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American Academy of Pediatrics
Article

Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial

Olof H. Jonsdottir, Inga Thorsdottir, Patricia L. Hibberd, Mary S. Fewtrell, Jonathan C. Wells, Gestur I. Palsson, Alan Lucas, Geir Gunnlaugsson and Ronald E. Kleinman
Pediatrics December 2012, 130 (6) 1038-1045; DOI: https://doi.org/10.1542/peds.2011-3838
Olof H. Jonsdottir
aUnit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland;
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Inga Thorsdottir
aUnit for Nutrition Research, Landspitali, The National University Hospital of Iceland and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland;
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Patricia L. Hibberd
bDivision of Global Health, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts;
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Mary S. Fewtrell
cChildhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom;
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Jonathan C. Wells
cChildhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom;
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Gestur I. Palsson
dChildren’s Hospital, Landspitali, The National University Hospital of Iceland, and
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Alan Lucas
cChildhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom;
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Geir Gunnlaugsson
eDirectorate of Health and Reykjavik University, Reykjavik, Iceland; and
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Ronald E. Kleinman
fDepartment of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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Abstract

OBJECTIVE: To increase knowledge on iron status and growth during the first 6 months of life. We hypothesized that iron status would be better in infants who received complementary foods in addition to breast milk compared with those exclusively breastfed.

METHODS: One hundred nineteen healthy term (≥37 weeks) singleton infants were randomly assigned to receive either complementary foods in addition to breast milk from age 4 months (CF) or to exclusive breastfeeding for 6 months (EBF). Dietary data were collected by 3-day weighed food records, and data on iron status and growth were also collected.

RESULTS: One hundred infants (84%) completed the trial. Infants in the CF group had higher mean serum ferritin levels at 6 months (P = .02), which remained significant when adjusted for baseline characteristics. No difference was seen between groups in iron deficiency anemia, iron deficiency, or iron depletion. The average daily energy intake from complementary foods of 5-month-olds in the CF group was 36.8 kJ per kg body weight. Infants in both groups grew at the same rate between 4 and 6 months of age.

CONCLUSIONS: In a high-income country, adding a small amount of complementary food in addition to breast milk to infants’ diets from 4 months of age does not affect growth rate between 4 and 6 months, but has a small and positive effect on iron status at 6 months. The biological importance of this finding remains to be determined.

KEY WORDS
  • exclusive breastfeeding
  • complementary feeding
  • iron status
  • growth rate
  • randomized trial
  • Abbreviations:
    CF —
    complementary feeding in addition to breast milk from the age of 4 months
    EBF —
    exclusive breastfeeding to the age of 6 months
    Hb —
    hemoglobin
    ID —
    iron deficiency
    IDA —
    iron deficiency anemia
    MCV —
    mean corpuscular volume
    RDW —
    red blood cell distribution width
    SF —
    serum ferritin
    TIBC —
    total iron-binding capacity
    WHO —
    World Health Organization
    • Accepted July 27, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 6
    1 Dec 2012
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    Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial
    Olof H. Jonsdottir, Inga Thorsdottir, Patricia L. Hibberd, Mary S. Fewtrell, Jonathan C. Wells, Gestur I. Palsson, Alan Lucas, Geir Gunnlaugsson, Ronald E. Kleinman
    Pediatrics Dec 2012, 130 (6) 1038-1045; DOI: 10.1542/peds.2011-3838

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    Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial
    Olof H. Jonsdottir, Inga Thorsdottir, Patricia L. Hibberd, Mary S. Fewtrell, Jonathan C. Wells, Gestur I. Palsson, Alan Lucas, Geir Gunnlaugsson, Ronald E. Kleinman
    Pediatrics Dec 2012, 130 (6) 1038-1045; DOI: 10.1542/peds.2011-3838
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    Subjects

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    Keywords

    • exclusive breastfeeding
    • complementary feeding
    • iron status
    • growth rate
    • randomized trial
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