Non-Cochrane · intervention · PM35807827
Complementary Feeding Caregivers' Practices and Growth, Risk of Overweight/Obesity, and Other Non-Communicable Diseases: A Systematic Review and Meta-Analysis.
Bergamini Marcello, Simeone Giovanni, Verga Maria Carmen, et al. · Nutrients · 2022 · PubMed · doi:10.3390/nu14132646
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
20
current version
GRADE rated
8
No studies
7
Included studies
24
linked below
No studies 7 · 35%Ungraded 5 · 25%Very low 4 · 20%Low 3 · 15%Moderate 1 · 5%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Healthy, term-born, normal-birth-weight, breastfed and/or formula-fed children aged 4-24 months (or older for long-term outcomes) in Western industrialized countries | Healthy children aged 4-24 months in Western industrialized countries |
| Intervention | Caregivers' feeding practices: baby-led weaning (BLW), Baby-Led Introduction to SolidS (BLISS), and responsive complementary feeding (RCF) | BLW, BLISS, and RCF |
| Comparison | Traditional complementary feeding (TCF) and non-responsive complementary feeding (NRCF) | Traditional and non-responsive complementary feeding |
| Outcomes | Primary: growth (weight-length gain), risk of overweight/obesity, risk of choking. Additional: risk of dental caries, type 2 diabetes, and hypertension later in life | Weight-length gain, overweight/obesity, and choking had eligible evidence; no eligible studies for dental caries, type 2 diabetes, or hypertension |
| Study designs | Retrospective observational studies and prospective controlled studies/RCTs (educational interventions for caregivers); evidence-based guidelines and previously published good-quality systematic reviews used as supporting evidence | Observational studies (cross-sectional, case-control, prospective cohort) and RCTs, accessed partly through 5 included systematic reviews; ~24 primary studies across questions |
| Timing | 4-24 months, with short- and long-term (later-life) outcomes | Follow-up from 13 months to 78 months (to ~3-5 years) |
Search date: Updated to September 2021. Databases: Not specified (full search strategy and sources in Supplementary File S1)
Questions and results
Baby-led weaning (BLW) vs Other models of complementary feeding (traditional CF)
Population: Healthy, term-born, normal-birth-weight infants aged 4-24 months (breastfed and/or formula-fed) in Western industrialized countries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overweight/obesity risk Follow-up interval 18-78 months · BLW; observational studies Among observational studies, baby-led weaning was associated with lower odds of overweight/obesity than other feeding models (OR 0.37, 95% CI 0.25 to 0.55), but certainty is very low. Source: Table 2 (SoF, row 1); Results 3.2; Supplementary File S4 (Analysis 1.2) · same question in other reviews | OR 0.37 [0.25, 0.55] 388 per 1000 vs 189 per 1000 | 3 studies · 969 participants | Very low Downgraded: risk of bias, inconsistency |
Overweight/obesity risk 18–78 months · BLW observational studies Population: Healthy children aged 6–24 months in Western industrialized countries BLW was associated with lower overweight/obesity risk in observational studies, but the certainty was very low. Source: Table 2; Results 3.2 · same question in other reviews | OR 0.37 [0.25, 0.55] 388 per 1,000 (299 to 485) vs 189 per 1,000 | 3 studies · 969 participants | Very low Downgraded: risk of bias |
Choking events during complementary feeding · BLW/BLISS Population: Healthy children aged 6–24 months in Western industrialized countries No statistically significant difference in choking events between BLW/BLISS and TCF was reported. Source: Results 3.5 · same question in other reviews | no estimate extracted | 6 studies | Ungraded |
Infant weight-length gain (achievement of adequate weight) Measured at 18-78 months of age · observational studies Baby-led weaning/BLISS did not significantly influence infant weight-length (adequate weight) gain versus other complementary feeding models (pooled OR 1.36, 95% CI 0.18 to 10.51; ungraded). Source: Results 3.1; Supplementary File S4 (Analysis 1.1) · same question in other reviews | OR 1.36 [0.18, 10.51] | 3 studies | Ungraded |
Overweight/obesity risk Follow-up to 24 months · BLISS; randomized controlled trials In RCTs, BLISS did not significantly change overweight/obesity risk versus traditional feeding (RR 0.15, 95% CI 0.00 to 17.79; low certainty). Source: Table 2 (SoF, row 2); Results 3.2 · same question in other reviews | RR 0.15 [0.00, 17.79] 142 per 1000 vs 17 per 1000 | 2 studies · 457 participants | Low Downgraded: risk of bias, imprecision |
Choking Infancy to ~24-36 months No significant difference in choking risk was found between BLW/BLISS-fed and traditionally fed infants (ungraded). Source: Results 3.5; Discussion 4.2 · same question in other reviews | No statistically significant differences in the rate of choking events were observed between TCF-fed infants and BLW/BLISS-fed infants (2 BLW observational studies, 1 BLISS RCT, plus 3 later studies; not pooled). | 6 studies | Ungraded |
Responsive complementary feeding (RCF) vs Control (usual care)
Population: Healthy, term-born, normal-birth-weight infants aged 4-24 months (breastfed and/or formula-fed) in Western industrialized countries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
BMI z-score (overweight/obesity) at 13 months 13 months In one RCT, responsive complementary feeding lowered BMIz at 13 months versus control (0.23 vs 0.42, p=0.01; low certainty). Source: Table 3 (SoF, row 2); Results 3.3-3.4 · same question in other reviews | Risk of overweight and obesity after 13 mo (RCT, BMIz): DANIELS 2012 - children in the intervention group had a lower BMIz at 13 months than controls (0.23 +/- 0.93 vs 0.42 +/- 0.85; p = 0.01); 698 (1 RCT); Low. | 1 study · 698 participants | Low Downgraded: risk of bias, imprecision |
