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Complementary feeding: New styles versus old myths
Abstract
Early life feeding habits may potentially alter future metabolic programming and body composition. Complementary feeding is the period of time when infants introduce food different from milk in their diet, together with a gradual reduction of the intake of milk (either breast milk or formula), to finally acquire the diet model of their family. This period is important in the transition of the infant from milk feeding to family foods, and is necessary for both nutritional and developmental reasons. Over time, the timing for introducing complementary foods and the method of feeding have changed over time. Available literature data show increasing interest and concerns about the impact of complementary feeding timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes. While international scientific guidelines on complementary feeding have been published, many baby food companies' websites, blogs, and books, in most European countries exist. The aim of this manuscript is to look over current recommendations, and to revise "old myths". The adoption of an adequate weaning method is a cornerstone in the development of life-long health status. A correct strategy could reduce the risk of feeding disorders and other health problems later in life.
... The adoption of an adequate weaning method is a cornerstone in the development of life-long health status. An optimal strategy has the potential to reduce the risk of feeding disorders and other health problems later in life (Dipasquale & Romano, 2020). 8 These data suggest that baby-led weaning should be defined more comprehensively. ...
... An optimal strategy has the potential to reduce the risk of feeding disorders and other health problems later in life (Dipasquale & Romano, 2020). 8 These data suggest that baby-led weaning should be defined more comprehensively. Moreover, its potential influence on developmental domains beyond risks for choking and gagging, as well as nutrition and eating behavior warrants future targeted exploration. ...
... The term complementary feeding (CF) describes a period in which there is a gradual reduction of frequency and volume of breast milk or formula together with the introduction of CFs. This period is important in the transition of the infant from milk feeding to family foods and is necessary for both nutritional and developmental reasons (Dipasquale & Romano, 2020). Available literature data show increasing interest and concerns about the impact of CF timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes (Dipasquale & Romano, 2020). ...
... This period is important in the transition of the infant from milk feeding to family foods and is necessary for both nutritional and developmental reasons (Dipasquale & Romano, 2020). Available literature data show increasing interest and concerns about the impact of CF timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes (Dipasquale & Romano, 2020). Moreover, nutrition early in life was recognized as a strong determinant of the children gut microbiome assembly and maturation (Lim et al., 2016). ...
... After birth, even though there is a limited evidence base suggesting the relationship between breastfeeding, timing and type of foods used in weaning with disease later in life, nutritional surveillance is also mandatory in infants in the first year of life [14]. A number of studies suggest the beneficial role of breastfeeding on immune and neurocognitive development and its protective effects against obesity, diabetes and hypertension [15,16]. The impact of complementary feeding timing and modality on later onset of NCDs should be also considered in life-long health status outcome [16]. ...
... A number of studies suggest the beneficial role of breastfeeding on immune and neurocognitive development and its protective effects against obesity, diabetes and hypertension [15,16]. The impact of complementary feeding timing and modality on later onset of NCDs should be also considered in life-long health status outcome [16]. ...
This Special Issue aims to examine the crucial role of nutritional status starting from pregnancy in modulating fetal, neonatal and infant growth and metabolic pathways, with potential long-term impacts on adult health. Poor maternal nutritional conditions in the earliest stages of life during fetal development and early life may induce both short-term and longer lasting effects; in particular, an increased risk of noncommunicable diseases (NCDs) and other chronic diseases such as obesity, which itself is a major risk factor for NCDs, is observed over the lifespan. Poor maternal nutrition affects the fetal developmental schedule, leading to irreversible changes and slowdown in growth. The fetus limits its size to conserve the little energy available for cardiac functions and neuronal development. The organism will retain memory of the early insult, and the adaptive response will result in pathology later on. Epigenetics may contribute to disease manifestation affecting developmental programming. After birth, even though there is a limited evidence base suggesting a relationship between breastfeeding, timing and type of foods used in weaning with disease later in life, nutritional surveillance is also mandatory in infants in the first year of life. We will explore the latest findings on nutrition in early life and term and preterm babies, as well as the role of malnutrition in the short- and long-term impact over the lifespan. Focusing on nutritional interventions represents part of an integrated life-cycle approach to prevent communicable and non-communicable diseases.
... Examples of this trend can be found in Malaysia, France, and the Netherlands. This increase in anaemia prevalence could be attributed to socioeconomic instability or economic changes that affect healthcare funding and access, maternal anaemia [30], and changes in nutritional habits [31]. Changes in anaemia prevalence necessitate additional research at the national or regional level to delve deeper into what local factors influence these changes and how they do so. ...
Introduction
Anaemia is a major health concern worldwide. A comprehensive analysis of the global prevalence of anaemia is essential for creating suitable strategies to achieve global disease control goals. This study aimed to examine the prevalence of and changes in anaemia in children on a global scale. The results were stratified by country income.
Material and methods
We analysed the prevalence of anaemia among children aged 6–59 months in 189 countries from 2000 to 2019 using data collected by the WHO. We compared this prevalence with the income earned by each country in 2022. Finally, we calculated the changes in each country’s anaemia burden throughout the study period.
Results
: In 2019, 33.7% of children aged 6–59 months were anaemic globally, compared to 39.8% in 2000. In 2019, the prevalence of anaemia in children exceeded 70% in 11 countries. Anaemia prevalence differed across geographic regions, with the highest incidences observed in Africa and Southern Asia. Our analysis indicated a highly significant association between prevalence of anaemia and country income (p < 0.001). This significance was persistent throughout the study period. The greatest decline in anaemia prevalence was observed between 2000 and 2010.
Conclusions
The highest incidence of anaemia was noticed in low-income countries. Progress in reducing anaemia among children aged 6–59 months was observed globally, regionally, and in almost every country. Nevertheless, the prevalence of anaemia in children remains significant.
... CF period have positive short-and long-term effects on optimal growth, body composition, neurodevelopment, healthy food preferences, and gut microbiota composition and function 20,21,22 . CF methods have the potential to not only ensure a diet of nutritional adequacy but also promote optimal food-related behaviors and skills 23 . ...
Introduction. Nutritional deficiency due to an unbalanced diet is one of the most important factors contributing to stunting or the development of comorbidities in infants. Poverty, lack of knowledge about complementary feeding (CF) schedules, or lack of information accessibility are among the major causes that affect nutritional status. Our objective was to investigate the association of caregivers' knowledges, attitudes, and CF practices with the nutritional status of children aged 6 to 23 months attending the Camilo Ponce Enriquez Health Center from October to December 2022. Methods: An observational study was conducted. Information from caregivers of 137 children aged from 6 to 23 months (mean age 12.66 ± 5.00, 51.82% female) was analyzed. The data collection process was carried out through the application of the KAP survey of the Food and Agriculture Organization of the United Nations (FAO), which first includes a socio-demographic survey consisting of 10 questions, 7 of which obtain information from the caregiver and 3 oriented to obtain data from the child. Informed consensus was obtained previous to the survey application. Information on the nutritional status was obtained from the medical history data provided by the nursing department. Pearson's Chi-squared test was applied to establish whether or not there was an association between the nutritional variables. Results: 55.96% of caregivers had appropriate CF practices. Meanwhile, 77.89% and 77.55% had adequate knowledge and attitudes about CF. A statistically significant association (p < 0.05) was found between nutritional diagnosis and maternal CF knowledge, attitudes, and practices. Conclusions: The knowledge, attitudes, and practices of the target population reached a moderate level, laying the foundation for the study of risk factors, as well as educational strategies to prevent malnutrition.
... Additionally, the study identifies myths and misconceptions, especially regarding complementary feeding and the use of nutritional supplements, which can challenge certain aspects of existing nutritional models (18). These community-specific beliefs should be considered in the design of interventions and policies (9). ...
Introduction
The importance of nurturing care for child development is well-established, and parents play a central role in providing this care. However, cultural values and traditions can influence child-rearing practices, and there are gaps in child welfare in Ecuador. Two research questions delve into caregivers’ definitions of nurturing care for children aged 0–5 and its alignment with World Health Organization’s concept.
Methods
A qualitative methodology was applied to comprehensively explore caregivers’ perspectives and application of nurturing care across diverse cultural contexts in rural areas of Cotopaxi and Loja in Ecuador. Using snowball sampling primary caregivers, healthcare professionals, childcare workers, and community leaders were interviewed and participated in focus groups, examining its congruence with WHO’s Nurturing Care Framework for Early Childhood Development.
Results
While there is alignment with the WHO framework, the study reveals challenges such as a lack of awareness of the term “nurturing care” among participants. Findings also indicate issues in health communication, reliance on traditional medicine, and myths around nutritional practices. The role of technology in early learning is explored, noting both its advantages and disadvantages. Notably, preventive health activities were not mentioned, emphasizing a universal need for knowledge.
Conclusion
This study urges tailored interventions for nurturing care, emphasizing success tied to robust healthcare and child protection. Urgency lies in cultural sensitivity, local adaptation, and targeted training for implementation. These insights contribute significantly to the global discourse, stressing the importance of context-specific approaches. Implications are crucial for policymakers, practitioners, and researchers dedicated to elevating care quality for vulnerable populations worldwide.
... 19 La incorporación temprana (4 a 6 meses), de AC con ciertos potenciales alérgenos en lactantes con antecedentes familiares de alergias, podría inducir el desarrollo de tolerancia oral. 20 Dada la incertidumbre sobre los riesgos de iniciarla a los 4 meses, así como del potencial beneficio, se recomienda mantener la lactancia exclusiva hasta los 6 meses. 21 Esto es un objetivo deseable, pero, cuando no es posible, la lactancia materna exclusiva durante períodos más breves también resulta valiosa. ...
... In contrast, human milk contains ∼7% CHs, with lactose as the main CH, and additional CH fractions, such as HMOs and fructose, contributing altogether to the higher energy supply of CHs and simple sugars to the total daily energy intake (81) compared to both infant formulas at 6 months and to EF-fed infants at 12 months of age. From 6 to 12 months of age, we observed a greater difference between BF and both formula-fed groups regarding dietary intake, because it is the period when complementary feeding is initiated, together with a gradual reduction of breast milk or infant formula intake (82). Nonetheless, at 18 months old, other dietary factors come into play, because their diet is not mainly based on breast milk or infant formula intake anymore, and they are almost completely integrated with family meals (83). ...
