Read on to learn about some key brain nutrients and what foods you can find these nutrients in. Decades-long research highlights a set of macronutrients and micronutrients that are specifically important for brain development and function.

Amino acids from protein are needed by the brain to synthesise neurotransmitters. Another essential macronutrient is polyunsaturated fatty acids PUFA such as omega 3. This group of macronutrients is involved in creating and migrating neurons in a developing brain.

A growing brain also needs certain micronutrients. Iron is involved in the activity of proteins and enzymes needed for brain growth. It is also required for the development of hormone systems in early life.

Zinc, iodine, and vitamin B12 are crucial in the formation and transport of neurons, as well as the development of specialised structures and areas of the brain. Copper, choline, and folate are also involved in a host of important structural and neurotransmitter development in the brain.

Oily fish such as mackerel and sardines are great sources of omega-3 fatty acids. Seafood is good for the brain as it contains other essential nutrients like zinc, iodine, iron, magnesium, potassium, vitamin D, vitamin B2, and protein. The benefits of omega-3 consumed in the first 12 months of life are critical to cognitive development later in childhood.

Eggs are a great source of choline and vitamin B It is also another excellent protein source. Research has shown that choline, like copper and zinc, is important for cognitive development in the womb and during early infancy.

Not only are they another source of protein, but lean meats can also help ensure your little one gets enough iron in their diet. It showed children who received sufficient levels of these macronutrients before age two scored higher on reading, numeracy, reading, and vocabulary.

Your family may be vegetarian. If so, beans are a great meat substitute for your growing child. In addition to being high in protein, beans are excellent sources of choline, folate, iron, zinc, and vitamins B1, B6, E and K.

Did you know that certain types of beans like kidney and soybeans are also great sources of omega-3 fatty acids? This one goes without saying, though it is worth repeating. Leafy green vegetables like kale and spinach are a powerhouse of crucial vitamins and minerals, such as iron and folate.

Chlorophyta or green algae lu zao, 绿藻 and leafy greens spinach, arugula, and watercress contain chlorophyll, the phytochemicals responsible for their bright green hue. Chlorophyll can maintain liver health, rejuvenate blood, and improve anaemia symptoms. Try to incorporate these early on to develop a vegetable-loving palate in your child.

Ensuring your child gets enough iron early is critical to their brain development. Research confirms that catch-up iron supplementation can be too late, so getting adequate iron through diet is crucial.

Mea nwhile, phytonutrients like anthocyanins in berries help improve connections between neurons and prevent cell damage. If you are still having trouble getting enough protein on the plate, protein-rich drinks can be one solution.

With 10 grams of protein per serving and added nutrients like vitamin D, calcium, fiber and potassium, it's an easy way to help fill gaps in your child's diet.

Kids can learn to balance nutrients at meals with the USDA's MyPlate , but parents can also teach them to follow these same principles at snack time. Meeting daily protein intake goals is an essential part of child growth and development. When kids get the nutrition they need, they're in the best position to begin long, healthy lives.

References: 1. Data on File, April Abbott Nutrition. NHANES data analysis. National Academies of Science's RDA for protein ranges from g daily in children. Generating Targetable Strategies for Improving Malnutrition Status among Year Olds.

Archdeacon AL, et al. Presented at Pediatric Academic Societies Meeting, Toronto, Canada. Nutrition Education for Kids: 3 Ways to Encourage Nutritious, Sustainable Eating Habits.

Earth Month takes place every April, making this a great time to focus on your children's nutrition education as it relates to sustainability. While nutrition education for kids is important year-round, Earth Month presents the perfect opportunity to talk with them about how their food choices impact both their bodies and the planet.

Every year, nearly 3 million kids in the U. lace up their cleats to play soccer. If your child is one of them, you probably already know soccer is a physically demanding game.

That's why sports nutrition for kids is so important. All Rights Reserved. Please read the Legal Notice for further details.. Terms and conditions apply. Unless otherwise specified, all product and services names appearing in this Internet site are trademarks owned by or licensed to Abbott, its subsidiaries or affiliates.

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If you continue to opt-out of these cookies, some content on our site may not be viewable. We use functional cookies to analyze your use of the site, improve performance and provide a better customer experience. Those between ages 9 and 13 need 34 grams.

