Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial

Unit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
PEDIATRICS (Impact Factor: 5.47). 11/2012; 130(6). DOI: 10.1542/peds.2011-3838
Source: PubMed


To increase knowledge on iron status and growth during the first 6 months of life. We hypothesized that iron status would be better in infants who received complementary foods in addition to breast milk compared with those exclusively breastfed.

One hundred nineteen healthy term (≥37 weeks) singleton infants were randomly assigned to receive either complementary foods in addition to breast milk from age 4 months (CF) or to exclusive breastfeeding for 6 months (EBF). Dietary data were collected by 3-day weighed food records, and data on iron status and growth were also collected.

One hundred infants (84%) completed the trial. Infants in the CF group had higher mean serum ferritin levels at 6 months (P = .02), which remained significant when adjusted for baseline characteristics. No difference was seen between groups in iron deficiency anemia, iron deficiency, or iron depletion. The average daily energy intake from complementary foods of 5-month-olds in the CF group was 36.8 kJ per kg body weight. Infants in both groups grew at the same rate between 4 and 6 months of age.

In a high-income country, adding a small amount of complementary food in addition to breast milk to infants' diets from 4 months of age does not affect growth rate between 4 and 6 months, but has a small and positive effect on iron status at 6 months. The biological importance of this finding remains to be determined.

Download full-text


Available from: Geir Gunnlaugsson, Dec 29, 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Studies on iron status in infancy and early childhood have shown contradicting results concerning prolonged breast-feeding and cow's milk intake. The aim of the present study was to investigate associations between iron status among one-year-olds and feeding, with focus on the type of milk. Methods: Randomly selected healthy infants were prospectively investigated until 1 year of age in two cohorts born 1995-1996 (n = 114) and 2005 (n = 140). Information on birth data, feeding and growth until 12 months and iron status at 12 months was collected. Data from the two cohorts were pooled and the infants categorized into three groups according to their predominant milk consumption at 9 months of age, that is, breast milk, cow's milk or follow-on formula. Results: The prevalence of iron deficiency was highest in the cow's milk group and lowest in the follow-on formula group. According to a linear model, adjusted for gender, birth weight and exclusive breast-feeding duration, cow's milk consumption was negatively associated with serum ferritin (SF) and formula positively, but breast milk not. Predicted SF (μg/l) = 11.652(intercept) - 5.362(boy) + 0.005 × birth weight (g) + 2.826(exclusively breastfed ≥ 4 months) + 0.027 × formula (ml) - 0.022 × cow's milk (ml) + 0.005 × breast milk (ml). Correction for other dietary factors did not change these results. Conclusion: In this pooled analysis, cow's milk intake in late infancy associated negatively, and follow-on formula positively, with iron status. Prolonged partial breast-feeding does not seem to be of importance for iron status. Fortified food seems to improve iron status in late infancy.
    No preview · Article · Dec 2012 · European Journal of Nutrition
  • [Show abstract] [Hide abstract]
    ABSTRACT: The foods that tend to be rejected by children include those which may have greatest importance for later health. This paper reviews some of the intrinsic and extrinsic influences on preschool children's eating behavior, with particular reference to their acceptance of new foods into their diet. Factors conceptualized as intrinsic to the child in this review include sensory processing, taste perception, neophobia, and temperament. The important extrinsic determinants of children's food acceptance which are reviewed include parental and peer modeling, the family food environment, infant feeding practices including breastfeeding and age at weaning, concurrent feeding practices including restriction, pressure to eat, prompting and reward, and the taste & energy content of foods. Children's willingness to accept new foods is influenced by a wide range of factors that likely have individual and also interactive effects on children's willingness to taste, and then continue to eat, new foods. The literature lacks longitudinal and experimental studies, which will be particularly important in determining interventions most likely to be effective in facilitating children's acceptance of healthy foods.
    No preview · Article · Feb 2013 · Physiology & Behavior
  • Source

    Preview · Article · Apr 2013 · Pediatric Annals
Show more