Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Review
  • Published:

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review

Abstract

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle–Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4–6 months or >6 months, may increase the risk of childhood overweight.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. World Health Report. Reducing Risks, Promoting Healthy Life. WHO: Geneva, Switzerland, 2002.

  2. Government Office for Statistics. Foresight. Tackling Obesities: Future Choices–Project Report. Department of Innovation, Universities and Skills: UK, 2007.

  3. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W . Annual medical spending attributable to obesity: payer-and service-specific estimates. Health affairs (Project Hope) 2009; 28: w822–w831.

    Article  Google Scholar 

  4. National Child Measurement Programme, England, 2010/2011 School Year. The Health and Social Care Information Centre, NHS, 2011.

  5. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012; 307: 483–490.

    Article  Google Scholar 

  6. DoH. National Child Measurement Programme: 2006/07 School Year, Headline Results, 2007.

  7. Singh AS, Mulder C, Twisk JWR, van Mechelen W, Chinapaw MJM . Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008; 9: 474–488.

    Article  CAS  Google Scholar 

  8. WHO. Complementary Feeding: Report of the Global Consultation. Geneva, Switzerland, 2002.

  9. Health Do. Weaning: Starting solid food In: NHS, (ed UK: Department of Health, 2008.

  10. American Academy of Pediatrics. Breastfeeding and the use of human milk In 2012.

  11. Martorell R, Khan LK, Schroeder DG . Reversibility of stunting–epidemiologic findings in children from developing countries. Eur J Clin Nutr 1994; 48: S45–S57.

    PubMed  Google Scholar 

  12. Seach KA, Dharmage SC, Lowe AJ, Dixon JB . Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes 2010; 34: 1475–1479.

    Article  CAS  Google Scholar 

  13. Fak F, Friis-Hansen L, Westrom B, Wierup N . Gastric ghrelin cell development is hampered and plasma ghrelin is reduced by delayed weaning in rats. J Endocrinol 2007; 192: 345–352.

    Article  Google Scholar 

  14. NHS. Infant Feeding Survey, 2010, 2012.

  15. Grummer-Strawn LM, Scanlon KS, Fein SB . Infant feeding and feeding transitions during the first year of life. Pediatrics 2008; 122 (Suppl 2): S36–S42.

    Article  Google Scholar 

  16. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG . Effect of infant feeding on the risk of obesity across the life course: A quantitative review of published evidence. Pediatrics 2005; 115: 1367–1377.

    Article  Google Scholar 

  17. Pearce J, Langley-Evans SC . The types of food and feeding style introduced during complementary feeding and risk of childhood obesity: a systematic review. Int J Obes (Lond) 2013; 37: 477–485.

    Article  CAS  Google Scholar 

  18. Moorcroft KE, Marshall JL, McCormick FM . Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review. Matern Child Nutr 2011; 7: 3–26.

    Article  Google Scholar 

  19. Lloyd LJ, Langley-Evans SC, McMullen S . Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes 2010; 34: 18–28.

    Article  CAS  Google Scholar 

  20. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al. CDC growth charts: United States. Adv Data 2000; 314: 1–27.

    Google Scholar 

  21. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  22. World Health Organisation. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i–xii 1-253.

    Google Scholar 

  23. Wells GA, Shia B, O'Connell D, Peterson J, Welch V, Losos M The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2011, http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm (accessed Oct 2012).

  24. Burdette HL, Whitaker RC, Hall WC, Daniels SR . Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age. Am J Clin Nutr 2006; 83: 550–558.

    Article  CAS  Google Scholar 

  25. Kuperberg K, Evers S . Feeding patterns and weight among first nations children. Can J Diet Pract Res 2006; 67: 79–84.

    Article  Google Scholar 

  26. Obeidat BA, Shriver BJ, Roman-Shriver CR . Factors involved in the persistence of overweight among children enrolled in the supplemental food program for women, infants, and children. Maternl Child Health J 2010; 14: 164–173.

    Article  CAS  Google Scholar 

  27. Zive MM, McKay H, Frank-Spohrer GC, Broyles SL, Nelson JA, Nader PR . Infant-feeding practices and adiposity in 4-y-old Anglo- and Mexican- Americans. Am J Clin Nutr 1992; 55: 1104–1108.

    Article  CAS  Google Scholar 

  28. Ariza AJ, Chen EH, Binns HJ, Christoffel KK . Risk factors for overweight in five- to six-year-old Hispanic-American children: a pilot study. J Urban Health 2004; 81: 150–161.

    Article  Google Scholar 

  29. Brophy S, Cooksey R, Gravenor MB, Mistry R, Thomas N, Lyons RA et al. Risk factors for childhood obesity at age 5: analysis of the Millennium Cohort Study. BMC Public Health 2009; 9: 467.

    Article  Google Scholar 

  30. Butte NF . Impact of infant feeding practices on childhood obesity. J Nutr 2009; 139: 412S–416S.

    Article  CAS  Google Scholar 

  31. Kanoa BJ, Zabut BM, Harried AT . Nutritional status compared with nutritional history of preschool aged children in gaza strip: cross sectional study. Pak J Nutr 2011; 10: 282–290.