... 19 The early introduction (4-6 months of age) of supplementary feeding with certain potential allergens in infants with a family history of allergy may induce the development of oral tolerance. 20 Given the uncertain risks of initiating supplementary feeding at 4 months old, as well as its potential benefit, it is recommended to maintain exclusive breastfeeding until 6 months old. 21 This is a desirable goal, but if it is not possible, exclusive breastfeeding for shorter periods is also valuable. ...
Human milk is the gold standard for infant nutrition, and breastfeeding should be started within the first hour of life. Cow's milk, other mammalian milk, or plant-based beverages should not be offered before 1 year of age. However, some infants require, at least in part, infant formulas. Even with subsequent enhancements throughout history, with the addition of oligosaccharides, probiotics, prebiotics, synbiotics, and postbiotics, infant formulas still have room for improvement in reducing the health gap between breastfed and formula-fed infants. In this regard, the complexity of infant formulas is expected to continue to increase as the knowledge of how to modulate the development of the gut microbiota is better understood. The objective of this study was to perform a non-systematic review of the effect of different milk scenarios on the gut microbiota.
... Our inclusion criteria will be based on the PICOS framework where the population of interest ("P") is defined as comprising healthy infants who were introduced to early feeding, the intervention ("I") is early introduction of complementary food (allergenic and nonallergenic) as a method of weaning when an infant approaches 4 months of age (ie, before turning 6 months old)-complementary food introduction is defined by the provision of nutrition other than breast milk or infants' milk formula [29]. Weaning may involve liquid food, as in formula feeding, or solid food that provides essential nutrients to an infant and the developing gut microbiome while influencing immune development [30]. ...
BACKGROUND
Infant feeding strategies recommended avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens in infants from 4 to 6 months of age may lead to food tolerance and possibly avert allergy development later in life.
OBJECTIVE
The aim of this study is to systematically review and meta-analyses evidence on the effect of early food introduction for prevention childhood allergic diseases.
METHODS
We will conduct a systematic review of intervention through comprehensive search of various databases including PubMed, EMBASE, Scopus, CENTRAL, PsycINFO, CINAHL and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to latest available studies in 2023. We will include only randomized controlled trials (RCTs) that assess the effect of early food introduction to prevent childhood allergic diseases.
RESULTS
Primary outcomes will include measures related with the effect of childhood allergic diseases (i.e., asthma, allergic rhinitis, eczema and food allergy). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed for studies selection. All data will be extracted using a standardized data extraction form and quality of the studies will be assessed using the Cochrane Risk-of-Bias Tool. Descriptive and meta-analysis will be performed using a random effect model in Review Manager File. Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023.
CONCLUSIONS
The results acquired from this study will contribute to harmonizing infant feeding guidelines with regards to prevention of childhood allergic diseases.
CLINICALTRIAL
International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021256776 was registered on 25 June 2021.
... Aquí, el aspecto de menor desempeño (3,5) fue el A1, sobre la selección de contenidos de alimentación complementaria. En este caso, al observar algunos comentarios recopilados de las madres (a1, a2, a3 y a4), ocurren particulares diferencias entre los contenidos incluidos en la app y aquellos esperados por las madres, siendo este un factor a tener en cuenta para aclaraciones específicas que deben incluirse con base a los respectivos estudios nutricionales 19 . Por otra parte, en la dimensión B de apariencia visual de la app, en promedio los 4 ítems evaluados obtuvieron un puntaje de 4,7, lo cual evidencia una aceptación satisfactoria de las madres en torno al diseño gráfico, imágenes y colores de la app, con comentarios y sugerencias positivas para un atractivo visual aún mayor (comentario b3). ...
Introduction: The current prevalence and affordability of smartphones have enabled a broad diffusion of a variety of mobile applications worldwide for monitoring infant's growth and nutritional status. However, most of these resources are not comprehensive enough to provide a user-friendly interface for growth tracking combined with proper parental education on nutrition and complementary feeding. Objectives: This work aims to present the development and evaluation of the proposed application "Baby Home", in order to study its potential as a digital tool for supporting parents and caregivers in the nutritional care of their children from home. Materials and methods: Baby Home integrates an interactive baby growth monitoring interface with a collection of educational content on infant feeding, allowing the user to check the recommended practices based on the estimated nutritional status of their baby. A panel of seven expert judges was assembled to evaluate the validity of these contents included in the application. Subsequently, a pilot study was carried out with eight participating mothers who contributed to the strengths and weaknesses of the proposed functionalities. Results: The developed application received positive feedback by the consulted specialists and a satisfactory acceptance within the participating mothers thanks to its friendly design and easy-to-use functionalities. The implemented visual resources proved to be well suited for the user's appropriation of feeding contents and their empowerment regarding the nutritional care required by their children. Conclusions: Baby Home is positioned as a practical and accessible support for the nutritional care of infants, providing safeness and confidence to the user in their child's feeding and the possibility of timely detection of growth problems.
... In contrast, human milk contains ∼7% CHs, with lactose as the main CH, and additional CH fractions, such as HMOs and fructose, contributing altogether to the higher energy supply of CHs and simple sugars to the total daily energy intake (81) compared to both infant formulas at 6 months and to EF-fed infants at 12 months of age. From 6 to 12 months of age, we observed a greater difference between BF and both formula-fed groups regarding dietary intake, because it is the period when complementary feeding is initiated, together with a gradual reduction of breast milk or infant formula intake (82). Nonetheless, at 18 months old, other dietary factors come into play, because their diet is not mainly based on breast milk or infant formula intake anymore, and they are almost completely integrated with family meals (83). ...
Breastfeeding (BF) is the gold standard in infant nutrition; knowing how it influences brain connectivity would help understand the mechanisms involved, which would help close the nutritional gap between infant formulas and breast milk. We analyzed potential long-term differences depending on the diet with an experimental infant formula (EF), compared to a standard infant formula (SF) or breastfeeding (BF) during the first 18 months of life on children's hypothalamic functional connectivity (FC) assessed at 6 years old. A total of 62 children participating in the COGNIS randomized clinical trial (Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02094547) were included in this study. They were randomized to receive an SF (n = 22) or a bioactive nutrient-enriched EF (n = 20). BF children were also included as a control study group (BF: n = 20). Brain function was evaluated using functional magnetic resonance imaging (fMRI) and mean glucose levels were collected through a 24-h continuous glucose monitoring (CGM) device at 6 years old. Furthermore, nutrient intake was also analyzed during the first 18 months of life and at 6 years old through 3-day dietary intake records. Groups fed with EF and BF showed lower FC between the medial hypothalamus (MH) and the anterior cingulate cortex (ACC) in comparison with SF-fed children. Moreover, the BF children group showed lower FC between the MH and the left putamen extending to the middle insula, and higher FC between the MH and the inferior frontal gyrus (IFG) compared to the EF-fed children group. These areas are key regions within the salience network, which is involved in processing salience stimuli, eating motivation, and hedonic-driven desire to consume food. Indeed, current higher connectivity found on the MH-IFG network in the BF group was associated with lower simple sugars acceptable macronutrient distribution ranges (AMDRs) at 6 months of age. Regarding linoleic acid intake at 12 months old, a negative association with this network (MH-IFG) only in the BF group was found. In addition, BF children showed lower mean glucose levels compared to SF-fed children at 6 years old. Our results may point out a possible relationship between diet during the first 18 months of life and inclined proclivity for hedonic eating later in life.
Clinical trial registration
https://www.clinicaltrials.gov/, identifier NCT02094547.
... 28,29 Strains belonging to the genera Lactobacillus and Bifidobacterium are commonly used as probiotics and are the most studied in the treatment and prevention of obesity-associated disorders. [30][31][32][33][34] Moreover, several potential bacterial candidates, such as A. muciniphila, 35 Christensenella minuta, 36 Parabacteroides goldsteinii, 37 Prevotella copri, 38 Enterobacter halii, and Saccharomyces cerevisiae var. boulardii, 39 have been identified, and novel mechanisms of action intervening in their positive effects on obesity have been elucidated. ...
Akkermansia muciniphila (A. muciniphila) is a mucin-degrading bacterium that commonly lives in the intestinal mucus layer. It is normally detected in human faecal specimens and is one of the few bacteria potentially associated to obesity development. In this narrative review, possible mechanisms that support how A. muciniphila is implicated in the pathogenesis of obesity and metabolic-associated disease are described with the evaluation of its role as an intermediary or independent agent whose manipulation could be useful in the management of metabolic disorders. The ampleness of A. muciniphila is notably diminished in obesity, type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD), cardiometabolic diseases and low-grade inflammation. Furthermore, an inverse relationship between A. muciniphila, body weight and insulin sensitivity has been observed in both humans and animals. Antidiabetic drugs, gastric bypass surgery, prebiotics and biologically active compounds, such as polyphenols or saponins, have been shown to be associated with A. muciniphila relative abundance and thus could have favourable effects on metabolic disorders. Furthermore, A. muciniphila supplementation alone has been correlated with weight reduction and improvement of metabolic disorders, including fat mass gain, adipose tissue inflammation, metabolic endotoxaemia, and insulin resistance. Nevertheless, since the primary beneficial impacts of this bacterium have been predominantly investigated in various preclinical models, these results need to be confirmed in randomized clinical trials.
... 11,26,27 in addition to bariatric surgery 28 and the pharmacological approach, 29,30 physical activity and diet are the primary therapeutic approaches to reduce body weight and reduce the risk of developing obesity-related diseases. [31][32][33][34][35][36][37] a very well-organized structure originates human cr and their synchronization with the environment, previously described, the mammalian circadian timing. 38 an important aspect of the CS is its capacity to be modified by internal or external cues. in addition to light exposure, as a typical external signal, there are other untrainable factors such as temperature, exercise, drugs, humidity, social cues, sound, and food. ...
