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

Lisa Daniels, Rachael W Taylor, Sheila M Williams, Rosalind S Gibson, Elizabeth A Fleming, Benjamin J Wheeler, Barry J Taylor, Jillian J Haszard, Anne-Louise M Heath, Lisa Daniels, Rachael W Taylor, Sheila M Williams, Rosalind S Gibson, Elizabeth A Fleming, Benjamin J Wheeler, Barry J Taylor, Jillian J Haszard, Anne-Louise M Heath

Abstract

Objective: To 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 intervention: This 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 measures: Intake 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.

Results: Differences 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.

Conclusions: A 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 number: ACTRN12612001133820; Pre-results.

Keywords: baby-led weaning; body iron; complementary feeding; dietary iron; infants; iron deficiency; iron status; toddlers.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Flow of participants through the study. BLISS, Baby-Led Introduction to SolidS.

References

    1. Cameron SL, Taylor RW, Heath AL. Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families. BMJ Open 2013;3:e003946 10.1136/bmjopen-2013-003946
    1. Brown A, Lee M. A descriptive study investigating the use and nature of baby-led weaning in a UK sample of mothers. Matern Child Nutr 2011;7:34–47. 10.1111/j.1740-8709.2010.00243.x
    1. D’Andrea E, Jenkins K, Mathews M, et al. . Baby-led Weaning: A Preliminary Investigation. Can J Diet Pract Res 2016;77:72–7. 10.3148/cjdpr-2015-045
    1. Cameron SL, Heath AL, Taylor RW. Healthcare professionals' and mothers' knowledge of, attitudes to and experiences with, Baby-Led Weaning: a content analysis study. BMJ Open 2012;2:e001542 10.1136/bmjopen-2012-001542
    1. Rapley G, Murkett T. Baby-led Weaning: Helping your Baby to Love Good Food. London: Vermillon, 2008.
    1. Morison BJ, Taylor RW, Haszard JJ, et al. . How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months. BMJ Open 2016;6:e010665–11. 10.1136/bmjopen-2015-010665
    1. Domellöf M, Braegger C, Campoy C, et al. . Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr 2014;58:119–29. 10.1097/MPG.0000000000000206
    1. Lozoff B, Beard J, Connor J, et al. . Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 2006;64:34–43. 10.1301/nr.2006.may.S34-S43
    1. Congdon EL, Westerlund A, Algarin CR, et al. . Iron deficiency in infancy is associated with altered neural correlates of recognition memory at 10 years. J Pediatr 2012;160:1027–33. 10.1016/j.jpeds.2011.12.011
    1. Taylor RW, Williams SM, Fangupo LJ, et al. . Effect of a baby-led approach to complementary feeding on infant growth and overweight: a randomized clinical trial. JAMA Pediatr 2017;171:838–46. 10.1001/jamapediatrics.2017.1284
    1. Fangupo LJ, Heath AM, Williams SM, et al. . A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics 2016;138:e20160772 10.1542/peds.2016-0772
    1. Daniels L, Heath AL, Williams SM, et al. . Baby-Led Introduction to SolidS (BLISS) study: a randomised controlled trial of a baby-led approach to complementary feeding. BMC Pediatr 2015;15:1–15. 10.1186/s12887-015-0491-8
    1. Ministry of Health New Zealand. Well Child/Tamariki Ora services. Wellington, 2014. (accessed 30 Jul 2017).
    1. Cameron SL, Taylor RW, Heath AL. Development and pilot testing of Baby-Led Introduction to SolidS--a version of Baby-Led Weaning modified to address concerns about iron deficiency, growth faltering and choking. BMC Pediatr 2015;15:1–11. 10.1186/s12887-015-0422-8
    1. Ministry of Health New Zealand. New Zealand food composition database. 2010. (accessed 4 Jul 2014).
    1. Ministry of Health New Zealand, University of Otago New Zealand. Methodology report for the 2008/09 New Zealand adult nutrition survey. Wellington: Ministry of Health, 2011. (accessed 20 Apr 2017).
    1. Clousten A. The role of commercial processed baby foods in the diets of New Zealand toddlers. New Zealand: Thesis, Master of Dietetics, University of Otago, 2014.
    1. Dewey KG, Heinig MJ, Nommsen LA, et al. . Adequacy of energy intake among breast-fed infants in the DARLING study: Relationships to growth velocity, morbidity, and activity levels. J Pediatr 1991;119:538–47. 10.1016/S0022-3476(05)82401-1
