Are there any known health risks to early introduction of solids to an infant’s diet?

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Clinical Inquiries

Are there any known health risks to early introduction of solids to an infant’s diet?

J Fam Pract. 2009 April;58(4):219-220

By

Kenneth S. Yew, MD

Bryant Webber, BA

James Hodges, BS

Nakia Joye Carter, MSIS, AHIP

References

1. Tarini BA, Carroll AE, Sox CM, et al. Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Arch Pediatr Adolesc Med. 2006;160:502-507.

2. Fergusson DM, Horwood LJ, Shannon FT. Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study. Pediatrics. 1990;86:541-546.

3. Schoetzau A, Filipiak-Pittroff B, Franke K, et al. Effect of exclusive breast-feeding and early solid food avoidance on the incidence of atopic dermatitis in high-risk infants at 1 year of age. Pediatr Allergy Immunol. 2002;13:234-242.

4. Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the prospective birth cohort study LISA. Pediatrics. 2008;121:e44-e52.

5. Filipiak B, Zutavern A, Koletzko S, et al. Solid food introduction in relation to eczema: results from a four-year prospective birth cohort study. J Pediatr. 2007;151:352-358.

6. Snijders BE, Thijs C, van Ree R, et al. Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: the KOALA Birth Cohort Study. Pediatrics. 2008;122:e115-e122.

7. Mehta KC, Specker BL, Bartholmey S, et al. Trial on timing of introduction of solids and food type on infant growth. Pediatrics. 1998;102:569-573.

8. Yeung DL, Pennell MD, Leung M, et al. Infant fatness and feeding practices: a longitudinal assessment. J Am Diet Assoc. 1981;79:531-535.

9. Burdette HL, Whitaker RC, Hall WC, et al. Breast-feeding, introduction of complementary foods, and adiposity at 5 y of age. Am J Clin Nutr. 2006;83:550-558.

10. Agras WS, Kraemer HC, Berkowitz RI, et al. Influence of early feeding style on adiposity at 6 years of age. J Pediatr. 1990;116:805-809.

11. Forsyth JS, Ogston SA, Clark A, et al. Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. BMJ. 1993;306:1572-1575.

12. Norris JM, Barriga K, Hoffenberg EJ, et al. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. JAMA. 2005;293:2343-2351.

13. Greer FR, Sicherer SH, Burks AW. American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183-191.

14. Host A, Halken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol. 2008;19:1-4.

15. World Health Organization. Global Strategy for Infant and Young Child Feeding. 2003. Available at: http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf. Accessed February 9, 2009.

16. Fiocchi A, Assa’ad A, Bahna S. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse Reactions to Foods Committee, American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 2006;97:10-21.

EVIDENCE-BASED ANSWER

No. Few studies support an association between early introduction of solid food and atopic conditions, obesity, or any other illness (strength of recommendation [SOR]: B, cohort studies with mixed results). Very weak evidence suggests an increased risk of atopic dermatitis.

A single cohort study found an association between early gluten exposure and increased risk of celiac disease in high-risk infants, who carry the HLA-DR3 or DR4 allele (SOR: B, single cohort study).

Evidence summary

Early feeding of solid food—defined as introduction of solids before 4 months of age—has been implicated as a potential cause of several adverse outcomes, including atopy, adiposity, gastrointestinal illness, and celiac disease. But what does the evidence tell us?

Atopy: Conflicting evidence, little support

A 2006 meta-analysis of 13 studies examining the risk of atopic diseases associated with early introduction of solids concluded that “there is insufficient evidence to suggest that, on its own, the early introduction of solids to infants is associated with an increased risk of asthma, food allergy, allergic rhinitis, or animal allergies.”¹

FAST TRACK

Few studies support an association between early introduction of solid food and atopic conditions, obesity, or any other illness.

The meta-analysis showed some evidence of an association between early solid introduction and eczema, the strongest being a 10-year New Zealand cohort study (N=1265).² The study concluded that introducing solids and increasing food diversity before 4 months of age was associated with eczema at 2 to 10 years.

Subsequent studies have not produced similar results.^3-6 A well-designed 6-year German birth cohort study (N=2612) found that delaying introduction of solids didn’t decrease the odds of asthma, allergic rhinitis, or food sensitization. Increased food diversity at 4 months (trying 3-8 foods vs none) was associated with some, but not all, measures of eczema.⁴

A German prospective cohort study (N=5991) found no benefit in delaying solids longer than 4 months or potentially allergenic solids longer than 6 months to prevent eczema.⁵ A Dutch prospective cohort study (N=2558) not only confirmed these findings, but found a higher risk of atopy at 2 years of age after delayed introduction of solids, even after accounting for reverse causation (delaying solids in children with early atopic symptoms).⁶

Adiposity and GI illness: No significant association

A randomized, prospective trial (N=165) compared early and late introduction of solids with fat mass at 3, 6, and 12 months of age. No significant difference in adiposity between treatment groups was noted at any end point.⁷ Several cohort studies (N=316, N=313, N=54) have found no statistically significant relationship between early solid feeding and obesity at 6 months, 5 years, and 6 years, respectively.^8-10

FAST TRACK

The best time to introduce gluten-containing foods to babies at increased risk of celiac disease is between 4 and 6 months of age.

A cohort study (N=455) in Dundee, Scotland, reported that infants fed solids before 12 weeks were “significantly heavier” at 26 weeks but not at 52 or 104 weeks; this finding has limited validity, however, because the study didn’t control for parental weight.¹¹ The Dundee study also found no significant association between gastrointestinal illness and the timing of introduction of solids.¹¹

Evidence-based answers from the Family Physicians Inquiries Network