Chronobiology studies the biological rhythms or circadian cycles of living organisms and their adaptation to external changes. Biological rhythms can affect hormone production cycles such as sleep/wake, and nutrition/fasting, but these factors can also alter the circadian rhythm (CR). In recent years, numerous studies have highlighted how feeding times and frequency can influence biological rhythms. Additionally, individuals' chronotype, working shifts, and food intake can make a deep impact on people's tendency to develop obesity and metabolic diseases. In this context, a single food and a specific combination of these, can also affect the CR and fasting cycle and consequently body weight and viceversa. The purpose of the review is to propose practical nutritional recommendations to help in resynchronizing the circadian rhythm as a tool in weight control.
... Early nutrition can potentially alter future metabolic programming [37]. The development of non-communicable diseases in adult life is marked both by the quality and quantity of nutrients consumed by the pregnant woman, and by the type and duration of breastfeeding and complementary feeding. ...
Experimental and epidemiological evidence has shown that modifications of the intrauterine environment can have deleterious consequences for individuals, expressed as an increased risk of suffering non-communicable pathologies in adult life, which is known as the hypothesis of the early origin of diseases or programming fetal. On the other hand, changes in gene expression patterns through epigenetic modifications can be the basis for long-term maintenance of the effects of fetal programming. In this sense, epigenetics comprises the study of intrauterine disturbances, which develop diseases in the adult, including Celiac Disease (CD). In addition, early feeding practices could influence the risk of CD development, such as breastfeeding timing and duration and age at gluten introduction in the diet. Gluten acts as a trigger for CD in genetically predisposed subjects, although approximately 30% of the world population has HLA DQ2 or DQ8, the prevalence of the disease is only 1-3%. It is not known what factors act to modify the risk of disease in genetically at risk subjects. Taking into account all these considerations, the aim of the current review is to elucidate the role of early programming and the effect of early nutrition on the development and progression of CD.
... Early nutrition can potentially alter future metabolic programming [41]. The available literature data show a growing interest and concern about the impact of both the timing and the modality of complementary feeding on the appearance of subsequent non-communicable diseases, including CD. ...
Experimental and epidemiological evidence has shown that modifications of the intrauterine environment can have deleterious consequences for individuals, expressed as an increased risk of suffering non-communicable pathologies in adult life, which is known as the hypothesis of the early origin of diseases or programming fetal. On the other hand, changes in gene expression patterns through epigenetic modifications can be the basis for long-term maintenance of the effects of fetal programming. In this sense, epigenetics comprises the study of intrauterine disturbances, which develop diseases in the adult, including Celiac Disease (CD). In addition, early feeding practices could influence the risk of CD development, such as breastfeeding timing and duration and age at gluten introduction in the diet. Gluten acts as a trigger for CD in genetically predisposed subjects, although approximately 30% of the world population has HLA DQ2 or DQ8, the prevalence of the disease is only 1-3%. It is not known what factors act to modify the risk of disease in genetically at risk subjects. Taking into account all these considerations, the aim of the current review is to elucidate the role of early programming and the effect of early nutrition on the development and progression of CD.
... Once the criteria have been applied, four of the resulting papers were eligible, but one was excluded because it was on complementary feeding in general [6] and another one on vitamin B12 deficiency due to reduced maternal Vitamin B12 status not related to diet [7]. Seven more papers have been added from references of articles retrieved from initial search, so that nine were finally selected for this review. ...
Background:
Vegetarian and vegan weaning have increasing popularity among parents and families. However, if not correctly managed, they may lead to wrong feeding regimens, causing severe nutritional deficiencies requiring specific nutritional support or even the need for hospitalization.
Aim:
To assess the prevalence of vegetarian and vegan weaning among Italian families and to provide an up-to-date narrative review of supporting evidence.
Materials and methods:
We investigated 360 Italian families using a 40-item questionnaire. The narrative review was conducted searching scientific databases for articles reporting on vegetarian and vegan weaning.
Results:
8.6% of mothers follow an alternative feeding regimen and 9.2% of infants were weaned according to a vegetarian or vegan diet. The breastfeeding duration was longer in vegetarian/vegan infants (15.8 vs. 9.7 months; p < 0.0001). Almost half of parents (45.2%) claim that their pediatrician was unable to provide sufficient information and adequate indications regarding unconventional weaning and 77.4% of parents reported the pediatrician's resistance towards alternative weaning methods. Nine studies were suitable for the review process. The vast majority of authors agree on the fact that vegetarian and vegan weaning may cause severe nutritional deficiencies, whose detrimental effects are particularly significant in the early stages of life.
Discussion and conclusion:
Our results show that alternative weaning methods are followed by a significant number of families; in half of the cases, the family pediatrician was not perceived as an appropriate guide in this delicate process. To date, consistent findings to support both the safety and feasibility of alternative weaning methods are still lacking. Since the risk of nutritional deficiencies in the early stages of life is high, pediatricians have a pivotal role in guiding parents and advising them on the most appropriate and complete diet regimen during childhood. Efforts should be made to enhance nutritional understanding among pediatricians as an unsupervised vegetarian or vegan diet can cause severe nutritional deficiencies with possible detrimental long-term effects.
Background
The development of child taste preferences seems to play a crucial role in food preferences and health outcomes. This study aimed to analyze the differences in taste preferences according to genetic polymorphisms in children allocated to different methods of complementary feeding (CF). This was a secondary analysis derived from a randomized clinical trial involving distinct groups of children regarding the method of CF. The intervention occurred at 5.5 months old. At 12 months old, the Feeding Preferences Questionnaire (FPQ) was applied. Between 12–35 months old, the Taste Acceptance Test (TAT) was performed and oral mucosa was collected. Data were analyzed by intention to treat. The main analyses were performed using Pearson’s chi-square test.
Results
The duration of exclusive breastfeeding was associated with TAS1R3(rs35744813) (p = 0.039). The type of milk consumed at 12 months was associated with TAS1R2(rs9701796) (p = 0.022), and with the number of polymorphisms related to sweet taste perception (p = 0.013). As for the FPQ, there was an association between TAS1R3(rs35744813) with the preference for sour-tasting foods (p = 0.040), and between TAS2R16(rs846672) with the preference for umami-flavored foods (p = 0.042). Concerning the TAT, the infant’s reaction to the bitter taste was associated with TAS1R2(rs9701796) (p = 0.021), with TAS1R3(rs307355) (p = 0.008), and with the count of polymorphisms related to the sweet taste perception (p = 0.037); in addition, the reaction to the sour taste was associated with the count of polymorphisms related to the bitter taste perception (p = 0.048).
Conclusions
The study concluded that genetic polymorphisms act on infant food acceptance, generating differences in food preferences.
Background: Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, chil�dren, and adults with CF were published in 2016. An update to these guidelines is presented.
Methods: The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members.
Results: The Working Group updated the nutritional guidelines including assessment and management at all ages. supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.
Background:
Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies.
Objective:
The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases.
Methods:
We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases.
Results:
Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023.
Conclusions:
The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases.
Trial registration:
PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a.
International registered report identifier (irrid):
PRR1-10.2196/46816.
Weaning plays an essential role in many facets of human life.
What are the characteristics of weaning? What are the practices of weaning? What are causes for early weaning? What are the risk factors for the termination of breastfeeding? What are the strategies to cope with early weaning? What are the management options?
In this research, The Biblical verses concerning weaning are described. Therefore, the present research investigates the description of weaning various medical situations.
The Present Research shows that the awareness of the weaning has accompanied humans during the long years of our existence
Publiziert : Ärztezeitschrift für Naturheilverfahren 1991; 32(2):106-112
__________ Das Ziel dieser prospektiven Studie war die Untersuchung des Eisenhaushaltes bei lakto-ovo-vegetabil (n = 13) ernährten Säuglingen und einer Kontrollgruppe (n = 14) mit gemischter, fleischhaltiger Beikost ernährter Säuglinge bis zum Alter von einem Jahr. Die Bestimmung von rotem Blutbild, Eisen, Transferrin und Ferritin erfolgte aus mütterlichem Blut zum Zeitpunkt der Geburt, Nabelschnurblut und venösem Blut des Kindes im Alter von vier bis zwölf Monaten. Insgesamt wurden in beiden Gruppen vergleichbare Ergebnisse erzielt. Diese zeigten, daß bis zu diesem Alter eine lakto-ovo-vegetabile Ernährung auch ohne Entstehung eines Eisenmangels möglich ist. Einzelbeispiele von Kindern aus beiden Gruppen mit einer grenzwertigen Versorgungslage am Ende der Studie und Säuglinge, die aufgrund der Studienkriterien ausschieden (zum Beispiel bei therapeutischer Eisengabe), zeigen die Problematik der ausreichenden Versorgung mit Eisen in diesem Alter auf.
Despite growing international interest in Baby-Led Weaning (BLW), we know almost nothing about food and nutrient intake in infants following baby-led approaches to infant feeding. The aim of this paper was to determine the impact of modified BLW (i.e., Baby-Led Introduction to SolidS; BLISS) on food and nutrient intake at 7⁻24 months of age. Two hundred and six women recruited in late pregnancy were randomized to Control (n = 101) or BLISS (n = 105) groups. All participants received standard well-child care. BLISS participants also received lactation consultant support to six months, and educational sessions about BLISS (5.5, 7, and 9 months). Three-day weighed diet records were collected for the infants (7, 12, and 24 months). Compared to the Control group, BLISS infants consumed more sodium (percent difference, 95% CI: 35%, 19% to 54%) and fat (6%, 1% to 11%) at 7 months, and less saturated fat (-7%, -14% to -0.4%) at 12 months. No differences were apparent at 24 months of age but the majority of infants from both groups had excessive intakes of sodium (68% of children) and added sugars (75% of children). Overall, BLISS appears to result in a diet that is as nutritionally adequate as traditional spoon-feeding, and may address some concerns about the nutritional adequacy of unmodified BLW. However, BLISS and Control infants both had high intakes of sodium and added sugars by 24 months that are concerning.
