What is the relationship between complementary feeding and micronutrient status?
Approach to Answering the Question
Existing NESR Systematic Review
Birth to 24 Months Subcommittee
Existing Systematic Review Protocol
Developed for each scientific question being examined, the protocol describes the plan for how the systematic review will be conducted. For this question, the existing NESR systematic reviews were conducted during the Pregnancy and Birth to 24 Months Project, and captured evidence published from January 1980 to March 2016. The Complementary Feeding Technical Expert Collaborative conducted the systematic reviews in collaboration with staff from USDA’s Nutrition Evidence Systematic Review (NESR). Complete documentation of the existing systematic reviews and the related publication in the American Journal of Clinical Nutrition is available on the NESR website:
Draft Conclusion Statement
The draft conclusion statements listed below describe the state of the science related to the specific question examined. Draft conclusions are not considered final until they have been deliberated with and decided upon by the full Committee and published in the Committee’s final advisory report. Individual conclusion statements should not be interpreted as dietary guidance or the Committee’s overarching advice to the Departments.
Timing of Introduction of Complementary Foods or Beverages
Moderate evidence suggests that introducing complementary foods and beverages at 4 months of age compared to 6 months of age offers no long-term advantages or disadvantages in terms of iron status among healthy, full-term infants who are breastfed, fed iron-fortified formula, or both. Grade: Moderate
There is not enough evidence to determine the relationship between timing of introduction of complementary foods and beverages and zinc, vitamin D, vitamin B12, folate, or fatty acid status. Grade: Grade Not Assignable
Types and Amounts of Complementary Foods or Beverages
Strong evidence suggests that consuming complementary foods and beverages that contain substantial amounts of iron, such as meats or iron-fortified cereal, helps maintain adequate iron status or prevent iron deficiency during the first year of life among infants with insufficient iron stores or breastfed infants who are not receiving adequate iron from another source. However, the benefit of these types of complementary foods and beverages for infants with sufficient iron stores, such as those consuming iron-fortified infant formula, is less evident. There is not enough evidence to determine the relationship between other types/amounts of complementary foods and beverages containing lesser amounts of iron, such as fruits and vegetables, and iron status. Grade: Strong
Limited evidence suggests that consuming complementary foods and beverages that contain substantial amounts of zinc, such as meats or cereals fortified with zinc, supports zinc status during the first year of life, particularly among breastfed infants who are not receiving adequate zinc from another source. However, the benefit of these types of complementary foods for infants consuming fortified infant formula is less evident. Grade: Limited
Moderate evidence suggests that consuming complementary foods and beverages with differing fatty acid profiles, particularly long-chain polyunsaturated fatty acids, can influence fatty acid status. Grade: Moderate
During the second year of life, good sources of micronutrients are still needed, but there is limited evidence to indicate which types and amounts of complementary foods and beverages are associated with adequate micronutrient status.
There is not enough evidence to determine the relationship between types and amounts of complementary foods and beverages and vitamin B12, vitamin D, or folate status. Grade: Grade Not Assignable