Autoimmune Thyroid Disease

An Unfortunate and Lengthy Adventure in Misdiagnosis

Babies overfed to meet flawed ideal

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This is an article published several months ago in the New Scientist, my favourite magazine. I’ll start backwards, with the sidebar:

Sidebar: Eating for two

Crucial as diet may be during the first months of a baby’s life, the amount of food the mother eats during pregnancy may also count. New research suggests that this may predetermine whether the baby grows fat and even preset an infant’s appetite for life.

Emily Oken of Harvard Medical School in Boston, Massachusetts, and her colleagues studied 1044 mothers and their children. They found that women who overshot or simply met US Institute of Medicine guidelines on weight gain during pregnancy were four times as likely to have an overweight child by age three as those whose weight gain was “inadequate” (American Journal of Obstetrics & Gynecology, DOI: 10.1016/j.ajog.2006.11.027).

The results are supported by the findings of Lucilla Poston at King’s College London and her colleagues, who showed that mice that overeat during pregnancy give birth to heavier pups, which then continue to overeat throughout infancy. “They still suckle their mothers as usual and so get calorie overload, taking in too much glucose and fat,” says Poston, who also presented preliminary results in Budapest last week.

Poston’s work builds on previous studies showing mice that are malnourished during pregnancy also produce offspring that overeat, often ending up fatter than pups born to mothers with normal diets. “As soon as they’re born, they overfeed,” says Poston, who believes the pups are trying to catch up nutritionally, but end up overcompensating.

She believes that over or undernutrition in the mother may reprogram genes that control appetite in the fetus, priming the pup to eat more than usual and lay down more fat once it has been born.

Poston is now seeking support for a study in humans, to see if mothers who exercise moderately and eat a balanced diet produce leaner babies with normal appetites. In the meantime, she advises prospective mothers to try to reduce weight before they attempt to get pregnant.

“Breastfeeding mothers describe feeling heavy pressure to feed up babies they themselves think are perfectly healthy”

Many new mothers come to dread the arcane growth charts produced by baby clinics to assess whether their new arrival is being under or overfed.

Now research is beginning to confirm what many mothers have long suspected – that the most commonly used growth charts, based on babies fed high-protein formula milk, wrongly classify lean but healthy babies as underweight. What’s more, by encouraging mothers to overfeed their babies, the charts may be setting perfectly healthy children on the path to obesity.

The most popular growth chart, produced by the US National Center for Health Statistics (NCHS), has been used for nearly 30 years to provide a reference against which to judge the growth of a new baby. Introduced in 1977, when rampant obesity had yet to manifest itself, its main aim was to make sure babies didn’t suffer from malnutrition. What is now being increasingly recognised is that these charts were based on babies that were atypically heavy: almost all of them had been bottle-fed and came from white, middle-class families in Ohio.

The charts were revised by the US Centers for Disease Control and Prevention (CDC) in 2000 to include more breastfed infants, but this has little bearing on the preceding 23 years. “They have skewed infant nutrition towards overfeeding for decades,” says Bert Koletzko of the University of Munich in Germany, who heads a major European programme known as Earnest to investigate the effects of infant nutrition on obesity in adult life. “You could say we’ve had avoidable obesity as a result.”

Last week, Koletzko presented preliminary results from Earnest showing that babies fed high-protein formula milk put on weight far faster and more extensively than those fed breast or low-protein formula milk. Previous studies reached the same conclusion, but these relied on simply watching how a group of babies turned out, without being able to isolate the effect from other factors, such as wealth or the smoking habits of parents.

Koletzko’s study is the first to demonstrate a link after being able to dictate what the babies ate and control for these other factors. In all, 1000 infants in five European countries randomly received breast milk, low-protein formula milk or high-protein formula milk and were monitored until the age of 2.

At any given age, babies in the high-protein group weighed around twice as much above the norm as the highest-scoring babies in other groups. “Children in the high-protein group were significantly heavier,” says Koletzko, who presented the results at a conference on the impact of infant and maternal nutrition on childhood obesity in Budapest, Hungary, on 20 April. He is now following the babies to school age to see whether those who were heaviest during the first two years of life are at greater risk of obesity later on, as earlier studies have suggested.

