by Anne Eglash MD, IBCLC, FABM
Does early introduction of solid foods for infants increase the risk of obesity?
Approximately 40% of families in the USA feed their infants solids before 4 months of age, despite The American Academy of Pediatrics’ recommendation to introduce solids around 6 months of age. A large study published in a 2011 issue of the journal Pediatrics found that the introduction of solid foods to formula feeding infants under 4 months of age increased the risk of obesity at 3 years of age.
The authors of the current study for our Clinical Question investigated whether breastfed infants and formula fed infants have the same risk of obesity when introduced to solids under 4 months of age.
What do you think the authors found about timing of solids for breastfeeding infants and risk of obesity? (choose one or more)
- Breastfeeding prevents the obesity caused by introduction of solids before 4 months of age.
- When the research is adjusted for other factors such as maternal age, race, education and pre-pregnancy BMI, there is no association between obesity and introduction of solids before 6 months, even for formula fed infants.
- Breastfed infants are more likely to be obese at 6 years of age if fed solids under 4 months, versus if fed solids between 4-6 months.
See the Answer
Read the ABSTRACT
Age at Introduction to Solid Foods and Child Obesity at 6 Years
Chloe M. Barrera, MPH, Cria G. Perrine, PhD, Ruowei Li, MD, PhD, and Kelley S. Scanlon, PhD, RD
CHILDHOOD OBESITY
June 2016 j Volume 12, Number 3
Background:
Epidemiological evidence suggests that timing of introduction of solid foods may be associated with subsequent obesity, and the association may vary by whether an infant is breastfed or formula-fed.
Methods:
We included 1181 infants who participated in the Infant Feeding Practices Study II (IFPS II) and the Year 6 Follow Up (Y6FU) study. Data from IFPS II were used to calculate the primary exposure and timing of solid food introduction (<4, 4–<6, and
‡6 months), and data from Y6FU were used to calculate the primary outcome and obesity at 6 years of age (BMI ‡95th percentile).
We used multivariable logistic regression to assess the association between timing of the introduction of solids and obesity at 6 years
and test whether this association was modified by breastfeeding duration (breastfed for 4 months vs. not).
Results:
Prevalence of obesity in our sample was 12.0%. The odds of obesity was higher among infants introduced to solids <4
months compared to those introduced at 4– this relationship was no longer significant after adjustment for covariates (OR = 1.18; 95% CI, 0.79, 1.77). Introduction of solids ‡6
months was not associated with obesity. We found no interaction between breastfeeding duration and early solid food introduction
and subsequent obesity.
Conclusions:
Timing of introduction of solid foods was not associated with child obesity at 6 years in this sample. Given the inconsistency in findings with other studies, further studies in larger populations may be needed.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
I hear from many families in my lactation clinic that their pediatric providers recommend solids at 4 months of age. I also hear from grandparents and other family members that infants ought to start solids at 6-8 weeks, based on their cultural and family experiences.
Fortunately, most major professional maternal/child organizations such as the AAP, AAFP, and WHO agree that waiting until 6 months of age for solids is ideal for infant health.
Even though this study failed to find an association between obesity and solids introduction before 4 months of age, or introduction between 4-6 months of age, there are still sufficient reasons to wait until 6 months to introduce solid foods. Early solids, also known as ‘stage 1’ by commercial baby food manufacturers, tend to be low in protein, fat and iron. Therefore, these solids would displace breastmilk, which is a much more nutrient-dense food for infants, since it is higher in fat and protein. The benefits of breastfeeding are generally dose-related. The less breastmilk an infant receives, the greater the risk of illnesses associated with not breastfeeding. So, if an infant begins weaning from breastfeeding under 6 months because of early introduction of solids, the infant has a risk of delayed brain and retinal maturation, bacterial infections, diarrhea, childhood cancers, and diabetes.
So, save the muss and fuss, and keep that babe at the breast until 6 months of age!