Introduction of solid food and risk of obesity.
Article Type: Report
Subject: Diet (Management)
Diet (Health aspects)
Obesity in children (Risk factors)
Author: Murphy, Kathleen
Pub Date: 03/22/2011
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Spring, 2011 Source Volume: 23 Source Issue: 1
Topic: Event Code: 200 Management dynamics; 310 Science & research Computer Subject: Company business management
Product: Product Code: 8000141 Nutrition & Diet Programs NAICS Code: 621498 All Other Outpatient Care Centers
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 254971784
Full Text: Huh S, Rifas-Shiman S, Taveras E et al. 2011. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics 127;e544-51.

Obesity, the leading public health challenge facing children today, is prevalent even among infants and preschool children. The first few months after birth may be a critical window for the development of obesity. Parental feeding practices during early infancy, such as the timing of solid food introduction, may be key modifiable determinant of childhood obesity.

This study aimed to examine, separately among breastfed and formula fed infants, the extent to which the introduction of solid foods at earlier than 4 months of age is associated with an increased risk of child obesity.

Study participants were from Project Viva, a longitudinal pre birth cohort of mother/offspring pairs. Women were recruited prior to 22 weeks' gestation. They were followed up at the end of the first and second trimesters, after delivery and at 6 months and 3 years after birth. At each postpartum visit researchers collected data on infant feeding practices, measured child length/height and weight; at 3 years of age they also measured children's skinfold thickness. At one and two years after delivery, mothers completed mailed questionnaires updating infant feeding practices. A total of 847 children were included in the study through to completion.

Six months after delivery each mother completed a questionnaire querying the timing of the first introduction of each of 10 solid foods or food groups including infant cereal, other starches, fruit, vegetables, meat, chicken or turkey, peanut butter, other cow's milk dairy products, eggs, fish and sweets.

The timing of the introduction of solid foods was defined as the child's age at the earliest introduction of any solid food, divided into 1 of 3 age categories: less than 4, 4 to 5, or 6 months and older. Mothers reported breastfeeding status, including the child's age when breastfeeding was stopped, at the 6 month visit and on the one year questionnaire.

At 4 months of age 67% of the children were breastfed and 33% were formula fed, with no substantial difference in breastfeeding status by gender or race/ethnicity. Breastfeeding status was associated with the timing of introduction of solid foods. Mothers reported introducing solid foods before 4 months of age for 8% of breastfed infants compared with 33% of formula fed infants; 17% of breastfed infants started solids after 6 months compared with 9% of formula fed infants (P < .0001).

Among breastfed infants the timing of solid food introduction was not related to the prevalence of obesity or other anthropometric measures at the age of 3 years. Among formula fed infants, early or late solid food introduction was related to a higher prevalence of obesity, weight, weight for age z score, BMI and BMI z score at the age of 3 years (odds ratio [OR]: 1.0 [95% confidence interval [CI]: 0.3-3.3]).

Formula fed infants who were introduced to solids before the age of 4 months (versus at 4-5 months of age) had a sixfold increase in the odds of obesity (OR: 6.3 [95% CI: 2.3-16.9]) after adjustment for covariates.

Among infants breastfed for at least 4 months the timing of solid food introduction was not associated with obesity, BMI z score or sum of skinfold at 3 years.

The researchers found that the association between early solid food introduction and obesity among formula fed infants was independent of the rate of early infancy weight gain. The researchers suggest that the reason for an association with formula fed but not breastfed infants is that formula fed infants may increase their energy intake when solids are introduced whereas breastfeeding may promote self regulation of an infant's energy intake and the mother may learn to recognise her infant's hunger and satiety cues.

Delayed introduction of solids after 6 months of age was not associated with obesity among breastfed infants. Among formula fed infants delayed introduction of solids was not associated with an increase in the odds of obesity at the age of 3 years (OR: 3.6 [95% CI: 0.8 -16.3]).

These results support recommendations to introduce solids after 4 months of age, particularly amongst infants who are formula fed or breastfed for less than 4 months.

Comment: WHO recommends solid food introduction at 6 months of age to promote exclusive breastfeeding for six months.

Kathleen Murphy mnhaa

murphykath@gmail.com
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