Fats are macronutrients that allow our bodies to store energy to insulate and protect our organs. Fats are also integral to produce certain hormones, support proper brain development, and absorb fat-soluble vitamins and aid the cells in our bodies.

Fat is commonly demonized, as fat has developed a notorious reputation for causing weight gain. However, that is not the case. Fats, like protein, are providing long-acting energy. Trans fats are the worst type of fats. These are made from partially hydrogenated oils and are often found in margarine, shortening, and baked goods.

Trans fats have been shown to cause a variety of negative health consequences, so they should be limited or avoided altogether. In , the USDA banned trans fats from food products in the United States, giving food manufacturers until to completely remove them from their foods. Very few products still contain trans fats, however there are some foods that contain trans fat in small amounts.

Saturated fats can provide cholesterol that help produce hormones. However, our bodies can produce their own cholesterol without the presence of this fat. They are referred to as healthy fats because they help prevent heart diseases and other health conditions.

Moreover, they regulate your metabolism, promote cell growth and regeneration as well as maintain the elasticity of your cell membrane. Every child's specific nutrition needs are different.

Age, gender, activity level, and the presence of certain health conditions determine nutrition requirements. However, all children need a balance of carbs, fat, and protein in their diet to promote health and proper growth and development.

She graduated from University of Arizona with a BA in psychology and then received a BS in dietetics from Arizona State University. After completion of the dietetic internship, she continued her education by receiving a MS in Human Nutrition from University of Western States.

Having a passion for nutrition communication, she has been featured in InStyle, Bustle, Livestrong, The List, MyFitnessPal and many others. Kristen was selected to act as a Produce for Better Health Foundation Fruit and Vegetable Ambassador in Action, helping to promote the health benefits and importance of consuming fruits and vegetables.

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For example, even if a child stubbornly resists eating vegetables, parents should continue to provide them.

Before long, the child may change their mind, and develop a taste for foods once abhorred. It is important to remember this is the time to establish or reinforce healthy habits.

Nutritionist Ellyn Satter states that feeding is a responsibility that is split between parent and child. According to Satter, parents are responsible for what their infants eat, while infants are responsible for how much they eat.

In the toddler years and beyond, parents are responsible for what children eat, when they eat, and where they eat, while children are responsible for how much food they eat and whether they eat.

Satter states that the role of a parent or a caregiver in feeding includes the following:. Children at this stage are often picky about what they want to eat.

They may turn their heads away after eating just a few bites. Or, they may resist coming to the table at mealtimes.

They also can be unpredictable about what they want to consume for specific meals or at particular times of the day. Although it may seem as if toddlers should increase their food intake to match their level of activity, there is a good reason for picky eating.

Another potential problem during the early childhood years is toddler obesity. According to the US Department of Health and Human Services, in the past thirty years, obesity rates have more than doubled for all children, including infants and toddlers. Some minority group children, such as Filipinos, Native Hawaiians, and Other Pacific Islanders, in Hawaii have higher rates of overweight and obesity.

In , Obesity during early childhood tends to linger as a child matures and cause health problems later in life. There are a number of reasons for this growing problem.

One is a lack of time. Parents and other caregivers who are constantly on the go may find it difficult to fit home-cooked meals into a busy schedule and may turn to fast food and other conveniences that are quick and easy, but not nutritionally sound.

Another contributing factor is a lack of access to fresh fruits and vegetables. This is a problem particularly in low-income neighborhoods where local stores and markets may not stock fresh produce or may have limited options. Physical inactivity is also a factor, as toddlers who live a sedentary lifestyle are more likely to be overweight or obese.

Another contributor is a lack of breastfeeding support. Children who were breastfed as infants show lower rates of obesity than children who were bottle-fed. Early childhood caries remains a potential problem during the toddler years. The risk of early childhood caries continues as children begin to consume more foods with a high sugar content.

According to the National Health and Nutrition Examination Survey, children between ages of two and five consume about calories of added sugar per day.

Parents also need to instruct a child on brushing their teeth at this time to help a toddler develop healthy habits and avoid tooth decay. An infant who switches to solid foods, but does not eat enough iron-rich foods, can develop iron-deficiency anemia.

This condition occurs when an iron-deprived body cannot produce enough hemoglobin, a protein in red blood cells that transports oxygen throughout the body.

