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Timing of Introduction of Complementary Foods and Beverages and Bone Health: A Systematic Review
Julie E. Obbagy, PhD, RD, Laural K. English, PhD, Tricia L. Psota, PhD, RD, Perrine Nadaud, MS, Kirsten Johns, MS, Yat Ping Wong, MLS, MPH, 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
- 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.
- This systematic review was conducted by the Nutrition Evidence Systematic Review (NESR) team 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 answer the following research question: What is the relationship between timing of introduction of complementary foods and beverages and bone health?
Conclusion Statement and Grades
- Insufficient evidence is available to draw conclusions about the relationship between the timing of introduction of complementary foods and beverages and bone health. Grade: [Grade Not Assignable]
Methods
- This systematic review was conducted by a team of staff from NESR in collaboration with a Technical Expert Collaborative.
- A literature search was conducted using 4 databases (CINAHL, Cochrane, Embase, and PubMed) to identify articles published from January 1980 to July 2016 that examined the age when complementary foods and beverages (CFB) were first introduced and bone health. CFB were defined as foods and beverages other than human milk or infant formula provided to an infant or young child. Bone health outcomes included bone, biomarkers of bone metabolism, and incidence and prevalence of osteoporosis, osteopenia, rickets, and fracture. A manual search was done to identify articles that may not have been included in the electronic databases searched. Articles were screened in a dual manner, independently by 2 NESR analysts, to determine which articles met predetermined criteria for inclusion.
- Data from each included article were extracted, risk of bias was assessed. The body of evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence. Research recommendations were identified.
Summary of Evidence
- Three studies met the inclusion criteria for this systematic review, one randomized controlled trial, one prospective cohort study, and one case-control study.
- The randomized controlled trial included a small sample of infants fed only vitamin D fortified infant formula, and did not follow infants long enough to assess the impact of timing of introduction to CFB and bone health, as outcomes were assessed when infants were 26 weeks (wk) of age.
- The observational studies did not measure and/or account for a number confounding factors that could have impacted the relationship between timing of CFB introduction and bone health later in childhood.
- The ability to draw conclusions about the relationship between the timing of CFB introduction and bone health is limited by an overall lack of research, as well as heterogeneity in the three studies included in this systematic review with regards to methodology, subject populations, and results.
Contents
FUNDING SOURCE: United States Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA
Suggested citation:
Obbagy JE, English LK, Psota TL, Nadaud P, Johns K, Wong YP, Terry N, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Casavale KO, Spahn JM, Stoody E. Timing of Introduction of Complementary Foods and Beverages and Bone Health: 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.SR0309.
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Related citations:
This systematic review has also been published in the American Journal of Clinical Nutrition: Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and bone health: a systematic review. Am J Clin Nutr. 2019;109(7):872S-878S. Available at: https://doi.org/10.1093/ajcn/nqy227 [PubMed: 30624593].
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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