Protein Intake in the First Year and Its Effects on Childhood BMI

CQ #268 - January 30, 2023

by Anne Eglash MD, IBCLC, FABM

#LactFact

Higher protein intake in the first year of life is associated with higher BMI at age 11.

What is the relationship between the amount of protein intake in the first year of life and BMI in childhood?

The American Academy of Pediatrics recently published their clinical guideline for the evaluation and treatment of children and adolescents with obesity. Childhood obesity is considered a complex chronic illness heavily influenced by negative environmental and social determinants of health (SDoH) that affect energy regulation. Examples of adverse SDoH include food insecurity, lack of fresh produce, and lack of safe spaces for physical activity.

Although it is clear from the AAP guideline that there is not one cause for childhood overweight and obesity, the question for this week is whether the amount of protein intake during the first year influences the risk of childhood BMI.

The CHOP study is a multicenter double blind randomized controlled trial in Belgium, Spain, Germany, Italy, and Poland that enrolled 1678 healthy term infants between 2002-2004 in their first 8 weeks of life, some of whom were formula fed and others breastfed (for at least 3 months). The protocol randomized the formula fed infants into 2 groups, one receiving formula with 1.25 grams/100ml of protein, and the other 2.05 g/100ml for the first year of life, with each group receiving the same number of calories. In 2009 the authors reported that the infants who received the higher protein formula had a higher weight %, weight-for-length %, and BMI at 6 months, 12 months and 24 months of age compared to the infants who received the lower protein formula. The breastfed infants had lower measurements compared to either formula group.

Fast forward to when these infants were 11 years of age- see the question!

What do you think the researchers found regarding the relationship between formula protein intake in the first year and BMI at age 11? Choose 1 or more:

By age 11, there was no difference in risk of overweight between the infants who received high protein formula vs low protein formula in the first year of life.
The children who received high protein formula in the first year of life had a higher risk of overweight by age 11 as compared to those who received low protein formula in the first year.
The children who were breastfed had the lowest risk of overweight at age 11 compared to the infants receiving low protein and high protein formula in the first year of life.

Click here to view the answer to this question.

Correct Answers: B (not A or C)

Different protein intake in the first year and its effects on adiposity rebound and obesity throughout childhood: 11 years follow-up of a randomized controlled trial
Pediatric Obesity 17(12) Dec 2022 e12961
Martina Totzauer, Joaquin Escribano, Ricardo Closa-Monasterolo, Veronica Luque, Elvira Verduci, Alice ReDionigi, Jean-Paul Langhendries, Francoise Martin, Annick Xhonneux, Dariusz Gruszfeld, Piotr Socha, Veit Grote, Berthold Koletzko

Abstract

Background and Objectives

Infant feeding affects child growth and later obesity risk. We examined whether protein supply in infancy affects the adiposity rebound, body mass index (BMI) and overweight and obesity up to 11 years of age.

Methods

We enrolled healthy term infants from five European countries in a double blind randomized trial, with anticipated 16 examinations within 11 years follow-up. Formula-fed infants (n = 1090) were randomized to isoenergetic formula with higher or lower protein content within the range stipulated by EU legislation in 2001. A breastfed reference group (n = 588) was included. Adiposity rebound and BMI trajectories were estimated by generalized additive mixed models in 917 children, with 712 participating in the 11-year follow-up.

Results

BMI trajectories were elevated in the higher compared to the lower protein group, with significantly different BMI at adiposity rebound (0.24 kg/m2 , 0.01–0.47, p = 0.040), and an increased risk for overweight at 11 years (adjusted Odds Ratio 1.70; 1.06–2.73; p = 0.027) but no significant difference for obesity (adjusted Odds Ratio 1.47; 0.66–3.27). The two formula groups did not differ in the timing of adiposity rebound, but all children with obesity at 11 years had an early adiposity rebound before four years.

Conclusions

Compared to conventional high protein formula, feeding lower protein formula in infancy lowers BMI trajectories up to 11 years and achieves similar BMI values at adiposity rebound as observed in breastfed infants.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

In this study, infants who were fed high protein formula in the first year of life had a higher risk of overweight at age 6 months, 12 months, 2 years, and 11 years of age, as compared to the low protein formula and breastfed groups.

The infants who received low protein formula had higher BMIs at 6 months, 12 months, and 2 years of age as compared to the breastfed group, but by 11 years of age, these 2 groups had similar BMI readings. The breastfed group was defined as having been breastfed for 3 months.

Interestingly, the low protein formula group consumed 14 and 20 g/day of protein at 3 and 6 months respectively, while the breastfed infants were estimated to have consumed 7 and 8 g/day.

The amount of protein in the study formulas were within the range of infant formulas sold in Europe at that time.

Current infant formulas in the USA have 1.2-2 grams/100ml, while term human milk usually has 0.9-1.5 grams/100ml.

The amount of protein intake may not be the only reason for the differences in BMI. I recently blogged about a study demonstrating a higher BMI among children who received formula sweetened with corn syrup solids vs lactose. And there is evidence that cow’s milk as a protein source may be more obesogenic than plant-based sources of protein.

While we need to attend to the social determinants of health for all families underlying childhood overweight and obesity, trouble-shooting the barriers to breastfeeding and choosing appropriate formulas are evidence-based interventions that are worth funding to reverse the trend of childhood obesity.

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Comments (1)

Aruna Sangisetty

January 31, 2023 at 1:20 PM

babies drinking breast milk learn to self regulate and have differrent eating habits
mother producing breast milk changes constitution of milk according the need of the child
like premeture milk is different from meture milk
3 months breast feeding not enough to probably show that much difference verses long term feeding
environmental factors like easy access to processed food sedentary activity and lack of family structure and too expensive fruits and vegetables
one child eating at mother father and grand parents step family and their parents with different cultures etc
finally eating food as emotional and comfort way out