The Programming Power of Complementary Foods

Speaker: F. Haschke Presented at: 2015 Europediatrics 7th Biennial EPA/UNEPSA Congress


WHO recommends exclusive breastfeeding until 6 months and thereafter stepwise introduction of complementary foods (CF). In developing countries, the global DHS survey indicates that infant cohorts who are not exclusively breastfed until 6 months (i.e. introduction of CF <6 months) have a higher prevalence of stunting and wasting and suffer from more infections. Infants who continue to be breastfed between 6 and 12 months and receive CF have less infactions than infants who are no more breastfed. ESPGHANand AAP committees repeatedly provided comments on time of introduction of CF in developed countries.

Their recommendations are based on studies which focus on health benefits/-risks in relation to time of introduction of CF: Obesity. Two systematic reviews in the past did not indicate a strong association between time of introduction of CF and childhood obesity in breast- and formulafed infants. However, two recent big cohort studies in preschool children show strong a strong association between BMI at 3-4 years and introduction of CF <4 months. Allergy. 

Based on the studies available, EACCI 2014 concluded that there is no need to avoid introducing complementary foods (cow´s milk, egg, fish, nuts etc.) beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. Gluten. The prevent CD trial (7 European countries) found that in high-risk children for celiac disease breastfeeding duration or time when gluten was introduced has no preventive effect. Delayed introduction of gluten does not protect from celiac disease but delays the onset of disease. Iron deficiency. Feeding iron-fortified complementary foods and meat reduces the risk of iron-deficiency anemia by 50 percent. Conclusion. In most developed countries, CF in infants are introduced between 4 and 6 months. There is now sufficient scientific evidence that starting CF during this time window is adequate and safe.