Conclusion Statement
Moderate evidence suggests that first introduction of any complementary food or beverage (CFB) between 4-5 months compared to approximately 6 months of age is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Grade: Moderate
Limited evidence suggests that introducing CFB before 4 months of age may be associated with higher odds of overweight/obesity. Grade: Limited
There is not enough evidence to determine the relationship between introduction of CFB at 7 months of age or older on growth, size, or body composition. Grade: Grade Not Assignable
Plain Language Summary
What is the question?
- The question is: What is the relationship between the timing of introduction of complementary foods and beverages and growth, size, and body composition?
What is the answer to the question?
- Moderate evidence suggests that first introduction of any complementary food or beverage (CFB) between 4-5 months compared to approximately 6 months of age is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants.
- Limited evidence suggests that introducing CFB before 4 months of age may be associated with higher odds of overweight/obesity.
- There is not enough evidence to determine the relationship between introduction of CFB at 7 months of age or older on growth, size, or body composition.
Why was this question asked?
- This important public health question was identified and prioritized as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
How was this question answered?
- A team of Nutrition Evidence Systematic Review staff conducted a systematic review in collaboration with a group of experts called a Technical Expert Collaborative
What is the population of interest?
- Generally healthy infants and toddlers who were fed complementary foods and beverages from ages 0-24 months and had growth, size, and/or body composition outcomes measured across the lifespan
What evidence was found?
- Eighty-one articles examined the association between timing of introduction of CFB, as early as 1mo and as late as 12mo of age, and growth, size, and/or body composition outcomes across the lifespan
- In the majority of studies, no significant associations were reported. A limited number of observational studies suggested that CFB introduction before age 4mo was associated with higher odds of overweight/obesity. No conclusion was drawn regarding the introduction of CFB at 7mo or older.
- Limitations in the evidence included inconsistency among all studies and a preponderance of null findings
How up-to-date is this systematic review?
- This review includes literature from 01/1980 to 07/2016.
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Technical Abstract
Background
- The goal of this systematic review was to examine the following question: What is the relationship between timing of introduction of complementary foods and beverages (CFB) and growth, size, and body composition?
- Systematic reviews were conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
- Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and typically continuing to 24 months of age.
Conclusion Statement and Grade
- Moderate evidence suggests that first introduction of any complementary food or beverage (CFB) between 4-5 months compared to approximately 6 months of age is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Grade: Moderate
- Limited evidence suggests that introducing CFB before 4 months of age may be associated with higher odds of overweight/obesity. Grade: Limited
- There is not enough evidence to determine the relationship between introduction of CFB at 7 months of age or older on growth, size, or body composition. Grade: Grade Not Assignable
Methods
- This systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.
- A literature search was conducted using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that evaluated the intervention or exposure of timing of CFB introduction and the outcomes of growth, size, and/or body composition. A manual search was conducted to identify articles that may not have been included in the electronic databases searched. Articles were screened by two authors independently for inclusion based on pre-determined criteria.
- Data extraction and risk of bias assessment were conducted for each included study, and both were checked for accuracy. The body of evidence was qualitatively synthesized to inform development of a conclusion statement(s), and the strength of evidence was graded using pre-established criteria evaluating the body of evidence on internal validity/risk of bias, adequacy, consistency, impact, and generalizability.
Summary of Findings
- This review includes 81 articles that examined the association between timing of introduction of CFB and growth, size, and/or body composition across the lifespan
- Timing of CFB introduction is the age at which any or specific types of CFB were first consumed and was examined as early as 1 month and as late as 12 months of age.
- Timing of CFB introduction was not associated with growth, size, body composition, and/or weight status in the majority of included studies. A limited number of observational studies suggested that CFB introduction before 4 months of age was associated with higher odds of overweight/obesity.
- Given the normal variation in healthy child growth patterns, caution should be used when interpreting results between timing, types and/or amounts of CFB and outcomes for individuals based on findings at the population level.
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Full Systematic Review
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Suggested Citation: English LK, Obbagy JE, Wong YP, Psota TL, Nadaud P, Johns K, Terry N, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Casavale KO, Spahn JM, Stoody E. Timing of Introduction of Complementary Foods and Beverages and Growth, Size, and Body Composition: A Systematic Review. April 2019. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.PB242018.SR0305.
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