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Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis
Zahra A Padhani1,2, Jai K Das1, Faareha A Siddiqui1
1Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan.
Insights
Introducing complementary feeding (CF) too early may increase adiposity and infection risk in infants. Current guidelines for CF timing should be maintained, pending further research, especially from diverse global settings.
Area of Science:
- Pediatric Nutrition
- Infant Health
- Public Health
Background:
- The timing of complementary feeding (CF) introduction is critical for infant health, as deviations from optimal timing can lead to adverse outcomes.
- This review evaluates the impact of CF introduction timing on infant health, nutrition, and development.
Approach:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies were conducted.
- Studies were categorized based on early (<3, <4, <6 months) or late (>6, >8 months) CF introduction.
- Evidence was synthesized using GRADE criteria, analyzing 268 documents including 7 RCTs and 217 observational studies.
Key Points:
- RCT evidence did not link early CF introduction to adverse outcomes.
- Observational studies suggest early CF (<6 months) may increase BMI and overweight/obesity risk.
- Early introduction (<3 months) may increase BMI and lower respiratory tract infection (LRTI) risk; early introduction (<4 months) may increase height, LRTI, and blood pressure.
- Late CF introduction (>6 months) may decrease height, BMI, and blood pressure, but increase helminth infection risk.
- Late introduction (>8 months) may improve height-for-age z-scores.
Conclusions:
- Current evidence suggests a potential link between early CF introduction and increased adiposity, though definitive conclusions are limited.
- The existing recommendations for CF timing should be upheld.
- More high-quality research, particularly from low- and middle-income countries, is required to clarify the long-term effects of CF timing.
Context:
The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood.
Objective:
This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants.
Data Sources:
Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews.
Data Extraction:
Two investigators independently extracted data from the included studies on a standardized data-extraction form.
Data Analysis:
Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score.
Conclusion:
Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed.
Systematic Review Registration:
PROSPERO registration number CRD42020218517.
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