Complementary feeding and micronutrient status: a systematic review

Am J Clin Nutr. 2019 Mar 1;109(Suppl_7):852S-871S. doi: 10.1093/ajcn/nqy266.


Background: Proper nutrition during early life is critical for growth and development.

Objectives: The aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)?

Methods: A literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded.

Results: Nine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status.

Conclusions: Several conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed.

Keywords: complementary feeding; complementary food and beverages; fatty acids; folate; iron; micronutrient status; systematic review; vitamin B-12; vitamin D; zinc.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Systematic Review

MeSH terms

  • Beverages
  • Breast Feeding
  • Deficiency Diseases / blood*
  • Deficiency Diseases / etiology
  • Deficiency Diseases / prevention & control
  • Diet*
  • Dietary Supplements
  • Fatty Acids / administration & dosage
  • Fatty Acids / blood
  • Fatty Acids / therapeutic use
  • Feeding Behavior*
  • Food, Fortified
  • Humans
  • Infant
  • Infant Food*
  • Infant Formula
  • Infant Health
  • Infant Nutritional Physiological Phenomena*
  • Micronutrients / administration & dosage
  • Micronutrients / blood*
  • Micronutrients / therapeutic use
  • Nutritional Status*
  • Trace Elements / administration & dosage
  • Trace Elements / blood
  • Trace Elements / therapeutic use
  • Vitamins / administration & dosage
  • Vitamins / blood
  • Vitamins / therapeutic use


  • Fatty Acids
  • Micronutrients
  • Trace Elements
  • Vitamins