Timing Of Complementary Food Introduction Research Articles

Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review.

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics.

Effects of timing of complementary food introduction on childhood food allergy development: A modified role of ambient air pollution exposure

BackgroundFood allergy increased in the recent years causing heavy disease burden worldwide, yet the unique factors for the second-wave allergy epidemic since a rise of allergic diseases are unclear. ObjectiveTo examine the impact of introduction timing of complementary foods on childhood food allergy and whether ambient air pollution modify this association. MethodsA retrospective cohort study of 2,598 preschoolers was conducted at 36 kindergartens at Changsha of China during 2011–2012. A standard questionnaire was developed to survey each preschooler's introduction timing of complementary foods, food allergy, and home environments. Each subject's exposure to ambient air pollutants including PM10, SO2, and NO2 was estimated for pregnancy and postnatal period. Association between food allergy and introduction timing of complementary foods as well as its modification by ambient pollution were evaluated by multiple logistic regression model. ResultsChildhood total food allergy (14.6%) was significantly positively associated with early introduction to fruit or vegetable before 3 months with OR = 1.97 (1.25–3.11), especially for egg and milk allergies. Food allergy was also significantly associated with NO2 exposure in pregnancy especially during the 1st trimester with ORs (95% CI) = 1.24 (1.00–1.54) and 1.27 (1.03–1.58) and postnatal period with OR of 1.30 (1.01–1.66) respectively for per IQR increase in their exposure. We observed that living near traffic-main road and other areas significantly increased food allergy risk of early introduction of fruit and vegetable. We further detected that early introduction of milk powder or porridge significantly decreased the risk of food allergy at the condition of light outdoor air pollution exposure during postnatal period. Sensitivity analysis showed that children living at urban area, male sex, younger age, and having breast-feeding were more susceptible to the effect of early introduction of fruit and vegetable on food allergy. ConclusionOur study indicates that the role of introduction timing of complementary foods on food allergy could be adjusted by air pollution exposure level, which may partly explain the second-wave allergy epidemic and provide a potential preventive strategy.

Гигиенические аспекты безопасности пищевых продуктов для питания детей первого года жизни

Objective. To conduct a hygienic assessment of chemical contamination of food products for infant nutrition. Materials and methods. Analysis of databases on the content of toxic elements (lead, cadmium, mercury, arsenic) in food products for infant nutrition and the infant morbidity rate according to the materials of social and hygienic monitoring in the Russian Federation was performed. The structure of nutrition for infants was studied. Based on the results of generated databases, the hazard quotient was calculated at the level of the median content of toxic elements in food products. Results. The primary chemical pollutants in food products for infants were found to be toxic elements (61.4% of samples), of which lead prevails. When analyzing the infant morbidity rate, an increase in gastrointestinal pathologies (by 15.7%) was observed, and in several cases – anemia and endocrine system diseases. It was revealed that only 37.3% of infants receive breastfeeding, and there is a violation of the timing of complementary food introduction (25.3%). Analysis of non-carcinogenic health risks showed that for formula-fed infants, the risk of alimentary-dependent diseases increases with age by months, which was confirmed by calculations of the hazard quotient (HQmedPb = 1.1; HQmedCd = 1.37; HQmedAs = 1.39). Conclusion. To prevent the morbidity rate in infants due to chemical contamination of food products, it is necessary to support breastfeeding, strict compliance with the terms of introduction and volume of complementary foods, and training in health education for medical students in accordance with the requirements of professional standards. Key words: infants, food products, toxic elements

The risk of inappropriate timing of complementary foods introduction is increased among first-time mothers and poor households

Background: Global recommendations suggest mothers provide the first complementary food to infants when they reach six months of age. Failure to introduce complementary foods promptly may put infants in adverse health and nutrition outcomes. Objective: This study aimed to analyze factors associated with inappropriate timing of complementary foods introduction in Kebumen Regency. Methods: This study used a cross-sectional design. A multistage cluster sampling was employed to select 355 mothers of children aged 6-23 months in Kebumen Regency. Our dependent variable was the timing of complementary food introduction. Meanwhile, independents variables included factors at the child, parental, and household levels. Univariate and multiple logistic regressions were performed in this study. Results: There was 39.15% of young children received inappropriate timing of complementary feeding. Being the second-born child or above (OR=0.56; 95%CI: 0.33-0.95) and coming from high-income households (OR= 0.57; 95%CI: 0.36-0.90) were protective factors of inappropriate timing of complementary foods introduction. Other variables such as maternal age, maternal education, maternal occupation, father’s education, and family support were not significantly associated with incorrect timing of complementary feeding. Conclusions: The proportion of inappropriate timing of complementary foods introduction in Kebumen Regency is alarming and is mainly explained by child’s birth rank and household economic status suggesting the importance of targeting nutritional education to first-time mothers as well as poor households.

