ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Am J Clin Nutr 2018;107:734-742

The higher protein contents of cow’s milk based milk formulas (2.2 g/100 kcal) compared to breast milk (1.5 g/100 kcal) have been thought to underlie their faster growth, weight gain and childhood obesity promoting effects. Consequently, there is increasing interest in the benefits of low protein cow’s milk based formulas (1.6-1.8 g/100 kcal) to reduce rapid infant weight gain and obesity. However, it is unclear whether the same issues relate to protein sources from infant complementary (solid or semi-solid) foods.

Here, the authors report a well-performed RCT. The infants were provided the same standard, intact milk protein–based formula which they consumed ad libitum. The meat-based diet consisted of commercially available puréed meats, and the dairy-based diet consisted of infant yogurt, cheese, and a powdered concentrate of 80% whey protein. During the intervention period, between ages 5-12 months, both groups showed the same slight increase in weight-for-age z score (WAZ) compared to the WHO growth standards, consistent with formula-fed infants in many western populations. The main difference was that infants on dairy-protein foods faltered in their WHO length-for-age z score (LAZ), reducing by on average −0.30 over 7 months, and reaching a mean LAZ of ~−0.60 at age 12 months. Although unexpected, this decline in LAZ was similar to that in an earlier study of a low-protein, cereal-based diet by the same group. With attention shifting towards the very early prevention of overweight, we should be careful to understand and avoid compromising the essential nutritional requirements for linear growth. Other comprehensive guidance on infant complementary feeding was published recently (see: https://www.gov.uk/government/collections/sacn-reports-and-position-statements).