    1. Barris A. Meat and haem iron intakes of New Zealand toddlers aged 12-24 months. New Zealand: Thesis, Master of Dietetics, University of Otago, 2012.
    1. Hartley N. Phytate and zinc intakes of toddlers from New Zealand. New Zealand: Thesis, Master of Dietetics, University of Otago, 2013.
    1. Thurnham DI, McCabe LD, Haldar S, et al. . Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 2010;92:546–55. 10.3945/ajcn.2010.29284
    1. Cogswell ME, Looker AC, Pfeiffer CM, et al. . Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006. Am J Clin Nutr 2009;89:1334–42. 10.3945/ajcn.2008.27151
    1. Harttig U, Haubrock J, Knüppel S, et al. . The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr 2011;65 (Suppl 1):S87–S91. 10.1038/ejcn.2011.92
    1. Gibson RS, Ferguson EL. An interactive 24-hour recall for assessing the adequacy of iron and zinc intakes in developing countries. HarvestPlus Technical Monograph 2008:1–160.
    1. European Food Safety Authority (EFSA) Panel on Dietetic Products Nutrition and Allergies. Scientific Opinion on Dietary Reference Values for Iron, 2015:1–115.
    1. Lombardi-Boccia G, Martinez-Dominguez B, Aguzzi A. Total Heme and Non-heme Iron in Raw and Cooked Meats. J Food Sci 2002;67:1738–41. 10.1111/j.1365-2621.2002.tb08715.x
    1. Szymlek-Gay EA, Ferguson EL, Heath AL, et al. . Food-based strategies improve iron status in toddlers: a randomized controlled trial12. Am J Clin Nutr 2009;90:1541–51. 10.3945/ajcn.2009.27588
    1. Olaya GA, Lawson M, Fewtrell MS. Efficacy and safety of new complementary feeding guidelines with an emphasis on red meat consumption: a randomized trial in Bogota, Colombia. Am J Clin Nutr 2013;98:983–93. 10.3945/ajcn.112.053595
    1. Walter T, Dallman PR, Pizarro F, et al. . Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Pediatrics 1993;91:976–82.
    1. Fox MK, Reidy K, Novak T, et al. . Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc 2006;106:28.e1–28.e25. 10.1016/j.jada.2005.09.034
    1. Wall CR, Brunt DR, Grant CC. Ethnic variance in iron status: is it related to dietary intake? Public Health Nutr 2009;12:1413–21. 10.1017/S1368980008004187
    1. European Food Safety Authority (EFSA) Panel on Contaminants in the Food Chain (CONTAM). Scientific Opinion on Arsenic in Food. EFSA Journal 2009;7:1351–199.
    1. World Health Organization. Joint FAO/WHO Expert Committee On Food Additives: Summary and Conclusions, 2010:1–16.
    1. Institute of Medicine,. Food and Nutrition Board. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001.
    1. World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization, 2001.
    1. Southern Community Laboratories Ltd. Southern Community Laboratories Paediatric Reference Ranges: Southern Community Laboratories, 2014.
    1. Gibson RS. Principles of Nutritional Assessment: Chapter 17 Assessment of iron status. 2nd ed New York: Oxford University Press, 2005.
    1. Domellöf M, Dewey KG, Lönnerdal B, et al. . The diagnostic criteria for iron deficiency in infants should be reevaluated. J Nutr 2002;132:3680–6. 10.1093/jn/132.12.3680
    1. Skinner JD, Carruth BR, Houck KS, et al. . Longitudinal study of nutrient and food intakes of infants aged 2 to 24 months. J Am Diet Assoc 1997;97:496–504. 10.1016/S0002-8223(97)00129-6
    1. Devaney B, Ziegler P, Pac S, et al. . Nutrient intakes of infants and toddlers. J Am Diet Assoc 2004;104:14–21. 10.1016/j.jada.2003.10.022
    1. Ponza M, Devaney B, Ziegler P, et al. . Nutrient intakes and food choices of infants and toddlers participating in WIC. J Am Diet Assoc 2004;104:71–9. 10.1016/j.jada.2003.10.018
    1. Briefel RR, Kalb LM, Condon E, et al. . The Feeding Infants and Toddlers Study 2008: study design and methods. J Am Diet Assoc 2010;110:S16–S26. 10.1016/j.jada.2010.09.005
    1. Sharma S, Kolahdooz F, Butler L, et al. . Assessing dietary intake among infants and toddlers 0–24 months of age in Baltimore, Maryland, USA. Nutr J 2013;12:1–7. 10.1186/1475-2891-12-52
    1. Atkinson J, Salmond C, Crampton P. NZDep2013 Index of Deprivation User’s Manual. New Zealand: Department of Public Health, University of Otago, Wellington and Division of Health Sciences, University of Otago, 2014.

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