Does a ‘baby-led’ approach to complementary feeding have an impact on intake of selected nutrients, food preference and food variety in 12 month old infants?

Abstract

Background: Baby-led weaning (BLW) is a form of complementary feeding where the baby feeds themselves foods that they can pick up right from the start of complementary feeding. It appears to be gaining popularity in the United Kingdom and New Zealand. However, the published evidence available in this area is very limited. Baby-Led Introduction to SolidS (BLISS) is a modified version of BLW, and the BLISS study is the first randomised controlled trial of a baby-led approach to complementary feeding in the world. It aims to address this current gap and determine whether a baby-led approach is associated with potential health benefits or risks in infants through to 2 years of age.

Aim: This thesis will use results from the BLISS study and focus on the food intake and behaviour of infants when they are 12 months of age. The three key objectives for this research are to determine: if a baby-led approach to complementary feeding has an effect on energy, macronutrients, calcium and dietary fibre intakes; if food taste and texture preferences are established differently as a result of following a baby-led approach to complementary feeding; and if a baby-led approach to complementary feeding increases the likelihood of offering a more varied diet.

Methods: Of the 206 participants who enrolled in the BLISS study, demographic data were available for 123 parent-child pairs at 12 months of age at the time this MSc thesis was being written. Data were obtained from questionnaires administered from 2-12 months of age, and a food preference questionnaire and 3-day Weighed Diet Record (WDR) collected at 12 months of age. The infant’s primary caregiver completed all questionnaires and the WDR. Weighed diet record data were entered into the ‘Kai-culator’ nutrient analysis program. Food preference scores for different food tastes and textures were determined using questions on how often the infant had been offered various foods (‘exposure’), and the infant’s ‘acceptance’ of foods - defined as whether the infant eats (or tastes) the food when it is offered. Food variety scores were determined using the 3-day WDR by counting the total number of different foods eaten, and counting the foods eaten from 9 different food groups. All statistical analyses were conducted using Stata 12.1. All tests with a two-sided p<0.05 were considered statistically significant.

Results: Infants in the BLISS group at 12 months of age had significantly higher exposure scores for foods classified as ‘savoury - vegetable’ (P=0.050), ‘savoury - non-meat high protein’ (P=0.024), and ‘lumpy’ (P=0.004), and a lower exposure score for ‘salty’ foods (P=0.014), when compared to the control group. However, the BLISS intervention did not appear to affect the 12 month infants’ overall nutrient intake, food preference, or food variety. Compared to the control group, BLISS did modify some specific eating behaviours and parent practices. Those in the BLISS group had a longer duration of exclusive breastfeeding (P=0.022), started complementary feeding later (P<0.001), and were less likely to be offered commercial baby foods (P=0.019).

Conclusion: Following a modified approach to Baby-led weaning resulted in an increased exposure to a range of tastes and textures; this could theoretically lead to positive influences on eating behaviours later in life. However, reassuringly both study groups had adequate nutrient intakes, and consumed a variety of foods at 12 months of age. However, there are still a number of unanswered questions concerning BLW and further research into the implications of BLW is needed to provide policy makers and health professionals with sound scientific evidence before any recommendations regarding BLW can be made to the general New Zealand population.