As to why high-protein formula milk should make babies heavier, Koletzko believes that the extra amino acids could drive production of the hormones insulin and insulin-like growth factor 1 (IGF-1). Insulin encourages fat storage in infants, while IGF-1 promotes body growth generally. Koletzko found that levels of IGF-1 were higher in the high-protein group, as were levels of C-peptide, a metabolite of insulin.

A adviser to infant food manufacturers says that protein levels in baby milk have more than halved over the past 25 years, and that companies would be happy to supply brands with lower protein content if this was proven to cut obesity.

Though Koletzko’s results have yet to be published in full, there is growing acceptance that the NCHS charts are out of date. Last month, representatives from 31 European countries met in Brindisi, Italy, to discuss whether to adopt new charts. These are based on a study coordinated by the WHO of 8500 children in six diverse countries, all of whom were breastfed and reared in optimal circumstances, free from poverty, illness and malnutrition (see Graphs).

The concern that infants receiving formula may be overfed was a critical factor behind the WHO study, says Laurence Grummer-Strawn of the CDC, who is coordinating efforts to assess the new charts in the US. He declined to comment on Koletzko’s results, but says that “rapid growth in infancy has been shown to be associated with increased obesity”.

Other researchers in Budapest were keen to see the new charts brought in. “Everyone is pleased they’re being changed,” says Lucilla Poston of King’s College London, who has been studying how a mouse’s diet during pregnancy affects the prospects of its offspring becoming obese in adulthood (see “Eating for two”, below).

“The reaction I get from breastfeeding mothers when I explain the new chart is one of relief, because they describe feeling heavy pressure from health visitors using the old charts to feed up babies they themselves think are perfectly healthy,” says Peter Aggett of the University of Central Lancashire, a member of a UK panel which evaluated the charts. “It means we have a much better standard to operate to in the first, crucial two years of life.”

As for Koletzko, he believes his results constitute new and powerful grounds for accelerating replacement of the old NCHS charts. He points out that infancy is probably the only time in life when an individual’s entire diet can be carefully controlled. “Infants only get one form of nutrition,” he says. “You can’t do that in 10-year-olds.” New Scientist

What is the betting that the ‘extra amino acids’ are in fact hydrolysed or partially hydrolysed, and that they contain free glutamates? I’ve blogged about glutamates in baby formula before.

I have a friend who gave birth to a baby a few months ago. My friend has struggled with her weight for most of her life. When her baby was born, he was overweight. When babies are born overweight, they normally undergo a sharp correction in the few weeks after birth where they lose the extra weight they were born with and normalise.

Instead of letting this natural process occur, my friend’s health visitor told her that he needed to be fed on formula as well as breast milk in order to prevent him from losing any of his excess weight. My friend complained that her baby was sleepless and cried through the night. So would I if I was drinking what he was drinking!

Sadly, my friend didn’t feel she could go against her health visitor’s advice. Young mothers are usually so concerned to do the best for their babies that they are too afraid to listen to anyone who is not a medical authority. Who am I to her apart from a slightly odd, diet-obsessed layperson?

I just hope her health visitor’s dreadful advice isn’t setting up her baby for a lifetime of obesity.


Written by alienrobotgirl

23 August, 2007 at 1:19 pm

Posted in Quacktitioners

One Response

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  1. My baby was big, 9 pounds 7.5 oz when she was born, she lost some like they do but then she gained it back just as quick, she was a big baby and very solid, was not even hugely interested in solid food until earlier this year and she is 2 now. She also had a gag reflex that interfered with solids. Of course food intolerance could play a part in all this too but at the same token that extra weight has served her well. She was always very strong and walking by 10 months, she never came down sick as often as my son did who was a lean baby and though she is horrible when sick or teething due to her personality/food intolerances they never took hold of her the way they did my son. She always managed to have energy.But also she is growing so fast, she hasn’t gained any weight at all since sometime last year and she has shot up like you wouldn’t believe. Weight wise it has all evened out for her.She is breast fed, my son was bottle fed and fed solids after his first few months, yes I listened to my health nurse that time but I didn’t this time with my daughter.


    24 August, 2007 at 10:37 am

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