Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Pediatrics Reports
Published in: Current Pediatrics Reports 4/2013

01-12-2013 | Nutrition/Growth (M Fewtrell, Section Editor)

Complementary Feeding: Critical Considerations to Optimize Growth, Nutrition, and Feeding Behavior

Authors: Bridget E. Young, Nancy F. Krebs

Published in: Current Pediatrics Reports | Issue 4/2013

Login to get access

Abstract

This review focuses on complementary feeding (CF) in westernized settings where primary health concerns are risk of obesity and micronutrient inadequacy. The current evidence is reviewed for: (1) when CF should be introduced, (2) what foods (nutrients and food types) should be prioritized and avoided, and (3) how the infant should be fed. Special attention is paid to the underlying physiological differences between breast- and formula-fed infants that often result in distinctly different nutritional and health risks. This difference is particularly acute in the case of micronutrient inadequacy, specifically iron and zinc, but is also relevant to optimal energy and macronutrient intakes. Emphasis is placed on the complex interplay among infants’ early dietary exposures; relatively high energy and nutrient requirements; rapid physical, social and emotional development; and the feeding environment—all of which interact to impact health outcomes. This complexity needs to be considered at both individual and population levels and in both clinical and research settings.
Literature
1.
Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr. 2008;4(Suppl 1):24–85.PubMedCrossRef
2.
Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040–50.PubMedCrossRef
3.
Cohen RJ, et al. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet. 1994;344(8918):288–93.PubMedCrossRef
4.
Lanigan JA, et al. Systematic review concerning the age of introduction of complementary foods to the healthy full-term infant. Eur J Clin Nutr. 2001;55(5):309–20.PubMedCrossRef
5.
Dewey KG, et al. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. Am J Clin Nutr. 1999;69(4):679–86.PubMed
6.
Kattelmann KK, Ho M, Specker BL. Effect of timing of introduction of complementary foods on iron and zinc status of formula fed infants at 12, 24, and 36 months of age. J Am Diet Assoc. 2001;101(4):443–7.PubMedCrossRef
7.
•• Jonsdottir OH, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics. 2012;130(6): 038–45. This well-designed study provides objective data on impact of timing of complementary foods in a developed country setting.
8.
Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2009;8:CD003517.
9.
•• Siega-Riz AM, et al. Food consumption patterns of infants and toddlers: where are we now? J Am Diet Assoc. 2010;110(12 Suppl):S38–51. The size and rigor of this survey provides important insight into consumption patterns of infants and young children in the U.S.
10.
Burdette HL, et al. Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age. Am J Clin Nutr. 2006;83(3):550–8.PubMed
11.
Seach KA, et al. Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes (Lond). 2010;34(10):1475–9.CrossRef
12.
Schack-Nielsen L, et al. Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight. Am J Clin Nutr. 2010;91(3):619–27.PubMedCrossRef
13.
Grote V, et al. The introduction of solid food and growth in the first 2 y of life in formula-fed children: analysis of data from a European cohort study. Am J Clin Nutr. 2011;94(6 Suppl):1785S–93S.PubMedCrossRef
14.
• Huh SY, et al. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544–51. While not an intervention, this was a large trial that analyzed breastfed and formula-fed infants separately. The analysis also controlled for infant weight gain, a powerful independent predictor of later obesity.
15.
Baker JL, et al. Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain. Am J Clin Nutr. 2004;80(6):1579–88.PubMed
16.
Wells JC, et al. Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe. Am J Clin Nutr. 2012;96(1):73–9.PubMedCrossRef
17.