The inadequate supply of hemoglobin for new blood cells results in anemia. Iron-deficiency anemia causes a number of problems including weakness, pale skin, shortness of breath, and irritability. It can also result in intellectual, behavioral, or motor problems.

In infants and toddlers, iron-deficiency anemia can occur as young children are weaned from iron-rich foods, such as breast milk and iron-fortified formula. They begin to eat solid foods that may not provide enough of this nutrient. As a result, their iron stores become diminished at a time when this nutrient is critical for brain growth and development.

Although milk is critical for the bone-building calcium that it provides, intake should not exceed the RDA to avoid displacing foods rich with iron.

By using this site, you consent to the use of cookies being set. Find out more. Available on:. All Sleep Feeding Development Health News Pregnancy.

Updated Dec 11, Written By Dana Peters Pediatric Registered Dietitian. Medically reviewed by Alan Salem, M. IN THIS ARTICLE: What are macronutrients? How the narrative has changed over time Carbohydrates Protein Fats Macronutrients FAQ What are macronutrients?

The main functions are: Carbohydrates Carbohydrates, or carbs for short, are our bodies' primary source of energy. Protein Protein builds and repairs muscle and other body tissues play an important role in immune function as well as help transport molecules throughout the body.

Get creative with fruits and veggies At times, it can feel like a struggle to get kids to enjoy fruits and veggies.

Choose whole grains When possible, choose whole grain products to up your kiddos intake of fiber. Serve dairy or dairy alternatives Although sometimes thought of as protein foods, dairy products, such as milk and yogurt contribute carbohydrates to the diet.

Protein Protein is often thought of as the muscle-building nutrient - and while it does support healthy muscle growth - protein does so much more! Try beans and lentils Pulses, the food group made up of beans and lentils, are high-protein and fiber-filled.

Cook with plant oils Cook vegetables with olive oil or another plant oil to increase unsaturated fat consumption. Snack on nuts and seeds As age-appropriate, add nuts and seeds to snacks. Macronutrients FAQ Q: What is the most important macronutrient for children? A: There is no single most important macronutrient for children.

Q: What are micronutrients for kids? A: Micronutrients are nutrients needed in smaller amounts as well as found in smaller amounts in food. Q: Which macronutrient do children need more of than adults? A: Children typically require more fat in their diets than adults.

Q: What happens if a child has too little carbohydrates? A: A child who has too few carbohydrates may experience low energy as well as trouble concentrating at school or in other activities. Q: How much protein does a child need per day?

A: The amount of protein a child needs per day depends on their age and weight. Q: What is a balanced meal for a child? A: A balanced meal for a child should include food from a variety of food groups and ideally, contain all of the macronutrients as well as fiber. Share article:.

Related Articles. Feeding When should my kid be sitting at the dinner table? Feeding Is my child a picky eater? Feeding 9 common food allergies in babies: When to introduce high-allergy foods? Subscribe for exclusive discounts, latest product info, and the best parenting hacks: Subscribe Now.

Our Story. Contact Us. Huckleberry App. Sleep training complete guide. Resources Sleep. a Fat mass kg ; b Lean mass kg. There were no significant differences between supplemented and unsupplemented groups in triceps skin fold thickness in toddlers 6 trials [ 37 , 44 , 61 , 70 ]; 1, toddlers; MD [mm] 0.

In studies that measured bone mineral content BMC , toddlers in the supplemented group had higher BMC than those in the unsupplemented group 13 trials [ 24 , 41 , 43 , 46 , 47 , 49 , 51 , 53 , 55 , 58 , 60 , 62 , 64 ]; toddlers; SMD 0.

There were no significant differences between groups in BMC in childhood 1 trial [ 46 ]; 51 children; SMD 0. In studies that measured bone mineral density BMD , the pattern was similar.

Toddlers in the supplemented group had higher BMD than toddlers in the unsupplemented group 5 trials [ 24 , 41 , 55 , 62 , 64 ]; children; SMD 0. There were no significant differences between supplemented and unsupplemented groups in BMD in childhood 1 trial [ 46 ]; 51 children; SMD 0.

There was no significant sex interaction for the effect of supplementation on BMI in childhood [ 67 ]. However, in toddlers, supplemented boys had greater length or height than unsupplemented boys 2 trials, boys; MD [cm] 1.

