding practices among infants (4-12 months) and associated factors: a cross-sectional study in Saudi Arabia

A global target of increasing exclusive breast-feeding (EBF) to at least 50 % by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010-18 and little is known about the status of mothers' feeding practices in Saudi Arabia. The present study aimed to assess mothers' actual feeding and weaning practices used with their infants by the mothers' different age groups. The present study was conducted among 247 mothers of infants aged 4-12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers' feeding practices. Only 5·3 % of mothers engaged in EBF, 44·9 % breast-fed their infants after an hour of birth, while 92·7 % of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were -0·4, 95 % CI -0·71, -0·13; P = 0·031). A total of 64·3 % of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2 % of the mothers believed that 'it is a good time' and 61·1 % felt that 'infants are hungry and need other sources of food'. Online sources and family advice were the top sources of information on mothers' feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.

Evaluating the pathways linking complementary feeding practices to obesity in early life

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.

Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management

A food allergy is an immunoglobulin E (IgE)-mediated hypersensitive reaction to food, which consists in the appearance of allergic symptoms; it can vary from common urticaria to even fatal anaphylaxis. The prevalence of food allergies has been increasing in the past twenty years and it represents a major public health problem in industrialized countries. The mechanism that leads to food allergies is the lack of immunologic and clinical tolerance to food allergens. The diagnosis of IgE-mediated food allergies is based on the combined use of a detailed medical history, in-vivo, and in-vitro research of specific IgE, the elimination diet, and the double-blind placebo-controlled food challenge. The only currently available treatment for allergies is the strict elimination diet. This type of attitude, which we could define as “passive”, does not overcome the risk of accidental reactions due to involuntary intake of the culprit food. For food allergy management, an “active” approach is urgently needed, such as specific allergen immunotherapy, which is currently under development and only used for research purposes. This article aims to give an updated review of IgE-mediated food allergies in pediatric populations in terms of epidemiology, pathogenesis, prevention, diagnosis, and management.

Appropriate age range for introduction of complementary feeding into an infant's diet

Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.

Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review

BACKGROUND

Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo.

OBJECTIVES

The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis?

METHODS

The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.

RESULTS

Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed.

CONCLUSIONS

Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.

Timing of introduction of complementary foods and beverages and growth, size, and body composition: a systematic review

BACKGROUND

The systematic review described in this article was conducted as part of the USDA and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.

OBJECTIVES

The aim was to describe the relationship between timing of introduction of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes across the life span.

METHODS

The literature was searched and selected using predetermined criteria. Data were extracted and risk of bias assessed for each included study. Evidence was qualitatively synthesized, conclusion statements were developed, and the strength of the evidence was graded.

RESULTS

Eighty-one articles were included in this systematic review that addressed timing of CFB introduction relative to growth, size, and body-composition outcomes from infancy through adulthood. Moderate evidence suggests that introduction of CFBs between the ages of 4 and 5 mo compared with ∼6 mo is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Limited evidence suggests that introduction of CFBs before age 4 mo may be associated with higher odds of overweight/obesity. Insufficient evidence exists regarding introduction at age ≥7 mo.

CONCLUSIONS

Although several conclusions were drawn in this systematic review, additional research is needed to address gaps and limitations in the evidence on timing of introduction of CFBs and growth, size, and body composition, such as randomized controlled trials that examine multiple outcomes and/or CFB introduction between the ages of 4 and 6 mo, and research that accounts for potential confounders such as feeding practices and baseline growth status and considers issues of reverse causality.

Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 Years: Follow-up of the PROBIT Randomized Trial

IMPORTANCE

Atopic diseases, including asthma and atopic eczema, are the most common chronic conditions of childhood.

OBJECTIVE

To investigate whether an intervention to promote prolonged and exclusive breastfeeding protects against asthma, atopic eczema, and low lung function in adolescence.

DESIGN, SETTING, AND PARTICIPANTS

Follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster randomized trial in 30 Belarusian maternity hospitals and affiliated polyclinics; recruitment of 17 046 healthy term infants took place from June 15, 1996, to December 31, 1997. Data analysis was conducted from May 9, 2016, to April 21, 2017. The primary analytic approach was by modified intention-to-treat analysis.

INTERVENTIONS

Randomization to receive a breastfeeding promotion intervention vs usual care.

MAIN OUTCOMES AND MEASURES

Spirometry and flexural eczema on standardized skin examination by study pediatricians were the primary outcomes; secondary outcomes were self-reported asthma diagnosis ever, and wheezing and flexural eczema symptoms in the previous year.

RESULTS

A total of 13 557 (79.5%) participants were followed up from September 15, 2012 to July 15, 2015. The intervention (7064 [79.7%]) and control (6493 [79.4%]) groups were similar at follow-up (3590 [50.8%] and 3391 [52.2%] male; mean [SD] age, 16.2 [0.6] and 16.1 [0.5] years, respectively). In the intervention group, 0.3% (21 of 7064) had flexural eczema on skin examination and mean (SD) forced expiratory volume in the first second of expiration/forced vital capacity (FEV1/FVC) ratio z score was -0.10 (1.82), compared with 0.7% (43 of 6493) and 0.35 (1.34), respectively, in the control group. In modified intention-to-treat analysis, accounting for clustering by polyclinic, a 54% lower risk of flexural eczema on skin examination was observed in the intervention compared with the control group (odds ratio [OR], 0.46; 95% CI, 0.25 to 0.86). Self-reported flexural eczema symptoms in the past year (OR, 0.57; 95% CI, 0.27 to 1.18), asthma (OR, 0.76; 95% CI, 0.47 to 1.23), and wheezing in the past year (OR, 0.66; 95% CI, 0.37 to 1.18) were less frequently reported in the intervention compared with the control group, but 95% CIs were wide and included the null. There was no significant difference in the FEV1/FVC ratio z score (β -0.15; 95% CI, -0.76 to 0.45). All results were similar with additional adjustment for baseline characteristics, on instrumental variable analysis, and with multiple imputation among all 17 046 randomized participants.

