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Age at Weaning and Infant Growth: Primary Analysis and Systematic Review
Brennan Vail1, Philippa Prentice2, David B Dunger2
1Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; School of Medicine, University of California San Francisco, San Francisco, CA.
Insights
Early weaning (3-6 months) does not impact infant growth in high-income countries. Faster infant weight gain before weaning may influence the timing of introduction of solid foods, suggesting reverse causality.
Area of Science:
- Pediatrics
- Human Growth and Development
- Nutritional Science
Background:
- Early infant feeding practices, including weaning, are crucial for optimal child development.
- Understanding the relationship between weaning age and infant growth is essential for public health guidelines.
Purpose of the Study:
- To investigate the association between early age at weaning (3-6 months) and infant growth trajectories.
- To explore potential reverse causality in the observed associations.
Main Methods:
- Prospective birth cohort study of 571 mothers in Cambridge, UK.
- Infant anthropometric measurements (weight, length) at birth, 3, and 12 months.
- Linear regression models adjusted for maternal and demographic factors, and milk feeding type.
Main Results:
- Weaning between 3-7 months showed an inverse association with infant weight and length at 12 months, which attenuated after controlling for early growth and milk feeding.
- Rapid infant weight gain between 0-3 months predicted earlier weaning.
- A systematic review of existing literature indicated mixed findings, with a notable proportion of observational studies suggesting reverse causality.
Conclusions:
- Weaning between 3-6 months appears to have a neutral effect on infant growth in high-income settings.
- Observed inverse associations between early weaning and infant growth are likely attributable to reverse causality, where infant growth influences weaning timing.
Objective:
To test whether earlier age at weaning (age 3-6 months) may promote faster growth during infancy.
Study Design:
Weaning at age 3.0-7.0 months was reported by 571 mothers of term singletons in a prospective birth cohort study conducted in Cambridge, UK. Infant weight and length were measured at birth and at age 3 months and 12 months. Anthropometric values were transformed into age- and sex-adjusted z-scores. Three linear regression models were performed, including adjustment for confounders in a stepwise manner. Measurements at age 3 months, before weaning, were used to consider reverse causality.
Results:
Almost three-quarters (72.9%) of infants were weaned before age 6 months. Age at weaning of 3.0-7.0 months was inversely associated with weight and length (but not with body mass index) at 12 months (both P ≤ .01, adjusted for maternal and demographic factors). These associations were attenuated after adjustment for type of milk feeding and weight or length at age 3 months (before weaning). Rapid weight gain between 0 and 3 months predicted subsequent earlier age at weaning (P = .01). Our systematic review identified 2 trials, both reporting null effects of age at weaning on growth, and 15 observational studies, with 10 reporting an inverse association between age at weaning and infant growth and 4 reporting evidence of reverse causality.
Conclusion:
In high-income countries, weaning between 3 and 6 months appears to have a neutral effect on infant growth. Inverse associations are likely related to reverse causality.
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