Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight

Abstract

IMPORTANCE 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.OBJECTIVE 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.INTERVENTIONS Mothers in the BLISS group received lactation consultant support (Ն5 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). MAIN OUTCOMES AND MEASURESThe 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. RESULTS 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 (BMIՆ95th 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. CONCLUSIONS AND RELEVANCEA 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.

Baby‐led complementary feeding: Randomized controlled study

“…It is not possible to conclude from these cross‐sectional studies whether there is an association between BLW and bodyweight. In a recent study using modified BLW, however, the baby‐led approach to complementary feeding did not result in more appropriate BMI than TSF, and the study noted that that further research should determine whether the findings apply to individuals using unmodified BLW …”

Complementary Feeding in Developed Countries: The 3 Ws (When, What, and Why?)

“…Another similar approach, the "baby-led introduction to solids" (BLISS), has been developed to address potential concerns with iron status, choking, and growth faltering [32]. BLISS infants showed less food fussiness and better enjoyment of food compared to infants who were spoon-fed, but it did not result in a more appropriate body weight than the traditional feeding method [33]. It is evident that the parent-infant relationship, in terms of attitudes and behaviors, will play a major role in the infant's feeding practices acquisition.…”

Baby‐led weaning: Where are we now?

“…; Taylor et al . ), as well as with a responsive feeding style (Brown & Lee ,c). It is also linked to shared mealtimes and the use of family foods (Brown & Lee ).…”

“…Evidence from observational studies suggests that BLW may pre‐dispose infants to a reduced risk of overweight through increased satiety responsiveness (Brown & Lee ) and a preference for non‐sweet carbohydrates (Townsend & Pitchford ) but, so far, the evidence from RCTs does not support this (Taylor et al . ), nor does it show a reduction in intakes of sugar and salt (Erickson et al . ).…”