PurposeWhile the prevalence of children on vegetarian diets is assumed to be on the rise in industrialized countries, there are hardly any representative data available. In general, vegetarian diets are presumed to be healthy; nevertheless, there are concerns as to whether the dietary specifications required during infancy, childhood, and adolescence can be met. Therefore, the objective of this systematic review was to evaluate studies on the dietary intake and the nutritional or health status of vegetarian infants, children, and adolescents. Methods
The database MEDLINE was used for literature search. In addition, references of reviews and expert opinions were considered. Inclusion criteria were (1) sufficient dietary information to define vegetarian type diet and (2) characteristics of nutritional or health status. Case reports and studies from non-industrialized countries were excluded. Results24 publications from 16 studies published from 1988 to 2013 met our criteria. Study samples covered the age range from 0 to 18 years, and median sample size was 35. Five studies did not include a control group. With regard to biomarkers, anthropometry, and dietary or nutritional intake, the outcomes were diverse. Growth and body weight were generally found within the lower reference range. The intakes of folate, vitamin C, and dietary fiber were relatively high compared to reference values and/or control groups. Low status of vitamin B12 was reported in one study and low status of vitamin D in two studies. Conclusions
Due to the study heterogeneity, the small samples, the bias towards upper social classes, and the scarcity of recent studies, the existing data do not allow us to draw firm conclusions on health benefits or risks of present-day vegetarian type diets on the nutritional or health status of children and adolescents in industrialized countries.
Objective:
To determine the impact of a baby-led approach to complementary feeding on infant choking and gagging.
Methods:
Randomized controlled trial in 206 healthy infants allocated to control (usual care) or Baby-Led Introduction to SolidS (BLISS; 8 contacts from antenatal to 9 months providing resources and support). BLISS is a form of baby-led weaning (ie, infants feed themselves all their food from the beginning of complementary feeding) modified to address concerns about choking risk. Frequencies of choking and gagging were collected by questionnaire (at 6, 7, 8, 9, 12 months) and daily calendar (at 6 and 8 months); 3-day weighed diet records measured exposure to foods posing a choking risk (at 7 and 12 months).
Results:
A total of 35% of infants choked at least once between 6 and 8 months of age, and there were no significant group differences in the number of choking events at any time (all Ps > .20). BLISS infants gagged more frequently at 6 months (relative risk [RR] 1.56; 95% confidence interval [CI], 1.13-2.17), but less frequently at 8 months (RR 0.60; 95% CI, 0.42-0.87), than control infants. At 7 and 12 months, 52% and 94% of infants were offered food posing a choking risk during the 3-day record, with no significant differences between groups (7 months: RR 1.12; 95% CI, 0.79-1.59; 12 months: RR 0.94; 95% CI, 0.83-1.07).
Conclusions:
Infants following a baby-led approach to feeding that includes advice on minimizing choking risk do not appear more likely to choke than infants following more traditional feeding practices. However, the large number of children in both groups offered foods that pose a choking risk is concerning.
Objectives To compare the food, nutrient and ‘family meal’ intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding.
Study design and participants Cross-sectional study of dietary intake and feeding behaviours in 51 age-matched and sex-matched infants (n=25 BLW, 26 TSF) 6–8 months of age.
Methods Parents completed a questionnaire, and weighed diet records (WDRs) on 1–3 non-consecutive days, to investigate food and nutrient intakes, the extent to which infants were self-fed or parent-fed, and infant involvement in ‘family meals’.
Results BLW infants were more likely than TSF infants to have fed themselves all or most of their food when starting complementary feeding (67% vs 8%, p<0.001). Although there was no statistically significant difference in the large number of infants consuming foods thought to pose a choking risk during the WDR (78% vs 58%, p=0.172), the CI was wide, so we cannot rule out increased odds with BLW (OR, 95% CI: 2.57, 0.63 to 10.44). No difference was observed in energy intake, but BLW infants appeared to consume more total (48% vs 42% energy, p<0.001) and saturated (22% vs 18% energy, p<0.001) fat, and less iron (1.6 vs 3.6 mg, p<0.001), zinc (3.0 vs 3.7 mg, p=0.001) and vitamin B12 (0.2 vs 0.5 μg, p<0.001) than TSF infants. BLW infants were more likely to eat with their family at lunch and at the evening meal (both p≤0.020).
Conclusions Infants following BLW had similar energy intakes to those following TSF and were eating family meals more regularly, but appeared to have higher intakes of fat and saturated fat, and lower intakes of iron, zinc and vitamin B12. A high proportion of both groups were offered foods thought to pose a choking risk.
Background
The age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. We evaluated whether the early introduction of allergenic foods in the diet of breast-fed infants would protect against the development of food allergy.
Methods
We recruited, from the general population, 1303 exclusively breast-fed infants who were 3 months of age and randomly assigned them to the early introduction of six allergenic foods (peanut, cooked egg, cow’s milk, sesame, whitefish, and wheat; early-introduction group) or to the current practice recommended in the United Kingdom of exclusive breast-feeding to approximately 6 months of age (standard-introduction group). The primary outcome was food allergy to one or more of the six foods between 1 year and 3 years of age.
Results
In the intention-to-treat analysis, food allergy to one or more of the six intervention foods developed in 7.1% of the participants in the standard-introduction group (42 of 595 participants) and in 5.6% of those in the early-introduction group (32 of 567) (P=0.32). In the per-protocol analysis, the prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group (2.4% vs. 7.3%, P=0.01), as was the prevalence of peanut allergy (0% vs. 2.5%, P=0.003) and egg allergy (1.4% vs. 5.5%, P=0.009); there were no significant effects with respect to milk, sesame, fish, or wheat. The consumption of 2 g per week of peanut or egg-white protein was associated with a significantly lower prevalence of these respective allergies than was less consumption. The early introduction of all six foods was not easily achieved but was safe.
Conclusions
The trial did not show the efficacy of early introduction of allergenic foods in an intention-to-treat analysis. Further analysis raised the question of whether the prevention of food allergy by means of early introduction of multiple allergenic foods was dose-dependent. (Funded by the Food Standards Agency and others; EAT Current Controlled Trials number, ISRCTN14254740.)
Background: Few large epidemiologic studies have investigated the role of postweaning protein intake in excess weight and adiposity of young children, despite children in the United Kingdom consistently consuming protein in excess of their physiologic requirements.
Objective: We investigated whether a higher proportion of protein intake from energy beyond weaning is associated with greater weight gain, higher body mass index (BMI), and risk of overweight or obesity in children up to 5 y of age.
Design: Participants were 2154 twins from the Gemini cohort. Dietary intake was collected by using a 3-d diet diary when the children had a mean age of 21 mo. Weight and height were collected every 3 mo, from birth to 5 y. Longitudinal models investigated associations of protein intake with BMI, weight, and height, with adjustment for age at diet diary, sex, total energy intake, birth weight/length, and rate of prior growth and clustering within families. Logistic regression investigated protein intake in relation to the odds of overweight or obesity at 3 and 5 y of age.
Results: A total of 2154 children had a mean ± SD of 5.7 ± 3.2 weight and height measurements up to 5 y. Total energy from protein was associated with higher BMI (β = 0.043; 95% CI: 0.011, 0.075) and weight (β = 0.052; 95% CI: 0.031, 0.074) but not height (β = 0.088; 95% CI: −0.038, 0.213) between 21 mo and 5 y. Substituting percentage energy from fat or carbohydrate for percentage energy from protein was associated with decreases in BMI and weight. Protein intake was associated with a trend in increased odds of overweight or obesity at 3 y (OR = 1.10; 95% CI 0.99, 1.22, P = 0.075), but the effect was not statistically significant at 5 y.
Conclusion: A higher proportion of energy from protein during the complementary feeding stage is associated with greater increases in weight and BMI in early childhood in this large cohort of United Kingdom children.
Background:
In 2002, the World Health Organization recommended that the age for starting complementary feeding should be changed from 4 to 6 months of age to 6 months. Although this change in age has generated substantial debate, surprisingly little attention has been paid to whether advice on how to introduce complementary foods should also be changed. It has been proposed that by 6 months of age most infants will have developed sufficient motor skills to be able to feed themselves rather than needing to be spoon-fed by an adult. This has the potential to predispose infants to better growth by fostering better energy self-regulation, however no randomised controlled trials have been conducted to determine the benefits and risks of such a "baby-led" approach to complementary feeding. This is of particular interest given the widespread use of "Baby-Led Weaning" by parents internationally.
Methods/design:
The Baby-Led Introduction to SolidS (BLISS) study aims to assess the efficacy and acceptability of a modified version of Baby-Led Weaning that has been altered to address potential concerns with iron status, choking and growth faltering. The BLISS study will recruit 200 families from Dunedin, New Zealand, who book into the region's only maternity hospital. Parents will be randomised into an intervention (BLISS) or control group for a 12-month intervention with further follow-up at 24 months of age. Both groups will receive the standard Well Child care provided to all parents in New Zealand. The intervention group will receive additional parent contacts (n = 8) for support and education on BLISS from before birth to 12 months of age. Outcomes of interest include body mass index at 12 months of age (primary outcome), energy self-regulation, iron and zinc intake and status, diet quality, choking, growth faltering and acceptability to parents.
Discussion:
This study is expected to provide insight into the feasibility of a baby-led approach to complementary feeding and the extent to which this method of feeding affects infant body weight, diet quality and iron and zinc status. Results of this study will provide important information for health care professionals, parents and health policy makers.
Trial registration:
Australian New Zealand Clinical Trials Registry ACTRN12612001133820 .
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.
Peanut allergy is an increasingly troubling global health problem, which affects between 1-3% of children in many westernized countries. Although multiple methods of measurement have been used and specific estimates differ, there appears to be a sudden increase in the number of cases in the past 10 - 15 year period, suggesting that the prevalence may have tripled in some countries, such as the USA. Extrapolating the currently estimated prevalence, this translates to nearly 100,000 new cases annually (in the USA and UK), affecting some 1 in 50 primary school-aged children in the USA, Canada, UK, and Australia. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Background:
The relationship between the risk of celiac disease and both the age at which gluten is introduced to a child's diet and a child's early dietary pattern is unclear.
Methods:
We randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age.
Results:
Of the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P=0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P=0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease.
