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ORIGINAL RESEARCH COMMUNICATION |
1 From Dr von Hauner Children's Hospital (BK, JB, HD, and BA), and the Institute of Social Paediatrics and Adolescent Medicine (RvK and VG), Ludwig-Maximilians-University, Munich, Germany; Universitad Rovira i Virgili, Reus, Spain (RCM and JES); the Department of Paediatrics, University of Milano, Milan, Italy (SS and MG); the Childrens Memorial Health Institute, Warsaw, Poland (DG and AD); the Department of Paediatrics, Université Libre de Bruxelles, Brussels, Belgium (AS); Centre Hospitalier Chrétien St Vincent, Liège-Rocourt, Belgium (J-PL); and INSERM, U557, Bobigny, France (M-FRC).
2 Presented at the workshop "Early Risk Determinants and Later Health Outcomes: Implications for Research Prioritization and the Food Supply," held in Washington, DC, July 8–9, 2008.
3 This article does not necessarily reflect the views of the Commission of the European Communities and in no way anticipates the future policy in this area.
4 Supported by the Commission of the European Communities, specific RTD Programme "Quality of Life and Management of Living Resources," within the 5th Framework Programme, research grant nos. QLRT-2001-00389 and QLK1-CT-2002-30582, and by the 6th Framework Programme, contract no. 007036. Additional support from the Child Health Foundation, Munich, Germany; the Ludwig-Maximilians-University innovative research priority project MC-Health (subproject I); and the International Danone Institutes is gratefully acknowledged. BK is the recipient of a Freedom to Discover Award of the Bristol-Myers-Squibb Foundation, New York, NY. Funds were also provided in part by the Project Committee on Early Nutrition of the International Life Sciences Institute North American Branch.
5 Reprints not available. Address correspondence to B Koletzko, Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Lindwurmstrasse 4, D-80337 Munich, Germany. E-mail: office.koletzko{at}med.uni-muenchen.de.
for the European Childhood Obesity Trial Study Group
Since the concept of lasting programming effects on disease risk in human adults by the action of hormones, metabolites, and neurotransmitters during sensitive periods of early development was proposed >3 decades ago, ample supporting evidence has evolved from epidemiologic and experimental studies and clinical trials. For example, numerous studies have reported programming effects of infant feeding choices on later obesity. Three meta-analyses of observational studies found that obesity risk at school age was reduced by 15–25% with early breastfeeding compared with formula feeding. We proposed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared with most infant formula (the early protein hypothesis). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial that includes >1000 infants in 5 countries (Belgium, Germany, Italy, Poland, and Spain). We randomly assigned healthy infants who were born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 y indicate that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the new World Health Organization growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects, and the results obtained should stimulate the review of recommendations and policies for infant formula composition.
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