Background:
Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and typically continuing to 24 months of age.
This systematic review was conducted by the Nutrition Evidence Systematic Review (NESR) team as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
The goal of this systematic review was to answer the following research question: What is the relationship between types and/or amounts of complementary foods and beverages and bone health?
Conclusion Statement and Grades:
Insufficient evidence is available to draw conclusions about the relationship between the types and/or amounts of complementary foods and beverages consumed and bone health. Grade: [Grade Not Assignable]
Methods:
This systematic review was conducted by a team of staff from NESR in collaboration with a Technical Expert Collaborative.
A literature search was conducted using 4 databases (CINAHL, Cochrane, Embase, and PubMed) to identify articles published from January 1980 to July 2016 that examined the the types and amounts of complementary foods and beverages (CFB) consumed and bone health. CFB were defined as foods and beverages other than human milk or infant formula provided to an infant or young child. Bone health outcomes included bone, biomarkers of bone metabolism, and incidence and prevalence of osteoporosis, osteopenia, rickets, and fracture. A manual search was done to identify articles that may not have been included in the electronic databases searched. Articles were screened in a dual manner, independently by 2 NESR analysts, to determine which articles met predetermined criteria for inclusion.
Data from each included article were extracted, risk of bias was assessed. The body of evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence. Research recommendations were identified.
Summary of Evidence:
Two prospective cohort studies published since 1980 met the inclusion criteria for this review, both of which examined the relationship between infants’ and toddlers’ dietary patterns and bone health.
The ability to draw conclusions about the relationship between the types and/or amounts of CFB consumed and bone health is limited by an overall lack of research.
Although both cohort studies included in this review assessed dietary patterns at 12-13 months, in relationship to a single assessment of bone mineral content at 4 or 6 years of age, it is not possible to draw conclusions for types and/or amounts of CFB and bone health given the non-specific nature of the dietary patterns, as well as the long interval between the assessment of dietary pattern and radiological measurement of bone health.