Can we do something in early life to reduce the risk of obesity?

Document Type : Original Article

Author

1-Former Associate Professor of Pediatrics, Baylor College of Medicine, Houston, Texas, USA 2- Consultant, Pediatric Gastroenterology, Italian Hospital, Buenos Aires, Argentina

Abstract

Obesity usually results from a combination of several modifiable and non-modifiable contributing factors, such as genetics, race, and socioeconomic status. Other factors, including birth by cesarean section, perinatal antibiotics usage, and promotion of exclusive breastfeeding for six months, could be potentially prevented or modulated. However, one of the factors can be easily implemented through reduction of protein content in infant formulas for non-breastfed infants. High protein (HP) in infant formula is one of the causes of rapid weight gain, predisposing the neonates to later obesity.
This study was performed to evaluate the effect of HP formula on weight gain and resulting risks of later obesity. The samples (i.e., non-breastfed infants) were randomly divided into two groups of HP formula (2.9 and 4.4 g protein/100 kcal before and after five months of age, respectively) and LP formula (1.77 and 2.2 g protein/100 kcal before and after five months of age, respectively) in this study. At the age of two, weight-for-length z-score of the infants in the HP formula group was calculated at 0.20 (95%CI: 0.06, 0.34), which was higher compared to the LP group. Meanwhile, the latter group had results similar to the findings of the control group (breastfed). Body length of the infants was not affected by the extent of protein intake. A six-year follow-up of the subjects indicated a significantly lower body mass index (BMI) (0.51) in the LP formula group (95% CI: 0.13, 0.90; P=0.009). In addition, a 2.43 fold risk of later obesity (95% CI: 1.12, 5.27; P=0.024) was reported in the LP group, which was lower compared to the HP formula group. Given the role of HP formula as one of the contributing factors in the development of metabolic syndrome and obesity risks in infants, it is recommended that lower protein content formulas be used in non-breastfed neonates to prevent later obesity and other complications. 

Keywords


  1. Yang W, Kelly T, He J. Genetic epidemiology of obesity. Epidemiol Rev. 2007; 29:49–61.
  2. Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity: what fits whom? Diabetes Care. 2008; 31(Suppl 2):S269–77.
  3. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005; 115(3):e290-6.
  4. Blustein J, Attina T, Liu M, Ryan AM, Cox LM, Blaser MJ, et al. Association of caesarean delivery with child adiposity from age 6 weeks to 15 years. Int J Obes (Lond). 2013; 37(7):900-6.
  5. Li HT, Zhou YB, Liu JM. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2013; 37(7):893-9.
  6. Ajslev TA, Andersen CS, Gamborg M, et al. Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics. Int J Obes 2011;35:522–9
  7. Bailey LC, Forrest CB, Zhang P, Richards TM, Livshits A, DeRusso PA, et al. Association of antibiotics in infancy with early childhood obesity. JAMA Pediatr. 2014; 168(11):1063–9.
  8. Michaelsen KF, Greer FR. Protein needs early in life and long-term health. Am J Clin Nutr. 2014; 99(3):718S–22S.
  9. Michaelsen KF, Larnkjaer A, Molgaard C. Amount and quality of dietary proteins during the first two years of life in relation to NCD risk in adulthood. Nutr Metab Cardiovasc Dis. 2012; 22(10):781–6.
  10. Alexy U, Kersting M, Sichert-Hellert W, Manz F, Schoch G. Macronutrient intake of 3- to 36-month-old German infants and children: results of the DONALD Study. Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Ann Nutr Metab. 1999; 43(1):14–22.
  11. Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obes Rev. 2005; 6(2):143–54.
  12. Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol. 2012; 26(1):19–26.
  13. Hitchcock NE, Gracey M, Gilmour Al, Owles EN. Nutrition and growth in infancy and early childhood: a longitudinal study from birth to five years. Basel, Switzerland: Monographs in Pediatrics; 1986. P. 19.
  14. Chandra RK. Physical growth of exclusively breast fed-infants. Nutr Res. 1982; 2(3):275-76.
  15. Salmenpera L, Perheentupa J. Siimes MA. Exclusively breast-fed healthy infants grow slower than reference infants. Pediatr Res. 1985; 19(3):307-12.
  16. Persson LA. Infant feeding and growth--a longitudinal study in three Swedish communities. Ann Hum Biol. 1985; 12(1):41-52.
  17. Whitehead RG, Paul AA, Ahmed EA. Weaning practices in the United Kingdom and variations in anthropometric development. Acta Paediatr Scand Suppl. 1986; 75(s323):14-23
  18. Duncan B, Schaefer C, Sibley B, Fonseca NM. Reduced growth velocity in exclusively breast-fed infants. Am J Dis Child. 1984; 138(3):309-313.
  19. Whitehead RG, Paul AA. Growth charts and the assessment of infant feeding practices in the Western world and in developing countries. Early Hum Dev. 1984; 9(3):187-207.
  20. Volz VR, Book LS, Churella HR. Growth and plasma amino acid concentrations in term infants fed either whey-predominant formula or human milk. J Pediatr. 1983; 102(1):27-31.
  21. Harrison GG, Graver EJ, Vargas M, Churella HR, Paule CL. Growth and adiposity of term infants fed whey-predominant or casein-predominant formulas or human milk. J Pediatr Gastroenterol Nutr. 1987; 6(5):739-47.
  22. Kohler L, Meeuwisse G, Mortensson W. Food intake and growth of infants between six and twenty-six weeks of age on breast milk, cow’s milk formula, or soy formula. Acta Paediatr Scand. 1984; 73(1):40-8.
  23. Koletzko B. Early nutrition and its later consequences: new opportunities. Adv Exp Med Biol. 2005; 569:1–12.
  24. Koletzko B, von Kries R, Closa R, Escribano J, Scaglioni S, Giovannini M, et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr. 2009; 89(6):1836–45.
  25. Socha P, Grote V, Gruszfeld D, Janas R, Demmelmair H, Closa-Monasterolo R et al. Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial. Am J Clin Nutr. 2011; 94(6Suppl):1776S–84S.
  26. Inostroza J, Haschke F, Steenhout P, Grathwohl D, Nelson SE, Ziegler EE. Low-protein formula slows weight gain in infants of overweight mothers. J Pediatr Gastroenterol Nutr. 2014; 59(1):70-7.
  27. Weber M, Grote V, Closa-Monasterolo R, Escribano J, Langhendries JP, Dain E, et al. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Am J Clin Nutr. 2014; 99(5):1041–1051.