Conclusions:
Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.).
Early nutrition is recognized as a target for the effective prevention of childhood obesity. Protein intake was associated with more rapid weight gain during infancy-a known risk factor for later obesity.
We tested whether the reduction of protein in infant formula reduces body mass index (BMI; in kg/m(2)) and the prevalence of obesity at 6 y of age.
The Childhood Obesity Project was conducted as a European multicenter, double-blind, randomized clinical trial that enrolled healthy infants born between October 2002 and July 2004. Formula-fed infants (n = 1090) were randomly assigned to receive higher protein (HP)- or lower protein (LP)-content formula (within recommended amounts) in the first year of life; breastfed infants (n = 588) were enrolled as an observational reference group. We measured the weight and height of 448 (41%) formula-fed children at 6 y of age. BMI was the primary outcome.
HP children had a significantly higher BMI (by 0.51; 95% CI: 0.13, 0.90; P = 0.009) at 6 y of age. The risk of becoming obese in the HP group was 2.43 (95% CI: 1.12, 5.27; P = 0.024) times that in the LP group. There was a tendency for a higher weight in HP children (0.67 kg; 95% CI: -0.04, 1.39; P = 0.064) but no difference in height between the intervention groups. Anthropometric measurements were similar in the LP and breastfed groups.
Infant formula with a lower protein content reduces BMI and obesity risk at school age. Avoidance of infant foods that provide excessive protein intakes could contribute to a reduction in childhood obesity. This trial was registered at clinicaltrials.gov as NCT00338689.
Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's ( EAACI ) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis . It aims to provide evidence‐based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review.
Based on this evidence, families can be provided with evidence‐based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4–6 months of life. If breastfeeding is insufficient or not possible, infants at high‐risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.
Infant formulas provide more protein than breast milk. High protein intakes, as well as maternal obesity, are risk factors for later obesity. The present study tested whether a formula with lower protein content slows weight gain of infants of overweight mothers (BMI>25).
In a randomized double-blind study infants of overweight mothers received from 3 months an experimental (EXPL) formula with 1.65 g of protein/100 kcal (62.8 kcal/100 ml) and containing probiotics, or a control (CTRL) formula with 2.7 g of protein/100 kcal (65.6 kcal/100 ml). Breastfed (BF) infants were studied concurrently. Primary assessment was between 3 and 6 months, although formulas were fed until 12 months. Biomarkers of protein metabolism (BUN, IGF-1, insulinogenic amino acids) were measured.
Infants fed the low-protein EXPL formula gained less weight between 3 and 6 months (-1.77 g/day; P = 0.024) than infants fed the CTRL formula. In the subgroup of infants of mothers with BMI>30 the difference was -4.21 g/day (P = 0.017). Weight (P = 0.011) and BMI (P = 0.027) of EXPL infants remained lower than that of CTRL infants until 2 years but were similar to that of BF infants. BUN, IGF-1, and insulinogenic amino acids at 6 months were significantly lower in EXPL compared with CTRL.
A low-protein formula with probiotics slowed weight gain between 3 and 6 months in infants of overweight mothers. Weight gain and biomarkers were more like those of breastfed infants.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
Nutrition during infancy may have a long-term impact upon weight gain and eating style. How infants are introduced to solid foods may be important. Traditionally, infants are introduced to solid foods via spoon-feeding of purees. However, baby-led weaning advocates allowing infants to self-feed foods in their whole form. Advocates suggest this may promote healthy eating styles, but evidence is sparse. The aim of the current study was to compare child eating behaviour at 18-24 months between infants weaned using a traditional weaning approach and those weaned using a baby-led weaning style.
Two hundred ninety-eight mothers with an infant aged 18-24 months completed a longitudinal, self-report questionnaire. In Phase One, mothers with an infant aged 6-12 months reported breastfeeding duration, timing of solid foods, weaning style (baby-led or standard) and maternal control, measured using the Child Feeding Questionnaire. At 18-24 months, post-partum mothers completed a follow-up questionnaire examining child eating style (satiety-responsiveness, food-responsiveness, fussiness, enjoyment of food) and reported child weight.
Infants weaned using a baby-led approach were significantly more satiety-responsive and less likely to be overweight compared with those weaned using a standard approach. This was independent of breastfeeding duration, timing of introduction to complementary foods and maternal control.
A baby-led weaning approach may encourage greater satiety-responsiveness and healthy weight-gain trajectories in infants. However, the limitations of a self-report correlational study are noted. Further research using randomized controlled trial is needed.
To investigate the growth and the prevalence of overweight in early childhood among infants exclusively breastfed for 6 months (EBF) compared with those receiving complementary foods from 4 months of age in addition to breast milk (CF).
A total of 119 mother-infant pairs were randomized either in the CF or EBF group. Each infant's weight, length and head circumference were measured at birth, 6 weeks, 3, 4, 5 and 6 months of age. In the follow-up the children's weight, length and head circumference were measured at 8, 10, 12 and 18 months and infant's weight and height at 29-38 months.
There were no differences between groups in the anthropometric outcome measures of weight-for-age (p=0.78), length-for-age (p=0.59), head circumference-for-age (p=0.82) and BMI-for-age (p=0.61), using repeated measurements ANOVA. Furthermore, no difference was seen in the prevalence between groups in risk of being overweight or in those who were overweight at 18 months and 29-38 months of age.
Exclusive breastfeeding for the first 4 or 6 months of life does not seem to affect the risk of being overweight or the prevalence of those who were overweight in early childhood. This article is protected by copyright. All rights reserved.
The present systematic literature review is a part of the 5th revision of the Nordic Nutrition Recommendations. The aim was to assess the health effects of different levels of protein intake in infancy and childhood in a Nordic setting. The initial literature search resulted in 435 abstracts, and 219 papers were identified as potentially relevant. Full paper selection resulted in 37 quality-assessed papers (4A, 30B, and 3C). A complementary search found four additional papers (all graded B). The evidence was classified as convincing, probable, limited-suggestive, and limited-inconclusive. Higher protein intake in infancy and early childhood is convincingly associated with increased growth and higher body mass index in childhood. The first 2 years of life is likely most sensitive to high protein intake. Protein intake between 15 E% and 20 E% in early childhood has been associated with an increased risk of being overweight later in life, but the exact level of protein intake above which there is an increased risk for being overweight later in life is yet to be established. Increased intake of animal protein in childhood is probably related to earlier puberty. There was limited-suggestive evidence that intake of animal protein, especially from dairy, has a stronger association with growth than vegetable protein. The evidence was limited-suggestive for a positive association between total protein intake and bone mineral content and/or other bone variables in childhood and adolescence. Regarding other outcomes, there were too few published studies to enable any conclusions. In conclusion, the intake of protein among children in the Nordic countries is high and may contribute to increased risk of later obesity. The upper level of a healthy intake is yet to be firmly established. In the meantime, we suggest a mean intake of 15 E% as an upper limit of recommended intake at 12 months, as a higher intake may contribute to increased risk for later obesity.
Background/aim:
In Poland, vegetarian diets are becoming more and more popular. The aim of this study was to examine the effect of iron intake on iron status in vegetarian children.
Methods:
Dietary iron intake, iron food sources, blood count, serum iron, ferritin level and total iron-binding capacity were estimated in two groups of children, namely vegetarians (n = 22) and omnivores (n = 18) of both sexes, aged from 2 to 18 years. Seven-day food records were used to assess their diet.
Results:
Dietary iron intake in vegetarians and omnivores was low (up to 65.0 and 60.1% of the recommended dietary allowance). A significantly higher intake of vitamin C was observed in vegetarians compared with omnivores (p = 0.019). The main sources of iron in vegetarians were cereal products, followed by vegetables and mushroom products, then fruit. The prevalence of iron deficiency (ID) was higher in the vegetarian group (p = 0.023). The serum ferritin level and mean corpuscular volume in the vegetarians were also lower than in the omnivores (p = 0.01 and p = 0.014, respectively).
Conclusions:
Children who follow a vegetarian diet may suffer from ID in spite of having a high vitamin C intake. This indicates the need to introduce dietary education and iron status monitoring.
This review of the developmental readiness of normal, full-term infants to progress from exclusive breastfeeding to the introduction of complementary foods is the result of the international debate regarding the best age to introduce complementary foods into the diet of the breastfed human infant. After a list of definitions, four papers focus on: "Immune System Development in Relation to the Duration of Exclusive Breastfeeding" (Armond S. Goldman); "Gastrointestinal Development in Relation to the Duration of Exclusive Breastfeeding" (W. Allan Walker); "Infant Oral Motor Development in Relation to the Duration of Exclusive Breastfeeding" (Audrey J. Naylor, Sarah Danner, and Sandra Lang); and "Maternal Reproductive and Lactational Physiology in Relation to the Duration of Exclusive Breastfeeding" (Alan S. McNeilly). (SM)
Baby-Led Weaning (BLW) is an alternative approach for introducing complementary foods to infants that emphasises infant self-feeding rather than adult spoon-feeding. Here we examined healthcare professionals' and mothers' knowledge of, attitudes to and experiences with, BLW.
Healthcare professionals (n=31) and mothers who had used BLW (n=20) completed a semistructured interview using one of two tailored interview schedules examining their knowledge of, attitudes to and experiences with, BLW. Interview notes and transcripts were analysed using content analysis to identify subcategories and extract illustrative quotes.
Healthcare professionals had limited direct experience with BLW and the main concerns raised were the potential for increased risk of choking, iron deficiency and inadequate energy intake. Although they suggested a number of potential benefits of BLW (greater opportunity for shared family meal times, fewer mealtime battles, healthier eating behaviours, greater convenience and possible developmental advantages) most felt reluctant to recommend BLW because of their concern about the potential increased risk of choking. In contrast, mothers who had used this style of feeding reported no major concerns with BLW. They considered BLW to be a healthier, more convenient and less stressful way to introduce complementary foods to their infant and recommended this feeding approach to other mothers. Although mothers did not report being concerned about choking, 30% reported at least one choking episode-most commonly with raw apple.