Islam MM, et al. Effects of varied energy density of complementary foods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children. Am J Clin Nutr. 2006;83(4):851–8.PubMed
18.
Heinig MJ, et al. Intake and growth of breast-fed and formula-fed infants in relation to the timing of introduction of complementary foods: the DARLING study. Davis Area Research on Lactation, Infant Nutrition and Growth. Acta Paediatr (Oslo, Norway: 1992). 1993;82(12):999–1006.CrossRef
19.
Ong KK, et al. Dietary energy intake at the age of 4 months predicts postnatal weight gain and childhood body mass index. Pediatrics. 2006;117(3):e503–8.PubMedCrossRef
20.
Li R, et al. Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics. 2010;125:e1386–93.PubMedCrossRef
21.
Disantis KI, et al. Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? Int J Behav Nutr Phys Act. 2011;8:89–100.PubMedCrossRef
22.
Young, et al. Biological determinants linking infant weight gain and child obesity: current knowledge and future directions. Adv Nutr. 2012;3:675–86.
23.
Stunkard AJ, et al. Energy intake, not energy output, is a determinant of body size in infants. Am J Clin Nutr. 1999;69(3):524–30.PubMed
24.
Stunkard AJ, et al. Predictors of body size in the first 2 y of life: a high-risk study of human obesity. Int J Obes Relat Metab Disord. 2004;28(4):503–13.PubMedCrossRef
25.
Institute of Medicine. Dietary reference intakes; the essential guide to nutrient requirements. Washington, DC: National Academy Press; 2006.
26.
Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122(1):198–208.PubMedCrossRef
27.
Butte NF, et al. Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes. J Am Diet Assoc. 2010;110(12 Suppl):S27–37.PubMedCrossRef
28.
Schwartz J, et al. PUFA and LC-PUFA intake during the first year of life: can dietary practice achieve a guideline diet? Eur J Clin Nutr. 2010;64(2):124–30.PubMedCrossRef
29.
Heppe DH, et al. Parental, fetal, and infant risk factors for preschool overweight: the Generation R Study. Pediatr Res. 2013;73(1):120–7.PubMedCrossRef
30.
Damsgaard CT, et al. Fish oil affects blood pressure and the plasma lipid profile in healthy Danish infants. J Nutr. 2006;136(1):94–9.PubMed
31.
Damsgaard CT, et al. Fish oil supplementation modulates immune function in healthy infants. J Nutr. 2007;137(4):1031–6.PubMed
32.
Simell O, et al. Special Turku Coronary Risk Factor Intervention Project for Babies (STRIP). Am J Clin Nutr. 2000;72(5 Suppl):1316S–31S.PubMed
33.
Niinikoski H, et al. Growth until 3 years of age in a prospective, randomized trial of a diet with reduced saturated fat and cholesterol. Pediatrics. 1997;99(5):687–94.PubMedCrossRef
34.
Niinikoski H, et al. Intake and indicators of iron and zinc status in children consuming diets low in saturated fat and cholesterol: the STRIP baby study. Special Turku Coronary Risk Factor Intervention Project for Babies. Am J Clin Nutr. 1997;66(3):569–74.PubMed
35.
Lagstrom H, et al. Nutrient intakes by young children in a prospective randomized trial of a low-saturated fat, low-cholesterol diet. The STRIP Baby Project. Special Turku Coronary Risk Factor Intervention Project for Babies. Arch Pediatr Adolesc Med. 1997;151(2):181–8.PubMedCrossRef
36.
Hakanen M, et al. Development of overweight in an atherosclerosis prevention trial starting in early childhood. The STRIP study. Int J Obes (Lond). 2006;30(4):618–26.CrossRef
37.
Pahkala K, et al. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the Special Turku Coronary Risk Factor Intervention Project for Children [STRIP] study). Circulation. 2013;127(21):2088–96.PubMedCrossRef
38.
Rolland-Cachera MF, et al. Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 years of age. Int J Obes Relat Metab Disord. 1995;19(8):573–8.PubMed
39.
Gunther AL, et al. Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr. 2007;86(6):1765–72.PubMed
40.
Gunther AL, Buyken AE, Kroke A. Protein intake during the period of complementary feeding and early childhood and the association with body mass index and percentage body fat at 7 y of age. Am J Clin Nutr. 2007;85(6):1626–33.PubMed
