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Complementary Feeding in an Obesogenic Environment: Behavioral and Dietary Quality Outcomes and Interventions.

The WHO infant feeding guidelines, including those for complementary feeding (CF), are very prescriptive, largely based on the outcomes of exclusive breastfeeding, and have a bias towards undernutrition. Consideration of longer-term outcomes related to overnutrition, the predominant nutrition problem in affluent countries, is limited. Compared to the ongoing and often zealous debates regarding the short- and long-term benefits of exclusive breastfeeding to 6 months in affluent countries, exposures (particularly feeding practices) and outcomes related to CF, independent of exclusive breastfeeding, have received little attention. In this context, consideration of a broader range of outcomes (e.g. food preferences, energy intake regulation, dietary quality, and eating behaviors) that potentially mediate the associations between infant feeding and long-term obesity and chronic disease outcomes is required. The aim of this paper is to (i) consider the impact of CF on outcomes relevant to the risk of child obesity and (ii) provide an overview of the NOURISH trial, the first large trial to evaluate an intervention that specifically targeted CF feeding practices ('how'), including reports on long-term outcomes.