Babykost mit Augenmaß

Zusammenfassung

Die ersten Lebensmonate sind eine sensible Wachstumsperiode, in der die Ernährung langfristig programmierende Effekte hat. Offenbar erhöht eine übermäßige Gewichtszunahme in der frühen Kindheit das spätere Adipositasrisiko. Studien zeigen, dass gestillte Kinder weniger Gewicht zunehmen als ungestillte. Als Ursache wird die im Vergleich zur Flaschennahrung niedrigere Proteinzufuhr mit der Muttermilch diskutiert. Die Effekte unterschiedlicher Proteingehalte in der Flaschennahrung auf das Wachstum im Alter von zwei und sechs Jahren wurden in einer randomisierten, kontrollierten Studie (CHOP-Studie, Childhood Obesity Project[*]) untersucht. Eine höhere Proteinmenge in der Flaschennahrung war mit metabolischen Veränderungen assoziiert, u. a. mit höheren Plasmakonzentrationen an wachstumsfördernden Stoffen wie Insulin und IGF-1. Es kam zu einer stärkeren Gewichtszunahme in den ersten beiden Lebensjahren und einem höheren Adipositasrisiko im frühen Schulalter. Die Ergebnisse der CHOP-Studie legen nahe, dass eine niedrigere Proteinzufuhr im Säuglingsalter das spätere Adipositasrisiko senken könnte.

Abstract

The first few months of life are a sensitive growth period during which nutrition has effects that set the body’s programming for the long-term. Excessive weight gain in infancy obviously increases the later risk of obesity. Studies have shown that breastfed babies put on less weight than formula-fed babies. The lower protein intake with breast milk compared with infant formula is being discussed as the possible cause. The effects of different protein contents in formula milk on growth at the ages of 2 years and 6 years have been investigated in the randomized controlled Childhood Obesity Project (CHOP) study. A higher protein content in infant formula was associated with metabolic changes – among others, with raised plasma concentrations of growth promoting substances such as insulin and IGF-1. Babies fed in this way put on more weight during the first two years of life and had a higher risk of obesity in the early school years. The results of the CHOP study imply that a lower protein intake in infancy might reduce the later risk of obesity.

Schlüsselwörter

Proteinzufuhr - Flaschennahrung - frühe Gewichtszunahme - Adipositasrisiko - Stillen - CHOP-Studie - BMI-Verlauf

Keywords

protein intake - infant formula - early weight gain - obesity risk - breast feeding - CHOP study - BMI development

^* The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007 – 2013), project EarlyNutrition under grant agreement n°[289346].

• Literatur

• 1 Monasta L, Batty GD, Cattaneo A et al. Early-life determinants of overweight and obesity: a review of systematic reviews. Obes Rev 2010; 11: 695-708
• 2 Widdowson EM, McCance RA. The Effect of Finite Periods of Undernutrition at Different Ages on the Composition and Subsequent Development of the Rat. Proc R Soc Lond B Biol Sci 1963; 158: 329-342
• 3 McCance RA, Widdowson EM. The determinants of growth and form. Proc R Soc Lond B Biol Sci 1974; 185: 1-17
• 4 Johnson L, Llewellyn CH, van Jaarsveld CHM et al. Genetic and Environmental Influences on Infant Growth: Prospective Analysis of the Gemini Twin Birth Cohort. PLoS One 2011; 6
• 5 Touwslager RN, Gielen M, Mulder AL et al. Changes in genetic and environmental effects on growth during infancy. Am J Clin Nutr 2011; 94: 1568-1574
• 6 Dewey KG. Growth characteristics of breast-fed compared to formula-fed infants. Biol Neonate 1998; 74: 94-105
• 7 Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006; 95: 904-908
• 8 Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obes Rev 2005; 6: 143-154
• 9 Baird J, Fisher D, Lucas P et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity. Br Med J 2005; 331: 929-931
• 10 Druet C, Stettler N, Sharp S et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol 2012; 26: 19-26
• 11 Owen CG, Martin RM, Whincup PH et al. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 2005; 115: 1367-1377
• 12 Harder T, Bergmann R, Kallischnigg G et al. Duration of breastfeeding and risk of overweight: A meta-analysis. Am J Epidemiol 2005; 162: 397-403
• 13 Arenz S, Ruckerl R, Koletzko B et al. Breast-feeding and childhood obesity – a systematic review. Int J Obes 2004; 28: 1247-1256
• 14 Thompkinson DK, Kharb S. Aspects of infant food formulation. Comprehensive Reviews in Food Science and Food Safety 2007; 6: 79-102
• 15 Dewey KG. Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am 2001; 48: 87-104
• 16 Socha P, Grote V, Gruszfeld D et al. Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial. Am J Clin Nutr 2011; 94: 1776S-1784S
• 17 Dupont C. Protein requirements during the first year of life. Am J Clin Nutr 2003; 77 : 1544S-1549S
• 18 Gunther AL, Buyken AE, Kroke A. Protein intake during the period of complementary feeding and early childhood and the association with body mass index and percentage body fat at 7 y of age. Am J Clin Nutr 2007; 85: 1626-1633
• 19 Gunnarsdottir I, Thorsdottir I. Relationship between growth and feeding in infancy and body mass index at the age of 6 years. Int J Obes Relat Metab Disord 2003; 27: 1523-1527
• 20 Scaglioni S, Agostoni C, Notaris RD et al. Early macronutrient intake and overweight at five years of age. Int J Obes Relat Metab Disord 2000; 24: 777-781
• 21 Heinig MJ, Nommsen LA, Peerson JM et al. Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING Study. Am J Clin Nutr 1993; 58: 152-161
• 22 Koletzko B, Broekaert I, Demmelmair H et al. Protein intake in the first year of life: A risk factor for later obesity? The EU Childhood Obesity project. In: Koletzko B, Dodds PF, Akerblom H, et al, eds. Early Nutrition and Its Later Consequences: New Opportunities. Berlin: Springer; 2005: 69-79
• 23 Koletzko B, von Kries R, Closa R et al. Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr 2009; 89: 1836-1845
• 24 Agostoni C, Scaglioni S, Ghisleni D et al. How much protein is safe?. Int J Obes 2005; 29: S8-S13
• 25 World Health Organization. Protein and amino acid requirements in human nutrition. In: Report of a Joint FAO/WHO/UNU Expert Consultation ed, World Health Organ Tech Rep Ser. Geneva, Switzerland: FAO/WHO/UNU; 2002
• 26 Agostoni C, Riva E, Giovannini M. Complementary food: international comparison on protein and energy requirement/intakes. Nestle Nutr Workshop Ser Pediatr Program 2006; 58: 147-156; discussion 149 – 156
• 27 Moorcroft KE, Marshall JL, McCormick FM. Association between timing of introducing solid foods and obesity in infancy and childhood: a systematic review. Matern Child Nutr 2011; 7: 3-26
• 28 Gunther AL, Remer T, Kroke A et al. Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age?. Am J Clin Nutr 2007; 86: 1765-1772