Type 2 diabetes (later in life) Later in life No eligible studies examined the influence of complementary feeding practices on later type 2 diabetes; this is an evidence gap. Source: Results 3.6 · same question in other reviews | No studies on the influence of caregivers' feeding practices during complementary feeding on type 2 diabetes later in life were identified. | 0 studies | No studies |
Physical growth / weight gain First 2 years (up to 3-5 years) Two RCTs suggest responsive complementary feeding leads to better weight gain in the first two years, though effects were small and not always sustained (ungraded). Source: Results 3.3; Discussion 4.1.2 · same question in other reviews | The results of the two RCTs are consistent and suggest that RF during CF is effective, leading to better weight gain in the first 2 years of life; observational cohort results (2 RCTs and 5 observational studies) were… | 7 studies | Ungraded |
Hypertension (later in life) Later in life No eligible studies examined the influence of complementary feeding practices on later hypertension; this is an evidence gap. Source: Results 3.7 · same question in other reviews | No studies on the influence of caregivers' feeding practices during complementary feeding on hypertension later in life were identified. | 0 studies | No studies |
Overweight/obesity risk Follow-up to 3 years Responsive complementary feeding probably reduces the risk of overweight/obesity versus other feeding models (RR 0.41, 95% CI 0.24 to 0.71; moderate certainty). Source: Table 3 (SoF, row 1); Results 3.4 · same question in other reviews | RR 0.41 [0.24, 0.71] 185 per 1000 vs 76 per 1000 | 2 studies · 478 participants | Moderate Downgraded: risk of bias |
Choking Infancy No systematic reviews or studies assessed choking risk for RCF or NRCF (only BLW/BLISS); this is an evidence gap. Source: Results 3.5 (final sentence) · same question in other reviews | No SRs or studies relevant to the risk of choking were found that included NRCF or RCF approaches other than those specifically defined as BLW or BLISS. | 0 studies | No studies |
Overweight/obesity risk 24 months · BLISS RCTs Population: Healthy children aged 6–24 months in Western industrialized countries BLISS did not show a statistically significant reduction in overweight/obesity risk at 24 months (low certainty). Source: Table 2; Results 3.2 · same question in other reviews | RR 0.15 [0.00, 17.79] 142 per 1,000 vs 17 per 1,000 | 2 studies · 457 participants | Low Downgraded: risk of bias, inconsistency |
Dental caries (later in life) Later in life No eligible studies examined the influence of complementary feeding practices on later dental caries; this is an evidence gap. Source: Results 3.8 · same question in other reviews | No studies on the influence of caregivers' feeding practices during complementary feeding on dental caries later in life were identified. | 0 studies | No studies |
Responsive complementary feeding (RCF) vs Other models of complementary feeding
Population: Healthy children aged 6–24 months in Western industrialized countries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hypertension No eligible studies on caregivers' feeding practices during complementary feeding and later hypertension were found. Source: Results 3.7 · same question in other reviews | no estimate extracted | 0 studies | No studies |
Dental caries No eligible trials explored caregivers' feeding practices during complementary feeding and dental caries. Source: Results 3.8 · same question in other reviews | no estimate extracted | 0 studies | No studies |
Overweight/obesity risk Follow-up interval 15-20 months Population: Healthy, term-born, normal-birth-weight infants aged 4-24 months (breastfed and/or formula-fed) in Western industrialized countries Non-responsive complementary feeding showed no significant association with overweight/obesity across observational studies (very low certainty). Source: Table 4 (SoF); Results 3.4 · same question in other reviews | NRCF, risk of overweight and obesity (observational; follow up interval 15 to 20 months; assessed with % overweight/obesity, BMIz, delta-BMI, skinfold): No significant association for all comparisons (for documented… | 4 studies | Very low Downgraded: risk of bias, inconsistency |
Weight gain (restrictive vs coercive styles) Infancy to early childhood · Restrictive vs coercive/pressuring styles Population: Healthy, term-born, normal-birth-weight infants aged 4-24 months (breastfed and/or formula-fed) in Western industrialized countries Narratively, restrictive NRCF style tended to favor excess weight and coercive/pressuring style tended to favor lower weight (3 of 5 studies each; ungraded). Source: Results 3.4; Discussion 4.1.2 · same question in other reviews | Restrictive style would favor excess weight (three of five studies); coercive style (pressure to eat) would favor a lower weight (three of five studies); clinical significance never quantified. | NR | Ungraded |
Choking events No eligible studies of RCF and choking were found. Source: Results 3.5 · same question in other reviews | no estimate extracted | 0 studies | No studies |
Non-responsive complementary feeding (NRCF) vs Other models of complementary feeding
Population: Healthy children aged 6–24 months in Western industrialized countries
