Rivista di formazione e aggiornamento professionale del pediatra e del medico di base, fondata nel 1982. In collaborazione con l'Associazione Culturale Pediatri.
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Alimentazione complementare nel primo anno di vita

Complementary feeding during the first year of life in Italy

Doriana Lacorte1, Paolo Lionetti2, Cristiana Retetangos1, Roberto Ghio3, Piero Di Saverio4, Patrizia De Gregorio4, Patrizia Alvisi1

1Programma Gastroenterologia Pediatrica, Ospedale Maggiore, Bologna
2Dipartimento NEUROFARBA; Università di Firenze, AOU Meyer, Firenze
3Pediatria di famiglia, Castelfiorentino (Firenze)
4Pediatria di famiglia, Teramo

Marzo 2018 - pagg. 172 -177

Abstract
Background - Complementary feeding (CF) is a delicate phase in children’s growth. The lack of evidence-based clinical recommendation on CF creates confusion and leads to important differences of behaviour both among primary care paediatricians and families.
Aim - This article reports two simple surveys carried out all over Italy that involved a sample of primary care paediatricians and one of families respectively, with the intention of describing the habits related to CF.
Methods - A 4-question questionnaire on timing and weaning methods, the use of industrial processed food and the use of a written scheme was sent to a group of 538 primary care paediatricians. A second 5-question questionnaire on the type of nursing, the timing and type of food used to complement milk (breastmilk or formula), the use or not of industrial processed food and the importance of paediatric indications was distributed to 1,435 families.
Results - Responses were received from 538 paediatricians and 1,199 families. Almost 90% of mothers in Italy start to breastfeed their babies, but this percentage is drastically reduced (almost by 50%) to six months of age. The fifth and the sixth month of infant life are the privileged months to start complementary feeding. This age is recommended by 91% of paediatricians and 73.7% of the parents follow this advice. The classic Italian baby food (rice or corn and tapioca flour with vegetable broth, parmesan, extra virgin olive oil and meat) is still very used and is recommended by 62.4% of paediatricians and used by 84.8% of households. Baby led weaning (BLW) has a rather marginal role as just 7.6% of the paediatricians indicate it and 8.3% of the families practice it, while 30% of the paediatricians propose a classic weaning with adult meal tastes. Industrial food is widely used, indeed 64.5% of paediatricians recommend it and 79.7% of households use it at least partially. More than 99% of households follow the paediatrician's instructions concerning weaning and 93.3% of the paediatricians give a written scheme to the parents.
Conclusions - Primary care paediatricians have a central role in managing the weaning time for Italian families. The use of Italian classic baby food is widespread, while BLW has a marginal role. Paediatricians rely on written schemes in most cases. It would be desirable that such schemes should not replace a training interview with parents that should provide families with few but clear indications based on scientific evidence.
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Bibliografia
Early Nutrition Programming Project. The early nutrition programming project (EARNEST): 5 y of successfull multidisciplinary collaborative research. Am J Clin Nutr 2011;94(6 Suppl):1749S-1753S. 2. Piermarini L. Io mi svezzo da solo! Dialoghi sullo svezzamento. Bonomi, 2009. 3. Schiess S, Grote V, Scaglioni S, et al.; European Childhood Obesity Project. Introduction of complementary feeding in 5 European countries. J Pediatr Gastroenterol Nutr 2010; 50(1):92-8. 4. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017;64(1):119-132. 5. EFSA. Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal 2009;7(12):1423-61. 6. ISTAT. Gravidanza, parto, allattamento al seno. Anno 2013. ISTAT 9 dicembre 2014. www. istat. it/it/archivio/141431. 