Protein intake during the period of complementary feeding and early childhood and the association with body fat at 7 years of age

Research Institute of Child Nutrition, Affiliated Institute of the University of Bonn, Dortmund, Germany.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 07/2007; 85(6):1626-33.
Source: PubMed


A high protein intake during infancy and early childhood has been proposed to increase the risk of subsequent obesity.
We analyzed the association of different protein intakes during 6-24 mo with body mass index (BMI; in kg/m2) and percentage body fat (%BF) at 7 y of age.
The analyses included 203 participants of the DOrtmund Nutritional and Longitudinally Designed (DONALD) Study with complete information on early diet (6, 12, and 18-24 mo) and anthropometric data at the age of 7 y. The median of energy-adjusted protein intakes (in g/d) was used to distinguish different patterns of low and high protein intakes throughout the first 2 y of life, which were then related to BMI SD scores (SDSs), %BF, and the risk of overweight and overfatness at 7 y of age.
Although protein intake at 6 mo of age was not associated with the outcomes, a consistently high protein intake at the ages of 12 and 18-24 mo was independently related to a higher mean BMI SDS and %BF at the age of 7 y [BMI SDS: 0.37 (95% CI: 0.12, 0.61) compared with 0.08 (95% CI: -0.09, 0.26), P = 0.04; %BF: 18.37 (95% CI: 17.29, 19.51%) compared with 16.91 (95% CI: 16.19, 17.66%), P = 0.01] and a higher risk of having a BMI or %BF above the 75th percentile at that age [odds ratio for BMI: 2.39 (95% CI: 1.14, 4.99), P = 0.02); odds ratio for %BF: 2.28 (95% CI: 1.06, 4.88), P = 0.03].
High protein intakes during the period of complementary feeding and the transition to the family diet are associated with an unfavorable body composition at the age of 7 y.

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    • "NBF infants, in addition, displayed a higher than recommended intake of proteins, as confirmed by other studies [17,19]. This point may be important, given the growing evidence that a high intake of proteins early on in life, though not necessarily at six months, may be associated with a higher risk of obesity later on [38,39]. "
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    ABSTRACT: Background Adequate complementary feeding is recognized as an important predictor of health later in life. The objective of this study was to describe the feeding practices and nutrients’ intake, and their association with breastfeeding at six months of age, in a cohort of infants enrolled at birth in the maternity hospital of Trieste, Italy. Methods Out of 400 infants enrolled at birth, 268 (67%) had complete data gathered through a 24-hour feeding diary on three separate days at six months, and two questionnaires administered at birth and at six months. Data from feeding diaries were used to estimate nutrients’ intakes using the Italian food composition database included in the software. To estimate the quantity of breastmilk, information was gathered on the frequency and length of breastfeeds. Results At six months, 70% of infants were breastfed and 94% were given complementary foods. The average daily caloric intake was higher in non-breastfed (723 Kcal) than in breastfed infants (547 Kcal, p < 0.001) due to energy provided by complementary foods (321 vs. 190 Kcal, p < 0.001) and milk (363 vs. 301 Kcal, p = 0.007). Non-breastfed infants had also higher intakes of carbohydrates, proteins, and fats. The mean intake of macronutrients was within recommended ranges in both groups, except for the higher protein intake in non-breastfed infants. These consumed significantly higher quantities of commercial baby foods than breastfed infants. Conclusions Contrary to what is recommended, 94% of infants were not exclusively breastfed and were given complementary foods at six months. The proportion of daily energy intake from complementary foods was around 50% higher than recommended and with significant differences between breastfed and non-breastfed infants, with possible consequences for future nutrition and health.
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    • "Protein consumption is generally higher compared to protein reference intakes (Prentice et al., 2004). There are concerns that high protein intakes by children and young adolescents may lead to an increased risk for overweight and obesity (Gunther et al., 2007, Hermanussen, 2008, Rolland-Cachera et al., 1995). "
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    ABSTRACT: Abstract Utilization of expert recommendations in the development of food and beverage nutritional profiles represents an opportunity to merge science and food manufacturing to deliver nutritionally-optimized products into the marketplace and hands of consumers. This report details expert panel guidelines for the design of a pediatric nutritional product. This interaction demonstrates the essential synergy between academia and food manufacturers in translating nutrient recommendations to food for their delivery to a population. Important factors for such translation are the identification of applicable nutrient recommendations and selection of an appropriate delivery matrix. This report demonstrates the translation of expert nutritional recommendations to a milk-based product for children 1-6 years of age.
    Full-text · Article · Oct 2013 · Critical Reviews in Food Science and Nutrition
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    • "Öhlund et al. (4) found that BMI at 6–18 months was the strongest predictor of BMI at 4 years, but protein intake at 17–18 months and at 4 years, energy intake at 4 years and the father's, but not the mother's, BMI were also independent contributing factors. Günther et al. (34) found that consistent high protein intake at 12 and 18–24 months, but not 6 months, was positively related to a higher mean BMI SDS (SD score) at 7 years and a higher risk of having a BMI above the 75th percentile. Skinner et al. (39) found that mean protein and fat intakes recorded between 2 and 8 years were positive predictors of BMI at 8 years. "
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    ABSTRACT: The present systematic literature review is a part of the 5th revision of the Nordic Nutrition Recommendations. The aim was to assess the health effects of different levels of protein intake in infancy and childhood in a Nordic setting. The initial literature search resulted in 435 abstracts, and 219 papers were identified as potentially relevant. Full paper selection resulted in 37 quality-assessed papers (4A, 30B, and 3C). A complementary search found four additional papers (all graded B). The evidence was classified as convincing, probable, limited-suggestive, and limited-inconclusive. Higher protein intake in infancy and early childhood is convincingly associated with increased growth and higher body mass index in childhood. The first 2 years of life is likely most sensitive to high protein intake. Protein intake between 15 E% and 20 E% in early childhood has been associated with an increased risk of being overweight later in life, but the exact level of protein intake above which there is an increased risk for being overweight later in life is yet to be established. Increased intake of animal protein in childhood is probably related to earlier puberty. There was limited-suggestive evidence that intake of animal protein, especially from dairy, has a stronger association with growth than vegetable protein. The evidence was limited-suggestive for a positive association between total protein intake and bone mineral content and/or other bone variables in childhood and adolescence. Regarding other outcomes, there were too few published studies to enable any conclusions. In conclusion, the intake of protein among children in the Nordic countries is high and may contribute to increased risk of later obesity. The upper level of a healthy intake is yet to be firmly established. In the meantime, we suggest a mean intake of 15 E% as an upper limit of recommended intake at 12 months, as a higher intake may contribute to increased risk for later obesity.
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