Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood

Véronique Gingras; Izzuddin M. Aris; Sheryl L. Rifas-Shiman; Karen M. Switkowski; Emily Oken; Marie-France Hivert

doi:10.1542/peds.2019-1320

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TABLE 1

Parents’ and Children’s Characteristics Overall and According to Breastfeeding Status at 4 Months of Age and Timing of CF Introduction Among 1013 Mother-Child Pairs in the Project Viva Cohort

	Overall (N = 1013)	Breastfed (at Least Partly) at 4 mo (n = 704; 69%)			Formula Fed (Never Breastfed or Stopped Breastfeeding) at 4 mo (n = 309; 31%)
		Timing of CF Introduction			Timing of CF Introduction
		<4 mo (n = 81; 12%)	4–<6 mo (n = 509; 72%)	≥6 mo (n = 114; 16%)	<4 mo (n = 108; 35%)	4–<6 mo (n = 176; 57%)	≥6 mo (n = 25; 8%)
Parental characteristics
Maternal age at enrollment, y, mean (SD)	32.6 (4.8)	31.8 (5.4)	33.0 (4.2)	34.5 (4.4)	29.9 (5.6)	32.2 (5.0)	32.9 (5.7)
Maternal marital status, married or cohabitating, %	95	91	97	99	82	95	92
Maternal education, college graduate, %	74	65	83	88	48	63	60
Household income >$70 000 (US) per y, %	66	56	72	72	52	62	47
Maternal prepregnancy BMI, kg/m², mean (SD)	24.4 (5.0)	24.6 (4.6)	23.6 (4.1)	23.8 (4.3)	26.2 (6.4)	25.3 (5.9)	27.8 (7.6)
Paternal BMI, kg/m², mean (SD)	26.4 (3.9)	26.2 (3.3)	26.2 (3.9)	25.5 (3.2)	27.4 (5.0)	27.0 (3.9)	27.5 (4.7)
Child characteristics
Female sex, %	51	43	51	53	46	55	56
Race and/or ethnicity, %
White	69	53	73	80	55	70	48
Black or African American	12	22	10	4	21	10	36
Hispanic	4	10	3	2	7	2	4
Asian	3	0	3	4	2	6	4
Other	12	15	11	11	15	11	8
Gestational age at birth, wk, mean (SD)	39.7 (1.4)	39.6 (1.5)	39.7 (1.4)	39.8 (1.3)	39.8 (1.4)	39.6 (1.4)	39.2 (1.7)
Birth wt, kg, mean (SD)	3.53 (0.52)	3.48 (0.56)	3.54 (0.51)	3.60 (0.49)	3.51 (0.55)	3.50 (0.50)	3.35 (0.61)
Birth wt for gestational age, z score, mean (SD)	0.23 (0.97)	0.11 (1.01)	0.25 (0.95)	0.35 (0.96)	0.17 (0.99)	0.21 (0.99)	−0.02 (0.97)
Change in wt-for-age z score from 0 to 4 mo, SD units, mean (SD)	0.35 (1.01)	0.49 (1.13)	0.29 (0.99)	0.15 (1.05)	0.56 (1.00)	0.44 (0.93)	0.39 (1.12)

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TABLE 2

Adjusted Linear Regression Coefficients for Associations of Timing of CF Introduction and Offspring’s Adiposity at Midchildhood and Early Adolescence in Breastfed (at Least Partly for ≥4 Months) or Formula-Fed (Never Breastfed or Stopped Breastfeeding by 4 Months) Children

