Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial. Infant feeding bottle design, growth and behaviour: results from a randomised trial Strategies to improve immunization rates and well-child care in a disadvantaged population: a cluster randomized controlled trial. Ecology of weaning among nomadic Turkana pastoralists of Kenya: maternal thinking, maternal behavior, and human adaptive strategies. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Complementary feeding: a Global Network cluster randomized controlled trial Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study Relationship between child feeding practices and malnutrition in 7 remote and poor counties, P R China. Solid food introduction in relation to eczema: results from a four-year prospective birth cohort study. Iron status of breastfed infants is improved equally by medicinal iron and iron-fortified cereal. [Prevalence of iron deficiency in healthy 12-month-old infants]. Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras Trial on timing of introduction to solids and food type on infant growth. A pilot study to assess the viability of a randomised controlled trial of methods of supplementary feeding of breast-fed pre-term babies. A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Water supplementation in exclusively breastfed infants during summer in the tropics The Effect of Feeding Glucose Water to Breastfeeding Newborns on Weight, Body Temperature, Blood Glucose, and Breastfeeding Duration Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study. Influence of breastfeeding and complementary food on growth between 5 and 10 months Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Anemia and Iron Status in Inuit Infants from Northern Quebec Iron intake and iron status in breastfed infants during the first year of life. Breastfeeding and infant size: evidence of reverse causality. The Effect of Early Initiation of Colostrum Feeding on Proliferation of Intestinal Bacteria in Neonates Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. Exclusively Breast-Fed Healthy Infants Grow Slower than Reference Infants Milk feeding and dietary patterns predict weight and fat gains in infancy. Dietary practices and nutritional status of 0-24-month-old children from Brazilian Amazonia.
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 r and omly 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 Objective : Early supplementation of breastfed infants may have consequences both for the mother and the child . We hypothesised that it would result in decreased maternal weight loss and in shorter duration s of breastfeeding and birth intervals . Design : Controlled r and omised population -based trial . Setting : Six villages in the Sine area of Senegal , West Africa . Subjects : Healthy breastfed infants and their mothers , 68 controls and 66 supplemented infants at r and omization . Intervention : Supplementation with high-energy , nutrient dense food from 4 to 7 months of age , twice daily under supervision of field workers . Both controls and supplemented infants were free to eat other complementary foods .  Maternal weight was measured monthly . Date s of breastfeeding cessation and of subsequent births were collected prospect ively through weekly demographic surveillance , and were analysed using Cox 's regression models and ‘ intent-to-supplement ’ approach . Results : Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group ( + 0.25 kg/months , 95 % confidence interval ( CI ) : −0.07 , + 0.57 ) . Supplemented infants were breastfed for significantly longer duration s than controls ( medians : 24.9 and 23.7 months , respectively , P : 0.034 ) . Their adjusted hazard ratio ( HR ) for breastfeeding cessation was 0.59 ( 95 % CI : 0.40 , 0.89 ) . Their mothers had a lower risk of a new birth than mothers of controls ( adjusted HR : 0.57 , 95 % CI : 0.36 , 0.92 ) . Conclusions : Early short-term infant supplementation tended to decrease maternal postpartum weight loss , but it increased , rather than shortened , the duration of breastfeeding and birth interval . Sponsorship : This study was supported by a grant from the French Ministry of Research ( Grant 92L0623 ) OBJECTIVE --To assess the relations between early introduction of solid food and infant weight , gastrointestinal illness , and allergic illnesses during the first two years of life . DESIGN -- Prospect i ve observational study of infants followed up for 24 months after birth . SETTING --Community setting in Dundee . PATIENTS --671 newborn infants , of whom 455 were still available for study at 2 years of age . MAIN OUTCOME MEASURES --Infants ' diet , weight , and incidence of gastrointestinal illness , respiratory illness , napkin dermatitis , and eczema at 2 weeks and 2 , 3 , 4 , 6 , 9 , 12 , 15 , 18 , 21 , and 24 months of age . RESULTS --The infants given solid food at an early age ( at < 8 weeks or 8 - 12 weeks ) were heavier than those introduced to solids later ( after 12 weeks ) at 4 , 8 , 13 , and 26 weeks of age ( p < 0.01 ) but not at 52 and 104 weeks . At their first solid feed those given solids early were heavier than infants of similar age who had not yet received solids . The incidence of gastrointestinal illness , wheeze , and nappy dermatitis was not related to early introduction of solids . There was a significant but less than twofold increase in respiratory illness at 14 - 26 weeks of age and persistent cough at 14 - 26 and 27 - 39 weeks of age among the infants given solids early . The incidence of eczema was increased in the infants who received solids at 8 - 12 weeks of age . CONCLUSION --Early introduction of solid food to infants is less harmful than was previously reported . Longer follow up is needed , but , meanwhile , a more relaxed approach to early feeding with solids should be considered BACKGROUND Koko , a fermented maize porridge used as the primary complementary food in Ghana , has been implicated in the high prevalence of child malnutrition . Weanimix , a cereal-legume blend developed by the United Nations Children 's Fund and the Ghanaian government , has been promoted as an alternative . OBJECTIVE We evaluated the effect of feeding Weanimix and 3 other locally formulated , central ly processed complementary foods on the nutritional status of 208 breast-fed infants . DESIGN Infants were r and omly assigned to receive 1 of 4 foods from 6 to 12 mo of age : Weanimix ( W ) , Weanimix plus vitamins and minerals ( WM ) , Weanimix plus fish powder ( WF ) , and koko plus fish powder ( KF ) . Dietary and anthropometric data were collected regularly . Blood was collected at 6 and 12 mo of age to assess iron , zinc , vitamin A , and riboflavin status . Before and after the intervention , cross-sectional data on the anthropometric status of infants not included in the intervention ( NI ; n = 464 ) were collected . RESULTS There were no significant differences between intervention groups in weight or length gain or in hemoglobin , hematocrit , transferrin saturation , plasma zinc , or erythrocyte riboflavin values between 6 and 12 mo of age . From 9 to 12 mo of age , z scores were lower in NI infants than in the combined intervention groups [ at 12 mo : -1.71 + /- 0.90 compared with -1.19 + /- 0.93 for weight and -1.27 + /- 1.02 compared with -0.63 + /- 0.84 for length ( P < 0.001 for both ) , respectively ] . The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W , WF , and KF but not in group WM . Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined ( 0.14 + /- 0.3 compared with -0.04 + /- 0.3 micromol/L , P = 0 . 003 ) . CONCLUSIONS All 4 foods improved growth relative to the NI group . Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods BACKGROUND Women who are overweight or obese before pregnancy breastfeed for shorter duration s than do normal-weight women . These shorter duration s may place infants of overweight and obese women at risk of not receiving the benefits of breastfeeding , which may include a reduced risk of overweight later in life . OBJECTIVE We examined how maternal prepregnant body mass index ( BMI ; in kg/m2 ) and infant feeding pattern are associated with  infant weight gain .  DESIGN In this prospect i ve , observational study , we used multiple regression analyses adjusted for potential confounding factors to examine these associations among 3768 mother-infant dyads from the Danish National Birth Cohort . RESULTS In multiple regression analyses , increasing maternal prepregnant BMI , decreasing duration s of breastfeeding , and earlier complementary food introduction were associated with increased infant weight gain . An interaction was identified for short duration s of breastfeeding ( < 20 wk ) . Earlier complementary food introduction ( < 16 wk ) was associated with greater infant weight gain ; however , the timing of complementary food introduction did not increase infant weight gain at longer duration s of breastfeeding ( > or = 20 wk ) . In this sample , prepregnant obesity ( BMI > or = 30.0 ) , short duration s of breastfeeding , and earlier introduction of complementary food were associated with 0.7 kg of additional weight gain during infancy . CONCLUSIONS  Infant weight gain is associated with maternal prepregnant BMI and with an interaction between the duration of breastfeeding and the timing of complementary food introduction . Future investigations of the effects of breastfeeding on infant weight gain should account for all of these factors To evaluate the effect of introducing complementary foods before 6 mo of age , we r and omly assigned 164 infants who had been exclusively breast-fed for 4 mo to continue being exclusively breast-fed until 6 mo ( EBF group ) or to receive iron-fortified foods in addition to breast milk from 4 to 6 mo ( BF+SF group ) . At 6 mo , the BF+SF group had higher mean iron intake ( 4 mg/d compared with 0.2 mg/d in EBF infants ) and higher hemoglobin , hematocrit , and ferritin values than the EBF group ( P < 0.05 ) . The percentage with low hemoglobin ( < 103 g/L ) did not differ significantly between groups , but fewer infants in the BF+SF group had a low hematocrit ( < 0.33 ; 21.4 % compared with 32.0 % , respectively ; P < 0.05 ) . The percentage of infants with ferritin concentrations < 12 microg/L at 6 mo was lower than the percentage with low hemoglobin or hematocrit , raising questions about the validity of the cutoffs at this age . Infants at greatest risk for anemia and low ferritin were those with birth weights < 2500 g ; no infant with a birth weight > 3000 g had a low ferritin value at 6 mo . We conclude that the risk of iron deficiency is low among infants with birth weights > 3000 g who are exclusively breast-fed for 6 mo . Iron drops are recommended for low-birth-weight infants ; for breast-fed infants with birth weights between 2500 and 3000 g , further research is needed to determine whether iron drops are more effective than complementary foods for preventing iron deficiency before 6 mo The effect of supplementation on growth was tested by means of four similar controlled r and omized trials in the Congo ( n = 120 ) , Senegal ( n = 110 ) , Bolivia ( n = 127 ) , and New Caledonia ( n = 90 ) . Four-month-old infants were r and omly allocated to supplement or control groups . A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored . Both groups were free to eat local food . At 7 mo of age , all infants were still breast-fed in the Congo , Senegal , and Bolivia compared with 47 % in New Caledonia . Mean daily consumption of the supplement varied among countries ( 558 - 790 kJ/d ) . Mean length at 4 mo was lowest in Bolivia , higher in Senegal and the Congo , and near the National Center for Health Statistics reference in New Caledonia . The mean 4 - 7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal ( P < 0.05 ) , whereas weight increments did not differ . No significant effect was found in the other countries Background Whether the design of an anti-vacuum infant feeding bottle influences infant milk intake , growth or behavior is unknown , and was the subject of this r and omized trial . Methods Subjects : 63 ( 36 male ) healthy , exclusively formula-fed term infants . Intervention : R and omisation to use Bottle A ( n = 31 ) , one-way air valve : Philips Avent ) versus Bottle B ( n = 32 ) , internal venting system : Dr Browns ) . 74 breast-fed reference infants were recruited , with r and omisation ( n = 24 ) to bottle A ( n = 11 ) or B ( n = 13 ) if bottle-feeding was subsequently introduced . R and omisationstratified by gender and parity ; computer-based telephone r and omisation by independent clinical trials unit . Setting Infant home . Primary outcome measureinfant weight gain to 4 weeks . Secondary outcomes ( i ) milk intake ( ii ) infant behaviour measured at 2 weeks ( vali date d 3-day diary ) ; ( iii ) risk of infection ; ( iv ) continuation of breastfeeding following introduction of mixed feeding . Results Number analysed for primary outcome Bottle A n = 29 , Bottle B n = 25 . Primary outcome There was no significant difference in weight gain between r and omised groups ( 0 - 4 weeks Bottle A 0.74 ( SD 1.2 ) SDS versus bottle B 0.51 ( 0.39 ) , mean difference 0.23 ( 95 % CI -0.31 to 0.77 ) . Secondary outcomes Infants using bottle A had significantly less reported fussing ( mean 46 versus 74 minutes/day , p < 0.05 ) than those using bottle B. There was no significant difference in any other outcome measure . Breast-fed reference groupThere were no significant differences in primary or secondary outcomes between breast-fed and formula fed infants . The likelyhood of breastfeeding at 3 months was not significantly different in infants subsequently r and omised to bottle A or B. Conclusion Bottle design may have short-term effects on infant behaviour which merit further investigation . No significant effects were seen on milk intake or growth ; confidence in these findings is limited by the small sample size and this needs confirmation in a larger study .Trial registration Clinical Trials.gov NCT00325208 OBJECTIVE To measure the effect of a multimodal intervention on well-child care visit ( WCV ) and immunization rates in an inner-city population . DESIGN Cluster r and omized controlled trial . SETTING AND PARTICIPANTS One-year cohort of 2843 infants born at a hospital in an integrated inner-city health care system . INTERVENTIONS Eleven clinics were r and omly allocated to 1 of 3 study arms : WCV intervention ( n = 3 ) , immunization intervention ( n = 4 ) , and controls ( n = 4 ) . Interventions to improve immunization and WCV rates included both patient-based and clinic-based activities . MAIN OUTCOME MEASURES Up-to- date status with childhood immunizations and WCVs by age 12 months ( primary ) and health care utilization and charges ( secondary ) . RESULTS Compared with the control arm , the WCV and immunization