There were no significant sex interactions for weight or head circumference in toddlers Table 1. In children born SGA, there were no significant differences between supplemented and unsupplemented groups in BMI in childhood [ 32 ], weight in toddlers [ 31 — 33 , 65 ], length or height in toddlers [ 31 — 33 , 65 ], head circumference in toddlers [ 31 — 33 , 65 ], or height in childhood [ 32 ] Table 1.

There were no significant differences between supplemented and unsupplemented groups in the different timing subgroups for BMI in childhood, head circumference in toddlers, lean mass in childhood, or height in childhood and no evidence of an interaction between timing and effects of supplements.

Toddlers who had received supplements after hospital discharge, but not if they received supplements both in hospital and postdischarge or only in hospital, were heavier and longer than those who had not received supplements weight: 17 trials [ 24 , 31 , 33 , 46 , 50 — 53 , 57 — 62 , 64 — 66 ], 1, toddlers; MD [kg] 0.

However, supplemented toddlers had greater weight 22 trials [ 24 , 31 — 33 , 44 , 46 , 50 — 53 , 55 , 57 — 62 , 64 — 66 , 69 ], 1, toddlers; MD [kg] 0. In toddlers, there were no significant differences between groups in weight [ 36 — 38 , 40 , 43 ], length or height [ 36 — 38 , 40 , 43 ], and head circumference [ 36 — 38 , 40 , 43 ].

In the different trial timing subgroups, there were no significant differences between supplemented and unsupplemented groups in BMI in childhood. In trials conducted before or in , toddlers in the supplemented group had greater weight 16 trials [ 24 , 31 , 32 , 37 , 38 , 43 , 44 , 50 — 52 , 60 , 61 , 66 , 69 ], 1, toddlers; MD [kg] 0.

However, there were no significant differences between supplemented and unsupplemented groups in weight [ 33 , 36 , 39 , 40 , 42 , 46 , 53 , 55 , 57 — 59 , 62 , 64 , 65 , 71 ], length or height [ 33 , 36 , 39 , 40 , 42 , 46 , 53 , 55 , 57 — 59 , 62 , 64 , 65 , 71 ], and head circumference [ 33 , 36 , 39 , 40 , 42 , 46 , 53 , 55 , 57 — 59 , 62 , 64 , 65 , 71 ] in toddlers in the trials conducted after Table 1.

In the subgroup of SGA infants, supplemented infants had greater length mean Data were presented in figures, and no standard deviations were reported.

There were no differences in growth parameters weight, length, and head circumference between groups. Data were not presented, and the numbers of infants in each group were not reported.

There were no significant differences in weight, length, head circumference, and skin fold thickness between groups. Data were presented as percent of the expected values. There were no differences in growth rates between groups from 1 to 2 months after birth.

The absolute growth data were presented in figures, and no standard deviations were reported. There were no differences in growth rates between groups, but measurements were not presented. There were no significant differences in growth rate between groups, but measurements were not presented.

The quality of the evidence was assessed as low or very low for all the GRADE outcomes Table 2. In our systematic review and meta-analysis of 40 RCTs and 2 quasi-RCTs involving 4, infants born preterm or SGA, we found no evidence that early macronutrient supplements led to significant differences in BMI in childhood.

However, consistent with our hypothesis, we found that early macronutrient supplements may increase weight and length in toddlers, although the effect is inconsistent and unlikely to be clinically significant, and also increase bone mineralisation. Macronutrient supplements did not increase head circumference, and none of these effects persisted into later life.

We also found that early supplements may increase fat mass in childhood, but not in adolescence. Previous literature has suggested the possible early nutritional origins of obesity. An observational study indicated that faster weight gain in early life is associated with higher fat mass in later life [ 72 ].

Another retrospective study also demonstrated that higher average protein intake during initial hospitalisation was associated with increased fat mass at 9. We chose BMI as the primary outcome for this analysis, on the assumption that this would be the most widely available measure of adiposity and is predictive of later cardiometabolic risk.

Our data show that early supplements had no effect on BMI or lean mass in childhood and BMI in adolescence and no effect on skin fold thickness in toddlers or childhood.

Therefore, our findings from randomised trials challenge the previous observational reports that early supplements lead to faster early growth and also increased later adiposity. In toddlers, the supplemented group had greater weight and length or height but similar head circumference when compared to those in the unsupplemented nutrition group.

