Complementary Feeding and Health Consequences

 Exclusive breast feeding is recommendedfor the first six months of life. Around thattime solids are introduced and it has beensuggested that late (beyond 6 monthsof age) or too early (before 4 months ofage) introduction of solids may have healthconsequences later in life.One of the reasons for the introductionof (CF) at around 6 months of age is thatthe volume of human milk at 6 months isinsufficient to meet nutritional requirements.The introduction of solids already at 4 monthswas shown to positively influence iron stores,and psychomotor developmental indices.Introduction of CF has been studied formany health outcomes: on allergy, thereis good evidence from observationalstudies including prospective birth cohortsdemonstrating that delayed introductionof solids and the delayed introductionof allergenic foods beyond 6 months ofage does not prevent the development offood allergy and may even increase therisk of allergy. While awaiting the resultsof randomized controlled studies on thesubject, there is no reason to revise therecommendations of ESPGHAN CoN (2008)that CF should not be introduced before 4months of age (stated as 17 weeks) and notafter 6 months of age (26 weeks) are in linewith current scientific evidence.One “outlier” to this recommendationcould be the introduction of gluten. Datafrom 2 recent randomized controlledtrials conducted in infants at high risk fordeveloping celiac disease (one comparedintroduction at 4 months of age to 6 monthsof age and one compared the introductionat 6 months of age compared to 12 monthsof age). Both studies found no differencein the prevalence of CD at study end.Thus, for infants at high risk, there is noadvantage in introducing gluten earlier than6 months of age, and later introductiondoes not increase the risk of developingceliac disease. It is unknown, whether thesefindings could be extrapolated to the generalhealthy population.Regarding obesity, the timing of CFintroduction was not shown to be related tothe development of overweight or obesity.However, limited data suggest that veryearly introduction (before or at 4 monthsof age) may increase overweight rates inchildhood.In summary, adequate introduction ofCF may affect nutritional status, psychomotordevelopment and the risk of noncommunicable diseases. Guidelines ontiming and the role of specific food itemsmay change based on ongoing RCT’s.