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The best time to introduce solid food to infants is controversial. Boston investigators examined the association between timing of solid food introduction and obesity in a prospective birth cohort. Parents were questioned about mode of feeding and introduction of solid food at 6 months and 3 years after birth.
Of the 847 infants, 67% were breast-fed (defined as partially breast-fed for ≥4 months) and 33% were formula-fed (never breast-fed or breast-fed for <4 months). At age 3 years, 9% of children were obese (body-mass index ≥95th percentile) — 7% of breast-fed children and 13% of formula-fed children. Timing of introduction of solid food was not associated with obesity in breast-fed infants, but introduction of solid food before age 4 months was associated with significantly increased risk for obesity in formula-fed infants (odds ratio, 6.3).
Huh SY et al. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics 2011 Mar; 127:e544. (http://dx.doi.org/10.1542/peds.2010-0740)
Comment
Unfortunately, this study suffers from some limitations of previous studies mentioned by the authors, including small sample size (especially the number of breast-fed infants who received solids before age 4 months), recall bias, and arbitrary classification of feeding status. However, the results support a recent controversial review reinforcing numerous international recommendations that solid food should not be introduced before age 4 months, but questioning the wisdom of delaying introduction of solids beyond age 4 months in both formula-fed and breast-fed infants in developed countries (JW Pediatr Adolesc Med Mar 2 2011). So what do we tell parents? I believe that exclusive breast-feeding up to age 4 months still is optimal. With respect to introduction of solids in developed countries after 4 months, data are uncertain and all bets are off.