2017意见书:辅食添加

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Copyright © ESPGHAL and NASPGHAN. All rights reserved.ComplementaryFeeding:APositionPaperbythe

EuropeanSocietyforPaediatricGastroenterology,

Hepatology,andNutrition(ESPGHAN)Committeeon

Nutrition

ÃMaryFewtrell,yJiriBronsky,zCristinaCampoy,§MagnusDomello¨f,jjNicholasEmbleton,

ôNatasˇaFidlerMis,#IvaHojsak,ÃÃJessieM.Hulst,yyFlaviaIndrio,zz§§AlexandreLapillonne,

andjjjjôôChristianMolgaard

ABSTRACT

Thispositionpaperconsidersdifferentaspectsofcomplementaryfeeding

(CF),focussingonhealthyterminfantsinEurope.Afterreviewingcurrent

knowledgeandpractices,wehaveformulatedtheserecommendations:

Timing:Exclusiveorfullbreast-feedingshouldbepromotedforatleast

4months(17weeks,beginningofthe5thmonthoflife)andexclusiveor

predominantbreast-feedingforapproximately6months(26weeks,begin-

ningofthe7thmonth)isadesirablegoal.Complementaryfoods(solidsand

liquidsotherthanbreastmilkorinfantformula)shouldnotbeintroduced

before4monthsbutshouldnotbedelayedbeyond6months.Content:

Infantsshouldbeofferedfoodswithavarietyofflavoursandtextures

includingbittertastinggreenvegetables.Continuedbreast-feedingisrecom-

mendedalongsideCF.Wholecows’milkshouldnotbeusedasthemain

drinkbefore12monthsofage.AllergenicfoodsmaybeintroducedwhenCF

iscommencedanytimeafter4months.Infantsathighriskofpeanutallergy

(thosewithsevereeczema,eggallergy,orboth)shouldhavepeanut

introducedbetween4and11months,followingevaluationbyanappro-

priatelytrainedspecialist.Glutenmaybeintroducedbetween4and12

months,butconsumptionoflargequantitiesshouldbeavoidedduringthe

firstweeksafterglutenintroductionandlaterduringinfancy.Allinfants

shouldreceiveiron-richCFincludingmeatproductsand/oriron-fortified

foods.NosugarorsaltshouldbeaddedtoCFandfruitjuicesorsugar-

sweetenedbeveragesshouldbeavoided.Vegandietsshouldonlybeused

underappropriatemedicalordieteticsupervisionandparentsshouldunder-

standtheseriousconsequencesoffailingtofollowadviceregarding

supplementationofthediet.Method:Parentsshouldbeencouragedto

respondtotheirinfant’shungerandsatietyqueuesandtoavoidfeeding

tocomfortorasareward.

KeyWords:breast-feeding,complementaryfeeding,formulafeeding,

healthoutcomes,infant

(JPGN2017;64:

119–132)WhatIsKnown

󰀃Complementaryfoodsarenecessaryforbothnutri-

tionalanddevelopmentalreasons,andarean

importantstageinthetransitionfrommilkfeeding

tofamilyfoods.

󰀃Thecomplementaryfeedingperiodisoneofrapid

growthanddevelopmentwheninfantsaresusceptible

tonutrientdeficienciesandexcesses,andduringwhich

therearemarkedchangesinthedietwithexposuresto

newfoods,tastes,andfeedingexperiences.

󰀃Therelativelylimitedscientificevidencebaseis

reflectedinconsiderablevariationincomplementary

feedingrecommendationsandpracticesbetween

andwithincountries.

WhatIsNew

󰀃ThepositionpaperpublishedbythisCommitteein

2008hasbeenupdatedtoincludenewevidence,

includingdatafromrandomizedcontrolledtrialson

theintroductionofglutenandallergenicfoods.

󰀃Thearticleconsidersthetimingandcontentof

complementaryfeeding,themethodoffeeding,

andspecificdietarypractices,andmakesrecommen-

dations,focussingonhealthyterminfantsinEurope.

ReceivedOctober19,2016;acceptedOctober24,2016.FromtheÃChildhoodNutritionResearchCentre,UCLGreatOrmondStreetInstituteofChildHealth,London,UK,theyDepartmentofPaediatrics,UniversityHospitalMotol,Prague,CzechRepublic,thezDepartmentofPaediatrics,UniversityofGranada,Granada,Spain,the§DepartmentofClinicalSciences,Pediatrics,Umea˚University,Umea˚,Sweden,thejjNewcastleNeonatalService,NewcastleHospitalsNHSTrustandNew-castleUniversity,NewcastleuponTyne,UK,theôDepartmentofGas-troenterology,HepatologyandNutrition,UniversityChildren’sHospital,UniversityMedicalCentreLjubljana,Ljubljana,Slovenia,the#Univer-sityChildren’sHospitalZagreb,Zagreb,Croatia,theÃÃErasmusMC,SophiaChildren’sHospital,Rotterdam,TheNetherlands,theyyOspedalePediatricoGiovanniXXIII,UniversityofBari,Bari,Italy,thezzParisDescartesUniversity,APHPNecker-EnfantsMaladesHospital,Paris,France,the§§CNRC,BaylorCollegeofMedicine,Houston,TX,thejDepartmentofNutrition,ExerciseandSports,UniversityofCopenhagen,København,andtheôôPediatricNutritionUnit,Copenha-genUniversityHospital,Rigshospitalet,Denmark.AddresscorrespondenceandreprintrequeststoMaryFewtrell,MD,Child-hoodNutritionResearchCentre,UCLGreatOrmondStreetInstituteofChildHealth,30GuilfordSt,LondonWC1N1EH,UK(e-mail:m.fewtrell@ucl.ac.uk).Supplementaldigitalcontentisavailableforthisarticle.DirectURLcitationsappearintheprintedtext,andlinkstothedigitalfilesareprovidedintheHTMLtextofthisarticleonthejournal’sWebsite(www.jpgn.org).Theauthorsreportnoconflictsofinterest.Copyright#2016byEuropeanSocietyforPediatricGastroenterology,Hepatology,andNutritionandNorthAmericanSocietyforPediatricGastroenterology,Hepatology,andNutritionDOI: