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Solid food guidelines contribute to infants’ unhealthy weight
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Guidelines currently endorsed by several hospitals and infant formula manufacturers that recommend introducing solids to infants may contribute to both overweight and underweight by age 1 year, according to research published in the American Journal of Preventive Medicine.
On the national level, the CDC, the AAP and the United States Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children have all issued recommendations for introducing solids, otherwise known as complementary foods, into infants’ diets. Additionally, hospitals and infant formula manufacturers have provided recommendations on introducing complementary foods. However, according to Bruce Y. Lee, MD, associate professor of international health at the Johns Hopkins Bloomberg School of Public Health, and colleagues, these “guidelines vary appreciably in how much and what types of foods to provide.”
“Every infant is different, with different body types, sizes and circumstance, so it is difficult to have one-size-fits-all recommendations,” Lee told Infectious Diseases in Children. “The first year is crucial for future development because that's when a person's metabolism, hunger levels and feeding behaviors are often established, making it more difficult to lose weight later in life.”
The researchers created a computer model that simulated feeding behaviors, activity levels, metabolism and body size of infants aged between 6 months and 1 year. The infants’ daily food intake in the simulation model was based on feeding recommendations endorsed by Johns Hopkins Medicine, the Children’s Hospital of Philadelphia, Similac and Enfamil, which changed the infants’ body weight.
Additional simulations were conducted to assess the impact of complementary feeding guidelines endorsed by CHOP, Johns Hopkins Medicine, Enfamil and Similac.
None of the four guidelines used in the simulations resulted in normal weight among the virtual infants who were also breastfed at age 12 months. Infants who received half the amount of breastmilk and were introduced to complementary foods based on guidelines from CHOP, Johns Hopkins and Enfamil had overweight BMIs between the ages of 9 and 11 months. Unhealthy underweight BMIs were also observed among infants between ages 7 and 11 months who had their breastmilk consumption halved and followed the Children’s Hospital of Philadelphia, Johns Hopkins Medicine and Similac guidelines for complementary food intake.
“It is unclear how the suggested daily serving sizes for different food groups were developed and in which situations they should be applied. Pediatricians should understand that current guidelines are only rough guides and can instead emphasize the importance of responsive feeding practices,” Marie C. Ferguson, MSPH, a research associate at the Johns Hopkins Bloomberg School of Public Health, told Infectious Diseases in Children. “Responsive feeding includes caregivers spending time and attention learning the reactions and cues of their baby and responding to support their needs.”
Ferguson added that pediatricians can also spend additional time with caregivers and their infants to better understand their feeding routines as well as the child’s appetite and growth to inform parents how and when to introduce complimentary foods. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Keli Hawthorne, MS, RD, LD
Feeding babies is not one-size-fits-all. There are different ways to introduce foods, beginning with purees to baby-led weaning, where whole foods are introduced. Regardless of what feeding style parents choose, iron-rich foods such as meat and iron-fortified cereals should be included in diets starting at age 6 months.
Although computerized simulations are helpful models, the current incidence of obesity in infants based on BMI does not reflect the high numbers predicted by the model. The four feeding recommendations that the authors evaluated are all still in accord with recommendations from the AAP for introducing solids. An important takeaway is that growth should be carefully monitored to ensure that regardless of feeding strategy, individual infants are identified and solid food intake is discussed with the family. Pediatricians can help parents understand their baby’s feeding cues for when they are ready to try new foods and when they are not hungry or interested in eating. By paying attention to a baby’s cues, parents can provide nutritious foods in the right portion sizes at the right time to maintain healthy growth and weight gain.
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