Early Nutrition, Growth and Body Composition
Accelerated weight gain during infancy and early childhood is a strong predictor of childhood and adult obesity. WHO has published global growth standards which indicate “health growth” patterns. They are based on longitudinal data of predominantly breastfed (>6 months) children whose mothers were not malnourished (i.e. BMI 18-25 kg/m2). The WHO growth standards are now used in most countries of the world. Weight from 4 months to 2 years of the WHO standards is lower than indicated by international growth references, which are based on both data from formula- and breastfed children. Longitudinal randomized clinical trials now confirm that children who are fed infant- and follow-up formulas with protein concentrations >2,25 g/100 kcal (high protein formulas) during the first year of life grow faster than indicated by the WHO standards. It has also been shown in 3 studies that infants receiving high protein formulas show higher weight gain than infants fed low protein formulas. Biomarkers of growth such as IGF-1, insulin and c-peptide are higher in infants receiving high protein formulas. How can we slow down accelerated growth in formula-fed infants? A metaanalysis indicates that infants fed a whey based formula with 1,8g protein per 100 kcal during the first 4 months grow according o the WHO standards. Infants fed formulas with protein concentrations between 1,6 – 2,2g/100kcal from 3-4 months onwards showed weight gain which was very close to breastfed infants. At 5-6 years, children who had received the low protein formulas had a lower risk of childhood obesity (BMI >95th percentile) than children on high protein formulas. It is most important that the new low protein formulas are safe and adequate for the whole infant population. Based on new protein technologies, their essential- and branchedchained amino-acids are now close to breast milk. To confirm safety, anthropometric parameters have now been documented until 5-6 years. Another method to establish safety of low protein formulas is to monitor body composition (i.e. %fat- and %fat-free mass). One study indicates that feeding a high (2,7g/100 kcal) or low protein (1,65 g/100kcal) formula between 3 to 12 months results in similar body composition at 12 months of age (DEXA). Longitudinal data indicate that children who received a low protein formula until 12 months gain less fat between 6 and 36 months than children who received a high protein formula. Quantitative and qualitative growth indicators are among the most sensitive biomarkers to monitor long-term health of our children. Several studies now indicate that growth of children can be influenced by early nutrition. Breastfeeding and the use of low protein formulas in those infants who cannot be breastfed can help to prevent accelerated growth during infancy and early childhood.