CONCLUSIONS AND RELEVANCE

A breastfeeding promotion intervention reduced flexural dermatitis risk but had no detectable effect on lung function or questionnaire-derived measures of atopic eczema or asthma in adolescence in a setting where atopic eczema and allergies are rare.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01561612.

Does the early introduction of solids promote obesity?

Childhood obesity is a major public health challenge across the developed world, and it is vital to understand the modifiable factors that contribute to it. The influence of early-life nutrition on predisposition to later obesity and metabolic disease is now well established. Much research has concentrated on the preventative effects of breastfeeding in relation to childhood obesity risk, but the optimal timing of introducing solid foods has received far less attention. This remains a much-debated and contentious issue, and differing guidelines from international bodies have caused confusion among parents. There is no conclusive evidence from current research that introducing solids before six months of age is associated with an increased risk of obesity in infancy or childhood. Current studies suggest that the most clearly established risk factor for childhood obesity is maternal body mass index. There is a need for continued research in this area.

Is breast best? Is early solid feeding harmful?

The health benefits of breastfeeding for babies and mothers have long been recognised and it is now globally recommended that it be continued exclusively for six months. Although there are few controlled trials to support this recommendation, the most important advantage is less morbidity from gastrointestinal infection in developing countries. There is also evidence that respiratory tract infections and atopic dermatitis is reduced, and the maternal risk of breast cancer decreases, particularly with a longer duration of breastfeeding and a high parity. There is little to suggest that exclusive breastfeeding for six months adversely affects infant growth, nutritional status or infant feeding skills, but more studies are needed. Equally, there is no evidence that introduction of solids from 17 weeks is harmful in developed countries. However, in the UK breastfeeding prevalence is low and solids are introduced early for the majority of infants and much can be done to positively encourage and support all mothers to continue breastfeeding for a longer period.

Early weaning is beneficial to prevent atopic dermatitis occurrence in young children

BACKGROUND

Epidemiological data on infant feeding practices and allergic diseases are controversial. The purpose of this study was to explore the association of early weaning with the occurrence of atopic dermatitis (AD).

METHODS

We conducted a matched case-control study on incident physician-diagnosed AD in early childhood including 451 cases and 451 controls. Data on several factors, including feeding practices, were collected through an interviewer-administered questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated through logistic regression models, conditioned on study center, age, sex, and period of interview, and adjusted for potential confounders.

RESULTS

Early weaning, defined as the introduction of solid foods at 4 or 5 months of age, was inversely related to the risk of AD, with children weaned at 4 months having lower AD risk (OR = 0.41, 95% CI, 0.20-0.87) compared to those exclusively breastfed. Similar results were observed for weaning started at 5 months of age (OR = 0.39, 95% CI, 0.18-0.83). This association persisted when children with and without family history of allergy were considered separately. Prolonged partial breastfeeding (breastmilk plus milk formulas) was not associated with AD. Consistently, the introduction of a high number of different solid foods reduced the risk of AD (P trend = 0.02 at 4 months of age and P trend = 0.04 at 5 months).

CONCLUSION

Our data provide evidence against the preventing role of prolonged exclusive (but not partial) breastfeeding in AD occurrence and confirm recent results indicating a beneficial role of early weaning in AD.

Introduction of complementary feeding before 4months of age increases the risk of childhood overweight or obesity: a meta-analysis of prospective cohort studies

The association between the age at introduction of complementary feeding and the risk of overweight or obesity during childhood has been hotly debated, but the result remains uncertain. This meta-analysis of prospective cohort studies attempted to evaluate this association, as well as provide evidence for infant feeding recommendations. The PubMed, Embase, and Cochrane databases were systematically searched for relevant original articles published prior to March 1, 2015 that met predefined inclusion criteria. The pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using fix-effect or random-effect models, which were chosen based on heterogeneity among studies. Ten articles consisting of 13 studies, where 8 measured being overweight as an outcome and 5 measured being obese, were included in this meta-analysis. There were a total of 63,605 participants and 11,900 incident cases in the overweight studies, and 56,136 individuals and 3246 incident cases in the obese studies. The pooled results revealed that introducing complementary foods before 4months of age compared to at 4 to 6months was associated with an increased risk of being overweight (RR, 1.18; 95% CI, 1.06-1.31) or obese (RR, 1.33; 95% CI, 1.07-1.64) during childhood. No significant relationship was observed between delaying introduction of complementary foods after 6months of age, and being overweight (RR, 1.01; 95% CI, 0.90-1.13) or obese (RR, 1.02; 95% CI, 0.91-1.14) during childhood. The results of this study suggest that the introduction of complementary foods to infants before 4months of age should be avoided to protect against childhood obesity.

Effects on childhood body habitus of feeding large volumes of cow or formula milk compared with breastfeeding in the latter part of infancy

BACKGROUND

There is controversy over whether a lack of breastfeeding is related to obesity development.

OBJECTIVE

We examined the effects of feeding different types of milk in late infancy on childhood growth.