arms had 5 % to 6 % higher immunization rates and 7 % to 8 % higher WCV rates . In multivariate analyses that accounted for the clustered nature of the data , the number of immunizations received was greater in the WCV arm than in controls . However , neither the WCV nor the immunization intervention increased WCV or immunization up-to- date rates . The WCV arm had slightly higher health care charges . Neither intervention affected emergency , urgent care or inpatient utilization . CONCLUSIONS This multimodal intervention produced a small increase in the number of childhood immunizations delivered . However , patient- and clinic-based methods did not lead to significant increases in WCV or immunization up-to- date rates after controlling for other factors . Methods found in some setting s to increase immunization up-to- date rates may not be as effective in a population of inner-city socioeconomically disadvantaged children Weaning of human children is a complex process involving the introduction of non-breast-milk foods , reduction in suckling activity , and eventual termination of breast feeding . Because the choice of strategies for each component of the weaning process depends on the operating environmental constraints , reproductive dem and s on women , and prevailing levels of infant and weanling mortality , it is appropriate to examine weaning practice s as human adaptive strategies . Here , I examine the structure of weaning and maternal attitudes toward weaning among nomadic Turkana pastoralists from the perspective of human adaptation . Using retrospective and prospect i ve data on breast feeding , the use of non-breast-milk foods , and the cessation of breast feeding . I identify ideal strategies as those defined by Turkana women .  Real behavior in relation to weaning , however , deviates considerably from the ideal , and this deviation reflects adaptive responses to nutritional and disease risks to infants . Particular attention is given to problematic aspects of weaning practice s in Turkana , such as premature introduction of non-breast-milk foods and abrupt termination of breast feeding , which have been shown to contribute to high infant and weanling mortality in population s in developing countries . These practice s have evolved from the dual caretaking and childbearing role of women and the necessity of reconciling the needs of the breast-feeding child with the dem and s of the next pregnancy . As such , they represent rational strategies for enhancing reproductive success in this and other similarly stressful environments Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low re source setting s. Animal source foods in particular are cited as essential to achieve micronutrient requirements . The efficacy of the recommendation for regular meat consumption , however , has not been systematic ally evaluated . Methods / Design A cluster r and omized efficacy trial was design ed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement . The study is being conducted in 4 sites of the Global Network for Women 's and Children 's Health Research located in Guatemala , Pakistan , Democratic Republic of the Congo ( DRC ) and Zambia in communities with toddler stunting rates of at least 20 % . Five clusters per country were r and omized to each of the food arms , with 30 infants in each cluster . The daily meat or cereal supplement was delivered to the home by community coordinators , starting when the infants were 6 months of age and continuing through 18 months . All participating mothers received nutrition education messages to enhance complementary feeding practice s delivered by study coordinators and through posters at the local health center . Outcome measures , obtained at 6 , 9 , 12 , and 18 months by a separate assessment team , included anthropometry ; dietary variety and diversity scores ; biomarkers of iron , zinc and Vitamin B12 status ( 18 months ) ; neurocognitive development ( 12 and 18 months ) ; and incidence of infectious morbidity throughout the trial . The trial was supervised by a trial steering committee , and an independent data monitoring committee provided oversight for the safety and conduct of the trial . Discussion Findings from this trial will test the efficacy of daily intake of meat commencing at age 6 months and , if beneficial , will provide a strong rationale for global efforts to enhance local supplies of meat as a complementary food for young children . Trial registration Abstract Objective : To investigate the relation of infant feeding practice to childhood respiratory illness , growth , body composition , and blood pressure . Design : Follow up study of a cohort of children ( mean age 7.3 years ) who had detailed infant feeding and demographic data collected prospect ively during the first two years of life . Setting : Dundee . Subjects : 674 infants , of whom 545 ( 81 % ) were available for study . Data on respiratory illness were available for 545 children ( mean age 7.3 ( range 6.1- 9.9 ) years ) ; height for 410 children ; weight and body mass index for 412 children ; body composition for 405 children ; blood pressure for 301 children ( mean age 7.2 ( range 6.9 - 10.0 ) years ) . Main outcome measures : Respiratory illness , weight , height , body mass index , percentage body fat , and blood pressure in relation to duration of breast feeding and timing of introduction of solids . Results : After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower ( 17.0 % ( 95 % confidence interval 15.9 % to 18.1 % ) for exclusive breast feeding , 31.0 % ( 26.8 % to 35.2 % ) for partial breast feeding , and 32.2 % ( 30.7 % to 33.7 % ) for bottle feeding . Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood ( 21.0 % ( 19.9 % to 22.1 % ) v 9.7 % ( 8.6 % to 10.8 % ) ) . It was also associated with increased percentage body fat and weight in childhood ( mean body fat 18.5 % ( 18.2 % to 18.8 % ) v 16.5 % ( 16.0 % to 17.0 % ) ; weight st and ard deviation score 0.02 ( −0.02 to 0.06 ) v −0.09 ( −0.16 to 0.02 ) . Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk ( mean 94.2 ( 93.5 to 94.9 ) mm Hg v 90.7 ( 89.9 to 91.7 ) mm Hg ) . Conclusions : The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time . Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease . Key messages Current guidelines in the United Kingdom recommend that babies are exclusively breast fed for the first 4 months of life , with solids being introduced thereafter This study found that exclusive breast feeding is associated with a significant reduction in childhood respiratory illness The early introduction of solids is associated with increased body fat and weight in childhood Exclusive bottle feeding is associated with higher systolic blood pressure in childhood Breast feeding and delaying the introduction of solids until after 15 weeks may have a beneficial effect on childhood health and subsequent adult The World Health Organization reported that inappropriate feeding in children is responsible for one-third of the cases of malnutrition . This cross-sectional study aim ed to determine the prevalence of malnutrition and identify the relationship between feeding practice s and malnutrition in children below 5 years , in 7 remote and poor counties of China . A sample of 2201 children and 1978 caregivers were obtained with multistage cluster r and om sampling . A survey about feeding practice s among the caregivers was implemented