Postnatal High Protein Intake Can Contribute to Accelerated Weight Gain of Infants and Increased Obesity Risk

Abstract

Worldwide, 38% of women are now overweight (BMI 25-30) or obese (BMI ≥30). There is increasing evidence that maternal obesity can result in unfavorable (epigenetic) pre- and postnatal programming of important genes of the offspring. Infants of overweight mothers show faster weight gain during infancy, which is associated with higher risk of obesity during childhood and adult life. This can have lifelong consequences such as increased risk of noncommunicable diseases. Many studies indicate that infants of obese and nonobese mothers who were fed traditional (high-protein) formulas gain more rapidly weight than breastfed infants. An updated meta-analysis (n = 1,150) indicates that infants from four continents who were fed a whey-based, low-protein (1.8 g/100 kcal) formula with an essential amino-acid profile closer to breast milk grow in accordance with the World Health Organization (WHO) growth standard (0-4 months). A new experimental low-protein (1.61-1.65 g protein/100 kcal) formula for infants between 3 and 12 months of age was recently tested in two randomized clinical trials. One trial in the general US population indicates lower weight between 4 and 12 months of age in infants fed the low-protein formula when compared to infants on the high-protein formula (p = 0.031). Weight gain was not inferior to the WHO growth standards. Longitudinal analysis of odds ratios from 4 to 12 months of age showed a lower incidence of infants with weight >85th percentile in the low-protein group compared with the high-protein group (p = 0.015). In the second trial, which was conducted in Chile and included infants of mothers with BMI >25, infants fed the low-protein formula gained less weight between 4 and 12 months (p = 0.022) and until 24 months (p = 0.031) than the high-protein group. Weight gain was similar to the breastfed reference group. In both trials, biomarkers of protein metabolism (insulin-like growth factor-1 and C-peptide) of the low-protein groups were closer to breastfed infants than the respective biomarkers of the high-protein groups. Health economic analyses indicate that feeding low-protein formulas to nonbreastfed infants would result in cost savings for both the individual and the society. Preventive measures against childhood and adult obesity should include promotion of breastfeeding for 6 months or longer, and use of low-protein formulas in nonbreastfed infants.

Metabolic Programming: Effects of Early Nutrition on Growth, Metabolism and Body Composition

“…A randomized controlled trial [17] indicated that infants fed a whey-based formula with a protein content of 1.8 g/100 kcal have growth and metabolic outcomes that are similar to those of breastfed infants through 4 months of age. A meta-analysis (n = 1,150 infants) recently confirmed that at 4 months of age the weight of infants fed the 1.8 g/100 kcal formula corresponds to the median of the WHO standard [15] . The formula tested in those studies had an amino acid pattern that was close to the pattern in breast milk [15] .…”

“…A meta-analysis (n = 1,150 infants) recently confirmed that at 4 months of age the weight of infants fed the 1.8 g/100 kcal formula corresponds to the median of the WHO standard [15] . The formula tested in those studies had an amino acid pattern that was close to the pattern in breast milk [15] .…”

“…A review of data from epidemiological studies [15] and randomized controlled trials [9,12,16] indicates that children who are fed infant formulas with protein concentrations >2.10 g/100 kcal (high protein formulas) during the first year of life grow faster than indicated by the WHO standards. How can formula-fed infants be prevented from rapid growth?…”

“…Our group performed 2 randomized controlled trials to evaluate a modified whey formula containing a lower protein concentration (1.6 g/100 kcal; fig. 2 ) [15] . Experimental design and results of the trials through 1-2 years have recently been published [9,15,16] .…”

Nutritive and Bioactive Proteins in Breastmilk

“…Composition of infant formulas has evolved with increasing knowledge of BM. Recently, a pooled analysis of individual growth data (11 clinical trials; n = 1,882 [15] ) of infants who received a modified whey-based low-protein starter formula (1.8 g protein/100 kcal) [16] with an amino acid profile close to term BM [17] has become available. The weight and length of formula-fed infants at 4 months correspond to the 50th percentile of the WHO global growth standard [18] .…”