DESIGN

A cohort of 1112 term, singleton children (born in 1992) from the Avon Longitudinal Study of Parents and Children, United Kingdom, were studied prospectively. Food records collected at 8 mo of age were used to define the following 5 mutually exclusive feeding groups on the basis of the type and amount of milk consumed: breast milk (BM), <600 mL formula milk/d (FMlow), ≥600 mL formula milk/d (FMhigh), <600 mL cow milk/d (CMlow), and ≥600 mL cow milk/d (CMhigh). Weight, height, and BMI were measured at 14 time points from birth to 10 y of age, and SD scores (SDSs) were calculated. Dietary energy and macronutrient intakes were available at 7 time points.

RESULTS

CMhigh children were heavier than were BM children from 8 mo to 10 y of age with weight differences (after adjustment for maternal education, smoking, and parity) ≥0.27 SDSs and an average of 0.48 SDSs. The maximum weight difference was at 18 mo of age (0.70 SDS; 95% CI: 0.41, 1.00 SDS; P = <0.0001). CMhigh children were taller at some ages (25-43 mo; P < 0.01) and had greater BMI SDSs from ≥8 mo of age (at 9 y of age; P = 0.001). FMhigh children were heavier and taller than were BM children from 8 to 37 mo of age. There were marked dietary differences between milk groups at 8 mo of age, some of which persisted to 18 mo of age. Adjustments for current energy and protein intakes did not attenuate the growth differences observed.

CONCLUSIONS

The feeding of high volumes of cow milk in late infancy is associated with faster weight and height gain than is BM feeding. The feeding of bottle-fed infants with high volumes of cow milk in late infancy may have a persisting effect on body habitus through childhood.

Age of introduction of first complementary feeding for infants: a systematic review

Background

Despite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.

Methods

An electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.

Results

Three RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.

Conclusions

RCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

Age at Weaning and Infant Growth: Primary Analysis and Systematic Review

OBJECTIVE

To test whether earlier age at weaning (age 3-6 months) may promote faster growth during infancy.

STUDY DESIGN

Weaning at age 3.0-7.0 months was reported by 571 mothers of term singletons in a prospective birth cohort study conducted in Cambridge, UK. Infant weight and length were measured at birth and at age 3 months and 12 months. Anthropometric values were transformed into age- and sex-adjusted z-scores. Three linear regression models were performed, including adjustment for confounders in a stepwise manner. Measurements at age 3 months, before weaning, were used to consider reverse causality.

RESULTS

Almost three-quarters (72.9%) of infants were weaned before age 6 months. Age at weaning of 3.0-7.0 months was inversely associated with weight and length (but not with body mass index) at 12 months (both P ≤ .01, adjusted for maternal and demographic factors). These associations were attenuated after adjustment for type of milk feeding and weight or length at age 3 months (before weaning). Rapid weight gain between 0 and 3 months predicted subsequent earlier age at weaning (P = .01). Our systematic review identified 2 trials, both reporting null effects of age at weaning on growth, and 15 observational studies, with 10 reporting an inverse association between age at weaning and infant growth and 4 reporting evidence of reverse causality.

CONCLUSION

In high-income countries, weaning between 3 and 6 months appears to have a neutral effect on infant growth. Inverse associations are likely related to reverse causality.

Indicators of dietary patterns in Danish infants at 9 months of age

Background

It is important to increase the awareness of indicators associated with adverse infant dietary patterns to be able to prevent or to improve dietary patterns early on.

Objective

The aim of this study was to investigate the association between a wide range of possible family and child indicators and adherence to dietary patterns for infants aged 9 months.

Design

The two dietary patterns ‘Family Food’ and ‘Health-Conscious Food’ were displayed by principal component analysis, and associations with possible indicators were analysed by multiple linear regressions in a pooled sample (n=374) of two comparable observational cohorts, SKOT I and SKOT II. These cohorts comprised infants with mainly non-obese mothers versus infants with obese mothers, respectively.

Results

A lower Family Food score indicates a higher intake of liquid baby food, as this pattern shows transition from baby food towards the family's food. Infants, who were younger at diet registration and had higher body mass index (BMI) z-scores at 9 months, had lower Family Food pattern scores. A lower Family Food pattern score was also observed for infants with immigrant/descendant parents, parents who shared cooking responsibilities and fathers in the labour market compared to being a student, A lower Health-Conscious Food pattern score indicates a less healthy diet. A lower infant Health-Conscious Food pattern score was associated with a higher maternal BMI, a greater number of children in the household, a higher BMI z-score at 9 months, and a higher infant age at diet registration.

Conclusions

Associations between infant dietary patterns and maternal, paternal, household, and child characteristics were identified. This may improve the possibility of identifying infants with an increased risk of developing unfavourable dietary patterns and potentially enable an early targeted preventive support.

The timing of solid introduction in an 'obesogenic' environment: a narrative review of the evidence and methodological issues

OBJECTIVE

To evaluate the evidence for association between obesity risk outcomes >12 months of age and timing of solid introduction in healthy term infants in developed countries, the large majority of whom are not exclusively breastfed to six months of age.

METHODS

Studies included were published 1990 to March 2013.

RESULTS

Twenty-six papers with weight status or obesity prevalence outcomes were identified. Studies were predominantly cohort design, most with important methodological limitations. Ten studies reported a positive association. Of these, only two were large, good-quality studies and both examined the outcome of early (<4 months) introduction of solids. None of the four good-quality studies that directly evaluated current guidelines provided evidence of any clinically relevant protective effect of solid introduction from 4-5 versus ≥6 months of age.

CONCLUSION

The introduction of solids prior to 4 months of age may result in increased risk of childhood obesity but there is little evidence of adverse weight status outcomes associated with introducing solids at 4-6 rather than at six months.