Outcomes	n	Model 1 β (95% CI)			Model 2 β (95% CI)
		Timing of CF Introduction			Timing of CF Introduction
		<4 mo	4–<6 mo	≥6 mo	<4 mo	4–<6 mo	≥6 mo
Breastfed children
Midchildhood
BMI, z score	620	0.34 (0.11 to 0.58)	0.0 (reference)	−0.10 (−0.30 to 0.11)	0.20 (−0.02 to 0.43)	0.0 (reference)	−0.05 (−0.24 to 0.14)
Waist circumference, cm	620	2.71 (1.10 to 4.31)	0.0 (reference)	−0.04 (−1.44 to 1.36)	1.78 (0.19 to 3.36)	0.0 (reference)	0.17 (−1.18 to 1.52)
DXA whole-body fat percentage, %	483	1.76 (0.29 to 3.22)	0.0 (reference)	−0.21 (−1.57 to 1.16)	1.08 (−0.41 to 2.57)	0.0 (reference)	0.00 (−1.34 to 1.35)
DXA truncal fat mass, kg	483	0.53 (0.21 to 0.85)	0.0 (reference)	−0.06 (−0.36 to 0.24)	0.33 (0.01 to 0.65)	0.0 (reference)	−0.01 (−0.30 to 0.29)
Sum of skinfolds (subscapular plus triceps), mm	618	2.86 (0.97 to 4.75)	0.0 (reference)	−0.38 (−2.03 to 1.27)	1.58 (−0.29 to 3.45)	0.0 (reference)	0.01 (−1.58 to 1.60)
Skinfold ratio (subscapular/triceps)	618	0.04 (−0.01 to 0.08)	0.0 (reference)	−0.01 (−0.05 to 0.03)	0.01 (−0.03 to 0.06)	0.0 (reference)	0.00 (−0.04 to 0.03)
Early adolescence
BMI, z score	601	0.34 (0.08 to 0.60)	0.0 (reference)	−0.06 (−0.28 to 0.17)	0.22 (−0.02 to 0.47)	0.0 (reference)	0.02 (−0.19 to 0.22)
Waist circumference, cm	604	3.48 (0.90 to 6.07)	0.0 (reference)	0.63 (−1.57 to 2.83)	2.97 (0.47 to 5.47)	0.0 (reference)	1.09 (−0.99 to 3.16)
DXA whole-body fat percentage, %	415	2.41 (0.43 to 4.38)	0.0 (reference)	0.70 (−1.15 to 2.55)	1.73 (−0.23 to 3.68)	0.0 (reference)	0.53 (−1.24 to 2.31)
DXA truncal fat mass, kg	415	1.72 (0.83 to 2.61)	0.0 (reference)	0.39 (−0.44 to 1.23)	1.20 (0.33 to 2.06)	0.0 (reference)	0.40 (−0.39 to 1.19)
Sum of skinfolds (subscapular plus triceps), mm	603	4.36 (1.34 to 7.38)	0.0 (reference)	−0.26 (−2.84 to 2.32)	3.26 (0.33 to 6.19)	0.0 (reference)	0.26 (−2.19 to 2.70)
Skinfold ratio (subscapular/triceps)	603	0.07 (0.02 to 0.13)	0.0 (reference)	0.03 (−0.02 to 0.07)	0.04 (−0.02 to 0.09)	0.0 (reference)	0.04 (−0.01 to 0.09)
Formula-fed children
Midchildhood
BMI, z score	271	0.43 (0.17 to 0.68)	0.0 (reference)	0.48 (0.04 to 0.93)	0.32 (0.09 to 0.55)	0.0 (reference)	0.37 (−0.03 to 0.77)
Waist circumference, cm	272	3.17 (0.99 to 5.36)	0.0 (reference)	4.26 (0.51 to 8.02)	2.58 (0.59 to 4.57)	0.0 (reference)	2.65 (−0.75 to 6.05)
DXA whole-body fat percentage, %	219	1.18 (−0.56 to 2.91)	0.0 (reference)	0.19 (−2.99 to 3.36)	1.15 (−0.44 to 2.73)	0.0 (reference)	−0.87 (−3.76 to 2.03)
DXA truncal fat mass, kg	219	0.64 (0.14 to 1.14)	0.0 (reference)	0.52 (−0.40 to 1.43)	0.52 (0.07 to 0.97)	0.0 (reference)	0.07 (−0.75 to 0.89)
Sum of skinfolds (subscapular plus triceps), mm	271	4.85 (2.14 to 7.55)	0.0 (reference)	2.99 (−1.55 to 7.54)	4.23 (1.70 to 6.77)	0.0 (reference)	1.25 (−2.98 to 5.48)
Skinfold ratio (subscapular/triceps)	271	0.08 (0.03 to 0.13)	0.0 (reference)	0.14 (0.05 to 0.22)	0.06 (0.01 to 0.11)	0.0 (reference)	0.10 (0.02 to 0.18)
Early adolescence
BMI, z score	245	0.47 (0.18 to 0.75)	0.0 (reference)	0.38 (−0.14 to 0.90)	0.34 (0.07 to 0.61)	0.0 (reference)	0.33 (−0.15 to 0.81)
Waist circumference, cm	246	4.63 (1.00 to 8.27)	0.0 (reference)	5.75 (−0.65 to 12.14)	3.42 (0.12 to 6.71)	0.0 (reference)	4.27 (−1.46 to 10.00)
DXA whole-body fat percentage, %	184	2.34 (−0.15 to 4.83)	0.0 (reference)	3.36 (−1.13 to 7.86)	2.55 (0.20 to 4.91)	0.0 (reference)	2.25 (−1.87 to 6.37)
DXA truncal fat mass, kg	184	1.44 (−0.08 to 2.96)	0.0 (reference)	1.55 (−1.19 to 4.29)	1.12 (−0.25 to 2.50)	0.0 (reference)	0.59 (−1.82 to 3.00)
Sum of skinfolds (subscapular plus triceps), mm	243	6.22 (2.08 to 10.36)	0.0 (reference)	7.85 (0.21 to 15.49)	5.04 (1.13 to 8.95)	0.0 (reference)	6.27 (−0.79 to 13.33)
Skinfold ratio (subscapular/triceps)	243	0.13 (0.06 to 0.19)	0.0 (reference)	0.17 (0.05 to 0.29)	0.10 (0.04 to 0.17)	0.0 (reference)	0.13 (0.02 to 0.25)