using a structured question naire , and the health status of children was evaluated using anthropometric measurements . We found 5 problems : first , high prevalence of stunting , underweight and wasting in children below 5 years old ( 19.3 % , 13.1 % and 5.5 % ) ; second , short duration of breastfeeding for children below 36 months ; third , low prevalence of exclusive breastfeeding among children below 6 months of age and continued breastfeeding to 1 year ( 17.5 % and 32.2 % ) . Fourth , although most of the infants ( 81.1 % ) between 6 and 8 months of age were given complementary foods , some of the 6- to 8-month-old infants did not receive any complementary foods . Last , a higher prevalence of stunting among Chinese children who had never been breastfed , who had been breastfed for less than 1 year , or had been fed with semi-solid foods of poor quality . Therefore , we suggest that more programs to increase caregivers ' feeding knowledge and practice s be conducted , to improve the health of children in remote and poor areas in China OBJECTIVE To assess the association between the introduction of solid foods in the first 12 months and the occurrence of eczema during the first 4 years of life in a prospect i ve study of newborns . STUDY DESIGN Data were taken from annually administered question naires from a large birth cohort ( recruited 1995 - 1998 ) comprised of an intervention and a nonintervention group . Outcomes were doctor-diagnosed and symptomatic eczema . Multiple generalized estimation equation models were performed for the 2 study groups . RESULTS From the 5991 recruited infants , 4753 ( 79 % ) were followed up . The 2 study groups were different in their family risk of allergies and feeding practice s. No association was found between the time of introduction of solids or the diversity of solids and eczema . In the nonintervention group , a decreased risk was observed for avoidance of soybean/nuts , but an increased risk was seen in doctor-diagnosed eczema for the avoidance of egg in the first year . CONCLUSION The evidence from this study supports neither a delayed introduction of solids beyond the fourth month nor a delayed introduction of the most potentially allergenic solids beyond the sixth month of life for the prevention of eczema . However , effects under more extreme conditions can not be ruled out BACKGROUND Although uncommon , iron deficiency ( ID ) occurs in breastfed infants . The regular provision of iron may prevent ID . OBJECTIVE The objective was to test the feasibility and effectiveness of 2 modalities of providing iron ( medicinal iron or iron-fortified cereal ) to breastfed infants . The study tested the hypothesis that regular provision of iron improves iron status of breastfed infants without adverse effects . DESIGN In this prospect i ve , r and omized , open-label trial , breastfed infants received on a regular basis either medicinal iron ( n = 48 ) or an iron-fortified fruit-cereal combination ( n = 45 ) from 4 to 9 mo or no intervention ( control group ; n = 59 ) . The interventions provided 7.0 - 7.5 mg ferrous sulfate/d . Infants were enrolled at 1 mo and were followed to 2 y. Iron-status indicators were determined periodically , stool characteristics were recorded , and growth was monitored . RESULTS The regular provision of iron led to improved iron status during and for some months after the intervention . Both sources of iron were about equally effective . Iron affected stool color but had no effect on feeding-related behavior . However , medicinal iron was associated with a small but significant reduction in length gain and a trend toward reduced weight gain . ID anemia was observed in 4 infants ( 2.3 % ) , most of whom had a low birth iron endowment .  Mild ID was common in the second year of life . CONCLUSIONS Regular provision of medicinal iron or iron-fortified cereal improves the iron status of breastfed infants and may prevent ID . Both modalities are equally effective , but medicinal iron leads to somewhat reduced growth . This trial was registered at Clinical Trials.gov as NCT00760890 BACKGROUND Iron deficiency is the most prevalent nutritional deficiency among infants in industrialized countries . There is ample documentation of both short- and long-term adverse effects of iron deficiency . OBJECTIVE To study the prevalence of iron deficiency in 12-month-old infants and to investigate the influence of several factors ( dietary , growth , etc . ) on iron status . MATERIAL AND METHODS A r and om sample of 94 healthy infants from a basic health district was studied . Maternal and perinatal variables , dietary intake and anthropometry were assessed at regular intervals from birth to the age of 12 months . Hemoglobin , mean corpuscular volume , transferrin saturation and serum ferritin were also evaluated . RESULTS The prevalence of iron deficiency was 9.6 % and that of iron deficiency anemia was 4.3 % . Of the nine infants with iron deficiency , four had been breast-fed for more than 6 months with late introduction of complementary foods and another had not been fed an iron-fortified formula while the 85 children without iron deficiency had received an appropriate diet ( p < 0.05 ) . Weight increase in the first year of life was significantly and positively correlated with hemoglobin and serum ferritin . CONCLUSIONS Iron deficiency is relatively common in 12-month-old-infants but is limited to groups with inadequate feeding practice s. Iron deficiency screening should be performed only in children with risk factors and /or inadequate diets OBJECTIVE To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread ( FS ) or micronutrient-fortified maize-soy flour ( likuni phala [ LP ] ) . DESIGN R and omized , controlled , single-blind trial . SETTING Rural Malawi . PARTICIPANTS A total of 182 six-month-old infants . INTERVENTION Participants were r and omized to receive 1 year of daily supplementation with 71 g of LP ( 282 kcal ) , 50 g of FS ( FS50 ) ( 256 kcal ) , or 25 g of FS ( FS25 ) ( 130 [ corrected ] kcal ) . OUTCOME MEASURES Weight and length gains and the incidences of severe stunting , underweight , and wasting . RESULTS Mean weight and length gains in the LP , FS50 , and FS25 groups were 2.37 , 2.47 , and 2.37 kg ( P = .66 ) and 12.7 , 13.5 , and 13.2 cm ( P = .23 ) , respectively . In the same groups , the cumulative 12-month incidence of severe stunting was 13.3 % , 0.0 % , and 3.5 % ( P = .01 ) , of severe underweight was 15.0 % , 22.5 % , and 16.9 % ( P = .71 ) , and of severe wasting was 1.8 % , 1.9 % , and 1.8 % ( P > .99 ) . Compared with LP-supplemented infants , those given FS50 gained a mean of 100 g more weight and 0.8 cm more length . There was a significant interaction between baseline length and intervention ( P = .04 ) ; in children with below-median length at enrollment , those given FS50 gained a mean of 1.9 cm more than individuals receiving LP . CONCLUSION One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants , but it is likely to boost linear growth in the most disadvantaged individuals and , hence , decrease the incidence of severe stunting In developing countries , the age at which breastfed infants are first given complementary foods is of public health importance because of the risk of diarrhoeal disease from contaminated weaning foods , and the potential risk of growth faltering if foods are inappropriately delayed . To evaluate whether there are any