However, in the sensitivity analyses including only trials at low risk of bias, there were no differences between groups in weight, length or height, and head circumference in toddlers.

Several factors may contribute to these apparent discrepancies between findings using absolute values and those using z-scores. Firstly, the analyses of absolute values and z-scores included different trials.

For instance, only 8 trials reported both absolute values and z-scores for weight in toddlers, and the differences between groups were in the same direction for both outcomes in all of these trials. Four trials only reported weight z-scores, and 22 trials only reported absolute values.

Secondly, in 4 of 12 trials reporting z-scores, infants in the unsupplemented groups were larger than those in the supplemented nutrition groups at followup. In 3 of these trials [ 34 , 57 , 58 ], infants in the unsupplemented group had greater gestational age at study entry, and in 1 trial [ 42 ], infants in the unsupplemented group who were followed up were of greater gestational age and birth weight because of loss of followup.

Further, heterogeneity was high for both sets of analyses. The wide range of ages from 3 months to 24 months may contribute to heterogeneity in the analyses of absolute growth values, whereas z-scores are age- and sex-specific, which would be expected to result in narrower CIs.

However, only a few studies reported z-scores. We would recommend reporting both absolute and z-score values in future studies.

Moreover, a much larger number of trials and participants have been included in the quantitative analysis of absolute growth measurements than those of z-scores.

Statistical significance is heavily dependent on the sample size, so when the sample size is large, even small treatment effects can appear statistically significant [ 74 ]. We conclude that, given the lack of effect of supplementation on growth measurements in the subgroup of low-risk studies or in those reporting z-scores, the small apparent effect of macronutrient supplementation on absolute weight MD 0.

Our data also suggest that toddlers in the supplemented group had greater bone mineralisation than infants in the unsupplemented group. Deficits in mineralisation during this period could increase risk of childhood fracture and cause reduced peak bone mass [ 75 , 76 ], which may result in higher risk of osteoporosis in later life [ 77 ].

Thus, providing adequate nutritional support to achieve adequate bone accretion in early life may be of initial clinical benefit for infants born small. However, limited evidence from this systematic review suggests that early macronutrient supplementation does not affect long-term bone mineralisation.

In order to further explore sources of heterogeneity in key outcomes, we undertook a number of prespecified subgroup analyses. We specifically hypothesised that the effects of supplements may be different in girls and boys.

We found that supplementation increased length or height in toddler boys, but not girls, suggesting that the effects of nutrient supplements may be sex-specific, although there were no data to show whether these differences persisted in later life.

Animal studies have shown some evidence of sex differences in these effects, with preterm male lambs who received early supplemented nutrition having greater early weight gain and increased ponderal index in adulthood, effects that were not seen in females [ 78 ].

Male, but not female, preterm piglets receiving a high-protein diet also had higher growth rates than those receiving an adequate protein diet after weaning [ 79 ]. We anticipated that the effect of supplementation on growth may also depend in part upon the primary feed being supplemented formula versus breastmilk versus parenteral nutrition.

Intriguingly, supplements appeared to increase early growth in weight, length, and head circumference only if the primary feed was formula, but not if the primary feed was breastmilk, whereas supplements provided as both parenteral and enteral feeds decreased toddler weight and head circumference.

A previous systematic review also reported that feeding preterm infants with formula is associated with faster in-hospital rates of growth [ 80 ]. Our review shows that the effect of nutrient-enriched formula on growth may persist after hospital discharge but not last through childhood and adolescence.

However, the reason for the lack of effect of supplements on early growth if breastmilk was the primary feed is not clear and raises the interesting possibility that the previously reported protective effect of breastmilk for later obesity [ 81 , 82 ] may also apply to early growth acceleration.

However, this conflicts with our findings that supplemented breast milk decreased BMI but increased fat mass in childhood.

Another possible explanation may be that infants whose primary feed was breastmilk, which is generally of lower calorie and protein content than formula, received less total nutrition or less additional nutrition in the supplemented group.

However, our estimates showed that infants in the supplemented group who received breastmilk as their primary feed had similar energy intakes as those whose primary feed was formula, making this explanation unlikely S3 Table.

In subgroup analysis, it appeared that providing both parenteral and enteral supplements had an adverse effect on early growth.

However, in one trial, infants in the unsupplemented group who were followed up were of greater gestational age and birthweight than those in the supplemented group, and after exclusion of this trial, there was no effect of parenteral and enteral supplements on early growth.

