Abstract
BackgroundIn term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity. Therefore, timely introduction of complementary feeding during infancy is necessary. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. However, these guidelines cannot be directly translated to preterm infants. Recent literature looking at the introduction of complementary feeding in preterm infants gives contrasting information. Given these contrasting reports on the introduction of solid foods in premature born infants, a systematic review is needed. The primary objective of this study is to analyze the effect of the time starting complementary feeding on overweight (including obesity) in preterm infants.MethodsAn electronic systematic literature search with pre-defined terms will be conducted in Cochrane, PubMed, EMBASE, Web of Science, Scopus, and CINAHL. There will be no restriction for time period. Primarily, data from randomized controlled trials (RCTs) will be included in this systematic review. Search terms will include preterm infants, complementary feeding, overweight, and their synonyms. Article selection, including risk of bias assessment, will be performed by three reviewers independently. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. The consistency of results across the studies will influence the decision whether or not to combine results in a meta-analysis. Studies that cannot be included in the meta-analysis will be described in a narrative analysis.DiscussionThis systematic review will give an overview of the existing knowledge on the timing of complementary feeding in preterm infants and the effect on overweight. It will form a basis for future guidelines for complementary feeding for preterm infants.Systematic review registrationPROSPERO CRD42015014215Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0324-3) contains supplementary material, which is available to authorized users.
Highlights
In term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity
Complementary feeding is defined as the introduction of non-(breast)milk foods or nutritive liquids when milk alone is no longer sufficient to meet all nutritional requirements of infants
In healthy term-born infants living in Europe, the recommendations for the age at which complementary feeding should be introduced are based on considerations on the optimal duration of exclusive breastfeeding
Summary
There is evidence that early complementary feeding is a risk factor for childhood obesity. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. These guidelines cannot be directly translated to preterm infants. The WHO recommends mothers worldwide to exclusively breastfeed infants for the child’s first 6 months to achieve optimal growth, development, and health Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond [3,4,5]. The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Committee recommended that the introduction of complementary feeding should not be before 17 weeks but should not be delayed beyond 26 weeks of age, acknowledging exclusive or full breastfeeding until 6 months as a desirable goal [6]
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