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Timing of Complementary Feeding in Preterm Infants and Prevalence of Overweight and Obesity: A Randomized Clinical
Karin M Vissers1,2, Edith J M Feskens3, Johannes B van Goudoever2
1Department of Pediatrics, Hospital Gelderse Vallei, Ede, the Netherlands.
Insights
Introducing complementary foods between 12 and 17 weeks corrected age did not impact overweight and obesity rates in preterm infants by age 2. This study provides key insights for infant feeding guidelines.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Growth and Development
Background:
- Initiating complementary feeding in preterm infants is critical for growth and preventing long-term health issues like overweight.
- Current guidelines for complementary feeding in preterm infants are lacking.
Purpose of the Study:
- To investigate the impact of initiating complementary feeding at corrected age 12 weeks versus 17 weeks on overweight and obesity prevalence at corrected age 2 years in preterm infants.
Main Methods:
- A multicenter randomized clinical trial involving preterm infants (gestational age 30-36 weeks) and a reference group of full-term infants.
- Preterm infants were randomized to start complementary feeding at 12 weeks (early group) or 17 weeks (late group) corrected age.
- Primary outcome was overweight and obesity prevalence at corrected age 2 years; secondary outcomes included growth parameters and neurodevelopment.
Main Results:
- Overweight prevalence at 2 years was 6.0% in the early group and 5.5% in the late group. Obesity prevalence was 1.7% and 1.8%, respectively.
- No significant difference in overweight or obesity prevalence was observed between the early and late complementary feeding groups.
- The full-term reference group exhibited higher rates of overweight (9.0%) and obesity (3.5%) compared to the preterm groups.
Conclusions:
- Initiating complementary feeding between 12 and 17 weeks corrected age does not influence the prevalence of overweight and obesity at 2 years in preterm infants.
- These findings suggest that the timing within this window may not be a critical factor for preventing later overweight and obesity in this population.
- Further research may be needed to establish optimal feeding guidelines for preterm infants.
Importance:
The appropriate time for initiating complementary feeding in preterm infants is crucial for optimizing growth and preventing long-term health issues, such as overweight. Currently, there are no established guidelines for preterm infants.
Objective:
To investigate the effect of initiating complementary feeding at corrected age 12 weeks vs 17 weeks on the prevalence of overweight and obesity at corrected age 2 years in preterm infants.
Design, Setting, And Participants:
This multicenter randomized clinical trial was conducted between May 13, 2016, and April 26, 2021, with follow-up completed in December 2023. Seventeen hospitals in the Netherlands recruited preterm infants born between gestational age (GA) 30 and 36 weeks, supplemented with a reference group of full-term infants.
Intervention:
Preterm infants were randomized to initiating complementary feeding at corrected age 12 weeks (early group) or 17 weeks (late group).
Main Outcomes And Measures:
The primary outcome was the prevalence of overweight and obesity at corrected age 2 years measured using logistic mixed models. Secondary outcomes were height, weight, head circumference, body mass index, and z scores at corrected age 1 and 2 years, as well as neurodevelopment, atopic dermatitis score, and health-related quality of life.
Results:
A total of 255 preterm infants were included and randomly assigned, with 131 (51.4%; median [IQR] GA, 34 weeks 2 days [32 weeks 5 days to 35 weeks 1 day]; 77 male [58.8%]) allocated to the early group and 124 (48.6%; median [IQR] GA, 34 weeks 0 days [32 weeks 6 days to 34 weeks 6 days]; 62 male [50.0%]) allocated to the late group. A total of 159 full-term infants (median [IQR] GA, 40 weeks 0 days [39 week 0 days to 41 weeks 0 days]; 84 female [52.8%]) were included as the reference group. Information on the primary outcome was available for 226 preterm infants (88.6%) and 144 full-term infants (90.6%). At corrected age 2 years, the prevalence of overweight was 6.0% (95% CI, 2.7%-11.5%) in the early group and 5.5% (95% CI, 2.3%-11.1%) in the late group. For obesity, the prevalence was 1.7% (95% CI, 0.3%-5.5%) in the early group and 1.8% (95% CI, 0.3%-5.9%) in the late group. The full-term reference group showed a higher prevalence of overweight (9.0%; 95% CI, 5.1%-14.6%) and obesity (3.5%; 95% CI, 1.3%-7.5%).
Conclusions And Relevance:
In this randomized clinical trial of preterm infants, initiating complementary feeding between corrected age 12 and 17 weeks did not affect overweight and obesity prevalence at corrected age 2 years.
Trial Registration:
Onderzoekmetmensen.nl Identifier: NL-OMON53076.
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