Relationship Between Feeding Behavior And Infant Anemia:A Birth Cohort Study

A number of previous studies have found that feeding behavior such as exclusive breastfeeding and complementary foods introduction is closely associated with infant anemia.But results from these studies varied and most of them were conducted in Western/European countries.More prospective studies are needed to further clarify this important issue,especially in Asian population.The primary aim of the present study was to examine the relationship between exclusive breastfeeding duration,age of complementary foods introduction and risk of infant anemia,based on a large birth cohort in China-Jiaxing Birth Cohort.In Jiaxing Birth Cohort,infants providing general information,detailed breastfeeding and complementary feeding information,and anthropometry data were selected.The associations between exclusive breastfeeding duration,age of complementary foods introduction and risk of anemia at 12 months and 48-71 months of age were assessed as the adjusted ORs by using multiple logistic regressions.The associations with hemoglobin concentrations were assessed as the adjusted mean difference by using multiple linear regression.In the study of examining the relationship between exclusive breastfeeding duration and risk of anemia,25,393 infants aged 12 months and 32,658 children aged 48-71 months were included.Exclusive breastfeeding>6 months,but not 3-5 months,was significantly associated with a higher risk of anemia in infants at age 12 months(OR:1.15;95%CI:1.02,1.29),compared with exclusive breastfeeding<3 months.For young children of 48-71 months of age,it was only marginally significant(OR:1.13;95%CI:0.99,1.29).While exclusive breastfeeding ≥6 months was significantly associated with a lower hemoglobin concentration in both infants aged 12 months and young children aged 48-71 months.In the study of investigating the association between age of complementary foods introduction and anemia risk,18,446 children aged 48-71 months were included.Early introduction of complementary foods at 3-6 months of age was significantly associated with a higher risk of anemia(OR:1.14;95%CI:1.01,1.28)and a lower hemoglobin concentration of-0.84 g/L(95%CI:-1.33,-0.35)in children aged 48-71 months,compared with those fed complementary foods starting at 6 months of age.When it comes to the specific type of complementary foods,early introduction of plant-based foods such as bread/steamed bun/fine dried noodle,pureed noodle/cookies and tofu was associated with increased anemia risks and lower hemoglobin concentrations,while early introduction of most animal-based foods was not.In conclusion,prolonged exclusive breastfeeding duration(≥6 months)and early introduction of complementary foods(at 3-6 months of age)were significantly associated with an increased anemia risk and a lower hemoglobin concentration.These findings are consistent with WHO recommendations on the age of complementary foods introduction for infants and suggest that appropriate complementary feeding should start from the age of 6 months.Parents should provide infants with an adequate source of iron after 6-months of exclusive breastfeeding.