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Types and Amounts of Complementary Foods and Beverages and Developmental Milestones: A Systematic Review
Laural K. English, PhD, Julie E. Obbagy, PhD, RD, Yat Ping Wong, MLS, MPH, Tricia L. Psota, PhD, RD, Perrine Nadaud, MS, Kirsten Johns, MS, Nancy Terry, MLS, Nancy F. Butte, PhD, RD, Kathryn G. Dewey, PhD, David M. Fleischer, MD, Mary Kay Fox, MEd, Frank R. Greer, MD, Nancy F. Krebs, MD, MS, Kelley S. Scanlon, PhD, RD, Kellie O. Casavale, PhD, RD, Joanne M. Spahn, MS, RDN, and Eve Stoody, PhD.
Author Information and AffiliationsAlexandria (VA): USDA Nutrition Evidence Systematic Review; 2019 Apr.
TECHNICAL ABSTRACT
Background
- Systematic reviews were conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
- The goal of this systematic review was to examine the following question: What is the relationship between types and amounts of complementary foods and beverages (CFB) consumed and developmental milestones?
- Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and typically continuing to 24 months of age. CFB were defined as foods and/or beverages other than human milk or infant formula (liquids, semisolids, and solids) provided to an infant or young child to provide nutrients and energy.
Conclusion Statement
- There was insufficient evidence to draw a conclusion about the relationships between types and amounts of CFB consumed and developmental milestones.
- Grade: Grade Not Assignable
Methods
- This systematic review was conducted by a team of staff from the Nutrition Evidence Systematic Review in collaboration with a Technical Expert Collaborative.
- Literature search was conducted using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that evaluated the intervention or exposure of timing of CFB introduction and the outcomes of developmental milestones. A manual search was conducted to identify articles that may not have been included in the electronic databases searched. Articles were screened by two analysts independently for inclusion based on pre-determined criteria.
- Data extraction and risk of bias assessment were conducted for each included study, and both were checked for accuracy. The body of evidence was qualitatively synthesized to inform development of a conclusion statement(s), and the strength of evidence was graded using pre-established criteria evaluating the body of evidence on risk of bias, adequacy, consistency, impact, and generalizability.
Summary of the Evidence
- This review includes eight studies published since 1980 that examined the relationship between consuming different types and/or amounts of CFB and developmental milestones during childhood through 18 years of age, including three randomized controlled trials and five prospective cohort studies.
- The studies varied in terms of the types and/or amounts of CFB examined, which included dietary patterns consumed during the complementary feeding period, meat and/or fortified-cereal intake, and foods with differing levels of DHA or phytate
- Different types of developmental milestone outcomes were measured between 4 months and 8.5 years of age, including:
- Communication (e.g., sentence repetition)
- Cognitive (e.g., mental development index)
- Motor (e.g., psychomotor development index)
- Neurological (e.g., cortical processing)
- Three articles from two observational studies identified positive associations between dietary patterns emphasizing vegetables and meats during the complementary feeding period, and intelligence quotient (IQ) between ages 4-8.5y. However, a conclusion could not be drawn due to low generalizability and heterogeneity in exposures, observed effects, and potential confounding
- Because there was substantial variation in how studies were designed, it is difficult to compare and contrast the reported results.
- No conclusion regarding the relationship between types and/or amounts of CFB and developmental milestones could be drawn due to an inadequate number of studies that were comparable in terms of design, the types of CFB examined, how and when developmental milestones outcomes were assessed, and reported results.
Contents
FUNDING SOURCE: United States Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA
Suggested citation:
English LK, Obbagy JE, Wong YP, Psota TL, Nadaud P, Johns K, Terry N, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Casavale KO, Spahn JM, Stoody E. Types and Amounts of Complementary Foods and Beverages and Developmental Milestones: A Systematic Review. April 2019. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.PB242018.SR0308.
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Related citations:
This systematic review has also been published in the American Journal of Clinical Nutrition: English LK, Obbagy JE, Wong YP, Butte NF, Dewey KG, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. T Complementary feeding and developmental milestones: a systematic review. Am J Clin Nutr. 2019;109(7):879S-889S. Available at: https://doi.org/10.1093/ajcn/nqy321 [PubMed: 30982876].
Related citations are published in the American Journal of Clinical Nutrition:
- P/B-24 Project overview: Stoody EE, Spahn JM, Casavale KO. The Pregnancy and Birth to 24 Months Project: a series of systematic reviews on diet and health. Am J Clin Nutr. 2019;109(7):685S–97S. Available at: https://doi.org/10.1093/ajcn/nqy372 [PubMed: 30982878].
- P/B-24 Project systematic review methodology: Obbagy JE, Spahn JM, Wong YP, Psota TL, Spill MK, Dreibelbis C, Gungor DE, Nadaud P, Raghavan R, Callahan EH, English LK, Kingshipp BL, LaPergola CC, Shapiro MJ, Stoody EE. Systematic review methodols used in the Pregnancy and Birth to 24 Months Project. Am J Clin Nutr. 2019;109(7):698S–704S. Available at https://doi.org/10.1093/ajcn/nqy226 [PubMed: 30445449].
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