Abstract
Background: Few large epidemiologic studies have investigated the role of postweaning protein intake in excess weight and adiposity of young children, despite children in the United Kingdom consistently consuming protein in excess of their physiologic requirements.Objective: We investigated whether a higher proportion of protein intake from energy beyond weaning is associated with greater weight gain, higher body mass index (BMI), and risk of overweight or obesity in children up to 5 y of age.Design: Participants were 2154 twins from the Gemini cohort. Dietary intake was collected by using a 3-d diet diary when the children had a mean age of 21 mo. Weight and height were collected every 3 mo, from birth to 5 y. Longitudinal models investigated associations of protein intake with BMI, weight, and height, with adjustment for age at diet diary, sex, total energy intake, birth weight/length, and rate of prior growth and clustering within families. Logistic regression investigated protein intake in relation to the odds of overweight or obesity at 3 and 5 y of age.Results: A total of 2154 children had a mean ± SD of 5.7 ± 3.2 weight and height measurements up to 5 y. Total energy from protein was associated with higher BMI (β = 0.043; 95% CI: 0.011, 0.075) and weight (β = 0.052; 95% CI: 0.031, 0.074) but not height (β = 0.088; 95% CI: −0.038, 0.213) between 21 mo and 5 y. Substituting percentage energy from fat or carbohydrate for percentage energy from protein was associated with decreases in BMI and weight. Protein intake was associated with a trend in increased odds of overweight or obesity at 3 y (OR = 1.10; 95% CI 0.99, 1.22, P = 0.075), but the effect was not statistically significant at 5 y.Conclusion: A higher proportion of energy from protein during the complementary feeding stage is associated with greater increases in weight and BMI in early childhood in this large cohort of United Kingdom children.
Highlights
There is substantial evidence from a large, high-quality randomized control trial that the higher protein content of formula milk than breast milk is associated with adverse infant and child outcomes [1, 2]
Modeling protein intake and obesity outcomes To account for variation in energy intake (EI) by growth and development, we modeled protein intake as the %proportion of energy from protein (Epro)
There was no evidence that the odds of overweight or obesity at 60 mo were associated with %Epro at 21 mo in any of the models (Table 3 and Figure 2B). This analysis of longitudinal growth data from .2000 children in the Gemini twin cohort has demonstrated that higher protein intake at 21 mo is associated with higher weight gain and higher body mass index (BMI) between 21 and 36 mo and 21 and 60 mo, with no evidence of diminution over time
Summary
There is substantial evidence from a large, high-quality randomized control trial that the higher protein content of formula milk than breast milk is associated with adverse infant and child outcomes [1, 2]. Investigations of other dietary macronutrients in relation to childhood obesity have not found strong associations for fat or carbohydrate [5], the role of protein intake on adiposity beyond the weaning period is unclear. Objective: We investigated whether a higher proportion of protein intake from energy beyond weaning is associated with greater weight gain, higher body mass index (BMI), and risk of overweight or obesity in children up to 5 y of age. Longitudinal models investigated associations of protein intake with BMI, weight, and height, with adjustment for age at diet diary, sex, total energy intake, birth weight/length, and rate of prior growth and clustering within families. Conclusion: A higher proportion of energy from protein during the complementary feeding stage is associated with greater increases in weight and BMI in early childhood in this large cohort of United Kingdom children.
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