    Article  Google Scholar 

  32. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I et al. Early life risk factors for obesity in childhood: cohort study. Br Med J 2005; 330: 1357–1359.

    Article  Google Scholar 

  33. Simon VG, Souza JM, Souza SB . Breastfeeding, complementary feeding, overweight and obesity in pre-school children. Rev Saude Publica 2009; 43: 60–69.

    Article  Google Scholar 

  34. Schack-Nielsen L, Sørensen TIA, Mortensen EL, Michaelsen KF . Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight. Am J Clin Nutr 2010; 91: 619–627.

    Article  CAS  Google Scholar 

  35. Agras WS, Kraemer HC, Berkowitz RI, Hammer LD . Influence of early feeding style on adiposity at 6 years of age. J Pediatr 1990; 116: 805–809.

    Article  CAS  Google Scholar 

  36. Caleyachetty A, Krishnaveni GV, Veena SR, Hill J, Karat SC, Fall CHD et al. Breastfeeding duration, age of starting solids and high BMI risk and adiposity in Indian children. Matern Child Nutr 2013; 9: 199–216.

    Article  Google Scholar 

  37. Neutzling MB, Hallal PRC, Araujo CLP, Horta BL, Vieira MDA, Menezes AMB et al. Infant feeding and obesity at 11 years: prospective birth cohort study. Int J Pediatr Obes 2009; 4: 143–149.

    Article  Google Scholar 

  38. Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ . Association between infant breastfeeding and overweight in young children. JAMA 2001; 285: 2453–2460.

    Article  CAS  Google Scholar 

  39. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW . Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. Br Med J 1998; 316: 21–25.

    Article  CAS  Google Scholar 

  40. Gooze RA, Anderson SE, Whitaker RC . Prolonged bottle use and obesity at 5.5 years of age in US children. J Pediatr 2011; 159: 431–436.

    Article  Google Scholar 

  41. Patterson RE, Typpo JT, Typpo MH, Krause GF . Factors related to obesity in preschool-children. J Am Diet Assoc 1986; 86: 1376–1381.

    CAS  PubMed  Google Scholar 

  42. Wolman PG . Feeding practices in infancy and prevalence obesity in preschool-children. J Am Diet Assoc 1984; 84: 436–438.

    CAS  PubMed  Google Scholar 

  43. Butte NF, Wong WW, Hopkinson JM, Smith EO, Ellis KJ . Infant feeding mode affects early growth and body composition. Pediatrics 2000; 106: 1355–1366.

    Article  CAS  Google Scholar 

  44. Robinson SM, Marriott LD, Crozier SR, Harvey NC, Gale CR, Inskip HM et al. Variations in infant feeding practice are associated with body composition in childhood: a prospective cohort study. J Clin Endocrinol Metab 2009; 94: 2799–2805.

    Article  CAS  Google Scholar 

  45. Zhou LS, He GP, Zhang JP, Xie RH, Walker M, Wen SW . Risk factors of obesity in preschool children in an urban area in China. Eur J Pediatr 2011; 170: 1401–1406.

    Article  Google Scholar 

  46. WHO. A Growth Chart for International Use in Maternal and Child Health Care: Guidelines for Primary Health Care Personnel. WHO Geneva; HMSO: London, 1978.

  47. NHS. Infant Feeding Survey 2005. NHS, 2005; http://www.hscic.gov.uk/pubs/ifs2005 (accessed Oct 2012).

  48. Griffiths LJ, Smeeth L, Hawkins SS, Cole TJ, Dezateux C . Effects of infant feeding practice on weight gain from birth to 3 years. Arch Dis Child 2009; 94: 577–582.

    Article  CAS  Google Scholar 

  49. Caleyachetty A, Krishnaveni GV, Veena SR, Hill J, Karat SC, Fall CH et al. Breastfeeding duration, age of starting solids and high BMI risk and adiposity in Indian children. Matern Child Nutr 2011; 9: 199–216.

    Article  Google Scholar 

  50. Agras WS, Hammer LD, McNicholas F, Kraemer HC . Risk factors for childhood overweight: a prospective study from birth to 9.5 years. J Pediatr 2004; 145: 20–25.

    Article  Google Scholar 

  51. Haschke F, van't Hof MA . The influence of nutritional and genetic factors on growth and BMI until 5 years of age. Monatsschrift Kinderheilkunde 2003; 151: S54–S57.

    Article  Google Scholar 

  52. Moore AP, Milligan P, Goff LM . An online survey of knowledge of the weaning guidelines, advice from health visitors and other factors that influence weaning timing in UK mothers. Matern Child Nutr 2012. doi: 10.1111/j.1740-8709.2012.00424.x.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by a grant from the Feeding for Life Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J Pearce.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pearce, J., Taylor, M. & Langley-Evans, S. Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. Int J Obes 37, 1295–1306 (2013). https://doi.org/10.1038/ijo.2013.99

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2013.99

Keywords

This article is cited by

Search

Quick links