41.
Koletzko B, et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr. 2009;89(6):1836–45.PubMedCrossRef
42.
Escribano J, et al. Effect of protein intake and weight gain velocity on body fat mass at 6 months of age: The EU Childhood Obesity Programme. Int J Obes (Lond). 2012;36:548–53.CrossRef
43.
Koletzko B, et al. Can infant feeding choices modulate later obesity risk? Am J Clin Nutr. 2009;89(5):1502S–8S.PubMedCrossRef
44.
Larnkjaer A, et al. The effects of whole milk and infant formula on growth and IGF-I in late infancy. Eur J Clin Nutr. 2009;63(8):956–63.PubMedCrossRef
45.
Dube K, et al. Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial. Eur J Nutr. 2010;49(1):11–8.PubMedCrossRef
46.
Krebs NF, et al. Meat as a first complementary food for breastfed infants: feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr. 2006;42(2):207–14.PubMed
47.
•• Krebs NF, et al. Effects of different complementary feeding regimens on iron status and enteric microbiota in breastfed infants. J Pediatr. 2013;163(2):416–23, e4. The results of this study emphasizes the frequency of iron deficiency in healthy breastfed infants fed according to current recommendations. It also indicates an impact of feeding regimen on the infant microbiome.
48.
•• Krebs NF, et al. Comparison of complementary feeding strategies to meet zinc requirements of older breastfed infants. Am J Clin Nutr. 2012;96:30–5. This study illustrates the dependence of the older breastfed infant on either fortified foods or naturally rich food sources such as meat to meet zinc requirements.
49.
Hoppe C, et al. High intakes of skimmed milk, but not meat, increase serum IGF-I and IGFBP-3 in eight-year-old boys. Eur J Clin Nutr. 2004;58(9):1211–6.PubMedCrossRef
50.
Michaelsen KF, Larnkjaer A, Molgaard C. Amount and quality of dietary proteins during the first two years of life in relation to NCD risk in adulthood. Nutr Metab Cardiovasc Dis. 2012;22(10):781–6.PubMedCrossRef
51.
Hornell A, et al. Protein intake from 0 to 18 years of age and its relation to health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res. 2013;57.
52.
Food and Nutrition Board and Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academy Press; 2001. p. 442–501.
53.
Levine A, et al. Screening criteria for diagnosis of infantile feeding disorders as a cause of poor feeding or food refusal. J Pediatr Gastroenterol Nutr. 2011;52(5):563–8.PubMedCrossRef
54.
Krebs NF. Update on zinc deficiency and excess in clinical pediatric practice. Ann Nutr Metab. 2013;62(Suppl 1):19–29.PubMedCrossRef
55.
Schneider JM, et al. The prevalence of low serum zinc and copper levels and dietary habits associated with serum zinc and copper in 12- to 36-month-old children from low-income families at risk for iron deficiency. J Am Diet Assoc. 2007;107(11):1924–9.PubMedCrossRef
56.
Skinner JD, et al. Fruit juice intake is not related to children’s growth. Pediatrics. 1999;103(1):58–64.PubMedCrossRef
57.
Emmett P, North K, Noble S. Types of drinks consumed by infants at 4 and 8 months of age: a descriptive study. The ALSPAC Study Team. Public Health Nutr. 2000;3(2):211–7.PubMedCrossRef
58.
Dennison BA, Rockwell HL, Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediatrics. 1997;99(1):15–22.PubMed
59.
Alexy U, et al. Fruit juice consumption and the prevalence of obesity and short stature in german preschool children: results of the DONALD Study. Dortmund Nutritional and Anthropometrical Longitudinally Designed. J Pediatr Gastroenterol Nutr. 1999;29(3):343–9.PubMedCrossRef
60.
Faith MS, et al. Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction. Pediatrics. 2006;118(5):2066–75.PubMedCrossRef
61.
American Academy of Pediatrics. The use and misuse of fruit juice in pediatrics. Pediatrics. 2001;107(5):1210–3.CrossRef
62.
Dattilo AM, et al. Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions. J Obes. 2012;2012:123023.PubMedCrossRef
63.
