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Pearl Toh, 17 Feb 2020
Toddlers with a longer screen viewing time were more sedentary and spent less time engaged in physical activity later in life at age 5.5 years, according to the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study — supporting the hypothesis that screen viewing may have a negative influence on health by displacing physical activity.

Early complementary feeding tied to increased childhood adiposity

Elaine Soliven
13 Feb 2020

Introduction of complementary feeding (CF) at <4 months appears to be associated with increased adiposity in mid-childhood and early adolescence, regardless of whether the infants were breastfed or formula-fed, a study has shown.

Using data from the Project Viva* cohort, the researchers prospectively analysed 1,013 children (mid-childhood, mean age 7.9 years; early adolescence, mean age 13.2 years). Of these, 69 percent were breastfed for ≥4 months and 31 percent were formula-fed (never breastfed or stopped breastfeeding at <4 months). The children were categorized according to time of CF introduction: <4 months (19 percent), 4 to <6 months (68 percent), and ≥6 months (14 percent). [Pediatrics 2019;144:e20191320]

At mid-childhood and early adolescence, breastfed children who received CF at <4 months had an increased waist circumference (2.71 and 3.48 cm, respectively), BMI z-score (0.34 and 0.34), and DXA** truncal fat mass (0.53 and 1.72 kg) and whole-body fat percentage (1.76 percent and 2.41 percent) compared with those who started CF at 4 to <6 months.

Introduction of CF at <4 months was also associated with increased BMI z-score, waist circumference, DXA truncal fat mass, sum of skinfolds, and skinfold ratio in formula-fed children (0.43, 3.17 cm, 0.64 kg, 4.85 mm, and 0.08, respectively, in mid-childhood, and 0.47, 4.63 cm, 1.44 kg, 6.22 mm, and 0.13, respectively, in early adolescence) compared with CF introduction at 4 to <6 months.

“[Of note,] CF introduction at ≥6 months also seemed to be associated with other adiposity measures with estimated effect sizes similar to or greater than what we observed for [early] CF introduction at <4 months in formula-fed children,” the researchers noted. “This finding was not initially expected and needs to be interpreted with caution considering the small number of formula-fed participants with CF introduction at ≥6 months.”

The most common complementary foods fed to children at <4 months were infant cereals (15.3 percent), fruits (5.7 percent), and fruit juice (5.6 percent).

In breastfed children, early intake of infant cereals and fruit juice was associated with increased BMI z-score (0.28) and waist circumference (2.24 cm) during mid-childhood, the latter persisting through early adolescence (3.02 cm).

Increases in BMI z-score (0.33) and waist circumference (2.58 cm) in mid-childhood were also observed among formula-fed children who had an early intake of infant cereals, though only an increase in BMI z-score (0.31) was observed through early adolescence.

“Interestingly, the magnitude of the effect for early introduction of CF remained rather large for overall adiposity [from mid-childhood] up to early adolescence, [with stronger associations seen in formula-fed children],” noted the researchers.

Moreover, associations between late CF introduction and higher adiposity were noted in formula-fed children only, they said.

“Our findings, along with those from previous studies, [also] suggest no clear benefit in delaying CF introduction beyond 6 months, which is in line with recommendations from the European guidelines … [However,] more studies are needed with contemporary cohorts recruited after the implementation of the newest guidelines to better understand the effects of CF introduction beyond 6 months,” said the researchers. [J Pediatr Gastroenterol Nutr 2017;64:119-132; Ital J Pediatr 2015;41:36]

“[Overall, our] findings support the [current guideline] recommendations not to introduce CF at <4 months [or at >6 months] in children and suggest that delaying CF introduction could possibly be detrimental for obesity prevention [particularly] in formula-fed children,” said the researchers. [Ital J Pediatr 2015;41:36]

“The child’s feeding environment and behaviours during CF should be further explored and considered for more comprehensive guidance on CF introduction,” they added.

 

*Project Viva: A Longitudinal Study of Health for the Next Generation

**DXA: Dual-energy radiograph absorptiometry

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Most Read Articles
Pearl Toh, 17 Feb 2020
Toddlers with a longer screen viewing time were more sedentary and spent less time engaged in physical activity later in life at age 5.5 years, according to the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study — supporting the hypothesis that screen viewing may have a negative influence on health by displacing physical activity.