IMPLICATIONS

More and better quality evidence is required to inform guidelines on the 'when, what and how' of complementary feeding.

Timing of complementary feeding and the risk of atopic eczema

AIM

To find out whether there was an association between when complementary feeding was introduced and the appearance of atopic eczema in children with a family history of allergy.

METHODS

This prospective study followed 256 mother and child pairs until the child was four-years-old. Repeated skin prick testing was performed and a clinical diagnosis of eczema made by a physician. The mothers kept a continuous diary about the introduction of complementary feeding. To control the possible reverse causation of delaying complementary food introduction due to presumed child allergy, parental suspicions of allergic reactions were recorded.

RESULTS

The introduction of cereals and fish after seven-months-of-age was associated with an increased risk of atopic eczema. However, when the parents' suspicions that their child might be exhibiting symptoms of allergic disease were taken into account, this effect was no longer significant.

CONCLUSION

We found no evidence that the timing of the introduction of complementary feeding increased the risk of atopic eczema in a high-risk cohort, when parental suspicions were taken into account. Therefore, it seems that families with a history of allergy can safely comply with current feeding recommendations, although confirmation in further studies is warranted.

Diaper dermatitis: a survey of risk factors for children aged 1-24 months in China

OBJECTIVES

To measure the prevalence of diaper dermatitis and identify risk factors relating to diaper dermatitis in Chinese children aged 1-24 months.

METHODS

This was a cross-sectional study that used structured questionnaires during face-to-face interviews with parents to determine the risk factors associated with diaper dermatitis. Univariate and multivariate logistic regression analyses were used to test the association between diaper dermatitis and 15 potential risk factors.

RESULTS

A total of 43.8% (454/1036) of infants in the study had experienced diaper dermatitis in the 6 weeks prior to enrolment. Multivariate logistic regression analyses showed that the risk of diaper dermatitis was significantly decreased by solid foods (eggs), home location (urban) and frequency of diaper changing (≥ 6 changes/day), whereas the risk was increased by diarrhoea.

CONCLUSIONS

Diarrhoea was a major risk factor for diaper dermatitis. Confirmation of the risk factors could lead to better understanding of the aetiology of diaper dermatitis and to new prevention strategies in Chinese infants.

Timing of solid food introduction and obesity: Hong Kong's "children of 1997" birth cohort

BACKGROUND

Some observational studies in Western settings show that early introduction of solid food is associated with subsequent obesity. However, introduction of solid food and obesity share social patterning. We examined the association of the timing of the introduction of solid food with BMI and overweight (including obesity) into adolescence in a developed non-Western setting, in which childhood obesity is less clearly socially patterned.

METHODS

We used generalized estimating equation models to estimate the adjusted associations of the timing of the introduction of solid food (<3, 3-4, 5-6, 7-8, and >8 months) with BMI z score and overweight (including obesity) at different growth phases (infancy, childhood, and puberty) in 7809 children (88% follow-up) from a Chinese birth cohort, "Children of 1997." We assessed if the associations varied with gender or breastfeeding. We used multiple imputation for missing exposure and confounders.

RESULTS

The introduction of solid food at <3 months of age was associated with lower family socioeconomic position (SEP) but was not clearly associated with BMI or overweight (including obesity) in infancy [mean difference in BMI z score: 0.01; 95% confidence interval (CI): -0.14 to 0.17], childhood (0.14; 95% CI: -0.11 to 0.40), or at puberty (0.22; 95% CI: -0.07 to 0.52), adjusted for SEP and infant and maternal characteristics.

CONCLUSIONS

In a non-Western developed setting, there was no clear association of the early introduction of solid food with childhood obesity. Together with the inconsistent evidence from studies in Western settings, this finding suggests that any observed associations might simply be residual confounding by SEP.

Does early feeding promote development of oral tolerance?

The prevalence of food allergy has continued to rise over the last 10-15 years, with building concern over the underlying causes and the best strategies to reverse this. Although it is still not clear if infant feeding practices play any significant role in either the aetiology of this epidemic or in its prevention, these have nonetheless been core to many previous prevention strategies. Early 'allergen avoidance' strategies have not only failed, but have instead been increasingly associated with increased risk of allergic disease. Together with other observations in humans and animals, this suggests that earlier introduction of allergenic foods may be a more logical preventive strategy. Based on this, there are several randomised controlled trials world-wide assessing the merits of early introduction of complementary feeding and/or allergenic foods. Until the results of these studies are available it is difficult to provide definitive recommendations regarding the role of early feeding in the induction of oral tolerance and prevention of food allergy.

Impact of nutrition since early life on cardiovascular prevention

The cardiovascular disease represents the leading cause of morbidity and mortality in Western countries and it is related to the atherosclerotic process. Cardiovascular disease risk factors, such as dyslipidemia, hypertension, insulin resistance, obesity, accelerate the atherosclerotic process which begins in childhood and progresses throughout the life span. The cardiovascular disease risk factor detection and management through prevention delays the atherosclerotic progression towards clinical cardiovascular disease. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role for this topic.

The metabolic and neuroendocrine environment of the fetus is fundamental in the body’s “metabolic programming”. Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins and carbohydrates) is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood.

The purpose of this review is to examine the impact of nutrition since early life on disease.

