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Nutrition in infancy and long-term risk of obesity: evidence from 2 randomized controlled trials

2010; Elsevier BV; Volume: 92; Issue: 5 Linguagem: Inglês

10.3945/ajcn.2010.29302

1938-3207

Atul Singhal, Kathy Kennedy, Julie Lanigan, Mary Fewtrell, Tim Cole, Terence Stephenson, A C Elias-Jones, Lawrence T. Weaver, Samuel Ibhanesebhor, P. Macdonald, Jacques Bindels, Alan Lucas,

Diet and metabolism studies

Background: Growth acceleration as a consequence of relative overnutrition in infancy has been suggested to increase the risk of later obesity. However, few studies have investigated this association by using an experimental study design. Objective: We investigated the effect of early growth promotion on later body composition in 2 studies of infants born small for gestational age (weight <10th percentile in study 1 and <20th percentile in study 2). Design: We reviewed a subset of children (n = 153 of 299 in study 1 and 90 of 246 in study 2) randomly assigned at birth to receive either a control formula or a nutrient-enriched formula (which contained 28–43% more protein and 6–12% more energy than the control formula) at 5–8 y of age. Fat mass was measured by using bioelectric impedance analysis in study 1 and deuterium dilution in study 2. Results: Fat mass was lower in children assigned to receive the control formula than in children assigned to receive the nutrient-enriched formula in both trials [mean (95% CI) difference for fat mass after adjustment for sex: study 1: −38% (−67%, −10%), P = 0.009; study 2: −18% (−36%, −0.3%), P = 0.04]. In nonrandomized analyses, faster weight gain in infancy was associated with greater fat mass in childhood. Conclusions: In 2 prospective randomized trials, we showed that a nutrient-enriched diet in infancy increased fat mass later in childhood. These experimental data support a causal link between faster early weight gain and a later risk of obesity, have important implications for the management of infants born small for gestational age, and suggest that the primary prevention of obesity could begin in infancy.