Elsevier

The Journal of Pediatrics

Volume 179, December 2016, Pages 104-110.e1
The Journal of Pediatrics

Original Articles
The Impact of Timing of Introduction of Solids on Infant Body Mass Index

https://doi.org/10.1016/j.jpeds.2016.08.064Get rights and content

Objectives

To evaluate the associations between breastfeeding duration, age at solids introduction, and their interaction in relation to infant (age 9-15 months) above normal body mass index (BMI).

Study design

Cross-sectional, population-based study with 3153 infants from Melbourne (2007-2011). Above normal BMI (z score > 2, equivalent to >97.7th percentile) defined using the World Health Organization standard.

Results

Both longer duration of full and any (full or partial) breastfeeding were associated with lower odds of above normal BMI (eg, aOR, 0.37 [95% CI, 0.22-0.60] for full breastfeeding 4-5 months versus 0-1 months). Compared with introduction of solids at 5-6 months, both early and delayed introduction were associated with increased odds of above normal BMI (aOR for 4 months, 1.75 [95% CI, 1.10-2.80] and for ≥7 months, 2.64 [95% CI, 1.26-5.54] versus 6 months). Such associations differ by breastfeeding status at 4 months (interaction P = .08). Early introduction of solids was associated with increased odds of above normal BMI in both infants fully or partially breastfed for ≥4 months (aOR, 3.66; 95% CI, 1.41-9.51) and those breastfed for <4 months (aOR, 3.11; 95% CI, 1.39-6.97). Introduction of solids at ≥7 months was associated with increased odds of above normal BMI (aOR, 5.79; 95% CI, 1.91-17.49) among infants breastfed for <4 months only.

Conclusion

Introduction of solids at 5-6 months, compared with either early or delayed introduction, is associated with decreased odds of above normal BMI at 1 year of age, regardless of infants' breastfeeding status at 4 months. These results may have implications for public health guidelines with regard to recommendations about the optimal timing of the introduction of solid foods in infancy.

Section snippets

Methods

The HealthNuts study is a cross-sectional population-based study that recruited 5276 infants at 1 year of age from council-run immunization sessions in metropolitan Melbourne, Australia, between September 2007 and August 2011. The study design and sample recruitment have been described previously.21 In this study, we included 3153 participants with feeding information, weight and length measurements at age 9 to 15 months (1 year) (Figure 1; available at www.jpeds.com). Approval was obtained

Results

Compared with infants excluded in this analysis, those included were less likely to be of a lower SES status and less likely to have siblings (Table I; available at www.jpeds.com). Included infants were also more likely to be fully breastfed for 4-5 months, to be any breastfed for ≥12 months, and to have introduced solids at 5 months, and less likely to be fully breastfed for 2-3 months, to be any breastfed for 0-2 months, and introduced to solids at ≥7 months. Mothers of included infants were

Discussion

In this large population-based cohort of 1-year-old infants in Melbourne, Australia, we found that the relationship between age at introduction of solid foods and infant with an above normal BMI was U-shaped with introduction of solids at 5-6 months the lowest risk with regard to the development of above normal BMI at 1 year of age. The infants to whom solids were introduced before or at 4 months, compared with thoseintroduced to solids at 6 months, were about 3 times as likely to have an above

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      Taken together, these findings support current AAP and WHO recommendations for introducing solid food around 6 months of age. Although previous studies have examined the relationship between timing of introduction to solid food and child growth,4-9 few have differentiated initiating solid food between 4 and 6 months of age. There is little evidence that introduction to solid food at 4 vs 6 months was associated with differences in weight or length in childhood; the authors noted a number of limitations of the existing literature, including lack of granularity on the timing of introduction to solid food between 4 and 6 months of age, poor understanding of the effect of early milk feeding (ie, breast or formula), and lack of evaluation of multiple outcomes (ie, weight, height, and feeding behavior).37

    • Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life

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      While previous studies demonstrated interaction between breastfeeding duration and the timing of introduction of complementary foods,8,26 we did not find a significant interaction in our sample. Others have shown that introduction of solid foods before 4 months, compared to after 6 months, is associated with increased BMI for infants breastfed for <4 months as well as those breastfed for ≥4 months.8 Delaying introduction of solids after 7 months, compared to 5 to 6 months, is also associated with increased BMI for infants breastfed for <4 months, but not for infants breastfed ≥4 months of age.

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    Funded by the Australian National Health and Medical Research Council (NHMRC), Ilhan Food Allergy Foundation, Anaphylaxi-Stop, and ANZ Trustees Medical Research & Technology, Victoria. C.S. and J.K. are supported by the NHMRC Early Career Public Health Fellowships. K.A., A-.L.P., M.W., and A.L. are supported by the NHMRC Research Fellowships. Murdoch Childrens Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. The authors declare no conflicts of interest.

    *

    Contributed equally.

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