Timing of Complementary Feeding, Growth, and Risk of Non-Communicable Diseases: Systematic Review and Meta-Analysis.

Maria Carmen Verga,Lucia Leonardi,Marcello Bergamini,Giuseppe Di Mauro,Andrea Vania,Vito Leonardo Miniello,Margherita Caroli,Filomena Palma,Iride Dello Iacono,Giuseppe D’Antonio,Immacolata Scotese,Barbara Cuomo,Giovanna Tezza,Giovanni Simeone

doi:10.3390/nu14030702

Abstract

No consensus currently exists on the appropriate age for the introduction of complementary feeding (CF). In this paper, a systematic review is conducted that investigates the effects of starting CF in breastfed and formula-fed infants at 4, 4–6, or 6 months of age (i) on growth at 12 months of age, (ii) on the development of overweight/obesity at 3–6 years of age, (iii) on iron status, and (iv) on the risk of developing (later in life) type 2 diabetes mellitus (DM2) and hypertension. An extensive literature search identified seven studies that evaluated the effects of the introduction of CF at the ages in question. No statistically significant differences related to the age at which CF is started were observed in breastfed or formula-fed infants in terms of the following: iron status, weight, length, and body mass index Z-scores (zBMI) at 12 months, and development of overweight/obesity at 3 years. No studies were found specifically focused on the age range for CF introduction and risk of DM2 and hypertension. Introducing CF before 6 months in healthy term-born infants living in developed countries is essentially useless, as human milk (HM) and formulas are nutritionally adequate up to 6 months of age.

Highlights

The European Commission formally requested the European Food Safety Authority (EFSA) Panel on Nutrition, Novel Foods and Food Allergens (NDA) to update its 2009 recommendations on the appropriate age for the introduction of complementary feeding (CF) to define whether the wording “from four months”, already displayed on baby food products according to European directives, should be changed to “from six months” according to the latest World Health Organization (WHO) recommendations
The meta-analyses are shown in Supplementary File S4, whereas the evaluation of the overall quality of evidence is given in Tables 1 and 2 and in Supplementary File S5
It has to be very clear that introducing complementary foods before 6 months in healthy term infants exclusive breastfeeding (EBF) and exclusive formula feeding (EFF) living in developed countries does not present any advantages

Summary

Introduction

Over the past two decades, our growing understanding of the nutritional, immunological, and neurodevelopmental benefits of breastfeeding has led many national and international associations and scientific societies to revise their recommendations on the age at which complementary feeding (CF) should be added to the diet of healthy infants.The World Health Organization (WHO), which considers exclusive breastfeeding (EBF) crucial for nutritional considerations, and as a public health issue, has changed its previous recommendation on EBF for 4–6 months to recommend it for the first 6 months of life, and up to 2 years of age or more, with the addition of nutritionally appropriate and safe complementary foods [1].Later on, the European Commission formally requested the European Food Safety Authority (EFSA) Panel on Nutrition, Novel Foods and Food Allergens (NDA) to update its 2009 recommendations on the appropriate age for the introduction of CF to define whether the wording “from four months”, already displayed on baby food products according to European directives, should be changed to “from six months” according to the latest WHO recommendations. To date, several factors (personal, socio-economic, cultural, and related to healthcare services) still influence the decision to replace/supplement human milk (HM) with formula or complementary foods at an early stage [3]. Among these factors, the following elements are likely to play a role:. CF at 4–6 months) than (introduction CF at 6 months) in order to develop overweight/obesity at 3–6 years. Patient or population: Development of overweight/obesity at 3–6 years Setting: Outpatient Intervention: (Introduction CF at 4–6 months) Comparator: (Introduction CF at 6 months)

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