Taylor Rachael W, Williams Sheila M, Fangupo Louise J, Wheeler Benjamin J, Taylor Barry J, Daniels Lisa, Fleming Elizabeth A, McArthur Jenny, Morison Brittany, Erickson Liz Williams, Davies Rhondda S, Bacchus Sabina, Cameron Sonya L, Heath Anne-Louise M
Department of Medicine, University of Otago, Dunedin, New Zealand.
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
JAMA Pediatr. 2017 Sep 1;171(9):838-846. doi: 10.1001/jamapediatrics.2017.1284.
Baby-led approaches to complementary feeding, which promote self-feeding of all nonliquid foods are proposed to improve energy self-regulation and lower obesity risk. However, to date, no randomized clinical trials have studied this proposition.
To determine whether a baby-led approach to complementary feeding results in a lower body mass index (BMI) than traditional spoon-feeding.
DESIGN, SETTING, AND PARTICIPANTS: The 2-year Baby-Led Introduction to Solids (BLISS) randomized clinical trial recruited 206 women (168 [81.6%] of European ancestry; 85 [41.3%] primiparous) in late pregnancy from December 19, 2012, through March 17, 2014, as part of a community intervention in Dunedin, New Zealand. Women were randomized to a control condition (n = 101) or the BLISS intervention (n = 105) after stratification for parity and education. All outcomes were collected by staff blinded to group randomization, and no participants withdrew because of an adverse event. Data were analyzed based on intention to treat.
Mothers in the BLISS group received lactation consultant support (≥5 contacts) to extend exclusive breastfeeding and delay introduction of complementary foods until 6 months of age and 3 personalized face-to-face contacts (at 5.5, 7.0, and 9.0 months).
The primary outcome was BMI z score (at 12 and 24 months). Secondary outcomes included energy self-regulation and eating behaviors assessed with questionnaires at 6, 12, and 24 months and energy intake assessed with 3-day weighed diet records at 7, 12, and 24 months.
Among the 206 participants (mean [SD] age, 31.3 [5.6] years), 166 were available for analysis at 24 months (retention, 80.5%). The mean (SD) BMI z score was not significantly different at 12 months (control group, 0.20 [0.89]; BLISS group, 0.44 [1.13]; adjusted difference, 0.21; 95% CI, -0.07 to 0.48) or at 24 months (control group, 0.24 [1.01]; BLISS group, 0.39 [1.04]; adjusted difference, 0.16; 95% CI, -0.13 to 0.45). At 24 months, 5 of 78 infants (6.4%) were overweight (BMI≥95th percentile) in the control group compared with 9 of 87 (10.3%) in the BLISS group (relative risk, 1.8; 95% CI, 0.6-5.7). Lower satiety responsiveness was observed in BLISS infants at 24 months (adjusted difference, -0.24; 95% CI, -0.41 to -0.07). Parents also reported less food fussiness (adjusted difference, -0.33; 95% CI, -0.51 to -0.14) and greater enjoyment of food (adjusted difference, 0.25; 95% CI, 0.07 to 0.43) at 12 months in BLISS infants. Estimated differences in energy intake were 55 kJ (95% CI, -284 to 395 kJ) at 12 months and 143 kJ (95% CI, -241 to 526 kJ) at 24 months.
A baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although children were reported to have less food fussiness. Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.
http://anzctr.org.au Identifier: ACTRN12612001133820.
提倡以婴儿主导的方式进行辅食添加，即让婴儿自主进食所有非流质食物，以改善能量自我调节并降低肥胖风险。然而，迄今为止，尚无随机临床试验研究这一观点。
确定与传统勺喂方式相比，婴儿主导的辅食添加方式是否会使儿童的体重指数（BMI）更低。
设计、背景与参与者：“婴儿主导的固体食物引入（BLISS）”为期两年的随机临床试验，于2012年12月19日至2014年3月17日在新西兰达尼丁的一项社区干预中，招募了206名妊娠晚期女性（168名[81.6%]为欧洲血统；85名[41.3%]为初产妇）。根据产次和教育程度分层后，将女性随机分为对照组（n = 101）或BLISS干预组（n = 105）。所有结果均由对分组随机情况不知情的工作人员收集，且没有参与者因不良事件退出。数据基于意向性分析。
BLISS组的母亲接受了泌乳顾问的支持（至少5次接触），以延长纯母乳喂养并推迟辅食添加至6月龄，以及3次个性化的面对面接触（分别在5.5、7.0和9.0月龄）。
主要结局为BMI z评分（在12和24月龄时）。次要结局包括在6、12和24月龄时通过问卷评估的能量自我调节和进食行为，以及在7、12和24月龄时通过3天称重饮食记录评估的能量摄入。
在206名参与者（平均[标准差]年龄为31.3[5.6]岁）中，166名在24月龄时可用于分析（保留率为80.5%）。12月龄时，平均（标准差）BMI z评分在对照组（0.20[0.89]）和BLISS组（0.44[1.13]）之间无显著差异（调整后差异为0.21；95%置信区间为 -0.07至0.48）；24月龄时亦无显著差异（对照组为0.24[1.01]；BLISS组为0.39[1.04]；调整后差异为0.16；95%置信区间为 -0.13至0.45）。在24月龄时，对照组78名婴儿中有5名（6.4%）超重（BMI≥第95百分位数）；BLISS组87名婴儿中有9名（10.3%）超重（相对风险为1.8；95%置信区间为0.6至5.7）。在24月龄时，观察到BLISS组婴儿的饱腹感反应较低（调整后差异为 -0.24；95%置信区间为 -0.41至 -0.07）。父母还报告称，在12月龄时，BLISS组婴儿对食物的挑剔程度较低（调整后差异为 -0.33；95%置信区间为 -0.51至 -0.14），且对食物的喜爱程度更高（调整后差异为0.25；95%置信区间为0.07至0.43）。12月龄时能量摄入的估计差异为55千焦（95%置信区间为 -284至395千焦），24月龄时为143千焦（95%置信区间为 -241至526千焦）。
尽管据报告采用婴儿主导方式添加辅食的儿童对食物的挑剔程度较低，但与传统勺喂方式相比，婴儿主导的辅食添加方式并未使BMI更合适。进一步的研究应确定这些发现是否适用于采用未改良的婴儿主导式断奶方法的个体。
http://anzctr.org.au 标识符：ACTRN126
