A recent study (Woo JG et al. J Pediatr 2015; 167: 969-74) indicates that breastfed infants in a US cohort had lower dietary diversity at 6-12 months of age than a cohort from Shanghai and Mexico City.
The diversity of consumed foods helps ensure intake of all necessary macro- and micronutrients. One indicator, the “minimum dietary diversity” (MDD) developed by the World Health Organization has been used. Infants meeting MDD standards between 6-23 months are less likely to experience stunting.
- “Only 28% of Cincinnati [US cohort] infants fed >50% human milk achieved MDD between 6 and 12 months.”
- Across all cohorts, dietary diversity increased from 31% at 6 months of age to 92% at 12 months of age.
- Shanghai infants had the highest diversification, “largely accounted for by significant consumption of eggs”
This study shows that some of previous recommendations, prior to 2008, to avoid foods like eggs and peanuts to lessen atopic disease/food allergies may have affected introduction of a more diverse diet. Newer data has shown that earlier introduction of foods lessens the likelihood of food allergies.
The associated editorial (pg 952-53) notes that despite the ‘breast is best’ philosophy, that “if this principle is taken to extreme and introduction of nutrient dense complementary foods is delayed well past 6 months of age, the extensively breastfed older infant is at risk for suboptimal intakes of multiple micronutrients, anemia, growth faltering, and other poor health outcomes.”