7. Ardau S, Grandolfo M. Allattamento al seno: prevalenza e fattori ostacolanti. Indagine di un osservatorio consultoriale di Cagliari. Medico e Bambino pagine elettroniche 2009;12(7). 8. Alvisi P, Brusa S, Alboresi S, et al. Recommandation on complementary feeding in healthy fullterm infants. Ital J Pediatr 2015; 41:36. 9. Manno CJ, Fox C, Eicher PS, Kerwin MLE. Early oral motor interventions for pediatric feeding problems: what, when and how. JEIBI 2005;2(3):145-59. 10. Ministero della Salute. Corretta alimentazione ed educazione nutrizionale della prima infanzia F.A.Q. http://www.salute.gov.it/ imgs/C_17_pubblicazioni_2520_allegato.pdf. 11. Caffarelli C, Di Mauro D, Mastrorilli C, Cipriani F, Ricci G. Nuove indicazioni allergologiche per l’alimentazione complementare. Quaderni acp 2017;24(4):169-73. 12. Muraro A, Halken S, Arshad SH, et al.; EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy. Allergy 2014;69(5):590-61. 13. Perkin MR, Kirsty L, Tseng A, et al.; EAT Study Team. Randomized trial of introduction of allergenic foods in breast-fed infants. New Engl J Med 2016 374(18):1733-43. 14. Prescott SL, Smith P, Tang M, et al. The importance of early complementary feeding in the development of oral tolerance: concerns and controversies. Pediatr Allergy Immunol 2008;19(5):375-80. 15. Oddy WH. Breastfeeding, childhood asthma, and allergic disease. Ann Nutr Metab 2017;70 Suppl 2:26-36. 16. Mermiri DT, Lappa T, Papadopoulou AL. Review suggests that the immunoregulatory and anti-inflammatory properties of allergenic foods can provoke oral tolerance if introduced early to infants’ diets. Acta Paediatr 2017;106 (5):721-6. 17. Vriezinga SL, Auricchio R, Bravi E, et al. Randomized feeding intervention in infants at high risk for celiac disease. N Engl J Med 2014;371(14):1304-15. 18. Lionetti E, Castellaneta S, Francavilla R, et al.; SIGENP (Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition) Working Group on Weaning and CD Risk. Introduction of gluten, HLA status, and the risck of celiac disease in children. N Engl J Med 2014;371(14):1295-303. 19. Szajewska H1, Shamir R, Chmielewska A, et al.; PREVENTCD Study Group. Systematic review with meta-analysis: early infant feeding and coeliac disease-update 2015. Aliment Pharmacol Ther 2015;41(11):1038-54. 20. Agostoni C1, Decsi T, Fewtrell M, et al.; ESPGHAN Committee on Nutrition. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008;46(1):99-110. 21. Du Toit G, Roberts G, Sayre PH, et al.; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372(9):803-13. 22. Perkin MR, Logan K, Marrs T, et al.; EAT Study Team. Enquiring About Tolerance (EAT) study: feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol 2016;137(5):1477-1486.e8. 23. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017;64(1):119-32. 24. Garcia AL, McLean K, Wright CM. Types of fruits and vegetables used in commercial baby foods and their contribution to sugar content. Matern Child Nutr 2016;12(4):838-47. 25. García AL, Raza S, Parrett A, Wright CM. Nutritional content of infant commercial weaning foods in the UK. Arch Dis Child 2013;98 (10):793-7. 26. Associazione Culturale Pediatri (ACP). Cibi industriali meglio di quelli naturali? Vietato disinformare. 28 nov. 2016. http://www.acp. it/2016/11/cibi-industriali-meglio-di-quelli-naturali- vietato-disinformare-10071.html. 27. Piermarini L. Autosvezzamento. Medico e Bambino 2002;21(7):268-70. 28. Townsend E, Pitchford NJ. Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample. BMJ Open 2012;2(1):e000298. 29. Cameron SL, Heath AL, Taylor RW. How feasible is baby-led weaning as an approach to infant feeding? A review of the evidence. Nutrients 2012;4(11):1575-609. 30. Campanozzi A, Avallone S, Barbato A, et al. MINISAL-GIRCSI Program Study Group. High sodium and low potassium intake among Italian children: relationship with age, body mass and blood pressure. PLoS One 2015;10(4):e0121183. 31.Cameron SL, Taylor RW, Heath AL. Parent- led or baby-led? Associations between complementary feeding practices and healthrelated behaviours in a survey of New Zealand families. BMJ Open 2013;3(12):e003946.

Corrispondenza: patrizia.alvisi@ausl.bologna.it