Patro-Gołąb Bernadeta, Zalewski Bartłomiej M, Kouwenhoven Stefanie Mp, Karaś Jacek, Koletzko Berthold, Bernard van Goudoever Johannes, Szajewska Hania
Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland;
Department of Pediatrics, VU University Medical Center, Amsterdam, Netherlands;
J Nutr. 2016 Mar;146(3):551-64. doi: 10.3945/jn.115.223651. Epub 2016 Feb 10.
Protein intake may influence important health outcomes in later life.
The objective of this study was to investigate current evidence on the effects of infant formulas and follow-on formulas with different protein concentrations on infants' and children's growth, body composition, and later risk of overweight and obesity.
In this systematic review, we searched electronic databases (including MEDLINE, Embase, and the Cochrane Library) up until November 2014 for randomized controlled trials (RCTs). Eligible studies had to include children aged 0-3 y who represented the general population and were fed cow milk-based infant formulas with variations in protein concentration. Control groups received lower-protein cow milk-based formulas (as defined by the authors). The primary outcomes were growth, overweight, obesity, and adiposity. Various time points for outcomes assessment were accepted for inclusion. If possible, a meta-analysis was performed.
Twelve RCTs met our inclusion criteria. Different formula protein concentrations did not affect linear growth other than a transient effect on mean length at 3 mo observed in a meta-analysis of 4 studies (mean difference, - 0.27 cm; 95% CI: -0.52, -0.02). Lower mean weight and weight z scores obtained from the infants fed lower-protein formulas were observed only from 6 to 12 mo of age. Data from one large RCT showed that consumption of a lower-protein infant formula may reduce body mass index at 12 mo of age and later (12 mo, 24 mo, and 6y) and the risk of obesity at 6 y. Effects on body composition remained unclear.
The current evidence is insufficient for assessing the effects of reducing the protein concentration in infant formulas on long-term outcomes, but, if confirmed, this could be a promising intervention for reducing the risk of overweight and obesity in children. In view of the limited available evidence, more studies replicating effects on long-term health outcomes are needed.
蛋白质摄入量可能会影响晚年的重要健康结局。
本研究的目的是调查当前关于不同蛋白质浓度的婴儿配方奶粉和后续配方奶粉对婴幼儿生长、身体成分以及日后超重和肥胖风险影响的证据。
在这项系统评价中，我们检索了截至2014年11月的电子数据库（包括MEDLINE、Embase和Cochrane图书馆），以查找随机对照试验（RCT）。符合条件的研究必须纳入代表一般人群的0至3岁儿童，他们食用蛋白质浓度不同的以牛奶为基础的婴儿配方奶粉。对照组接受低蛋白以牛奶为基础的配方奶粉（作者定义）。主要结局为生长、超重、肥胖和肥胖度。接受纳入各种结局评估的时间点。如果可能，进行荟萃分析。
12项RCT符合我们的纳入标准。不同的配方奶粉蛋白质浓度除了在4项研究的荟萃分析中观察到对3个月时平均身长有短暂影响外（平均差异，-0.27厘米；95%CI：-0.52，-0.02），对线性生长没有影响。仅在6至12月龄时观察到，食用低蛋白配方奶粉的婴儿平均体重和体重z评分较低。一项大型RCT的数据显示，食用低蛋白婴儿配方奶粉可能会降低12月龄及以后（12个月、24个月和6岁）的体重指数以及6岁时的肥胖风险。对身体成分的影响仍不明确。
目前的证据不足以评估降低婴儿配方奶粉中蛋白质浓度对长期结局的影响，但如果得到证实，这可能是一种有前景的干预措施，可降低儿童超重和肥胖的风险。鉴于现有证据有限，需要更多研究来重复对长期健康结局的影响。
