Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial

Abstract

ObjectiveTo determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.Design, participants and interventionThis randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and ‘Well Child’ care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.Outcome measuresIntake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.ResultsDifferences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI −1.0 to 2.3) or 12 (−0.1 mg/day; −1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference −2.6 µg/L; 95% CI −10.9 to 5.8), body iron (0.04 mg/kg; −1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.ConclusionsA baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer ‘high-iron’ foods with each meal.Trial registration numberACTRN12612001133820; Pre-results.

Impact of a Modified Version of Baby-Led Weaning on Infant Food and Nutrient Intakes: The BLISS Randomized Controlled Trial

“…Infants in the BLISS group were exclusively breastfed for substantially longer (median 21.7 weeks; 95% CI: 13.0 to 23.8 weeks) than those in the Control group (median 17.3 weeks; 95% CI: 6.0 to 21.7 weeks; p = 0.002) [ 11 ]. In keeping with this, BLISS infants were introduced to solid foods later than Control infants (median 24.6 weeks compared to 22.6 weeks, p < 0.001) [ 12 ] and, therefore, fewer of them started solids before six months (26 weeks) of age (35% compared to 82%, p < 0.001).…”

“…There were no significant group differences in estimated intake of breast milk at 7 (difference BLISS relative to Controls, 95% CI: 0.0 g, −5.1 to 5.1; p = 1.00 [ 12 ]), 12 (−0.0 g, −0.1 to 0.1; p = 0.94 [ 12 ]) or 24 (−6 g, −32 to 20; p = 0.648) months of age. Corresponding differences (95% CI) in infant formula intake were 216 g (−97.2 to 530 g; p = 0.17) at 7 months and −85 g (−277 to 107 g; p = 0.38) at 12 months of age [ 12 ]. No infants were consuming infant formula at 24 months of age.…”

“…In response to concerns from health professionals that unmodified BLW might be associated with increased risk of growth faltering, iron deficiency and choking [ 10 ], the Baby-Led Introduction to SolidS (BLISS) randomized controlled trial investigated the impact of a modified form of BLW on these outcomes. We have shown that this modified version of BLW was associated with a number of benefits including: a reduction in food fussiness compared to traditional spoon-feeding [ 11 ]; higher iron [ 12 ] and zinc [ 13 ] intakes than have been reported for unmodified Baby-Led Weaning [ 9 ]; and no evidence of an increased risk of iron deficiency [ 12 ], choking [ 14 ] or growth faltering [ 11 ]. However, it is not known whether BLISS has beneficial or detrimental impacts on infant food and nutrient intake.…”

Modifiable “Predictors” of Zinc Status in Toddlers

“…This is a cross-sectional analysis of data collected in the Baby-Led Introduction to SolidS (BLISS) study [ 26 ]. BLISS was a randomized controlled trial investigating the impact of a modified version of Baby-Led Weaning (BLW) on several infant outcomes including growth [ 27 ], iron [ 28 ], and zinc [ 29 ] status, and choking [ 30 ]. Written consent was obtained from all adult participants before randomization to one of two groups: BLISS (infant self-feeding using a modified version of BLW) or Control (usual care) between November 2012 and March 2014.…”

Mediation Analysis as a Means of Identifying Dietary Components That Differentially Affect the Fecal Microbiota of Infants Weaned by Modified Baby-Led and Traditional Approaches

“…The Baby-Led Introduction to SolidS (BLISS) randomized controlled trial (20,21) has investigated the impact of a modified version of BLW on growth (22), choking risk (23), and iron status (24) and provides an opportunity to investigate the impact of the early introduction of an adult-type diet on the developing infant gut microbiota. The aim of this study was to determine whether a "baby-led" approach to complementary feeding affects the fecal microbiota composition relative to traditional spoon-feeding and, if so, to use mediation analysis to associate dietary components with altered microbiota.…”