La malattia cardiovascolare rappresenta la principale causa di morbilità e mortalità dei paesi occidentali ed è correlata a degenerazione vascolare aterosclerotica. I fattori di rischio cardiovascolari quali dislipidemia, ipertensione, insulino resistenza e obesità accelerano tale processo il cui esordio è noto sin dell’età pediatrica ed evolve nel corso della vita. L’individuazione e la cura dei fattori di rischio cardiovascolari mediante la prevenzione dei fattori causali ritardano la progressione dell’aterosclerosi e l’insorgenza dei sintomi cardiovascolari. La nutrizione svolge un ruolo preventivo fondamentale sin dall’epoca prenatale e nelle diverse età della crescita.

La condizione metabolica e neuro-endocrino cui è sottoposto il feto è rilevante per la “programmazione metabolica”. E’ dimostrata inoltre l’importanza delle modalità di allattamento e divezzamento con particolare interesse per l’assunzione di proteine nel controllo dei fattori di rischio cardiovascolari. La corretta distribuzione di macronutrienti (lipidi, proteine e carboidrati) dall’infanzia all’adolescenza favorisce una crescita corretta e risulta utile a prevenire l’insorgenza dei determinanti di rischio di malattia cardiovascolare in età adulta.

Nella presente review verrà esaminato l’impatto della nutrizione dalle più precoci fasi delle vita sul rischio cardiovascolare.

Relationship between breastfeeding and obesity in childhood

A cross-sectional study was conducted to investigate the weight status and the relationship of infant-feeding variables, birthweight and birth order with BMI in a group of Iranian children. Five hundred and eleven students of both sexes at the first grade in elementary schools (aged 7 years) were recruited randomly from all 19 educational districts of Tehran. Weights and heights of children and their mothers were measured. Data on breastfeeding (BF), formula-feeding, the timing of introduction of complementary foods (CF), birthweight, and birth order were collected from the mothers. The 2007 WHO reference value was used for determining child's weight status. Regression analysis in single and a 2-level linear regression models was used for examining the independent relationships of infant-feeding variables, birthweight and birth order with childhood BMI. The prevalence of underweight and overweight in this group of children was 7.6% and 19.7%, respectively. Total time of BF and duration of exclusive BF were not associated with childhood BMI. The timing of introduction of CF was inversely related to childhood BMI after controlling for other variables (beta:-0.34; 95% CI:-0.58,-0.10). Children with an early introduction of CF had significantly higher mean BMI (p for linear trend=0.012). Birth order and birthweight were related to childhood BMI significantly. These data suggest that overweight and obesity are nutritional problems among 7 years old Teharani children. The timing of introduction of CF, birth order, and birthweight were independent predictors of childhood BMI. Neither total time of BF nor duration of exclusive breastfeeding was associated with adiposity in children.

Infant nutrition and later health: a review of current evidence

There is a growing recognition of the need for a lifecourse approach to understanding the aetiology of adult disease, and there is now significant evidence that links patterns of infant feeding to differences in health outcomes, both in the short and longer term. Breastfeeding is associated with lower rates of infection in infancy; in high-income populations, it is associated with reductions in blood pressure and total blood cholesterol, and lower risks of obesity and diabetes in adult life. Breastfeeding rates are suboptimal in many countries, and strategies to promote breastfeeding could therefore confer important benefits for health at a population level. However, there are particular challenges in defining nutritional exposures in infancy, including marked social gradients in initiation and duration of breastfeeding. In recent studies of low and middle-income populations of children and young adults, where the influences on infant feeding practice differ, beneficial effects of breastfeeding on blood pressure, BMI and risk of diabetes have not been confirmed, and further information is needed. Little is currently known about the long-term consequences of differences in the timing and nature of the weaning diet. Future progress will depend on new studies that provide detailed prospective data on duration and exclusivity of breastfeeding together with appropriate characterisation of the weaning diet.

Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions

Childhood obesity is currently one of the most prevailing and challenging public health issues among industrialized countries and of international priority. The global prevalence of obesity poses such a serious concern that the World Health Organization (WHO) has described it as a "global epidemic." Recent literature suggests that the genesis of the problem occurs in the first years of life as feeding patterns, dietary habits, and parental feeding practices are established. Obesity prevention evidence points to specific dietary factors, such as the promotion of breastfeeding and appropriate introduction of nutritious complementary foods, but also calls for attention to parental feeding practices, awareness of appropriate responses to infant hunger and satiety cues, physical activity/inactivity behaviors, infant sleep duration, and family meals. Interventions that begin at birth, targeting multiple factors related to healthy growth, have not been adequately studied. Due to the overwhelming importance and global significance of excess weight within pediatric populations, this narrative review was undertaken to summarize factors associated with overweight and obesity among infants and toddlers, with focus on potentially modifiable risk factors beginning at birth, and to address the need for early intervention prevention.

Weight change before and after the introduction of solids: results from a longitudinal birth cohort

We studied the association, and its direction, between the introduction of solids and weight-for-height (WFH) change between birth and 45 months. Pregnant women were asked to participate in a birth cohort during their first antenatal visit. Data from 3184 children were used. The timing of the introduction of solids was reported by the mother from a questionnaire at 12 months postpartum, and categorised into very early (0-3 months), early (3-6 months) and timely (after 6 months) introduction of solids. Anthropometric data were collected during standardised child health centre visits. WFH was converted into a z-score. Repeated-measurements analyses with splines positioned according to the moments of solid introduction were used to obtain estimates for WFH change before and after the introduction of solids. Analyses were adjusted for educational level, ethnicity, smoking during pregnancy, mother's BMI, breast-feeding, history of food allergy and infant's hospital admission. Before solids were introduced, weight gain was higher in children introduced to solids early (z= 0.65, 95 % CI 0.34, 0.95) than in children introduced to solids very early (z= 0.02, 95 % CI -0.03, 0.08) and timely (z= -0.04, 95 % CI -0.05, -0.03). Shortly after the introduction of solids, children introduced to solids very early and early showed a relative decrease in WFH. WFH change did not differ between the solid introduction groups after 12 months, and at that time, weight change was as expected (i.e. z= 0). We therefore conclude that differences in WFH in childhood are not the result of early introduction to solids.

