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Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood
Véronique Gingras1, Izzuddin M Aris2,3,4, Sheryl L Rifas-Shiman2
1Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; veronique_gingras@harvardpilgrim.org.
Insights
Introducing complementary foods early (<4 months) or late (≥6 months) is linked to childhood adiposity. Early introduction correlated with higher body fat in breastfed and formula-fed infants, while late introduction was associated with increased adiposity in formula-fed children.
Area of Science:
- Pediatric Nutrition
- Childhood Obesity Research
- Growth and Development Studies
Background:
- Complementary feeding (CF) timing is a critical factor in infant nutrition.
- Childhood adiposity is a growing public health concern with long-term implications.
- Understanding the relationship between CF and adiposity is essential for guiding feeding practices.
Purpose of the Study:
- To investigate the association between the timing of complementary feeding (CF) introduction and adiposity throughout childhood.
- To differentiate these associations based on infant feeding type (breastfed vs. formula-fed).
Main Methods:
- Longitudinal study of 1013 children from Project Viva.
- CF introduction categorized as <4 months, 4 to <6 months (reference), and ≥6 months.
- Adiposity measured in midchildhood and early adolescence using linear regression models adjusted for confounders.
- Separate analyses conducted for breastfed and formula-fed infants.
Main Results:
- Early CF introduction (<4 months) was associated with higher midchildhood adiposity in breastfed children, with some measures persisting into adolescence.
- Associations between early CF and adiposity were stronger and more persistent into adolescence for formula-fed children.
- Late CF introduction (≥6 months) was linked to a higher subscapular/triceps skinfold ratio in midchildhood and adolescence among formula-fed children.
Conclusions:
- Both early (<4 months) and late (≥6 months) complementary feeding introduction are associated with increased childhood adiposity.
- These associations differ between breastfed and formula-fed infants, with formula-fed infants showing more pronounced effects.
- Findings highlight the importance of optimal timing for complementary feeding to mitigate risks of childhood obesity.
Objectives:
To examine associations of the timing of complementary feeding (CF) introduction with adiposity throughout childhood.
Methods:
We studied 1013 children from Project Viva. Our exposure was CF introduction, categorized as <4 months (19%), 4 to <6 months (68%; reference group), and ≥6 months of age (14%). Our outcomes included adiposity measures in midchildhood (mean: 7.9 years; SD 0.8; n = 896) and early adolescence (mean: 13.2 years; SD 0.9; n = 850). We used linear regression models adjusted for potential confounders and ran separate models for infants who were breastfed at least partly for ≥4 months (categorized as breastfed; 69%) and infants who were never breastfed or stopped breastfeeding at <4 months (categorized as formula fed; 31%).
Results:
CF initiated at <4 months was associated with higher adiposity in midchildhood in breastfed children; associations persisted into adolescence for waist circumference, truncal fat mass, and the sum of subscapular and triceps skinfolds (eg, waist circumference: confounder-adjusted β 2.97 [95% confidence interval (CI) 0.47 to 5.47] cm). The effect estimates were larger in formula-fed children, with more associations persisting into adolescence (eg, waist circumference: adjusted β 3.42 [95% CI 0.12 to 6.71] cm). CF initiated at ≥6 months was associated with a higher subscapular/triceps skinfold ratio in midchildhood and adolescence (adjusted β 0.13 [95% CI 0.02 to 0.25]) in formula-fed children.
Conclusions:
We found associations of early CF introduction with higher adiposity measurements in breastfed and formula-fed children and associations of late introduction of CF with higher adiposity in formula-fed children.
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