Bouhlal S, Issanchou S, Nicklaus S. The impact of salt, fat and sugar levels on toddler food intake. Br J Nutr. 2011;105(4):645–53.PubMedCrossRef
64.
Elliott CD. Sweet and salty: nutritional content and analysis of baby and toddler foods. J Public Health. 2011;33(1):63–70.CrossRef
65.
Anzman SL, Rollins BY, Birch LL. Parental influence on children’s early eating environments and obesity risk: implications for prevention. Int J Obes (Lond). 2010;34(7):1116–24.CrossRef
66.
Forestell CA, Mennella JA. Early determinants of fruit and vegetable acceptance. Pediatrics. 2007;120(6):1247–54.PubMedCrossRef
67.
Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics. 1994;93(2):271–7.PubMed
68.
Mennella JA, Jagnow CP, Beauchamp GK. Prenatal and postnatal flavor learning by human infants. Pediatrics. 2001;107(6):E88.PubMedCrossRef
69.
Mennella JA, Trabulsi JC. Complementary foods and flavor experiences: setting the foundation. Ann Nutr Metab. 2012;60(Suppl 2):40–50.PubMedCrossRef
70.
Butte N, et al. The start healthy feeding guidelines for infants and toddlers. J Am Diet Assoc. 2004;104(3):442–54.PubMedCrossRef
71.
Paul IM, et al. Opportunities for the primary prevention of obesity during infancy. Adv Pediatr. 2009;56:107–33.PubMedCrossRef
72.
Adair AL, Thompson LS, Bentley ME. Pressuring and restrictive feeding styles influence infant feeding and size among a low-income African-American sample. Obesity (Silver, Spring). 2013;21(3):562–71.CrossRef
73.
Brown A, Lee M. Maternal child-feeding style during the weaning period: association with infant weight and maternal eating style. Eat Behav. 2011;12(2):108–11.PubMedCrossRef
74.
Rhee KE, et al. Parenting styles and overweight status in first grade. Pediatrics. 2006;117(6):2047–54.PubMedCrossRef
75.
Black MM, Aboud FE. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011;141(3):490–4.PubMedCrossRef
76.
Ciampa PJ, et al. Interventions aimed at decreasing obesity in children younger than 2 years: a systematic review. Arch Pediatr Adolesc Med. 2010;164(12):1098–104.PubMedCrossRef
77.
French GM, et al. An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors. Pediatrics. 2012;130(3):e507–17.PubMedCrossRef
78.
Fisher JO, et al. Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes. J Am Diet Assoc. 2000;100(6):641–6.PubMedCrossRef
79.
DiSantis KI, Hodges EA, Fisher JO. The association of breastfeeding duration with later maternal feeding styles in infancy and toddlerhood: a cross-sectional analysis. Int J Behav Nutr Phys Act. 2013;10:53.PubMedCrossRef
80.
Brown A, Lee M. Breastfeeding during the first year promotes satiety responsiveness in children aged 18–24 months. Pediatr Obes. 2012;7(5):382–90.PubMedCrossRef
81.
Daniels LA, et al. Outcomes of an early feeding practices intervention to prevent childhood obesity. Pediatrics. 2013;132(1):e109–18.PubMedCrossRef
82.
Daniels LA, et al. Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules. Int J Obes (Lond). 2012;36(10):1292–8.CrossRef
83.
Weng SF, et al. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012;97(12):1019–26.PubMedCrossRef
Metadata
Title
Complementary Feeding: Critical Considerations to Optimize Growth, Nutrition, and Feeding Behavior
Authors
Bridget E. Young
Nancy F. Krebs
Publication date
01-12-2013
Publisher
Springer US
Published in
Current Pediatrics Reports / Issue 4/2013
Electronic ISSN: 2167-4841
DOI
https://doi.org/10.1007/s40124-013-0030-8

Other articles of this Issue 4/2013

Current Pediatrics Reports 4/2013 Go to the issue

Neonatology (FR Greer, Section Editor)

The Microbiome and its Impact on Disease in the Preterm Patient

Nutrition/Growth (M Fewtrell, Section Editor)

Maternal Nutrition and Epigenetic Perturbation: Modeling Trends to Translation

Neonatology (FR Greer, Section Editor)

How Fast Should the Preterm Infant Grow?

Neonatology (FR Greer, Section Editor)

Immunologic Factors in Human Milk and Disease Prevention in the Preterm Infant

Neonatology (F Greer, Section Editor)

Aggressive Nutrition of the Preterm Infant