Given the lack of research on BLW, further work is needed to determine whether the concerns expressed by healthcare professionals and potential benefits outlined by mothers are valid. The current study suggests that there is a mismatch between healthcare professionals' and mothers' knowledge of, attitudes to and experiences, with BLW.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
The impact of different weaning methods on food preferences and body mass index (BMI) in early childhood is not known. Here, we examine if weaning method-baby-led weaning versus traditional spoon feeding-influences food preferences and health-related outcomes.
Parents (n=155) recruited through the Nottingham Toddler laboratory and relevant internet sites completed a questionnaire concerning (1) infant feeding and weaning style (baby-led=92, spoon-fed=63, age range 20-78 months), (2) their child's preference for 151 foods (analysed by common food categories, eg, carbohydrates, proteins, dairy) and (3) exposure (frequency of consumption). Food preference and exposure data were analysed using a case-controlled matched sample to account for the effect of age on food preference. All other analyses were conducted with the whole sample.
The primary outcome measures were food preferences, exposure and weaning style. The secondary outcome measures were BMI and picky eating.
Compared to the spoon-fed group, the baby-led group demonstrated (1) significantly increased liking for carbohydrates (no other differences in preference were found) and (2) carbohydrates to be their most preferred foods (compared to sweet foods for the spoon-fed group). Preference and exposure ratings were not influenced by socially desirable responding or socioeconomic status, although an increased liking for vegetables was associated with higher social class. There was an increased incidence of (1) underweight in the baby-led group and (2) obesity in the spoon-fed group. No difference in picky eating was found between the two weaning groups.
Weaning style impacts on food preferences and health in early childhood. Our results suggest that infants weaned through the baby-led approach learn to regulate their food intake in a manner, which leads to a lower BMI and a preference for healthy foods like carbohydrates. This has implications for combating the well-documented rise of obesity in contemporary societies.
The aim of this review is to give insight on the benefits and risks of vegetarianism, with special emphasis on vegetarian child nutrition. This eating pattern excluding meat and fish is being adopted by a growing number of people. A vegetarian diet has been shown to be associated with lower mortality of ischaemic heart disease and lower prevalence of obesity. Growth in children on a vegetarian diet including dairy has been shown to be similar to omnivorous peers. Although vegetarianism in adolescents is associated with eating disorders, there is no proof of a causal relation, as the eating disorder generally precedes the exclusion of meat from the diet. A well-balanced lacto-ovo-vegetarian diet, including dairy products, can satisfy all nutritional needs of the growing child. In contrast, a vegan diet, excluding all animal food sources, has at least to be supplemented with vitamin B(12), with special attention to adequate intakes of calcium and zinc and energy-dense foods containing enough high-quality protein for young children. The more restricted the diet and the younger the child, the greater the risk for deficiencies.
The function that the timing of introduction of solid foods may have in the development of child obesity has not been adequately explored, either as a potential confounder of the relationship between breastfeeding and child obesity, or as an independent modifiable risk factor.
To determine the association between infant feeding practices and child overweight/obesity.
Six hundred and twenty subjects were recruited antenatally from 1990 to 1994. A total of 18 telephone interviews over the first 2 years of life recorded infant feeding practices. At mean age of 10 years, height and weight were measured for 307 subjects. Multiple logistic regression was used to determine whether infant feeding practices (duration of exclusive and any breastfeeding, and age at introduction of solid foods) were associated with odds of being overweight/obese (internationally age- and sex-standardized body mass index category) at age 10 years, after adjustment for confounders.
Delayed introduction of solid foods was associated with reduced odds of being overweight/obese at age 10 years, after controlling for socioeconomic status, parental smoking and childcare attendance (adjusted odds ratio (aOR)=0.903 per week, 95% CI=0.841-0.970, P=0.005). Antenatal parental smoking was associated with overweight/obesity at age 10 years (aOR=3.178, 95% CI=1.643-6.147, P=0.001). Duration of exclusive or any breastfeeding was not associated with the outcome.
Delayed introduction of solids is associated with reduced odds of child overweight/obesity. Wider promotion of current infant feeding guidelines could have a significant impact on the rates of child overweight and obesity.
Following a request from the Commission, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver a scientific opinion on the appropriate age for the introduction of complementary food for infants in the EU. Many European countries have adopted the WHO recommendation for the duration of exclusive breast-feeding for 6 months, whilst other countries recommend the introduction of complementary feeding between 4 and 6 months. The Panel agrees with WHO and other authoritative national and international bodies that breast-milk is the preferred food for infants, but the focus in this opinion are the factors which determine the appropriate age for the introduction of complementary food into infants’ diets. The Panel has evaluated predominantly studies in breast-fed healthy infants born at term for indicators of an appropriate age at which to introduce complementary food irrespective of existing recommendations on breast-feeding duration and on exclusivity of breast-feeding. The Panel has focussed its evaluation on data from developed countries. On the basis of present knowledge, the Panel concludes that the introduction of complementary food into the diet of healthy term infants in the EU between the age of 4 and 6 months is safe and does not pose a risk for adverse health effects (both in the short-term, including infections and retarded or excessive weight gain, and possible long-term effects such as allergy and obesity).
Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children in Europe and, based on these findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children. The Panel concluded on the levels of nutrient and energy intakes that are considered adequate for the majority of infants and young children, and evaluated the risk of inadequate nutrient intakes in infants and young children in living Europe. Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe, and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients. No unique role of young-child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow's milk).
Background
Baby‐led weaning (BLW) is a method of introducing solid foods to infants, which centres around the infant self‐feeding family foods. BLW has grown in popularity over the last 10 years; however, although research is starting to build around the safety and impact of the method, research examining intake is sparse. This is important because concerns have been raised by healthcare providers regarding the nutrient and energy sufficiency of BLW. The present study aimed to invstigate exposure to different food types based on different weaning approaches.
Methods
One hundred and eighty parents completed a 24‐h recall of the foods given to their babies aged 6–12 months. Respondents were split into those following strict BLW, loose BLW and traditional spoon‐feeding. Recalls were examined to ascertain the number of times in 24 h infants were given different types of foods, including iron‐containing foods. The results were then compared between different weaning groups and age groups.
Results
Several significant differences were found between the frequency of foods eaten by different weaning and age groups: in the youngest age group, strict BLW infants were more likely to be exposed to vegetables (P = 0.000) and protein (P = 0.002) than traditionally weaned babies, whereas, at all age groups, the traditionally weaned group had the highest exposure to composite meals. However, no significant differences were found in reported exposure to iron‐containing foods between weaning groups at any age. Maternal age, education and milk feeding method were controlled for throughout the analyses.
Conclusions
The findings add to a growing body of evidence that suggest a BLW approach may be safe and sufficient.
Background:
Baby-led weaning (BLW) is an approach to introducing solid foods to infants which gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intakes among 6-12 month-old infants who were fed by traditional or baby-led complementary feeding.
Methods:
We recruited 280 healthy 5-6 month old infants allocated to control (traditional spoon feeding) (TSF) group or intervention of Baby-Led Weaning (BLW) group in a randomized controlled trial. İnfants' growth, hematologic parameters and iron intakes were evaluated at age 12 months.
Results:
Infants in the TSF were significantly currently heavier than those in the BLW group. Mean weight in kilogram of infants in the BLW group was 10.4 ± 0.9 compared with 11.1 ± 0.5 in the TSF group. There was no statistically significant difference in the iron intakes from complementary foods by the BLW (7.97 ± 1.37 mg/day) and TSF group (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups.
Conclusions:
To the best of our knowledge, this is the first randomized-controlled study to have examined the impact of weaning method on iron intakes, hematological parameters and growth in breastfed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking and growth faltering. This article is protected by copyright. All rights reserved.
Background:
Baby-led weaning (BLW) where infants self-feed family foods during the period that they are introduced to solid foods is growing in popularity. The method may promote healthier eating patterns, although concerns have been raised regarding its safety. The present study therefore explored choking frequency amongst babies who were being introduced to solid foods using a baby-led or traditional spoon-fed approach.
Methods:
In total, 1151 mothers with an infant aged 4-12 months reported how they introduced solid foods to their infant (following a strict BLW, loose BLW or traditional weaning style) and frequency of spoon-feeding and puree use (percentage of mealtimes). Mothers recalled if their infant had ever choked and, if so, how many times and on what type of food (smooth puree, lumpy puree, finger food and specific food examples).
Results:
In total, 13.6% of infants (n = 155) had ever choked. No significant association was found between weaning style and ever choking, or the frequency of spoon or puree use and ever choking. For infants who had ever choked, infants following a traditional weaning approach experience significantly more choking episodes for finger foods (F2,147 = 4.417, P = 0.014) and lumpy purees (F2,131 = 6.46, P = 0.002) than infants following a strict or loose baby-led approach.
Conclusions:
Baby-led weaning was not associated with increased risk of choking and the highest frequency of choking on finger foods occurred in those who were given finger foods the least often. However, the limitations of noncausal results, a self-selecting sample and reliability of recall must be emphasised.
Content:
Infants should be offered foods with a variety of flavours and textures including bitter tasting green vegetables. Continued breast-feeding is recommended alongside CF. Whole cows' milk should not be used as the main drink before 12 months of age. Allergenic foods may be introduced when CF is commenced any time after 4 months. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both) should have peanut introduced between 4 and 11 months, following evaluation by an appropriately trained specialist. Gluten may be introduced between 4 and 12 months, but consumption of large quantities should be avoided during the first weeks after gluten introduction and later during infancy. All infants should receive iron-rich CF including meat products and/or iron-fortified foods. No sugar or salt should be added to CF and fruit juices or sugar-sweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision and parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet.
Method:
Parents should be encouraged to respond to their infant's hunger and satiety queues and to avoid feeding to comfort or as a reward.
Importance Timing of introduction of allergenic foods to the infant diet may influence the risk of allergic or autoimmune disease, but the evidence for this has not been comprehensively synthesized.
Objective To systematically review and meta-analyze evidence that timing of allergenic food introduction during infancy influences risk of allergic or autoimmune disease.
Data Sources MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS databases were searched between January 1946 and March 2016.