Longitudinal associations of modifiable risk factors in the first 1000 days with weight status and metabolic risk in early adolescence

Many studies have identified early-life risk factors for childhood overweight/obesity (OwOb), but few have evaluated how they combine to influence later cardiometabolic health. We aimed to examine the association of risk factors in the first 1000 d with adiposity and cardiometabolic risk in early adolescence. We studied 1038 mother-child pairs in Project Viva. We chose 6 modifiable early-life risk factors previously associated with child adiposity or metabolic health in the cohort: smoking during pregnancy (yes compared with no); gestational weight gain (excessive compared with nonexcessive); sugar-sweetened beverage consumption during pregnancy (≥0.5 compared with <0.5 servings/d); breastfeeding duration (<12 compared with ≥12 mo); timing of complementary food introduction (<4 compared with ≥4 mo); and infant sleep duration (<12 compared with ≥12 h/d). We computed risk factor scores by calculating the cumulative number of risk factors for each child. In early adolescence (median: 13.1 y) we measured indicators of adiposity [BMI, fat mass index (FMI), trunk fat mass index (TFMI)]. We also calculated OwOb prevalence and metabolic syndrome (MetS) risk z score of adolescents. Among 1038 adolescents, 71% had >1 early-life risk factor. In covariate-adjusted models, we observed positive monotonic increases in BMI, FMI, TFMI, and MetS z scores with increasing risk factor score. Children with 5‒6 risk factors (compared with 0-1 risk factors) had the highest risk of OwOb [risk ratio (RR): 2.53; 95% CI: 1.63, 3.91] and being in the highest MetS quartile (RR: 2.46; 95% CI: 1.43, 4.21). The predicted probability of OwOb in adolescence varied from 9.4% (favorable levels for all factors) to 63.6% (adverse levels for all factors), and for being in the highest MetS quartile from 9.6% to 56.6%. Early-life risk factors in the first 1000 d cumulatively predicted higher adiposity and cardiometabolic risk in early adolescence. Intervention strategies to prevent later obesity and cardiometabolic risk may be more effective if they concurrently target multiple modifiable factors.

Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life.

To determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants. Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models. Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96). Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.

First Feeding Behaviors of Native Hawaiian, Pacific Islander, and Filipino Infants (P11-063-19)

ObjectivesThe objective of this study was to describe the first feeding behaviors (breastfeeding and complementary feeding timing) of Native Hawaiian, Pacific Islander, and Filipino infants 3 – 12 months of age. MethodsA convenient sample of Native Hawaiian, Pacific Islander, and Filipino infants ages 3 – 12 months were recruited for this study examining dietary diversity and the feasibility of a mobile phone food record. Eligible participants resided on the island of O‘ahu and had a caregiver who was 18 years of age or older with access to an Apple mobile device. This abstract provides a description on the first feeding practices collected via online questionnaire (RedCap) for the sample collected as of December 2018. This study was deemed exempt by the Institutional Review Board. ResultsA total of 67 infants had completed the study between March and December 2018. Only 64 infants had complete data and were included in this analysis. A majority of the sample were boys (n = 37, 58%) and were identified as Native Hawaiian (n = 45, 70%). The mean age was 7.6 months with a majority of infants being over 6 months of age (n = 52, 81%). Only 28% of the sample (n = 18) were exclusively breastfed. The mean timing of complementary food introduction was 5 months with a little more than half of the infants receiving their first food before 6 months (56%, n = 36). The most common first food introduced infant/rice cereal (n = 19) followed by poi (mashed taro root, n = 16). ConclusionsThe number of exclusively breastfed infants is significantly less than the Healthy People 2020 target of 60.6%. In addition, the timing of complementary feeding in this convenient sample of minority infants seems to occur earlier than the recommended guideline of 6 months. Examining first feeding practices is especially important due to its connections with health later in life and the significant health disparities that exist within these minority populations. Funding SourcesNIMHD.

MS 20171226 / Stordal et al - Does longer breastfeeding duration decrease the risk of asthma?