Strategies to prevent or reduce allergic disease

The need for allergy prevention strategies has never been greater. Surging rates of food allergy and eczema are now adding to the already substantial burden of asthma and respiratory allergic diseases. The parallel rise in many other immune diseases suggests that the developing immune system is highly vulnerable to modern environmental changes. These strong environmental pressures may be one reason why simple allergen avoidance strategies have not been successful. Another more recent strategy to curtail the allergy epidemic has been to identify factors associated with modern lifestyle that may be causally linked with allergic disease, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have prompted strategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventive merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate, and vitamin D are also currently under investigation. Modern environmental pollutants have also been associated with adverse effects on immune development and the risk of disease. While many of these avenues have provided some promise, they have not yet translated into specific recommendations. Current evidence-based guidelines for allergy prevention remain limited to avoidance of cigarette smoke, promotion of breastfeeding and the use of hydrolysed formula when breastfeeding is not possible. Allergen avoidance strategies have been largely removed from most guidelines. It is hoped that a number of ongoing studies will help provide clearer recommendations around the use of probiotics, prebiotics, specific dietary nutrients and the role of early introduction of allergenic foods for the promotion of tolerance. Despite the current uncertainties, prevention remains the best long-term strategy to reduce the growing burden of allergic disease.

The introduction of solid food and growth in the first 2 y of life in formula-fed children: analysis of data from a European cohort study

BACKGROUND

Early introduction of solid food has been suspected to induce excessive infant energy intake and weight gain.

OBJECTIVE

The objective of this study was to test whether introduction of solid foods influences energy intake or growth.

DESIGN

Healthy, formula-fed infants who were recruited in 5 European countries were eligible for study participation. Anthropometric measurements were taken at recruitment and at 3, 6, 12, and 24 mo. Time of introduction of solid foods and energy intake were determined by questionnaires and 3-d weighed food records at monthly intervals. Age at introduction of solid food was categorized into 4 groups: ≤ 13 wk, 14-17 wk, 18-21 wk, and ≥ 22 wk.

RESULTS

Of 1090 recruited infants, 830 (76%) had data available for age at first introduction of solid food, and 671 (61%) completed the study until 24 mo of age. The median age at introduction of solid food was 19 wk. The time of introduction of solid foods was associated with country, sex, birth weight, parental education and marital status, and maternal smoking. Energy intake was higher in the first 8 mo of life in children with solid-food intake. Solid-food introduction did not predict anthropometric measures at 24 mo. Growth trajectories differed significantly: children with solid-food introduction in the first 12 wk experienced early catch-up growth, whereas those introduced to solid food at >22 wk of age grew more slowly and stayed on lower trajectories.

CONCLUSIONS

Solid foods do not simply replace infant formula but increase energy intake. Time of introduction of solid food has little influence on infant growth. This trial was registered at clinicaltrials.gov as NCT00338689.

Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

BACKGROUND

Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease.

OBJECTIVES

To investigate whether exclusive breastfeeding protects against childhood eczema.

METHODS

Study subjects comprised 51,119 randomly selected 8- to 12-year-old schoolchildren in 21 countries. Information on eczema and breastfeeding was gathered by parental questionnaire. Children were also examined for flexural eczema and underwent skin prick testing. Odds ratios (ORs) were calculated for each study centre and then pooled across populations.

RESULTS

There was a small increase in the risk of reported 'eczema ever' in association with 'breastfeeding ever' and breastfeeding < 6 months [pooled adjusted OR 1·11, 95% confidence interval (CI) 1·00-1·22 and OR 1·10, 95% CI 1·02-1·20, respectively]. There was no significant association between reported 'eczema ever' and breastfeeding > 6 months (pooled adjusted OR 1·09, 95% CI 0·94-1·26). Risk estimates were very similar for exclusive breastfeeding < 2 months, 2-4 months and > 4 months and for eczema symptoms in the past 12 months and eczema on skin examination. As for more severe eczema, breastfeeding per se conveyed a risk reduction on sleep disturbed eczema (pooled adjusted OR 0·71, 95% CI 0·53-0·96), but this effect was lost where children had been exclusively breastfed for > 4 months (pooled adjusted OR 1·02, 95% CI 0·67-1·54). Allergic sensitization and a history of maternal allergic disease did not modify any of these findings.

CONCLUSIONS

Although there was a protective effect of ever having been breastfed on more severe disease, we found no evidence that exclusive breastfeeding for 4 months or longer protects against eczema. Our results are consistent with findings from a recent systematic review of prospective studies. The U.K. breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.

Recent perspectives on the global epidemiology of childhood eczema

The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest epidemiological study ever performed and the only truly global allergy study. This review summarises the childhood eczema-related findings from ISAAC and discusses how these fit into our current understanding of eczema aetiology, with particular emphasis on worldwide time trends in eczema prevalence, climatic and dietary risk factors, breastfeeding, the role of skin barrier impairment and allergic sensitisation.

Timing of solid food introduction and risk of obesity in preschool-aged children

OBJECTIVE

To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.