Study Selection Intervention trials and observational studies that evaluated timing of allergenic food introduction during the first year of life and reported allergic or autoimmune disease or allergic sensitization were included.
Data Extraction and Synthesis Data were extracted in duplicate and synthesized for meta-analysis using generic inverse variance or Mantel-Haenszel methods with a random-effects model. GRADE was used to assess the certainty of evidence.
Main Outcomes and Measures Wheeze, eczema, allergic rhinitis, food allergy, allergic sensitization, type 1 diabetes mellitus, celiac disease, inflammatory bowel disease, autoimmune thyroid disease, and juvenile rheumatoid arthritis.
Results Of 16 289 original titles screened, data were extracted from 204 titles reporting 146 studies. There was moderate-certainty evidence from 5 trials (1915 participants) that early egg introduction at 4 to 6 months was associated with reduced egg allergy (risk ratio [RR], 0.56; 95% CI, 0.36-0.87; I2 = 36%; P = .009). Absolute risk reduction for a population with 5.4% incidence of egg allergy was 24 cases (95% CI, 7-35 cases) per 1000 population. There was moderate-certainty evidence from 2 trials (1550 participants) that early peanut introduction at 4 to 11 months was associated with reduced peanut allergy (RR, 0.29; 95% CI, 0.11-0.74; I2 = 66%; P = .009). Absolute risk reduction for a population with 2.5% incidence of peanut allergy was 18 cases (95% CI, 6-22 cases) per 1000 population. Certainty of evidence was downgraded because of imprecision of effect estimates and indirectness of the populations and interventions studied. Timing of egg or peanut introduction was not associated with risk of allergy to other foods. There was low- to very low-certainty evidence that early fish introduction was associated with reduced allergic sensitization and rhinitis. There was high-certainty evidence that timing of gluten introduction was not associated with celiac disease risk, and timing of allergenic food introduction was not associated with other outcomes.
Conclusions and Relevance In this systematic review, early egg or peanut introduction to the infant diet was associated with lower risk of developing egg or peanut allergy. These findings must be considered in the context of limitations in the primary studies.
Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a scientific opinion on the essential composition of infant and follow-on formula. This opinion reviews the opinion provided by the Scientific Committee on Food in 2003 on the essential requirements of infant and follow-on formulae in light of more recent evidence and by considering the Panel’s opinion of October 2013 on nutrient requirements and dietary intakes of infants and young children in the European Union. The minimum content of a nutrient in formula proposed in this opinion is derived from the intake levels the Panel had considered adequate for the majority of infants in the first six months of life in its previous opinion and an average amount of formula consumed during this period. From a nutritional point of view, the minimum contents of nutrients in infant and follow-on formula proposed by the Panel cover the nutritional needs of virtually all healthy infants born at term and there is no need to exceed these amounts in formulae, as nutrients which are not used or stored have to be excreted and this may put a burden on the infant’s metabolism. Therefore, the Panel emphasises that maximum amounts should be interpreted not as target values but rather as upper limits of a range which should not be exceeded.
Background:
In addition to genetic background, a number of environmental factors have been claimed to influence the development of type 1 diabetes (T1D), including infant diet.
Aim:
To systematically update evidence on the possible relationship between early feeding practices and the risk of T1D.
Methods:
The Cochrane Library, MEDLINE, EMBASE, Web of Science, and CINAHL were searched for studies of any design up to July 2015. MEDLINE and EMBASE were additionally searched in March 2016. The primary outcome measures were the development of T1D or T1D-associated autoimmunity (T1DA).
Results:
Nine publications were identified. Breastfeeding at the time of gluten introduction, as compared to gluten introduction after weaning, did not reduce the risk of developing T1DA or T1D. In children at high risk of developing T1D, except for gluten introduction at ≤3 mo compared with gluten introduction at >3 mo of age which increased the risk of T1DA, the age of gluten introduction in infants had no effect on the risk of developing T1DA.
Conclusion:
Current evidence, mainly from observational studies, does not support the claim that early infant feeding practices, such as breastfeeding at gluten introduction or the age of the infant at the time of gluten introduction, may decrease the risk of developing T1D. More robust data are needed from randomized controlled trials.
In a randomized trial, the early introduction of peanuts in infants at high risk for allergy was shown to prevent peanut allergy. In this follow-up study, we investigated whether the rate of peanut allergy remained low after 12 months of peanut avoidance among participants who had consumed peanuts during the primary trial (peanut-consumption group), as compared with those who had avoided peanuts (peanut-avoidance group).
Methods: At the end of the primary trial, we instructed all the participants to avoid peanuts for 12 months. The primary outcome was the percentage of participants with peanut allergy at the end of the 12-month period, when the participants were 72 months of age.
Results: We enrolled 556 of 628 eligible participants (88.5%) from the primary trial; 550 participants (98.9%) had complete primary-outcome data. The rate of adherence to avoidance in the follow-up study was high (90.4% in the peanut-avoidance group and 69.3% in the peanut-consumption group). Peanut allergy at 72 months was significantly more prevalent among participants in the peanut-avoidance group than among those in the peanut-consumption group (18.6% [52 of 280 participants] vs. 4.8% [13 of 270], P<0.001). Three new cases of allergy developed in each group, but after 12 months of avoidance there was no significant increase in the prevalence of allergy among participants in the consumption group (3.6% [10 of 274 participants] at 60 months and 4.8% [13 of 270] at 72 months, P=0.25). Fewer participants in the peanut-consumption group than in the peanut-avoidance group had high levels of Ara h2 (a component of peanut protein)-specific IgE and peanut-specific IgE; in addition, participants in the peanut-consumption group continued to have a higher level of peanut-specific IgG4 and a higher peanut-specific IgG4:IgE ratio.
Conclusions: Among children at high risk for allergy in whom peanuts had been introduced in the first year of life and continued until 5 years of age, a 12-month period of peanut avoidance was not associated with an increase in the prevalence of peanut allergy. Longer-term effects are not known. (Funded by the National Institute of Allergy and Infectious Diseases and others; LEAP-On ClinicalTrials.gov number, NCT01366846 .).
Background:
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommended in 2008, based on observational data, to avoid both early (less than 4 months) and late (7 or more months) introduction of gluten and to introduce gluten while the infant is still being breastfed. New evidence prompted ESPGHAN to revise these recommendations.
Objective:
To provide updated recommendations regarding gluten introduction in infants and the risk of developing coeliac disease (CD) during childhood.
Summary:
The risk of inducing CD through a gluten-containing diet exclusively applies to persons carrying at least one of the CD risk alleles. Since genetic risk alleles are generally not known in an infant at the time of solid food introduction, the following recommendations apply to all infants, although they are derived from studying families with first-degree relatives with CD. Although breastfeeding should be promoted for its other well-established health benefits, neither any breastfeeding nor breastfeeding during gluten introduction has been shown to reduce the risk of CD. Gluten may be introduced into the infant's diet anytime between 4-12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs. 6 mo or 6 vs. 12 mo) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Based on observational data pointing to the association between the amount of gluten intake and risk of CD, consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy. However, the optimal amounts of gluten to be introduced at weaning have not been established.
Infant formulas provide more protein than breast milk. High protein intakes may place infants at risk of later obesity. The present study tested whether a formula with protein content below the regulatory level supports normal growth from age 3 months.
Randomized double-blind trial enrolled healthy infants <age 3 months. At 3 months, formula-fed infants were assigned to experimental (EXPL, 1.61 g protein /100 kcal; modified bovine whey proteins with caseino-glyco-macropeptide removed) or control (CTRL 2.15 g protein/100 kcal; unmodified bovine milk protein with a whey/casein ratio of 60/40) formula; breastfed infants were enrolled in a reference group (BF). Complementary foods were allowed in small amounts from 4-6 months and unrestricted after 6 months.
Weight gain (g/day) from 3-6 months was similar in EXPL and CTRL (EXPL-CTRL: - 0.84 g/day; 95% CI - 2.25, +0.57) and faster in EXPL and CTRL than BF. Weight analyzed longitudinally from 4-12 months was lower in EXPL than CTRL (P = 0.031) but higher than BF (P < 0.0001). Longitudinal analysis of odds ratios from 4-12 months indicated fewer infants with weight >85th percentile in EXPL than CTRL (P = 0.015). Length z-scores were lower than, and BMI z-scores were similar to, WHO Standards in all groups. Serum biochemical parameters in EXPL reflected the lower protein intake and were closer to parameters in BF infants than in CTRL.
A formula with 1.61 g of protein /100 kcal supports normal growth of infants after age 3 months. This protein content is adequate if provided from a high quality source.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.
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.
Studies included were published 1990 to March 2013.
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.
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.
More and better quality evidence is required to inform guidelines on the 'when, what and how' of complementary feeding.
© 2015 Public Health Association of Australia.
Background:
The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy.
Methods:
We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age.
Results:
Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy.
Conclusions:
The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
Background:
A window of opportunity has been suggested for reducing the risk of celiac disease by introducing gluten to infants at 4 to 6 months of age.
Methods:
We performed a multicenter, randomized, double-blind, placebo-controlled dietary-intervention study involving 944 children who were positive for HLA-DQ2 or HLA-DQ8 and had at least one first-degree relative with celiac disease. From 16 to 24 weeks of age, 475 participants received 100 mg of immunologically active gluten daily, and 469 received placebo. Anti-transglutaminase type 2 and antigliadin antibodies were periodically measured. The primary outcome was the frequency of biopsy-confirmed celiac disease at 3 years of age.
Results:
Celiac disease was confirmed by means of biopsies in 77 children. To avoid underestimation of the frequency of celiac disease, 3 additional children who received a diagnosis of celiac disease according to the 2012 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria (without having undergone biopsies) were included in the analyses (80 children; median age, 2.8 years; 59% were girls). The cumulative incidence of celiac disease among patients 3 years of age was 5.2% (95% confidence interval [CI], 3.6 to 6.8), with similar rates in the gluten group and the placebo group (5.9% [95% CI, 3.7 to 8.1] and 4.5% [95% CI, 2.5 to 6.5], respectively; hazard ratio in the gluten group, 1.23; 95% CI, 0.79 to 1.91). Rates of elevated levels of anti-transglutaminase type 2 and antigliadin antibodies were also similar in the two study groups (7.0% [95% CI, 4.7 to 9.4] in the gluten group and 5.7% [95% CI, 3.5 to 7.9] in the placebo group; hazard ratio, 1.14; 95% CI, 0.76 to 1.73). Breast-feeding, regardless of whether it was exclusive or whether it was ongoing during gluten introduction, did not significantly influence the development of celiac disease or the effect of the intervention.
