<p class="first" id="d7294731e456">This randomized clinical trial assesses whether
a baby-led approach to complementary
feeding reduces the risk for overweight compared with traditional spoon-feeding among
mothers in a single maternity hospital.
</p><div class="section">
<a class="named-anchor" id="ab-poi170035-1">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e462">Question</h5>
<p id="d7294731e464">Does a baby-led approach to complementary feeding reduce the
risk for overweight?</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-2">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e467">Findings</h5>
<p id="d7294731e469">In the randomized clinical trial Baby-Led Introduction to Solids
with 206 participating
mothers, the mean body mass index z score of infants who followed a modified version
of baby-led weaning was not different at 12 (0.44) or 24 (0.39) months of age compared
with infants who followed traditional spoon-feeding (0.20 and 0.24, respectively).
No evidence suggested a difference in the prevalence of overweight.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-3">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e472">Meaning</h5>
<p id="d7294731e474">A baby-led approach to complementary feeding does not appear
to result in healthier
growth or a reduced risk for overweight compared with traditional feeding practices.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-4">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e478">Importance</h5>
<p id="d7294731e480">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.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-5">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e483">Objective</h5>
<p id="d7294731e485">To determine whether a baby-led approach to complementary feeding
results in a lower
body mass index (BMI) than traditional spoon-feeding.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-6">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e488">Design, Setting, and Participants</h5>
<p id="d7294731e490">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.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-7">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e493">Interventions</h5>
<p id="d7294731e495">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).
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-8">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e498">Main Outcomes and Measures</h5>
<p id="d7294731e500">The primary outcome was BMI
<i>z</i> 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.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-9">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e506">Results</h5>
<p id="d7294731e508">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
<i>z</i> 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.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-10">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e514">Conclusions and Relevance</h5>
<p id="d7294731e516">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.
</p>
</div><div class="section">
<a class="named-anchor" id="ab-poi170035-11">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d7294731e519">Trial Registration</h5>
<p id="d7294731e521">
<a data-untrusted="" href="http://anzctr.org.au" id="d7294731e523" target="xrefwindow">http://anzctr.org.au</a>
Identifier:
<a data-untrusted="" href="http://www.anzctr.org.au/trial_view.aspx?ACTRN=ACTRN12612001133820"
id="d7294731e526" target="xrefwindow">ACTRN12612001133820</a>
</p>
</div>