Complementary feeding and micronutrient status: a systematic review

Abstract

BackgroundProper nutrition during early life is critical for growth and development.ObjectivesThe aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)?MethodsA literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.ResultsNine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status.ConclusionsSeveral conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.

Appropriate age range for introduction of complementary feeding into an infant's diet

“…EFSA staff hand‐searched through the bibliography of: −the studies included from all the searches described above, −the systematic reviews (those performed by USDA (English et al., , English et al., ; Obbagy et al., ; Obbagy et al., ; Obbagy et al., ) and published shortly before the launch of the public consultation on this Scientific Opinion were searched during the public consultation and relevant papers were added thereafter), −the theses found through the search of grey literature undertaken by the external contractor. …”

“…For micronutrient status, Obbagy et al. () found moderate evidence that introducing CFs at 4 months of age compared with 6 months does not affect iron status, derived from evidence generated in high‐income countries.…”

Supplemental Feeding as Preventive Measure for Overweight and Obesity in Children With Regard to the Concept of First 1000 Days

“…Вместе с тем другие исследователи считают, что значимость различий в сроках введения густой пищи и ее качестве (специфика продукта) преувеличена: связь характеристик прикорма и отдаленных последствий для здоровья младенцев не подтверждена [25]. В связи с этим рекомендовано предлагать младенцам продукты с различными вкусами и текстурой, включая горьковатые зеленые овощи [17], поскольку разнообразные растительные продукты помогут обеспечить ребенка необходимыми микроэлементами и витаминами, прежде всего железом, цинком, фолатами, витамином В 12 [26].…”

Association of infant and young child feeding practices with cognitive development at 10–12 years: a birth cohort in rural Western China

“…Some studies have reported that >90 % of the Fe requirements of a breast-fed infant must be met by complementary foods (26) . Recently, one review of studies mostly from developed countries concluded that complementary feeding with substantial amounts of Fe, such as meats or Fe-fortified foods, could provide an adequate amount of Fe or prevent Fe deficiency for breast-fed infants who were not receiving adequate Fe from another source (27) . However, the corresponding effects of these Fe-rich or Fe-fortified foods on child development outcomes were inconsistent (28) .…”

“…Similarly, protein is associated with the global development of the brain (29) , but the evidence on association between complementary high protein-based foods and child cognitive development is lacking. Furthermore, the association of timing of introducing complementary foods, one key aspect of complementary feeding which might be associated with micronutrient status among infants (27) , with development outcomes also remains unclear (28) .…”