There are many well-documented benefits of breastfeeding; however, the effect of breastfeeding in preventing childhood asthma is not clear. As randomized controlled trials on this topic would be unfeasible and unethical to conduct, clinicians must rely on the results of observational studies. However, this question has been difficult to untangle with observational studies, as breastfeeding practices are also confounded by other feeding practices, such as the timing of introducing complementary foods. In addition, large numbers of infants are needed for these studies to control for the many factors (delivery type, gestational age, maternal and paternal history of allergy, etc) that may be also associated with asthma risk. In this volume of The Journal, Størdal et al present the results of a cohort study to determine the association between breastfeeding duration and the risk of childhood asthma, as well as the timing of the introduction of complementary foods and the risk of childhood asthma. They analyzed data from the Norwegian Mother and Child Study, a national prospective cohort study that included prenatal and follow-up data for over 41 000 children up to 7 years of age. Based on the main analysis, the authors found that the timing of complementary food introduction was not associated with the development of asthma. In addition, breastfeeding duration was not associated with the development of asthma. Additional subanalyses were conducted. Only for those low-risk families, where both parents had no history of allergies or asthma, was decreased breastfeeding duration associated with an increased risk of asthma. There are some limitations to this study. The infants were from only one country and the results may not be generalizable to other populations. In addition, the outcome of interest, asthma, was determined at 7 years of age. It is still possible for some of the 7-year-olds in the cohort to develop asthma at a later age. Differences may still develop during the follow-up analyses and there may be still more to learn from this cohort. Nevertheless, the size and scope of this prospective birth cohort study offers a wonderful opportunity to examine the relationship between early infant feeding patterns and risk of childhood asthma. The results suggest no reason to stop championing breastfeeding and encouraging families to breastfeed as long as possible. However, the results of this study suggest that decreasing the risk of childhood asthma by 7 years of age for all children is far from a guaranteed benefit for breastfeeding. At best, we can make only limited statements about longer breastfeeding duration and the potential lower risk of asthma, for infants with both parents who have no history of allergies or asthma. Article page 182 ▶ Prospective Cohort Study of Breastfeeding and the Risk of Childhood AsthmaThe Journal of PediatricsVol. 195PreviewTo study whether the duration of breastfeeding and time for introduction of complementary foods was associated with the risk of childhood asthma. Full-Text PDF

Feeding Practices and Infant Growth: Quantifying the Effects of Breastfeeding Termination and Complementary Food Introduction on BMI z-Score Growth Velocity through Growth Curve Models.

Infant feeding practices are a focus of early obesity prevention. We tested whether infant growth velocity increased after breastfeeding termination and complementary food introduction. Our secondary analysis included a sample of 547 mother-infant dyads from a longitudinal randomized controlled trial conducted in Michigan and Colorado. Infant anthropometrics at birth, baseline, and 6- and 12-month follow-up were standardized to BMI-for-age z-score (ZBMI) according to World Health Organization (WHO) growth charts. We used growth curve models with time-varying predictors to quantify effects of breastfeeding termination and timing of complementary food introduction on growth velocity. Median breastfeeding duration was 2.0 months [confidence interval (CI) = 2.0-2.5]; median introduction of complementary foods occurred at 3.0 months (CI = 2.8-3.2). Breastfed infants not yet introduced to complementary foods had an average ZBMI growth velocity of 0.050 (CI = -0.013 to 0.113) z-score units per month [zpm], not significantly faster than WHO growth trajectory (p = 0.118) defined as 0 zpm. Breastfeeding termination had negligible effect on ZBMI growth velocity (γ11 = 0.001, CI = -0.027 to 0.030, p = 0.927). Introduction of complementary foods increased ZBMI growth velocity relative to an average child in the sample, but not significantly (γ12 = 0.033, CI = -0.034 to 0.100, p = 0.334). Growth velocities for infants receiving complementary foods both before and after breastfeeding termination were significantly faster than the WHO growth trajectory (0.083 zpm, CI = 0.052-0.114, and 0.084 zpm, CI = 0.064-0.105, respectively, p's < 0.001). Average postcomplementary food introduction growth velocity was significantly higher than WHO growth trajectory, but did not differ from the sample's initial average trajectory. Growth curve models can accurately estimate effects of feeding practices on infant growth to direct obesity prevention efforts.

Infant feeding practices and reported food allergies at 6 years of age.