advantage of complementary feeding prior to 6 months , low-income primiparous mothers who had exclusively breastfed for 4 months were r and omly assigned to one of 3 groups : continued exclusive breastfeeding to 6 months ( EBF ) ( n = 50 ) ; introduction of complementary foods at 4 months with ad libitum nursing from 4 - 6 months ( SF ) ( n = 47 ) ; and introduction of complementary foods at 4 months , with maintenance of baseline nursing frequency from 4 - 6 months ( SF-M ) ( n = 44 ) . Baby foods in jars were provided to the SF and SF-M groups from 4 to 6 months . Subjects were visited weekly and provided with lactation guidance ; at 4 , 5 , and 6 months measurements were made of infant intake and breast milk composition . At 4 months , breast milk intake averaged 797 ( 139 ) g per day ( no difference among groups ) . Between 4 and 6 months , breast milk intake was unchanged in EBF infants ( + 6 ) but decreased in the SF ( -103 ) , and SF-M ( -62 ) groups ( p < 0.001 ) . Change in total energy intake ( including solid foods ) and infant weight and length gain did not differ significantly between groups . Weight and length gain from 4 - 6 months were comparable to those of breastfed infants in an affluent USA population . The results indicate that breastfed infants self-regulate their total energy intake when other foods are introduced . As a result , there is no advantage in introducing complementary foods before 6 months in this population , whereas there may be disadvantages if there is increased exposure to contaminated weaning foods OBJECTIVE The optimal time and choice of solid foods to introduce to an infant 's diet is unknown . The aim of this r and omized trial was to determine whether early versus late introduction of solid foods and commercially prepared versus parent 's choice of solid foods affects growth or body composition in the first year . METHODS White infants ( n = 165 ) were recruited before 3 months of age and were r and omized to receive : 1 ) commercially prepared solid foods ( commercial ) from 3 to 12 months , 2 ) commercially prepared solid foods from 6 to 12 months , 3 ) parent 's choice of solid foods ( choice ) from 3 to 12 months , or 4 ) parent 's choice of solid foods from 6 to 12 months . Anthropometrics and body composition , using dual energy x-ray absorptiometry , were determined at 3 , 6 , and 12 months . Three-day diet diaries were completed at 3 , 6 , 9 , and 12 months . RESULTS There were no differences in growth or body composition between infants in early versus late introduction groups or commercial versus choice groups at any age . The total energy intake was not different among infants in the early compared with the late group at any age . Infants in the commercial group consumed less protein calories at 9 months ( 80 + /- 3 kcal/d vs 88 + /- 3 kcal/d ) and 12 months 101 + /- 5 kcal/d vs 148 + /- 5 kcal/d ) , less fat calories at 12 months ( 263 + /- 10 kcal/d vs 343 + /- 10 kcal/d ) , and less total calories at 12 months ( 884 + /- 24 kcal/d vs 1022 + /- 25 kcal/d ) compared with the choice group . CONCLUSION The early introduction of solid foods to an infant 's diet does not alter growth or body composition during the first year of life and results in a displacement of energy intake from formula . Infants consuming commercially prepared foods have a decreased caloric intake from protein and fat ; however , despite this difference , there is no effect on growth or body composition OBJECTIVES to compare the impact of two methods of supplementary feeding of pre-term babies ( bottle vs cup ) on subsequent breast feeding and to assess the feasibility of using a r and omised controlled trial ( RCT ) to investigate the topic . DESIGN AND METHOD small scale prospect i ve RCT . Data on breast feeding , as defined as the exclusive method of feeding , were collected . A range of relevant bio- data was also collected and their impact on breast feeding assessed . SETTING a special care baby unit in a District General Hospital in the UK . PARTICIPANTS over a three-month period , all pre-term babies ( 32 - 37 weeks ' gestation ) who fulfilled the inclusion criteria and has been born to mothers who had expressed a pre-partum desire to breast feed , who had consented to take part , were included ( n=14 ) . PROCEDURE the eligible babies were r and omly allocated to supplementary feeding of breast milk , via either a cup or a bottle . Whether or not the baby was being breast fed at discharge was noted . FINDINGS the study suggested that this RCT framework is a viable method of investigating baby feeding . Because of the small-scale nature of the project , the actual data base must be treated with extreme caution . No significant differences were found between the two groups in terms of breast feeding . However , the mothers reported high levels of support and also the breast-feeding rates were above the national averages . These two findings could have contributed to the non-significant results observed in this analysis . CONCLUSIONS if the present findings could be supported by further research , then the non-significant results relating method of supplementary feeds to subsequent breast feeding could be explained by reference to three factors . Firstly , there is , in fact , no real effect of method of supplementary feeding and subsequent breast feeding ; secondly , the method adopted differed from existing research and thus may be expected to produce non-corroborative results ; and finally , the overall levels of breast feeding within the Unit generally were higher than the national average . The relevance of the RCT for investigating this subject is also discussed with reference to the present data set . Further experimental work to develop these ideas and to identify causal links is required Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants This study was design ed to determine the need for water supplementation to maintain water homoeostasis in exclusively breastfed infants during summer in a tropical country . A pre study question naire revealed that 97 % of 34 nurses and 63 % of 70 doctors advocated such supplementation . 45 healthy , male , exclusively breastfed babies , aged 1 - 4 months , were recruited from a well-baby clinic . 9 who had never received supplemental water plus a r and om selection of 14 others were allocated to group I ( breastmilk only ) ; the remaining 22 infants were allocated to group II ( breastmilk plus supplemental fluid according to the mother 's usual practice ) . The babies were studied at the hospital for 8 h ; breastmilk intake was measured by weighing the infant before and after each feed , water intake by calibrated bottles , and urine output by accurate collection and measurement . The maximum room temperatures were 34 - 41 degrees C and relative humidities 9 - 60 % ( below 50 % in all but 3 infants ) . In group II the mean water intake was 11 % ( 95 % confidence interval 7 - 16 % ) of the total fluid intake . Both breastmilk intake ( 274 vs 210 ml ) and total fluid intake ( 274 vs 233 ml ) were higher in group I than in group II ( p = 0.003 , p = 0.073 , respectively ) , after adjustment for age , weight , length , room temperature , and humidity . However , there were no significant differences between the groups in urine output , urine or serum osmolality , weight change , or rectal temperature whether or not the factors adjusted for included total fluid intake . Thus , exclusively breastfed infants do not need supplemental water to maintain water homoeostasis ; a reduced breastmilk intake is a potential disadvantage of this practice In order to determine the effect of feeding glucose water on breastfeeding newborns , we r and omly distributed 180 normal newborns into two groups : a glucose water group ( GW ) , fed 5 % glucose solution during the first 3 days of life in addition to being breastfed ; and an exclusively breastfed nonglucose water group ( NGW ) . The following data were evaluated : weight at 6 , 12 , 24 , 48 , and 72 hours of life ; temperature during the first 72 hours of life ; serum glucose level at 6 , 12 , 24 , and 48 hours ; total duration of breastfeeding and age at introduction of infant formulas . In the NGW , there was a greater weight loss at 48 hours but not at 72 hours , temperatures higher than 37.50C were more frequent , and the mean serum glucose levels at 6 , 12 , and 24 hours were lower . This group also had more serum glucose level determinations under 2.2 mmol/l ( 40 mg/dL ) . However , no infants exhibited hypoglycemic symptoms . Infants in the GW received twice as many formulas during the first month and had a shorter duration of any breastfeeding . Our results suggest that the suppression of feedings with glucose water in the first days of life increases the probability of successful breastfeeding . However , infants who do not receive glucose water in the first few days of life may require greater supervision and close monitoring of blood glucose and body temperature , particularly in the first 24 hours of life CONTEXT Malnutrition causes death and impaired health in millions of children . Existing interventions are effective under controlled conditions ; however , little information is available on their effectiveness in large-scale programs . OBJECTIVE To document the short-term nutritional impact of a large-scale , incentive-based development program in Mexico ( Progresa )  , which included a nutritional component . DESIGN , SETTING , AND PARTICIPANTS A r and omized effectiveness study of 347 communities r and omly assigned to immediate incorporation to the program in 1998 ( intervention group ; n = 205 ) or to incorporation in 1999 ( crossover intervention group ; n = 142 ) . A r and om sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward . Participants were from low-income households in poor rural communities in 6 central Mexican states . Children ( N = 650 ) 12 months of age or younger ( n = 373 intervention group ; n = 277 crossover intervention group ) were included in the analyses . INTERVENTION Children and pregnant and lactating women in participating households received fortified nutrition supplements , and the families  received nutrition education , health care , and cash transfers . MAIN OUTCOME MEASURES Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children . RESULTS Progresa was associated with better growth in height among the poorest and younger infants . Age- and length-adjusted height was greater by 1.1 cm ( 26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group ) among infants younger than 6 months at baseline and who lived in the poorest households . After 1 year , mean hemoglobin values were higher in the intervention group ( 11.12 g/dL ; 95 % confidence interval [ CI ] , 10.9 - 11.3 g/dL ) than in the crossover intervention group ( 10.75 g/dL ; 95 % CI , 10.5 - 11.0 g/dL ) who had not yet received the benefits of the intervention ( P = .01 ) . There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention . The age-adjusted rate of anemia ( hemoglobin level < 11 g/dL ) in 1999 was higher in the crossover intervention group than in the intervention group ( 54.9 % vs 44.3 % ; P = .03 ) , whereas in 2000 the difference was not significant ( 23.0 % vs 25.8 % , respectively ; P = .40 ) . CONCLUSION Progresa , a large-scale , incentive-based development program with a nutritional intervention , is associated with better growth and lower rates of anemia in low-income , rural infants and children in Mexico The aim of this study was to examine the nature of the association between breastfeeding , complementary feeding and growth in a r and om sample of infants from Denmark , where the prevalence of breastfeeding is high . A semiquantitative food frequency question naire and a question naire on  breastfeeding duration and on weight and length measurements taken at the infant welfare visit at 5 and 10 months were sent to 590 families with 10‐month‐old infants . A total of 339 infants with complete growth data were included in the analyses . When controlling for mid‐parental height and birth weight infants breastfed for ≥ 7 months gained 198 g less in weight ( p < 0:01 ) and 7 mm less in length ( p < 0:01 ) during the period from 5 to 10 months than infants breastfed for < 7 months . Controlling for these effects , the 10 % of the sample with the highest protein intake ( i.e. ≥16 energy percentage ) gained 262 g more than those with a lower protein intake ( p= 0:03 ) . Infants breastfed for ≥ 7 months received significantly less cow 's milk ( p < 0:01 ) , and fewer meat‐containing dishes ( p < 0:05 ) and sweets or cakes ( p < 0:01 ) , which may partly explain the effect of breastfeeding . The long‐term consequences of this moderate difference in growth velocity are unknown and the findings should not be used to advocate against breastfeeding during late infancy BACKGROUND The WHO recommends exclusive breastfeeding ( EBF ) for 6 mo after birth . However , the time at which breast milk ceases to provide adequate energy and nutrition , requiring the introduction of complementary foods , remains unclear . Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth . OBJECTIVE We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods . DESIGN We measured anthropometric outcomes , body composition , and breast-milk intake at age 6 mo in infants who were r and omly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding . We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Icel and . In 100 infants who completed the protocol ( 50/group ) , breast-milk intake was measured by using stable isotopes , and complementary food intakes were weighed over 3 d in the complementary feeding ( CF ) group . RESULTS Breast-milk intake was 83 g/d ( 95 % CI : 19 , 148 g/d ) greater in EBF ( mean ± SD : 901 ± 158 g/d ) than in CF ( 818 ± 166 g/d ) infants and was equivalent to 56 kcal/d ; CF infants obtained 63 ± 52 kcal/d from complementary foods . Estimated total energy intakes were similar ( EBF : 560 ± 98 kcal/d ; CF : 571 ± 97 kcal/d ) . Secondary outcomes ( anthropometric outcomes , body composition ) did not differ significantly between groups . CONCLUSIONS On a group basis , EBF to age 6 mo did not compromise infant growth or body composition , and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output BACKGROUND The low micronutrient content of complementary foods is associated with growth faltering in many population s. A potential low-cost solution is the home fortification of complementary foods with Sprinkles ( SP ) powder , crushable Nutritabs ( NT ) tablets , or energy-dense ( 108 kcal/d ) , fat-based Nutributter ( NB ) . OBJECTIVE The objective was to test the hypothesis that multiple micronutrients added to home-prepared complementary foods would increase growth and that the effect would be greatest in the presence of added energy from fat . DESIGN We r and omly assigned 313 Ghanaian infants to receive SP , NT , or NB containing 6 , 16 , and 19 vitamins and minerals , respectively , daily from 6 to 12 mo of age . We assessed anthropometric status at 6 , 9 , and 12 mo ; micronutrient status at 6 and 12 mo ; motor development at 12 mo ; and morbidity weekly . Infants ( n = 96 ) not r and omly selected for the intervention ( nonintervention ; NI ) were assessed at 12 mo . RESULTS The groups did not differ significantly at baseline , except that the NB group had a higher proportion of boys and weighed slightly more . The dropout rate ( 15/313 ) was low . At 12 mo , after control for initial size , the NB group had a significantly greater weight-for-age z score ( WAZ ) ( -0.49 + /- 0.54 ) and length-for-age z score ( LAZ ) ( -0.20 + /- 0.54 ) than did the NT group ( WAZ : -0.67 + /- 0.54 ; LAZ : -0.39 + /- 0.54 ) and the NT and SP groups combined ( WAZ : -0.65 + /- 0.54 ; LAZ : -0.38 + /- 0.54 ) ; the difference with the NI group ( WAZ : -0.74 + /- 1.1 ; LAZ : -0.40 + /- 1.0 ) was not significant . A lower percentage of the NI infants ( 25 % ) than of the intervention groups ( SP : 39 % ; NT : 36 % ; NB : 49 % ) could walk independently by 12 mo . CONCLUSION All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention , but only NB affected growth The iron status and diet of Inuit infants living in northern Quebec who were part of a prospect i ve cohort study was described . The prevalence of anemia ( hemoglobin values > 2SD below the reference mean ) was 21.1 % ( 23/109 ) , 47.4 % ( 55/116 ) and 37.7 % ( 46/122 ) at 2 , 6 and 12 months , respectively . The corresponding prevalence of microcytic anemia was 0.0 % , 4.3 % and 21.3 % . At 2 , 6 and 12 months , iron-deficiency anemia ( serum ferritin < 10 μg/L coupled with anemia ) was present in 1.3 % ( 1/79 ) , 24.4 % ( 21/86 ) and 26.3 % ( 25/95 ) of infants , respectively . Compared with breastfeeding , the odds ratio for iron deficiency ( serum ferritin < 10 μg/L ) for bottle-feeding with cows ’ milk or low iron formula was 3.02 ( 95 % CI 1.25–7.27 ) at 6 months and 3.05 ( 95 % CI 1.28–7.28 ) at 12 months . This study shows iron-deficiency anemia to be a problem in Inuit infants as young as 6 months old . Breastfed infants were better protected against iron deficiency than infants fed cow ’s milk or low-iron formula . RésuméLe statut nutritionnel en fer et les apports alimentaires chez les nourrissons vivant dans le nord du Québec qui faisaient parti d’une étude de cohorte ont été décrit . La prévalence de l’anémie ( hémoglobine > 2SD au-dessous de la référence moyenne ) était de 21,1 % ( 23/109 ) , 47,4 % ( 55/116 ) et 37,7 % ( 46/122 ) à 2 , 6 et 12 mois respectivement . La prévalence correspondante d’anémie microcitique était de 0,0 % , 4,3 % et 21,3 % . À 2 , 6 et 12 mois , l’anémie dû à la carence en fer ( sérum ferritin < 10μg/L couplé à l’anémie ) était respectivement présente chez 1,3 % ( 1/79 ) , 24,4 % ( 21/86 ) et 26,3 % ( 25/95 ) des nourrissons . Comparativement à l’allaitement , les chances de carence en fer pour les enfants nourrissons nourris au lait de vache ou au lait maternisé faible en fer , était de 3,02 ( 95 % CI 1,25 - 7,27 ) à 6 mois et 3,05 ( 95 % CI 1,28–7,28 ) à 12 mois . Cette étude démontre que l’anémie dû à la carence en fer est un problème chez les nourrissons Inuits aussi jeune que 6 mois . Les nourrissons allaités étaient mieux protégés contre la carence en fer que les nourrissons nourris au lait de vache ou au lait maternisé faible en fer BACKGROUND & AIMS Breastfed infants may be at particular risk for iron deficiency because breast milk is low in iron . In a secondary analysis of data from a complementary feeding trial , indicators of iron status were examined , with particular focus on the development of iron status in those infants who were fully breastfed during the first 4 months of life . METHODS In this retrospective analysis of data from a r and omized controlled trial infants were stratified according to their predominant milk diet during the first 4 months of life , a subgroup of breastfed infants ( group BM , n=53 ) were compared with a subgroup of infants fed ( iron-fortified ) formula ( group F , n=23 ) .  Dietary iron intake and indicators of iron status were analysed at 4 months of age ( during the full milk feeding period ) , and during the complementary feeding period at 7 and 10 months of age . RESULTS Iron intake was low in the BM group , ranging below the Dietary Reference Intakes throughout the complementary feeding period , with the ( estimated ) bioavailable iron intake only just achieving the reference requirements . At 4 months , iron deficiency ( ID , Ferritin < 12.0 ng/mL ) was observed in 3 infants in the BM group and in 1 infant in the F group ; no infant developed iron deficiency anaemia ( IDA , ID and Hb < 10.5 g/dl ) . At 7 and at 10 months of age , iron status was adequate in all infants of the F group . In the BM group , at 7 ( 10 ) months of age , ID was diagnosed in 10 ( 11 ) infants and IDA was found in 2 ( 1 ) infants . CONCLUSIONS Healthy infants , fully breastfed at 4 months of age , demonstrated ID in about 21 % and IDA in up to 6 % during the second half of infancy while fed according to the paediatric dietary guidelines . This finding supports the recommendation that supplementation with bioavailable iron via complementary foods should be started early ( 4 - 6 months of age ) in order to prevent iron deficiency during infancy Infants who receive prolonged and exclusive breastfeeding  grow more slowly during the first year of life than those who do not . However , infant feeding and growth are dynamic processes in which feeding may affect growth , and prior growth and size may also influence subsequent feeding decisions . The authors carried out an observational analysis of 17,046 Belarusian infants who were recruited between June 1996 and December 1997 and who participated in a cluster-r and omized trial of a breastfeeding promotion intervention .  To assess the effects of infant size on subsequent feeding , the authors restricted the analysis to infants breastfed ( or exclusively breastfed ) at the beginning of each follow-up interval and examined associations between weight or length at the beginning of the interval and weaning or discontinuation of exclusive breastfeeding by the end of the interval . Smaller size ( especially weight for age ) was strongly and statistically significantly associated with increased risks of subsequent weaning and of discontinuing exclusive breastfeeding ( adjusted odds ratios = 1.2 - 1.6 ) , especially between 2 and 6 months , even after adjusment for potential confounding factors and clustered measurement . The authors speculate that similar dynamic processes involving infant crying , other signs of hunger , and supplementation/weaning undermine causal inferences about the " effect " of prolonged and exclusive breastfeeding on slower infant growth One hundred eighty normal neonates with an average weight above 2.50 kg and having no feeding difficulties were divided into two groups and r and omly assigned to either colostrum or to glucose water feeding regimens during the 3-day stay at the maternity ward . The effects of the feeding regimens on intestinal colonization were studied by examining the stools of the neonates . All bacteria recovered were identified quantitatively and biochemically . Of the 180 mothers , 105 