Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, UK.
Int J Obes (Lond). 2013 Oct;37(10):1295-306. doi: 10.1038/ijo.2013.99. Epub 2013 May 27.
The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.
世界卫生组织建议纯母乳喂养至 6 个月大，并持续母乳喂养至 2 岁或以上。应及时引入适当的补充食品，从婴儿 6 个月大时开始。在发展中国家，过早或不当的补充喂养可能导致营养不良和生长不良，但在英国和美国等肥胖是比营养不良更严重的公共卫生问题的国家，与生长的关系尚不清楚。我们对调查补充喂养时机与儿童期超重或肥胖之间关系的文献进行了系统综述。从开始到 2012 年 9 月 30 日，使用指定的关键词在电子数据库中进行了搜索。在严格应用纳入/排除标准后，确定了 23 项研究，并由两名独立审查员进行了审查。使用改编的纽卡斯尔-渥太华量表提取数据并评估质量方面。其中 21 项研究考虑了引入补充食品的时间与儿童体重指数（BMI）之间的关系，其中 5 项研究发现，在<3 个月（两项研究）、4 个月（两项研究）或 20 周（一项研究）时引入补充食品与儿童期 BMI 较高相关。其中 7 项研究考虑了补充喂养与身体成分的关系，但只有一项研究报告称，在 15 周龄之前给予补充食品的儿童体内脂肪百分比增加。我们的结论是，补充食品引入时间与儿童超重或肥胖之间没有明确的关联，但有一些证据表明，非常早的引入（在 4 个月或更早之前）而不是在 4-6 个月或>6 个月时，可能会增加儿童超重的风险。