Model 1 is adjusted for child age at outcome assessment and sex (except for BMI z score); Model 2 is Model 1 additionally adjusted for maternal education, marital status, household income, maternal prepregnancy BMI, paternal BMI, child’s race and/or ethnicity, infant gestational age at delivery, and change in wt-for-age z score from 0 to 4 mo.

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TABLE 3

Distribution of Participants (n = 1013) by Age at Introduction of Specific Food Items

	Timing of Introduction, %
	<4 mo	4–<6 mo	≥6 mo
Infant cereals	15.3	69.4	15.3
Starches other than infant cereals	0.5	12.9	86.6
Fruits	5.7	60.5	33.9
Vegetables	4.1	58.7	37.2
Fruit juice	5.6	23.7	70.8
Meat, chicken, and/or turkey	0.7	9.1	90.2
Cow’s milk (other than formula)	0.2	0.4	99.4
Dairy other than cow’s milk	0.5	4.1	95.5
Soy milk (other than formula)	1.4	0.6	98.0
Peanut butter	0	0.4	99.6
Eggs	0	1.3	98.7
Fish	0	0.5	99.5
Sweets	0.7	3.2	96.2

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TABLE 4

Adjusted Linear Regression Coefficients for Associations of Timing of Introduction of Specific Food Items and Offspring’s BMI z Score and Waist Circumference at Midchildhood and Early Adolescence in Breastfed (at Least Partly for ≥4 Months) or Formula-Fed (Never Breastfed or Stopped Breastfeeding by 4 Months) Children