Conclusions:
As compared with placebo, the introduction of small quantities of gluten at 16 to 24 weeks of age did not reduce the risk of celiac disease by 3 years of age in this group of high-risk children. (Funded by the European Commission and others; PreventCD Current Controlled Trials number, ISRCTN74582487.).
Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group since their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of iron deficiency anemia (IDA) include low birth weight, high cow's milk intake, low intake of iron-rich complementary foods, low socioeconomic status and immigrant status.The aim of this position paper is to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight.There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of iron deficiency. There is insufficient evidence to support general iron supplementation of healthy, European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron fortified infant formula, with an iron content of 4-8 mg/L (0.6-1.2 mg/kg/d). Marginally low birth weight infants (2000-2500 g) should receive iron supplements of 1-2 mg/kg/d. Follow-on formulas should be iron-fortified. However, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods including meat products and/or iron fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL daily in toddlers. It is important to ensure that this dietary advice reaches high risk groups such as socioeconomically disadvantaged families and immigrant families.
The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study rePORted an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.
Exclusive breastfeeding for six months (versus three to four months, with continued mixed breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and prevent pregnancy but has no long‐term impact on allergic disease, growth, obesity, cognitive ability, or behaviour. The results of two controlled trials and 21 other studies suggest that exclusive breastfeeding (no solids or liquids besides human milk, other than vitamins and medications) for six months has several advantages over exclusive breastfeeding for three to four months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections, allergic diseases, obesity, dental caries, or cognitive or behaviour problems have been demonstrated. A reduced level of iron has been observed in developing‐country settings.
Early nutrition is considered to be crucial for development of persistent obesity in later life. The aim of this paper is to present an overview of complementary feeding patterns across European countries. Most European infants introduce solid foods earlier than 6 completed months of age as recommended by WHO. The commonest risk factors for early introduction of solid foods have been shown to be smoking mothers of young age, low SES and no breastfeeding. The foods most frequently introduced as first solids are fruit and cereals followed by other foods that vary depending on the country of residence and the infants' type of feeding. Insufficient updated information has been made available in Europe in terms of infants' nutrient intake during complementary feeding, as well as on the potential acute metabolic effects of complementary feeding. Websites, e-forums and blogs on complementary feeding are widely spread in the web. The recipes and daily menus published in food industry websites are often nutritionally incorrect. Baby led-weaning (BLW) is based on the principle that babies, upon being started on complementary foods, should be allowed to eat whatever food they want (regular family foods included) in its normal shape. No nutrient intake and metabolic data are nevertheless available about BLW. The current scenario in terms of our understanding of complementary feeding in Europe opens several new research avenues. Not using and not improving our current knowledge of nutrition to improve children's health represents an infringement of children's rights.
Die besonderen ernährungs- und entwicklungsphysiologischen Anforderungen an die Säuglingsernährung werden in dem praktisch
bewährten “Ernährungsplan für das 1. Lebensjahr” berücksichtigt. Auch kulturell bedingte Ernährungsgewohnheiten und das aktuelle
Produktangebot sind von Bedeutung. In den ersten 4–6 Lebensmonaten ist ausschließliches Stillen die optimale Ernährung. Industriell
hergestellte Säuglingsanfangsnahrung als Muttermilchersatz unterliegt umfassenden nährstoffbezogenen toxikologischen und hygienischen
Vorschriften. In der Beikost ab dem 5.–7. Lebensmonat werden nur wenige nährstoffreiche Lebensmittel in gut aufeinander abgestimmten
Mahlzeiten benötigt. Zusätzliche Flüssigkeitszufuhr wird mit zunehmendem Beikostanteil erforderlich. Die Supplementierung
von Vitamin K und D und von Fluorid wird generell empfohlen. Gegen Ende des 1. Lebensjahres gehen die Mahlzeiten der Säuglingsernährung
in die Familienernährung über.
The specific nutritional and developmental requirements of infants have been considered with the “Dietary Schedule for 1st
year of life” in Germany. Also, the cultural background of dietary habits and the current food market for infants is respected.
Exclusive breastfeeding is the optimal nutrition during the first 4–6 months of life. Nutritional toxicological and hygienic
requirements for infant formula to be used as breastmilk substitute are distinctly specified. Beikost starts from the 5th–7th
month of age using a small variety of nutritious foods in well balanced meals. Additional fluid intake becomes necessary when
the beikost proportion increases. Supplemental Vitamin K, D and fluoride is generally recommended. Around the end of the 1st
year of life, the transition to the family diet takes place.
The WHO recommends exclusive breastfeeding (EBF) for 6 mo after birth. However, the time at which breast milk ceases to provide adequate energy and nutrition, requiring the introduction of complementary foods, remains unclear. Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth.
We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods.
We measured anthropometric outcomes, body composition, and breast-milk intake at age 6 mo in infants who were randomly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding. We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Iceland. In 100 infants who completed the protocol (50/group), breast-milk intake was measured by using stable isotopes, and complementary food intakes were weighed over 3 d in the complementary feeding (CF) group.
Breast-milk intake was 83 g/d (95% CI: 19, 148 g/d) greater in EBF (mean ± SD: 901 ± 158 g/d) than in CF (818 ± 166 g/d) infants and was equivalent to 56 kcal/d; CF infants obtained 63 ± 52 kcal/d from complementary foods. Estimated total energy intakes were similar (EBF: 560 ± 98 kcal/d; CF: 571 ± 97 kcal/d). Secondary outcomes (anthropometric outcomes, body composition) did not differ significantly between groups.
On a group basis, EBF to age 6 mo did not compromise infant growth or body composition, and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output.
Evidence for the role of food consumption during childhood in the development of β cell autoimmunity is scarce and fragmentary.
We set out to study the associations of longitudinal food consumption in children with the development of advanced β cell autoimmunity.
Children with advanced β cell autoimmunity (n = 232) (ie, with repeated positivity for antibodies against islet cells) together with positivity for at least one of the other 3 antibodies analyzed or clinical type 1 diabetes were identified from a prospective birth cohort of 6069 infants with HLA-DQB1-conferred susceptibility to type 1 diabetes who were born in 1996-2004, with the longest follow-up to the age of 11 y. Repeated 3-d food records were completed by the families and daycare personnel. Diabetes-associated autoantibodies and diets were measured at 3-12-mo intervals. Four control subjects, who were matched for birth date, sex, area, and genetic risk, were randomly selected for each case.
In the main food groups, only intakes of cow-milk products (OR: 1.05; 95% CI: 1.00, 1.10) and fruit and berry juices (OR: 1.09; 95% CI: 1.02, 1.12) were significantly, although marginally, associated with advanced β cell autoimmunity. The consumption of fresh milk products and cow milk-based infant formulas was related to the endpoint, whereas no evidence was shown for consumption of sour milk products and cheese. The intake of fat from all milk products and protein from fresh milk products was associated with risk of advanced β cell autoimmunity.
Intakes of cow milk and fruit and berry juices could be related to the development of advanced β cell autoimmunity. This trial was registered at clinicaltrials.gov as number NCT00223613.
Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved.
A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing.
In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative.
The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.
The objective of this study was to measure the effect of breastfeeding on hospitalization for diarrheal and lower respiratory tract infections in the first 8 months after birth in contemporary United Kingdom.
The study was a population-based survey (sweep 1 of the United Kingdom Millennium Cohort Study). Data on infant feeding, infant health, and a range of confounding factors were available for 15,890 healthy, singleton, term infants who were born in 2000-2002. The main outcome measures were parental report of hospitalization for diarrhea and lower respiratory tract infection in the first 8 months after birth.
Seventy percent of infants were breastfed (ever), 34% received breast milk for at least 4 months, and 1.2% were exclusively breastfed for at least 6 months. By 8 months of age, 12% of infants had been hospitalized (1.1% for diarrhea and 3.2% for lower respiratory tract infection). Data analyzed by month of age, with adjustment for confounders, show that exclusive breastfeeding, compared with not breastfeeding, protects against hospitalization for diarrhea and lower respiratory tract infection. The effect of partial breastfeeding is weaker. Population-attributable fractions suggest that an estimated 53% of diarrhea hospitalizations could have been prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding. The protective effect of breastfeeding for these outcomes wears off soon after breastfeeding cessation.
Breastfeeding, particularly when exclusive and prolonged, protects against severe morbidity in contemporary United Kingdom. A population-level increase in exclusive, prolonged breastfeeding would be of considerable potential benefit for public health.
To examine the association between timing of introduction of solid foods during infancy and obesity at 3 years of age.
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.
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]).
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.
A controlling maternal feeding style has been shown to have a negative impact on child eating style and weight in children over the age of 12 months. The current study explores maternal feeding style during the period of 6-12 months when infants are introduced to complementary foods. Specifically it examines differences between mothers who choose to follow a traditional weaning approach using spoon feeding and pureés to mothers following a baby-led approach where infants are allowed to self feed foods in their solid form. Seven hundred and two mothers with an infant aged 6-12 months provided information regarding weaning approach alongside completing the Child Feeding Questionnaire. Information regarding infant weight and perceived size was also collected. Mothers following a baby-led feeding style reported significantly lower levels of restriction, pressure to eat, monitoring and concern over child weight compared to mothers following a standard weaning response. No association was seen between weaning style and infant weight or perceived size. A baby-led weaning style was associated with a maternal feeding style which is low in control. This could potentially have a positive impact upon later child weight and eating style. However due to the cross sectional nature of the study it cannot be ascertained whether baby-led weaning encourages a feeding style which is low in control to develop or whether mothers who are low in control choose to follow a baby-led weaning style.