Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial

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 (≥5 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 measures: The 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 (BMI≥95th 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 relevance: A 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.

Trial registration: http://anzctr.org.au Identifier: ACTRN12612001133820.

Figure 1.. Study Flowchart

BLISS indicates Baby-Led Introduction to Solids.

Figure 2.. Kaplan-Meier Survival Curves for Study Variables

The numbers below the graphs refer to the number of children not yet introduced to complementary foods at a particular time, with the number in parentheses referring to the number who started complementary feeding between this time point and the next (A); the number of children not yet feeding themselves regularly at a particular time, with the number in parentheses referring to the number who started feeding themselves regularly between this time point and the next (B); and the number of children not yet feeding themselves most or all of their food at a particular time, with the number in parentheses referring to the number who started feeding themselves most or all of their food between this time point and the next (C). BLISS indicates Baby-Led Introduction to Solids.