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overweight and obesity 15–20 months · observational NRCF showed no significant association with overweight/obesity across the reported comparisons (very low certainty). Source: Table 4; Results 3.4 · same question in other reviews | No significant association for all comparisons for documented exposures of at least 6 months; 4 observational studies; Very low certainty. | 4 studies | Very low Downgraded: risk of bias |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Partial Yes | No | no |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | RCT: Yes · NRSI: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |
Included primary studies 24
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Brown 2015 Early influences on child satiety‐responsiveness: the role of weaning style DOI:10.1111/j.2047-6310.2013.00207.x | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Brown 2018 No difference in self‐reported frequency of choking between infants introduced to solid foods using a baby‐led weaning or traditional… DOI:10.1111/jhn.12528 | this review only | Choking | not extracted yet | not extracted yet |
| Cameron 2013 Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand… PMID:24327363 | this review only | Choking | not extracted yet | not extracted yet |
| Chaidez 2014 Sweetened Food Purchases and Indulgent Feeding Are Associated With Increased Toddler Anthropometry DOI:10.1016/j.jneb.2013.05.011 | this review only | Weight gain (restrictive vs coercive styles) | not extracted yet | not extracted yet |
| Daniels 2012 (NOURISH) Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: outcomes of the NOURISH RCT at… DOI:10.1038/ijo.2012.96 | this review only | BMI z-score (overweight/obesity) at 13 months | not extracted yet | not extracted yet |
| Daniels 2013 (NOURISH) Outcomes of an Early Feeding Practices Intervention to Prevent Childhood Obesity DOI:10.1542/peds.2012-2882 | this review only | Physical growth / weight gain | not extracted yet | not extracted yet |
| Daniels 2015 (NOURISH) An Early Feeding Practices Intervention for Obesity Prevention DOI:10.1542/peds.2014-4108 | this review only | Physical growth / weight gain | not extracted yet | not extracted yet |
| Dinkevich 2015 Mothers' feeding behaviors in infancy: Do they predict child weight trajectories? PMID:26537027 | this review only | Weight gain (restrictive vs coercive styles) | not extracted yet | not extracted yet |
| Dogan 2018 Baby‐led complementary feeding: Randomized controlled study DOI:10.1111/ped.13671 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Fangupo 2016 A Baby-Led Approach to Eating Solids and Risk of Choking DOI:10.1542/peds.2016-0772 | this review only | Choking | not extracted yet | not extracted yet |
| Fu 2018 Food fussiness and early feeding characteristics of infants following Baby-Led Weaning and traditional spoon-feeding in New Zealand: An… DOI:10.1016/j.appet.2018.07.033 | this review only | Choking | not extracted yet | not extracted yet |
| Hittner 2016 Infant emotional distress, maternal restriction at a home meal, and child BMI gain through age 6years in the Colorado Adoption Project DOI:10.1016/j.eatbeh.2016.01.008 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Kahraman 2020 Baby-led weaning versus traditional weaning: the assessment of nutritional status in early childhood and maternal feeding practices in… DOI:10.1080/03004430.2020.1726902 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Lumeng 2012 Observed assertive and intrusive maternal feeding behaviors increase child adiposity. PMID:22277552 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Machuca 2016 Well Baby Group Care: Evaluation of a Promising Intervention for Primary Obesity Prevention in Toddlers DOI:10.1089/chi.2015.0212 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Paul 2018 (INSIGHT 3y) Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical… PMID:30088009 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Rifas-Shiman 2011 Does maternal feeding restriction lead to childhood obesity in a prospective cohort study? PMID:21081589 | this review only | Weight gain (restrictive vs coercive styles) | not extracted yet | not extracted yet |
| Savage 2016 (INSIGHT) Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized… PMID:27271455 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Stifter 2015 Understanding and measuring parent use of food to soothe infant and toddler distress: A longitudinal study from 6 to 18 months of age. PMID:26164121 | this review only | Physical growth / weight gain | not extracted yet | not extracted yet |
| Taveras 2006 To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? PMID:17142517 | this review only | Weight gain (restrictive vs coercive styles) | not extracted yet | not extracted yet |
| Taylor 2017 Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial. PMID:28692728 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Thompson 2013 Pressuring and restrictive feeding styles influence infant feeding and size among a low-income African-American sample. PMID:23592664 | this review only | Weight gain (restrictive vs coercive styles) | not extracted yet | not extracted yet |
| Townsend 2012 Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample. PMID:22315302 | this review only | Overweight/obesity risk | not extracted yet | not extracted yet |
| Wright 2006 How Does Maternal and Child Feeding Behavior Relate to Weight Gain and Failure to Thrive? Data From a Prospective Birth Cohort DOI:10.1542/peds.2005-1215 | this review only | Physical growth / weight gain | not extracted yet | not extracted yet |