Institute of Global Health and Development, Aga Khan University, Karachi, Pakistan.
Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
Nutr Rev. 2023 Nov 10;81(12):1501-1524. doi: 10.1093/nutrit/nuad019.
The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood.
This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants.
Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews.
Two investigators independently extracted data from the included studies on a standardized data-extraction form.
Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score.
Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed.
PROSPERO registration number CRD42020218517.
引入补充喂养（CF）的时间至关重要，因为过早或过晚引入 CF 可能与儿童期和成年期的不良健康结果有关。
本系统评价旨在评估正常足月婴儿 CF 引入时间对健康、营养和发育结果的影响。
电子数据库和试验登记处，以及纳入研究和相关系统评价的参考文献列表均被检索。
两名调查员独立使用标准化数据提取表从纳入研究中提取数据。
根据 CF 早期引入（<3 个月、<4 个月、<6 个月龄）或晚期引入（>6 个月、>8 个月龄），分别对随机对照试验（RCT）和观察性研究进行荟萃分析。根据 GRADE 标准总结证据。共纳入 268 篇文献，其中 7 篇为 RCT（来自 24 篇文章），217 篇为观察性研究（来自 244 篇文章）。RCT 的证据并未表明早期引入有影响，而来自观察性研究的低确定性证据表明，CF 的早期引入（<6 个月）可能会增加体重指数（BMI）z 评分和超重/肥胖的风险。<3 个月龄的早期引入可能会增加 BMI 和下呼吸道感染（LRTI）的风险，而<4 个月龄的早期引入可能会增加身高、LRTI、收缩压和舒张压（BP）。对于 CF 的晚期引入，RCT 缺乏证据，但来自观察性研究的低确定性证据表明，CF 的晚期引入（>6 个月）可能会降低身高、BMI、收缩压和舒张压，并可能增加肠道寄生虫感染的风险，而 CF 的晚期引入（>8 个月）可能会增加身高-年龄 z 评分。
现有证据表明，早期引入 CF 可能会导致肥胖增加。因此，目前推荐的 CF 引入方法仍然有效，尽管需要更多来自中低收入国家的更有力研究。
PROSPERO 注册号 CRD42020218517。