Outcomes	Infant Cereals, β (95% CI)			Fruits, β (95% CI)			Vegetables, β (95% CI)			Fruit Juice, β (95% CI)
	Timing of Introduction			Timing of Introduction			Timing of Introduction			Timing of Introduction
	<4 mo	4–<6 mo	≥6 mo	<4 mo	4–<6 mo	≥6 mo	<4 mo	4–<6 mo	≥6 mo	<4 mo	4–<6 mo	≥6 mo
Breastfed children
Midchildhood
BMI, z score	0.28 (0.03 to 0.53)	0.0 (reference)	−0.08 (−0.26 to 0.11)	0.22 (−0.17 to 0.61)	0.0 (reference)	−0.08 (−0.23 to 0.06)	0.30 (−0.15 to 0.75)	0.0 (reference)	−0.08 (−0.22 to 0.06)	0.46 (0.04 to 0.88)	0.0 (reference)	0.03 (−0.14 to 0.21)
Waist circumference, cm	2.24 (0.46 to 4.01)	0.0 (reference)	0.12 (−1.18 to 1.42)	0.87 (−1.89 to 3.64)	0.0 (reference)	0.24 (−0.78 to 1.26)	0.75 (−2.45 to 3.96)	0.0 (reference)	0.06 (−0.94 to 1.06)	3.44 (0.48 to 6.40)	0.0 (reference)	0.10 (−1.14 to 1.35)
Early adolescence
BMI, z score	0.20 (−0.08 to 0.47)	0.0 (reference)	−0.04 (−0.24 to 0.16)	0.27 (−0.15 to 0.69)	0.0 (reference)	0.06 (−0.10 to 0.22)	0.34 (−0.16 to 0.84)	0.0 (reference)	0.08 (−0.08 to 0.23)	0.21 (−0.24 to 0.67)	0.0 (reference)	0.03 (−0.16 to 0.22)
Waist circumference, cm	3.02 (0.21 to 5.82)	0.0 (reference)	0.67 (−1.35 to 2.68)	3.72 (−0.56 to 8.00)	0.0 (reference)	1.03 (−0.57 to 2.64)	4.17 (−0.96 to 9.30)	0.0 (reference)	0.84 (−0.75 to 2.42)	2.71 (−1.93 to 7.35)	0.0 (reference)	−0.00 (−1.96 to 1.96)
Formula-fed children
Midchildhood
BMI, z score	0.33 (0.09 to 0.57)	0.0 (reference)	0.35 (−0.02 to 0.73)	0.11 (−0.24 to 0.47)	0.0 (reference)	0.24 (−0.03 to 0.50)	0.16 (−0.24 to 0.55)	0.0 (reference)	0.18 (−0.07 to 0.42)	0.12 (−0.30 to 0.53)	0.0 (reference)	−0.10 (−0.37 to 0.16)
Waist circumference, cm	2.58 (0.49 to 4.66)	0.0 (reference)	2.33 (−0.82 to 5.48)	−0.58 (−3.59 to 2.42)	0.0 (reference)	0.78 (−1.50 to 3.06)	−0.20 (−3.53 to 3.14)	0.0 (reference)	0.67 (−1.40 to 2.74)	1.33 (−2.16 to 4.82)	0.0 (reference)	−1.01 (−3.24 to 1.23)
Early adolescence
BMI, z score	0.31 (0.02 to 0.59)	0.0 (reference)	0.17 (−0.27 to 0.60)	0.11 (−0.30 to 0.53)	0.0 (reference)	0.06 (−0.25 to 0.36)	0.15 (−0.30 to 0.61)	0.0 (reference)	0.01 (−0.26 to 0.29)	0.34 (−0.11 to 0.79)	0.0 (reference)	−0.04 (−0.35 to 0.26)
Waist circumference, cm	3.10 (−0.39 to 6.58)	0.0 (reference)	1.77 (−3.38 to 6.92)	0.88 (−4.14 to 5.90)	0.0 (reference)	−0.50 (−4.21 to 3.20)	0.62 (−4.83 to 6.07)	0.0 (reference)	−0.93 (−4.27 to 2.41)	3.63 (−1.73 to 8.99)	0.0 (reference)	−2.43 (−6.05 to 1.18)

Adjusted for child age at outcome assessment and sex (except for BMI z score), maternal education, marital status, household income, maternal prepregnancy BMI, paternal BMI, child’s race and/or ethnicity, infant gestational age at delivery, and change in wt-for-age z score from 0 to 4 mo.