complied with the instructions on feeding regimens . The majority of the neonates receiving colostrum had significantly lower bacterial counts than those on glucose water ( p < 0.001 ) . The results of the preliminary study indicated that early initiation of colostrum feeding to neonates where potable water is not readily available will supress the proliferation of bacteria in the neonates OBJECTIVE The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different population s. STUDY DESIGN In a r and omized , placebo-controlled , masked clinical trial , we assigned term Swedish ( n = 101 ) and Honduran ( n = 131 ) infants to 3 groups at 4 months of age : ( 1 ) iron supplements , 1 mg/kg/d , from 4 to 9 months , ( 2 ) placebo , 4 to 6 months and iron , 6 to 9 months , and ( 3 ) placebo , 4 to 9 months . All infants were breast-fed exclusively to 6 months and partially to 9 months . RESULTS From 4 to 6 months , the effect of  iron  ( group 1 vs 2 + 3 ) was significant and similar in both population s for hemoglobin , ferritin , and zinc protoporphyrin . From 6 to 9 months , the effect ( group 2 vs group 3 ) was significant and similar at both sites for all iron status variables except hemoglobin , for which there was a significant effect only in Honduras . In Honduras , the prevalence of iron deficiency anemia at 9 months was 29 % in the placebo group and 9 % in the supplemented groups . In Sweden , iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months ( <3 % ) . CONCLUSION Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia  in Honduran breast-fed infants . The unexpected hemoglobin response at 4 to 6 months in both population s suggests that regulation of hemoglobin synthesis is immature at this age ABSTRACT : We have studied the nutritional adequacy of exclusive breast-feeding by following prospect ively the growth and protein nutrition of healthy infants during the 1st yr of life . The number of exclusively breast-fed infants was 116 at the age of 6 months and 36 at 9 months . These infants had slower length velocity after age 3 months than a comparison group of 32 infants who were weaned early and given formula plus solids .  As a group , the exclusively breast-fed  infants lagged slightly , but progressively , behind in relative length . By 9 months , 45 % of them versus 18 % of the comparison group showed a > 1 SD decrease in relative length . No such decrease was found in relative weight . Skinfolds and weight for length2 index showed that they were heavier for their length than the comparison infants . At 6 and 9 months the calculated protein intake ( 0.9 g/kg/day ) was much less than the recommended amount ( 2.0 g/kg/day ) . Serum prealbumin concentration was lower than in the comparison group but this was noted as early as 4 months . No relation was found between the parameters of growth and protein nutrition either individually or in general . Whether the slower growth of the exclusively breast-fed infants represents appropriate physiological growth or whether it indicates nutritional deficiency is not known but we did not find any evidence of protein deficiency . Six infants did , however , show subsequent catch-up growth which could indicate previous malnutrition Current guidelines recommend that infants are exclusively breast fed for the first 6 months of life , with particular solid foods being gradually introduced from 6 months . Our objective was to compare the growth of infants whose feeding most closely followed current guidelines with the growth of infants with other feeding practice s. Participants were 1740 infants in a prospect i ve cohort study in Southampton , UK . At 6 and 12 months , infants ' milk feeding was recorded , diets assessed using food frequency question naires ( FFQ ) , and anthropometry performed . Principal components analysis was used to identify patterns of foods in the diet using the food intakes assessed by the FFQs . Two patterns ( ' infant guidelines ' and ' adult foods ' ) explained most variance in infant diet at 6 and 12 months of age . The main outcomes were conditional growth in weight , length and skinfold thickness from 0 - 6 and 6 - 12 months . Infants who were breast fed from 0 - 6 months gained weight , length and adiposity more slowly than formula-fed infants , independent of age at introduction of solids and maternal factors : compared with infants who were breast fed from 0 - 6 months , formula-fed infants gained 0.21 st and ard deviation scores ( SDS ) in weight [ 95 % confidence interval ( CI ) 0.00 , 0.42 ] . Infants whose dietary pattern was most similar to current feeding guidelines , with high frequencies of fresh fruit and vegetables , home-prepared foods and breast milk , gained weight and skinfold thickness more rapidly from 6 to 12 months than other infants , independent of milk feeding , age at introduction of solids and maternal factors . Compared with infants in the lowest quarter , infants in the highest ' infant guidelines ' score quarter gained 0.24 SDS [ 95 % CI 0.06 , 0.43 ] in weight and 0.26 SDS [ 95 % CI 0.07 , 0.45 ] in skinfold thickness . Conversely , infants whose diets had the highest frequencies of breads and processed foods gained weight less rapidly from 6 to 12 months than other infants . The extent to which the patterns of diet and growth we have described will influence the current or later health of infants is unknown . We are following up the infants in this study to assess the impact of these patterns beyond the first year of life . These associations should also be examined in other setting s and population OBJECTIVE To assess the nutritional status and dietary practice s of 0 - 24-month-old children living in Brazilian Amazonia . DESIGN Cross-sectional study . Information on children 's dietary intakes was obtained from diet history data . Weight and length were measured for anthropometric evaluation . Fe status was assessed using fasting venous blood sample s ; Hb , serum ferritin and soluble transferrin receptor concentrations were measured . SETTING The towns of Assis Brasil and Acrelândia in the state of Acre , north-west Brazil . SUBJECTS A total of sixty-nine r and omly selected 0 - 24-month-old children . RESULTS Of these children , 40.3 % were anaemic  , 63.1 % were  Fe-deficient  , 28.1 % had  Fe-deficiency anaemia  and 11.6 % were stunted .  Breast-feeding was initiated by 97.1 % of mothers , followed by early feeding with complementary foods . The dietary pattern reflected a high intake of carbohydrate-rich foods and cow 's milk , with irregular intakes of fruit , vegetables and meat . All infants and 92.3 % of toddlers were at risk of inadequate Fe intakes . Fe from animal foods contributed on average 0.5 % and 14.3 % to total dietary Fe intake among infants and toddlers , respectively . CONCLUSIONS Poor nutritional status and inadequate feeding practice s in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life . Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practice
Background Despite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age , it is not clear what the health implication s may be .
Breast milk alone may not meet the nutrition needs for all growing infants , leaving them at risk for deficiencies .
The objective of this study was to investigate the relationship between moderate ( 4 months ) versus late ( 6 months ) introduction of complementary foods to the full-term breastfed infant on iron status and growth .