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Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial
  1. Lisa Daniels1,2,
  2. Rachael W Taylor2,
  3. Sheila M Williams3,
  4. Rosalind S Gibson1,
  5. Elizabeth A Fleming1,2,
  6. Benjamin J Wheeler4,
  7. Barry J Taylor4,
  8. Jillian J Haszard1,
  9. Anne-Louise M Heath1
  1. 1 Department of Human Nutrition, University of Otago, Dunedin, Otago, New Zealand
  2. 2 Department of Medicine, University of Otago, Dunedin, New Zealand
  3. 3 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  4. 4 Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Anne-Louise M Heath; anne-louise.heath{at}


Objective To determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.

Design, participants and intervention This randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and ‘Well Child’ care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.

Outcome measures Intake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.

Results Differences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI −1.0 to 2.3) or 12 (−0.1 mg/day; −1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference −2.6 µg/L; 95% CI −10.9 to 5.8), body iron (0.04 mg/kg; −1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.

Conclusions A baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer ‘high-iron’ foods with each meal.

Trial registration number ACTRN12612001133820; Pre-results.

  • baby-led weaning
  • complementary feeding
  • dietary iron
  • iron status
  • iron deficiency
  • body iron
  • infants
  • toddlers

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  • Contributors A-LMH and RWT conceived and designed the research. LD contributed to the design of the iron-related components of the research, collected data, and prepared the first full and subsequent drafts of this manuscript. SMW and JJH advised on study design and performed statistical analyses. RSG, EAF, BJW and BJT provided expert input into the design of the study and ongoing advice and support. All authors made an important intellectual contribution to this manuscript, and approved the final manuscript as submitted.

  • Funding This work was supported by Meat & Livestock Australia, Lottery Health Research, Karitane Products Society, Perpetual Trustees, the University of Otago and the New Zealand Federation of Women’s Institutes. Heinz Wattie’s Limited provided baby rice cereal for participants in the intervention group. Part of RWT’s salary is from a Karitane Products Society (KPS) Fellowship that is paid via the University of Otago. LD was supported by a University of Otago Doctoral Scholarship, and a University of Otago Postgraduate Publishing Bursary.

  • Disclaimer The funders provided funds only and played no role in the study design, development of the study aims, carrying out the study or the analysis or interpretation of the results.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Lower South Regional Ethics Committee (LRS/11/09/037), New Zealand.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.