Programming Through Early Nutrition: Intrauterine Aspects, Breast-and Formula Feeding

Speaker: F. Haschke Presented at: 2015 CIP 4th Global Congress for Consensus in Pediatrics & Child Health


In some developed and emerging countries more than 50% of young women are now overweight (BMI >25-30) or obese (BMI >30). If overweight/obese mothers are breastfeeding gain weight of their infants is faster during the first 12 months than indicated by the 50th percentile of the WHO Growth Standard. Rapid weight gain during infancy is associated with higher risk of obesity during childhood and adult life. Maternal obesity can result in unfavorable (epigenetic) pre- and postnatal programming of important genes of the offspring. This can have lifelong consequences such as increased risk of NCDs. It has also been speculated that rapid early weight gain is associated with changes in the microbiome of the infant and increased protein concentration in breast milk. Many studies indicate that infants of obese- and non-obese mothers who were fed traditional (high protein) formulas gain weight more rapidly than breastfed infants. Those formulas are still recommended by CODEX ALIMENTARIUS. An updated metaanalysis (n=1150) now indicates that infants who are fed a whey-based low-protein formula (1.8g/100kcal) with an essential amino-acid profile close to breast milk grow as indicated by the WHO Growth Standard (0-4 months). A new experimental lowprotein formula (1.61-1.65g protein/100kcal) for infants between 3 and 12 months was recently tested in 2 randomized clinical trials and children were followed until 2-3 years. Growth and biomarkers were compared with infants who were fed formulas with higher protein concentrations and breastfed reference groups. One trial was in a general US population where growth of infants fed the low protein-formula was not inferior to the WHO Growth Standard and the breast-fed reference group. The percentage of infants who were above the 85th percentile of the WHO standards during the intervention period was lower (p 0.036) in the group fed the low-protein formula than infants fed the control formula (2,15g protein/100kcal). The second trial (Chile) was in infants of mothers with BMI >25. Infants fed the low-protein formula gained less weight until 12 (p 0.015) and 36 months (0.031) than infants fed the control formula with 2,7g protein/100kcal, but weight gain was similar to the breast-fed reference group. In both trials, biomarkers of protein metabolism, IGF-1 and C-peptide of the infants fed the low-protein formulas were closer to breast-fed infants than the respective biomarkers of the infants fed the high-protein formulas. Prevention measures of childhood and adult obesity should start during the first 1000 days of life. Unfavorable fetal programming can be prevented by weight management/lifestyle change programs of young women before and during pregnancy. After birth, promotion of breastfeeding beyond 6 months is most important to prevent from excessive weight gain during infancy. Our studies indicate that nonbreastfed infants fed a low-protein formula (1,8g/100kcal) until 12 months grow according to the WHO standard. Feeding a new experimental low-protein formula (1,61-1,65g/100kcal) between 3 and 12 months can help to slow down rapid weight gain during infancy in at risk infants, which might contribute to a reduction of obesity risk in childhood and adult life.