Excessive protein intake in infancy promotes obesity, says expert

• Breastfeeding best way to reduce risk of obesity, says German professor citing a study by the World Health Organisation.

Abu Dhabi - Protein content in infant formula contributes to obesity in children at school age. This was stated by Professor Berthold Koletzko, head of metabolic and nutritional medicine at Dr Von Hauner Children’s Hospital in Munich, Germany, during the foetal and paediatrics conference in the Capital last week.

> Breastfeeding lowers risk of obesity later in life by 23 per cent, according to WHO > Obesity and consequences of obesity is the fifth leading cause of death around the world > According to Global School-based Student Health Survey (GSHS) published in 2010, 38.4 per cent of students in the UAE were overweight and 14.4 per cent were obese

Speaking about early childhood nutrition and obesity, Koletzko said excessive protein intake in infancy promotes weight gain in the first two years and this increases the chance of obesity in childhood and in later life.
Protein content in conventional formula is 1.5 to 1.8-fold higher than breast milk – the reason why infants taking formula grow faster and heavier whereas breastfed babies grow slower and leaner, Koletzko said.
In a study carried out in 2009 involving 1,678 healthy infants in five countries in Europe — Belgium, Germany, Italy, Poland and Spain — where Professor Koletzko was one of the investigators, the babies were grouped into three categories; breast feeding (protein = 1g/dl), those taking high protein formula (2.05g/dl) and follow-on formula (3.2g/dl) and those with low protein (1.25g/dl and 1.6g/dl).
In grams per 100 kilo calorie (g/100 kcal), high protein content (infant formula and follow-on formula) was 2.9 – 4.4g/100kcal while low protein was 1.77 – 2.2g/100kcal, nearly similar to those sold in the market. Professor Koletzko said that despite the differing protein levels, all the infants received the same energy supply.
Results of the study showed that children in high protein formula have increased BMI in the first two years of life while those in low protein were slightly heavier at one year, gained weight further at two years, yet their BMI were the same as breastfed babies, Professor Koletzko said.
A comparison of the children — six years old — in the study showed that those who took the conventional formula have 10 per cent risk of becoming obese while those with less protein intake have four per cent risk. Breastfed children, meanwhile, have three per cent risk of obesity.
“If you look at the randomised comparison of low protein group, it came down to almost four per cent by as simple as reducing protein in infant formula. This intervention, it doesn’t cost money, doesn’t need any lifestyle changes … but changing through an improved formula quality is very straight forward… (and) lower obesity at six years,” Professor Koletzko said.
According to him, breast feeding is still the best way to reduce the risk of obesity. “Longer breast feeding results in lesser obesity among children at school entry,” he stressed. Citing a study by the World Health Organisation (WHO), he said breastfeeding lowers the risk of obesity later in life by 23 per cent (2013).
“What happens in early life have impact on long-term health,” stated Professor Koletzko. He cited a US study which showed that rapid growth rate in the first two years of life increases the risk of obesity in childhood, adolescent and adulthood.
“During the first 1,000 days of human development, after conception, we have a window of opportunity that environmental cues including nutrition have lasting effects on determining our physiology and function, our health and long-term disease risk,” he said, adding that genes have limited predictive value in obesity at less than one per cent.
“We really need to limit protein supply to infants and promote breastfeeding (instead) as this produces lower obesity risk. We should avoid high protein supply in babies, even for not fully breastfed babies today must get infant formula with less protein closer to breast milk but high protein quality, and all infants must avoid unmodified cow’s milk because this has three times as much protein as breast milk,” he advised.
He noted that providing higher or less protein has no adverse effect on infants and that this remains safe for brain development.
 New piece of information
Physicians here said that although they are aware of the many benefits of breastfeeding, the association of protein as a contributing factor to obesity is new and welcome information.
“As an obstetrician and foetal medicine expert (and mother), I knew that breast milk is best for childhood immunity and nutrition and that it is associated with less childhood obesity. I did not know that this was linked to the protein content in infant formulas,” said Dr Leanne Bricker, consultant and chair of Foetal Medicine at Corniche Hospital, the largest maternity hospital in the emirate.
“It made me wonder why the manufacturers of infant milk formula do not change the protein content to make it more similar to breast milk. I presume (but this is my personal view) that this is either because they cannot or because they think mothers want their babies to be fed more so they are fatter (wrongly assumed to mean they are healthier) or they remain fuller for longer and therefore sleep better.
“Of course, even if infant formula manufacturers change the protein content, breast milk is still better for other reasons for both mother and baby,” she stressed.
 Promote breastfeeding
Dr Amal Salem Al Jaberi, paediatric specialist at a community clinic in the Capital, said that meta-analysis of observational studies have shown that the risk of obesity at school age increases by 20 per cent on formula-fed compared to breastfed babies.
“These are indicators that modification of feeding practices at early infancy will have a potential of long-term health promotion. These facts support the need to promote breast feeding as the best and first option for infants as it does reflect on life-long term health of individuals and society.

“The burden of obesity and its related health risk on the health care system and society is high and breastfeeding seems to be the optimal start for a healthy society… These studies support that and there is a future need to review the guidelines and recommendations with regards to the composition of milk formula in response to this growing evidence,” she said.

http://www.khaleejtimes.com/kt-article-display-1.asp?xfile=data/nationhealth/2015/March/nationhealth_March6.xml&section=nationhealth