The goal of this study was to identify the frequency of physician-diagnosed food allergies among 6-year-old US children and study the impact of exclusive breastfeeding and complementary food introduction on this frequency. Data were analyzed from children who participated in the Infant Feeding Practices Study II Year 6 Follow-Up Study (Y6FU). Children with probable food allergy (pFA) were defined as children with report of physician-diagnosed food allergy at age 6 years. Subgroups of pFA included children who were not diagnosed before 1 year of age (new pFA) and those with atopic risk factors (high risk). Prevalence of total pFA in the Y6FU was 6.34%. The majority of these children had new pFA and high-risk factors. Higher maternal education, higher family income, family history of food allergy, and reported eczema before 1 year of age were significantly associated with higher odds of total or new pFA. Exclusive breastfeeding duration and timing of complementary food introduction were not significantly associated with total pFA. However, exclusive breastfeeding of ≥4 months compared with no breastfeeding was marginally associated with lower odds of new pFA (adjusted odds ratio: 0.51; P = .07); this effect was not observed with high-risk children. Analysis of infant and maternal variables in the Y6FU cohort of US children revealed that socioeconomic and atopic factors were the main predictors of pFA at age 6 years. Exclusive breastfeeding of ≥4 months may have a preventive effect on development of pFA after 1 year of age in non high-risk children.

Timing of complementary food introduction and age at diagnosis of type 1 diabetes: the SEARCH nutrition ancillary study (SNAS).

The association between timing of complementary food introduction and age at diagnosis of type 1 diabetes was investigated among 1077 children in the SEARCH for Diabetes in Youth study. Age at diagnosis was 5-month earlier for children introduced to sugar-sweetened beverages (SSB) in the first 12 months of life compared to those who were not (9.0 ± 0.2 vs. 9.5 ± 0.1; p=0.02), independent of HLA-risk status. Analyses stratified by HLA-risk status found that children with a high risk HLA genotype had an earlier age at diagnosis if they were introduced to fruit juice in the first year of life (mean age of diagnosis=9.3 ± 0.1, 9.1 ± 0.1 and 9.6 ± 0.2 for introduction at ≤ 6 months, between 7 and 11 months, and ≤12 months, respectively; p=0.04). Introduction of SSB in the first year of life may accelerate onset of type 1 diabetes independent of HLA-risk status.

Mixed‐methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.

Timing of complementary food introduction and age at diagnosis of type 1 diabetes: the SEARCH nutrition ancillary study (SNAS)

Timing of complementary food introduction and age at diagnosis of type 1 diabetes: the SEARCH nutrition ancillary study (SNAS)

What are the beliefs of pediatricians and dietitians regarding complementary food introduction to prevent allergy?

BackgroundThe timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. The American Academy of Pediatrics offers dietary recommendations that were updated in 2008.ObjectiveIdentify the recommendations that general pediatricians and registered dietitians provide to parents and delineate any differences in counselling.MethodsA 9-item survey was distributed to pediatricians and dietitians online and by mail. Information on practitioner type, gender, length of practice and specific recommendations regarding complementary food introduction and exposure was collected.Results181 surveys were returned with a 54% response rate from pediatricians. It was not possible to calculate a meaningful dietitian response rate due to overlapping email databases. 52.5% of all respondents were pediatricians and 45.9% were dietitians. The majority of pediatricians and dietitians advise mothers that peanut abstinence during pregnancy and lactation is unnecessary. Dietitians were more likely to counsel mothers to breastfeed their infants to prevent development of atopic dermatitis than pediatricians. Hydrolyzed formulas for infants at risk of developing allergy were the top choice of formula amongst both practitioners. For food allergy prevention, pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction.ConclusionsIn the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months. More dietitians than pediatricians believe that breastfeeding decreases the risk of atopic dermatitis. Practitioners may benefit from increased awareness of current guidelines.

Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain

Women who are overweight or obese before pregnancy breastfeed for shorter durations than do normal-weight women. These shorter durations may place infants of overweight and obese women at risk of not receiving the benefits of breastfeeding, which may include a reduced risk of overweight later in life. We examined how maternal prepregnant body mass index (BMI; in kg/m2) and infant feeding pattern are associated with infant weight gain. In this prospective, observational study, we used multiple regression analyses adjusted for potential confounding factors to examine these associations among 3768 mother-infant dyads from the Danish National Birth Cohort. In multiple regression analyses, increasing maternal prepregnant BMI, decreasing durations of breastfeeding, and earlier complementary food introduction were associated with increased infant weight gain. An interaction was identified for short durations of breastfeeding (<20 wk). Earlier complementary food introduction (<16 wk) was associated with greater infant weight gain; however, the timing of complementary food introduction did not increase infant weight gain at longer durations of breastfeeding (> or =20 wk). In this sample, prepregnant obesity (BMI > or = 30.0), short durations of breastfeeding, and earlier introduction of complementary food were associated with 0.7 kg of additional weight gain during infancy. Infant weight gain is associated with maternal prepregnant BMI and with an interaction between the duration of breastfeeding and the timing of complementary food introduction. Future investigations of the effects of breastfeeding on infant weight gain should account for all of these factors.