METHODS

We studied 847 children in Project Viva, a prospective pre-birth cohort study. The primary outcome was obesity at 3 years of age (BMI for age and gender ≥ 95th percentile). The primary exposure was the timing of introduction of solid foods, categorized as <4, 4 to 5, and ≥ 6 months. We ran separate logistic regression models for infants who were breastfed for at least 4 months ("breastfed") and infants who were never breastfed or stopped breastfeeding before the age of four months ("formula-fed"), adjusting for child and maternal characteristics, which included change in weight-for-age z score from 0 to 4 months-a marker of early infant growth.

RESULTS

In the first 4 months of life, 568 infants (67%) were breastfed and 279 (32%) were formula-fed. At age 3 years, 75 children (9%) were obese. Among breastfed infants, the timing of solid food introduction was not associated with odds of obesity (odds ratio: 1.1 [95% confidence interval: 0.3-4.4]). Among formula-fed infants, introduction of solid foods before 4 months was associated with a sixfold increase in odds of obesity at age 3 years; the association was not explained by rapid early growth (odds ratio after adjustment: 6.3 [95% confidence interval: 2.3-6.9]).

CONCLUSIONS

Among formula-fed infants or infants weaned before the age of 4 months, introduction of solid foods before the age of 4 months was associated with increased odds of obesity at age 3 years.

Infant weaning and community pharmacy — the pharmacist's perspective

Community pharmacists' awareness of the COMA report on “Weaning and the weaning diet” and their knowledge of its recommendations was assessed in a questionnaire distributed to all (n=81) community pharmacists in the Western Health and Social Services Board in Northern Ireland. Sources of information and adequacy of training on childhood nutritional issues were determined. A knowledge score was computed for each pharmacist depending on their responses to questions based on key issues in the COMA report. Completed questionnaires were returned by 48 pharmacists (59 per cent). The COMA report had been read by 14.5 per cent of respondents while 12.5 per cent knew of its recommendations. Others had heard of it but not read it (52 per cent) or had never heard of it (21 per cent). The mean knowledge score was 66 per cent (±17.5). Scores ranged from 18 per cent to 90 per cent, indicating wide variability in pharmacists' knowledge of key recommendations for weaning. Only 29 per cent of pharmacists felt that they were adequately trained to give advice on weaning; 50 per cent felt that they did not have sufficient knowledge and 21 per cent were unsure. Pharmacists indicated that, on average, parents approached them weekly about a weaning topic, which emphasises the need for them to be well informed about current weaning recommendations.

Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review

Determining early-life risk factors for obesity in later life is essential in order to effectively target preventative interventions to reduce obesity. The aim of this systematic review was to investigate current evidence to determine whether the timing of introducing solid foods is associated with obesity in infancy and childhood. Relevant randomized and observational studies from developed countries were identified by searching the following six bio-medical databases (Medline, Embase, British Nursing Index, CINAHL, Maternity and Infant Care, and PsycINFO) and hand-searching reference lists. Studies of pre-term or low birthweight infants were excluded. Twenty-four studies met the inclusion criteria for the systematic review. Data from over 34,000 participants were available for interpretative analysis. No clear association between the age of introduction of solid foods and obesity was found. It is likely that a whole family approach to obesity prevention will be most effective and health professionals should continue to promote healthy infant feeding in line with national recommendations.

Factors associated with weaning practices in term infants: a prospective observational study in Ireland

The WHO (2001) recommends exclusive breast-feeding and delaying the introduction of solid foods to an infant's diet until 6 months postpartum. However, in many countries, this recommendation is followed by few mothers, and earlier weaning onto solids is a commonly reported global practice. Therefore, this prospective, observational study aimed to assess compliance with the WHO recommendation and examine weaning practices, including the timing of weaning of infants, and to investigate the factors that predict weaning at ≤ 12 weeks. From an initial sample of 539 pregnant women recruited from the Coombe Women and Infants University Hospital, Dublin, 401 eligible mothers were followed up at 6 weeks and 6 months postpartum. Quantitative data were obtained on mothers’ weaning practices using semi-structured questionnaires and a short dietary history of the infant's usual diet at 6 months. Only one mother (0·2 %) complied with the WHO recommendation to exclusively breastfeed up to 6 months. Ninety-one (22·6 %) infants were prematurely weaned onto solids at ≤ 12 weeks with predictive factors after adjustment, including mothers’ antenatal reporting that infants should be weaned onto solids at ≤ 12 weeks, formula feeding at 12 weeks and mothers’ reporting of the maternal grandmother as the principal source of advice on infant feeding. Mothers who weaned their infants at ≤ 12 weeks were more likely to engage in other sub-optimal weaning practices, including the addition of non-recommended condiments to their infants’ foods. Provision of professional advice and exploring antenatal maternal misperceptions are potential areas for targeted interventions to improve compliance with the recommended weaning practices.

Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight

BACKGROUND

Early nutrition may affect the risk of overweight in later life.

OBJECTIVE

The objective was to explore the effect of the duration of breastfeeding (BF) and age at introduction of complementary feeding (CF) on body mass index (BMI) during childhood through adulthood.

DESIGN

The study was based on a subsample of the Copenhagen Perinatal Cohort established in 1959-1961 (n = 5068). Information on BF and available information on CF (age of introduction of "spoon-feeding," "vegetables," "egg," "meat," and "firm food") and several covariates were collected in infancy and linked with information on BMI from follow-up examinations in childhood and adulthood at age 42 y.

