Recommendations on Complementary Feeding as a Tool for Prevention of Non-Communicable Diseases (NCDs)—Paper Co-Drafted by the SIPPS, FIMP, SIDOHaD, and SINUPE Joint Working Group

Abstract

Adequate and balanced nutrition is essential to promote optimal child growth and a long and healthy life. After breastfeeding, the second step is the introduction of complementary feeding (CF), a process that typically covers the period from 6 to 24 months of age. This process is, however, still highly controversial, as it is heavily influenced by socio-cultural choices, as well as by the availability of specific local foods, by family traditions, and pediatrician beliefs. The Società Italiana di Pediatria Preventiva e Sociale (SIPPS) together with the Federazione Italiana Medici Pediatri (FIMP), the Società Italiana per lo Sviluppo e le Origine della Salute e delle Malattie (SIDOHaD), and the Società Italiana di Nutrizione Pediatrica (SINUPE) have developed evidence-based recommendations for CF, given the importance of nutrition in the first 1000 days of life in influencing even long-term health outcomes. This paper includes 38 recommendations, all of them strictly evidence-based and overall addressed to developed countries. The recommendations in question cover several topics such as the appropriate age for the introduction of CF, the most appropriate quantitative and qualitative modalities to be chosen, and the relationship between CF and the development of Non-Communicable Diseases (NCDs) later in life.

Timing of Complementary Feeding, Growth, and Risk of Non-Communicable Diseases: Systematic Review and Meta-Analysis

“…This SR was conducted to support the recommendations on the appropriate age range for the introduction of CF into the diets of healthy term babies with normal birth weight, breastfed and/or formula-fed, ages 4–24 months or older for long term outcomes, living in Western industrialized countries [ 9 ].…”

“…The formulation of clinical questions, the search, the analysis of documents and scientific evidence with specific tools (AGREE II for GLs, AMSTAR 2 for SRs, Cochrane Assessment of risk of bias for RCTs, Newcastle Ottawa Scales for observational studies), and the GRADE method have been previously described [ 9 ].…”

“…The standard method of the Cochrane Review Group to synthesize the data was used and the effects were expressed as risk ratio (RR) and risk difference (RD) with 95% confidence intervals (Cis) for categorical data. For continuous outcomes, the mean difference (MD) or standardized main difference (SDM) and the 95% confidence intervals (Cis) were used [ 9 ].…”

“…The selection process and the assessment of the comprehensive methodological quality and of that of the individual studies, including handling missing data and data extraction, were carried out by at least two authors [ 9 ].…”

“…The SRs and the studies were evaluated using specific tools, (AMSTAR 2 for SRs, Cochrane Assessment of Risk of Bias for RCTs, and Newcastle Ottawa Scales for observational studies), as previously described [ 9 ].…”