Guideline / position statementindependent cross-checkabstract checked★ key study I-VEG-111 in-depth review
European paediatricians: offer green vegetables to infants
Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition.
Overview
Fewtrell M et al.. J Pediatr Gastroenterol Nutr 2017 · PMID 28027215 · DOI 10.1097/MPG.0000000000001454
ESPGHAN advises starting solids between 4 and 6 months and offering varied foods including bitter green vegetables.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Give complementary-feeding recommendations.
- How was the study done?
Position paper.
- How many people, animals or samples were studied?
Not applicable.
- What was actually found?
Green vegetables recommended from 4-6 months.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Vegetables are part of normal infant feeding after the first months.
- What are the study's limitations?
Consensus document.
- What does it say about Elawady's specific claim?
Contradicts removing vegetables for children; context for infant nitrate warning.
- Do the results apply to Germany and Europe?
European.
- What can explicitly not be concluded from this study?
Does not quantify nitrate risk.
Scientific in-depth review
1. Full reference
- Authors
- Fewtrell M et al.
- Journal
- J Pediatr Gastroenterol Nutr
- Year
- 2017
- Identifier
- PMID 28027215 DOI 10.1097/MPG.0000000000001454
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
When and how should complementary foods be introduced to healthy term infants in Europe?
3. Study design and population
- Study design
- Guideline / position statement – Position paper / consensus statement of the ESPGHAN Committee on Nutrition
- Population
Healthy term infants in Europe
- Country
Europe
- Period
Published 2017
- Sample size
not applicable
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Complementary feeding practices
- Comparator
not applicable
- Endpoints
Recommendations
- Statistical methods
Narrative review and expert consensus
5. Actual results
- Results
Complementary foods should not be introduced before 4 months nor delayed beyond 6 months; infants should be offered foods with a variety of flavours and textures including bitter-tasting green vegetables; no sugar or salt; vegan diets only under medical/dietetic supervision.
- Absolute risks
not reported
- Authors' conclusion
Recommendations as stated, including offering green vegetables during complementary feeding.
6. Strengths
- Authoritative European paediatric nutrition body
7. Weaknesses
- Consensus, not a formal GRADE guideline
- Healthy term infants in Europe
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Expert consensus.
9. Assessment of the statistical interpretation
not applicable
10. Relevance to the specific claim
Shows that paediatric guidance recommends green vegetables for infants from 4-6 months; the infant nitrate risk concerns earlier ages and badly stored purees.
11. Independent contrary findings
Infant methaemoglobinaemia case series (Savino 2006, Martinez 2013).
12. Transferability to Germany and Europe
European guidance.
13. Overall methodological judgement
Removing vegetables from children's diets conflicts with paediatric guidance.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | not replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
none
15. Linked fact checks
- Avoiding (nearly) all vegetables, salads and legumes is compatible with good health. – Studies contradicting or limiting the claim
- Nitrate-rich vegetables (e.g. courgette soup) given to young infants can cause severe methaemoglobinaemia. – Studies with mixed or unclear results