RESULTS

The median (10th, 90th percentiles) durations of any BF and age at introduction of spoon-feeding were 2.50 (0.23, 6.50) and 3.50 (2.00, 6.00) mo, respectively. After 1 y of age and throughout childhood and adolescence, no association between BF and BMI was found in regression models also adjusted for age at introduction of spoon-feeding and covariates. The risk of overweight at age 42 y decreased or tended to decrease with increasing age (in mo) at introduction of spoon-feeding [odds ratio (OR): 0.94; 95% CI: 0.86, 1.02], vegetables (OR: 0.90; 95% CI: 0.81, 0.98), meat (OR: 0.93; 95% CI: 0.87, 1.00), and firm food (OR: 0.92; 95% CI: 0.86, 0.98) but not egg (OR: 0.98; 95% CI: 0.91, 1.05).

CONCLUSION

The findings of this study suggest that introduction of CF at a later age (within the range of 2 to 6 mo) is protective against overweight in adulthood but do not support a protective effect of a longer duration of BF.

Early exposure to solid foods and the development of eczema in children up to 4 years of age

Early exposure to solid foods in infancy has been associated with the development of allergic diseases. However, scientific evidence for this is conflicting. The aim of this study was to examine the association between early exposure to solid foods in the infant's diet and the development of eczema up to 4 years of age. We conducted an etiologic case-control study nested in the PIPO cohort (Prospective Cohort on the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies). In this cohort data on nutrition, environmental exposures and parent-reported eczema were collected prospectively starting from 5 months pregnancy by means of questionnaires administered during two home visits and semi-annual postal questionnaires. In addition, detailed information on the timing of introduction of solid foods at individual food item level was collected at 1 year of age. Adjusted odds ratios and 95% confidence intervals were computed using logistic regression analysis as a measure of association between eczema and the timing of exposure to solid foods. Early introduction (within the first 4 months) of solid foods was inversely associated with eczema up to 4 years of age (adj OR: 0.49; 95% CI: 0.32-0.74). Moreover, we found that early exposure to solid foods was associated with a reduced risk for eczema only among children with allergic parents (adj OR: 0.35; 95% CI: 0.20-0.63), whereas no significant effect was found among children with non-allergic parents (adj OR: 0.69; 95% CI: 0.37-1.29). The results of this study show that early exposure to solid foods is associated with less parent-reported eczema in children, particularly among children with allergic parents. Therefore, the current study does not support a delayed introduction of solid foods for the prevention of eczema in childhood.

Prevention of overweight and obesity in children under the age of 6 years

Although obesity was rarely observed among children 30 years ago, it is now evident among Canadian children of all ages. Currently, 15.2% of 2- to 5-year-old children are overweight, whereas 6.3% are obese. Limited data suggest that poor dietary and physical activity patterns are increasing obesity risk among these young children. Body weight and lifestyle behaviours are known to track from childhood to adulthood, thereby increasing the risk for obesity and other chronic diseases later in life. Intrauterine life, infancy, and the preschool years may all include critical periods that program the long-term regulation of energy balance, and therefore obesity-prevention strategies should be initiated in utero and continue throughout childhood and adolescence. Although single-strategy obesity-prevention initiatives have had limited success, programs that target multiple behaviours may help reduce body weight and body fat among young children. Parental involvement is key to the success of obesity-prevention programs at a young age, as parents have primary control over their children's food and activity environments. Accordingly, parental obesity is the best predictor of childhood obesity. Parents should be encouraged to teach and role model healthy lifestyle behaviours for their young children. Health professionals can also be involved in obesity prevention, as they are ideally placed to identify young children at risk for obesity. By calculating and plotting the body mass index for all children, and initiating obesity-prevention strategies in utero, health professionals can help curb the rise in overweight and obesity among young children.

Health consequences of nutrition in childhood and early infancy

Medical and scientific studies have proven that the body's metabolic programming can be influenced by diet and nutrition from early infancy. As a result, the incidence and outcome of several metabolic diseases such as obesity, hypertension and cardiovascular disorders have been found to be associated with birth weight, growth and feeding patterns, and the body composition in early childhood. Exclusive or partial breast feeding for at least 6 months is recommended by the World Health Organization, while the European Society of Pediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition recommends the introduction of complementary foods at 4-6 months of age. The fat content of the diet should not be below 25% of the energy intake in order to maintain ideal growth while dietary proteins above 15% of the energy intake is related to future obesity. Long term benefits of breast feeding include a more ideal serum lipid profile and blood pressure, improved neuro-cognitive scores, and a decreased incidence for atopic dermatitis in children who have family members with atopic diseases. Several studies have also acknowledged the long term benefits for neuro-cognitive development from certain nutrients including long-chain polyunstaturated fatty acids and docosahexaenoic acid. Meat intake has proved to be beneficial to psychomotor development. It is suggested that early introduction for complementary foods before 4 months of age is a risk factor for atopic dermatitis; while no strong evidence showed delaying weaning foods can decrease the risk for allergic diseases.

Sources and acceptance of infant-feeding advice among low-income women

The purpose of this study is to identify sources and acceptability of infant-feeding advice among participants in the US-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups are used to identify sources of infant-feeding advice and factors that contribute to acceptance of or resistance to that advice among 65 WICeligible mothers (34 English speaking and 31 Spanish speaking). The mothers primarily rely on experienced family and friends for advice and frequently use their own intuition to find solutions that work to solve real or perceived infant-feeding problems. Professional advice is perceived as credible when caregivers exhibit characteristics similar to those of experienced family and friends: confidence, empathy, respect, and calm. Using this information, it may be possible for WIC staff to make programmatic modifications to increase their ability to promote optimal infant-feeding behaviors in this population, thereby contributing to the reduction in the prevalence of childhood overweight.