Therefore, we are unable to draw any conclusions about the effect of combination parenteral and enteral feed. We found that toddler weight, length, and head circumference increased in supplemented infants if they received postdischarge nutrition, but these effects were not seen in the other 2 timing groups, although this interaction term was not significant.

It is possible that introducing supplements before discharge has little effect on later size because illness and factors other than nutrient intake limit growth at this time, as opposed to after discharge, when infants are in the phase of catch-up growth.

It is also possible that the effects of supplementation were only transient in both groups but that growth outcomes after discharge were measured some time after the supplementation for infants who received in-hospital supplements but much closer to the time of supplementation for infants who received postdischarge supplements.

In order to explore other sources of heterogeneity, we carried out subgroup analyses according to the study date. We found that supplements increased growth in toddlers in studies conducted before and during , but not in studies conducted after , although the interaction term was not significant.

Possible reasons for these differences may be the wide variations in estimating the values of macronutrient composition of preterm human milk and different neonatal intensive care units and commercial companies using different values to modify the composition of formula and fortifier over time [ 83 , 84 ].

We expected that differences in baseline unsupplemented intakes over time may contribute to differences in the overall effects of macronutrient supplements, with later studies potentially reporting higher macronutrient intakes in the unsupplemented groups and hence smaller effects of additional supplements compared to earlier studies.

However, our analyses indicated that there were no differences in mean baseline intakes or in MDs between supplemented and unsupplemented nutrition groups between the 2 epochs S4 Table. In the subgroup of infants born SGA, there were no differences in BMI and height in childhood or in weight, length, and head circumference as toddlers between supplemented and unsupplemented groups, but there was substantial heterogeneity in these analyses.

Of the trials reporting growth in toddlers born SGA, 3 studied term SGA infants [ 31 — 33 ] and reported greater weight, length, and head circumference in the supplemented groups, whereas 1 trial studied preterm SGA infants [ 65 ] and reported no difference in these outcomes between supplemented and unsupplemented groups.

Term and preterm SGA infants may respond differently to early supplements, and further studies are needed to explore the interactions between gestational age and macronutrient supplements in SGA infants.

Previously published systematic reviews [ 17 , 25 , 26 ] of the effects of macronutrient supplements for preterm infants only reported growth outcomes up to 18 months of age. Our review included all eligible trials regardless of type and timing of intervention, and thus, more trials have been included, allowing analysis of some long-term outcomes.

This study had some limitations. There were many fundamental differences between studies, including different sizes and gestational ages of infants at birth and different types and timings of interventions, which could not be explained by our subgroup analyses and are likely to have contributed to the substantial heterogeneity we observed for most outcomes.

For this reason, we used random-effect models for all analyses, which allows for differing true effects across studies [ 85 ]. In addition, multiple outcomes, multiple time points, and a large number of subgroups were analysed in the current review, which may increase the risk of type 1 error [ 86 ].

Despite the large numbers of trials and infants included, the evidence is also limited by the low methodological quality, substantial heterogeneity, and limited data beyond early childhood, making strong conclusions difficult.

The quality was low for most of the included trials, largely because of unclear methodology used for random allocation and unclear role of commercial sponsors.

Few studies of nutrition in preterm infants have reported outcomes separately for boys and girls. An individual participant data IPD meta-analysis allows more in-depth exploration and more detailed analyses [ 87 ]. A planned IPD meta-analysis [ 88 ] PROSPERO CRD may prove helpful in further exploring possible sex differences in the effects of macronutrient supplements in infants born small.

Further, because of the lack of long-term outcomes, as well as new trials, further followup of existing trials would provide additional critical evidence about the long-term effects of macronutrients on growth of preterm and SGA infants.

Our study suggests that early macronutrient supplements given to infants born small does not alter BMI in childhood. Supplementation may increase weight and length, but not head circumference, in toddlers, but these effects are unlikely to be clinically significant and do not persist in later life.

Bone mineralisation is also increased, but only in toddlers. Our analysis does not support concerns from observational studies that early supplement may increase fat mass in later life.

