Complementary Feeding and Health Consequences

Speaker: R. Shamir Presented at: 2015 CIP 4th Global Congress for Consensus in Pediatrics & Child Health

Summary

 Exclusive breast feeding is recommended for the first six months of life. Around that time solids are introduced and it has been suggested that late (beyond 6 months of age) or too early (before 4 months of age) introduction of solids may have health consequences later in life. One of the reasons for the introduction of (CF) at around 6 months of age is that the volume of human milk at 6 months is insufficient to meet nutritional requirements. The introduction of solids already at 4 months was shown to positively influence iron stores, and psychomotor developmental indices. Introduction of CF has been studied for many health outcomes: on allergy, there is good evidence from observational studies including prospective birth cohorts demonstrating that delayed introduction of solids and the delayed introduction of allergenic foods beyond 6 months of age does not prevent the development of food allergy and may even increase the risk of allergy. While awaiting the results of randomized controlled studies on the subject, there is no reason to revise the recommendations of ESPGHAN CoN (2008) that CF should not be introduced before 4 months of age (stated as 17 weeks) and not after 6 months of age (26 weeks) are in line with current scientific evidence. One “outlier” to this recommendation could be the introduction of gluten. Data from 2 recent randomized controlled trials conducted in infants at high risk for developing celiac disease (one compared introduction at 4 months of age to 6 months of age and one compared the introduction at 6 months of age compared to 12 months of age). Both studies found no difference in the prevalence of CD at study end. Thus, for infants at high risk, there is no advantage in introducing gluten earlier than 6 months of age, and later introduction does not increase the risk of developing celiac disease. It is unknown, whether these findings could be extrapolated to the general healthy population. Regarding obesity, the timing of CF introduction was not shown to be related to the development of overweight or obesity. However, limited data suggest that very early introduction (before or at 4 months of age) may increase overweight rates in childhood. In summary, adequate introduction of CF may affect nutritional status, psychomotor development and the risk of non communicable diseases. Guidelines on timing and the role of specific food items may change based on ongoing RCT’s.