Qasem Wafaa, Fenton Tanis, Friel James
Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
Richardson Centre for Functional Foods and Nutraceuticals, 196 Innovation Drive, University of Manitoba, Winnipeg, MB, R3T 6C5, Canada.
BMC Pediatr. 2015 Sep 2;15:107. doi: 10.1186/s12887-015-0409-5.
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 implications 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.
An electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.
Three RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95% CI: 1.5, 8.5 g/L; P = 0.005]. Meta-analysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95% CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95% CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.
RCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.
尽管世界卫生组织建议所有足月婴儿纯母乳喂养至6个月，但尚不清楚这对健康有何影响。仅靠母乳可能无法满足所有成长中婴儿的营养需求，使他们面临营养缺乏的风险。本研究的目的是调查足月母乳喂养婴儿适度（4个月）与延迟（6个月）引入辅食对铁状态和生长的关系。
对同行评审文献和灰色文献进行电子检索，以查找与辅食引入时间相关的随机对照试验（RCT）和观察性研究。使用RevMan 5.2.11分析相关RCT的铁状态和生长数据。
三项RCT和一项观察性研究符合纳入标准。荟萃分析显示，在发展中国家，4个月时开始喂食固体食物的婴儿血红蛋白水平显著高于6个月时开始喂食固体食物的婴儿[平均差异[MD]：5.0 g/L；95%置信区间：1.5，8.5 g/L；P = 0.005]。荟萃分析还显示，在发达国家和发展中国家，4个月组的血清铁蛋白水平均较高[MD：26.0 μg/L；95%置信区间：-0.1，52.1 μg/L，P = 0.050]，[MD：18.9 μg/L；95%置信区间：0.7，37.1 μg/L，P = 0.040]。纳入研究的随访期短和样本量小是主要局限性。
RCT证据表明，4个月时引入固体食物可积极改变母乳喂养婴儿缺铁性贫血的发生率。
