title: The timing of complementary feeding in preterm infants and the effect on overweight: study protocol for a systematic review.
abstract: In term infants, there is evidence that early complementary feeding is a risk factor for childhood obesity. Therefore, timely introduction of complementary feeding during infancy is necessary. The World Health Organization (WHO) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) both developed recommendations for the start of complementary feeding for term-born infants. However, these guidelines cannot be directly translated to preterm infants. Recent literature looking at the introduction of complementary feeding in preterm infants gives contrasting information. Given these contrasting reports on the introduction of solid foods in premature born infants, a systematic review is needed. The primary objective of this study is to analyze the effect of the time starting complementary feeding on overweight (including obesity) in preterm infants.
  
  
  
  An electronic systematic literature search with pre-defined terms will be conducted in Cochrane, PubMed, EMBASE, Web of Science, Scopus, and CINAHL. There will be no restriction for time period. Primarily, data from randomized controlled trials (RCTs) will be included in this systematic review. Search terms will include preterm infants, complementary feeding, overweight, and their synonyms. Article selection, including risk of bias assessment, will be performed by three reviewers independently. Body mass index standard deviation score (BMI-SDS or BMI-Z-score) will be used to compare studies. The consistency of results across the studies will influence the decision whether or not to combine results in a meta-analysis. Studies that cannot be included in the meta-analysis will be described in a narrative analysis.
  
  
  
  This systematic review will give an overview of the existing knowledge on the timing of complementary feeding in preterm infants and the effect on overweight. It will form a basis for future guidelines for complementary feeding for preterm infants.
  
  
  
  PROSPERO CRD42015014215.
authors: Department of Pediatrics, Hospital Gelderse Vallei, Ede, The Netherlands.
authors: Karin M
authors: KM
authors: Vissers
authors: Division of Human Nutrition, Agrotechnology and Food Sciences Group, Wageningen University, Wageningen, The Netherlands. Edith.feskens@wur.nl.
authors: Edith J M
authors: EJ
authors: Feskens
authors: Department of Pediatrics, Emma Children's Hospital, Academic Medical Center and VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors: Johannes B
authors: JB
authors: van Goudoever
authors: Department of Pediatrics, Hospital Gelderse Vallei, Ede, The Netherlands.
authors: Arieke J
authors: AJ
authors: Janse
mesh_terms: D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology* / Q000592:standards*; D007234:Infant, Premature / Q000254:growth & development* / Q000502:physiology; D050177:Overweight; D000078202:Systematic Reviews as Topic; D013997:Time Factors; D015430:Weight Gain
keywords: Complementary feeding; Obesity; Overweight; Preterm infants