However, despite 41 trials with 4, infants included, there is still little evidence of the effects of early macronutrient supplements on later growth and body composition. AA, amino acid; AGA, appropriate for gestational age; BMC, bone mineral content; BMD, bone mineral density; BMI, body mass index; BPD, bronchopulmonary dysplasia; BW, birthweight; CA, corrected age; GA, gestational age; HC, head circumference; PMA, postmenstrual age; SGA, small for gestational age.

Forest plots of effect of macronutrient supplementation on growth outcomes including trials with low risk of bias. a Weight in toddlers kg , b length or height in toddlers cm , c head circumference in toddlers cm. Funnel plot of supplemented versus unsupplemented nutrition for the growth outcomes.

a Weight in toddlers, b length or height in toddlers, c head circumference in toddlers. The middle dashed line indicates the overall MD. CI, confidence interval; MD, mean difference. a Triceps skin fold thickness mm , b subscapular skin fold thickness mm. a BMC, b BMD.

BMC, bone mineral content; BMD, bone mineral density. We would like to acknowledge Dr. Julie Brown for help with developing the search strategies and study selection. Article Authors Metrics Comments Media Coverage Reader Comments Figures. Abstract Background Nutritional supplements may improve short-term growth of infants born small preterm or small for gestational age , but there are few data on long-term effects and concerns that body composition may be adversely affected.

Methods and findings We searched OvidMedline, Embase, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews from inception to January 30, , and controlled-trials. Conclusions In this systematic review and meta-analysis, we found no evidence that early macronutrient supplementation for infants born small altered BMI in childhood.

Author summary Why was this study done? Preterm and small-for-gestational-age infants are at increased risk of poor growth. There are few data on long-term effects, and it is possible that they may be different in girls and boys.

What did the researchers do and find? We undertook a systematic review and meta-analysis of 40 randomised clinical trials and 2 quasirandomised trial of nutritional supplements involving 4, infants born preterm or small for gestational age.

We found that early supplements given to infants born small did not alter BMI in childhood but may slightly increase weight and length in toddlers and fat mass in childhood. None of the effects persisted after early childhood, although data are limited and quality of evidence is low.

What do these findings mean? The available evidence suggests that early nutritional supplements for infants born preterm or small do not alter BMI in childhood but also have little effect on growth. Despite large numbers of trials involving thousands of infants, there is still limited evidence about the benefits and risks of early nutritional supplements after early childhood.

Introduction Infants born preterm or small for gestational age SGA are at increased risk of poor growth, delayed development, and disability [ 1 — 4 ]. Methods This study is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guideline S1 Checklist and registered prospectively in PROSPERO registration number CRD S1 Protocol.

Ethics approval was not required for this analysis of published data. Search strategy and selection criteria We searched OvidMedline, Embase, Cochrane Library Central Registry of Controlled Trials, and Cochrane Database of Systematic Reviews from inception to January 30, The primary outcome was body mass index BMI in childhood.

Data collection and analysis Two reviewers LL and EA independently screened titles and abstracts of all records identified, assessed potentially eligible full-text articles for inclusion, extracted data into a template data extraction form, and assessed the risk of bias for included studies using Cochrane criteria [ 27 ].

Statistical analysis We undertook meta-analyses using RevMan 5. Results After deduplication, 8, records were identified. Download: PPT. Fig 2. Secondary outcomes BMI. Fig 3. Forest plot of effect of macronutrient supplementation on weight kg in toddlers, childhood, and adolescence.

Length or height. Fig 4. Forest plot of effect of macronutrient supplementation on length or height cm in toddlers, childhood, and adolescence.

Head circumference. Fig 5. Forest plot of effect of macronutrient supplementation on head circumference cm in toddlers and childhood. Fat mass and lean mass. Fig 6. Forest plot of effect of macronutrient supplementation on fat mass and lean mass.

Skin fold thickness. Bone development. There were no data for the other secondary outcomes. Subgroup analyses Sex of infants. SGA infants. Timing of supplements. Primary feed. Trial timing.

Quality of evidence GRADE The quality of the evidence was assessed as low or very low for all the GRADE outcomes Table 2. Discussion In our systematic review and meta-analysis of 40 RCTs and 2 quasi-RCTs involving 4, infants born preterm or SGA, we found no evidence that early macronutrient supplements led to significant differences in BMI in childhood.

Supporting information. S1 Appendix. List of planned subgroup analysis. s DOCX. S2 Appendix. List of all references of included studies. S1 Table.