Haschke Ferdinand, Grathwohl Dominik, Detzel Patrick, Steenhout Philippe, Wagemans Natalia, Erdmann Peter
Nestle Nutr Inst Workshop Ser. 2016;85:101-9. doi: 10.1159/000439492. Epub 2016 Apr 18.
Worldwide, 38% of women are now overweight (BMI 25-30) or obese (BMI ≥30). There is increasing evidence that maternal obesity can result in unfavorable (epigenetic) pre- and postnatal programming of important genes of the offspring. Infants of overweight mothers show faster weight gain during infancy, which is associated with higher risk of obesity during childhood and adult life. This can have lifelong consequences such as increased risk of noncommunicable diseases. Many studies indicate that infants of obese and nonobese mothers who were fed traditional (high-protein) formulas gain more rapidly weight than breastfed infants. An updated meta-analysis (n = 1,150) indicates that infants from four continents who were fed a whey-based, low-protein (1.8 g/100 kcal) formula with an essential amino-acid profile closer to breast milk grow in accordance with the World Health Organization (WHO) growth standard (0-4 months). A new experimental low-protein (1.61-1.65 g protein/100 kcal) formula for infants between 3 and 12 months of age was recently tested in two randomized clinical trials. One trial in the general US population indicates lower weight between 4 and 12 months of age in infants fed the low-protein formula when compared to infants on the high-protein formula (p = 0.031). Weight gain was not inferior to the WHO growth standards. Longitudinal analysis of odds ratios from 4 to 12 months of age showed a lower incidence of infants with weight >85th percentile in the low-protein group compared with the high-protein group (p = 0.015). In the second trial, which was conducted in Chile and included infants of mothers with BMI >25, infants fed the low-protein formula gained less weight between 4 and 12 months (p = 0.022) and until 24 months (p = 0.031) than the high-protein group. Weight gain was similar to the breastfed reference group. In both trials, biomarkers of protein metabolism (insulin-like growth factor-1 and C-peptide) of the low-protein groups were closer to breastfed infants than the respective biomarkers of the high-protein groups. Health economic analyses indicate that feeding low-protein formulas to nonbreastfed infants would result in cost savings for both the individual and the society. Preventive measures against childhood and adult obesity should include promotion of breastfeeding for 6 months or longer, and use of low-protein formulas in nonbreastfed infants.
全球范围内，目前38%的女性超重（体重指数25 - 30）或肥胖（体重指数≥30）。越来越多的证据表明，母亲肥胖会导致后代重要基因在产前和产后出现不良（表观遗传）编程。超重母亲的婴儿在婴儿期体重增加更快，这与儿童期和成年期肥胖风险较高有关。这可能会产生终身后果，如非传染性疾病风险增加。许多研究表明，用传统（高蛋白）配方奶喂养的肥胖和非肥胖母亲的婴儿比母乳喂养的婴儿体重增加更快。一项更新的荟萃分析（n = 1150）表明，来自四大洲的婴儿，喂养一种基于乳清的低蛋白（1.8克/100千卡）配方奶，其必需氨基酸谱更接近母乳，其生长符合世界卫生组织（WHO）生长标准（0 - 4个月）。一种针对3至12个月婴儿的新型实验性低蛋白（1.61 - 1.65克蛋白质/100千卡）配方奶最近在两项随机临床试验中进行了测试。在美国普通人群中的一项试验表明，与喂养高蛋白配方奶的婴儿相比，喂养低蛋白配方奶的婴儿在4至12个月时体重较低（p = 0.031）。体重增加不低于WHO生长标准。对4至1岁婴儿比值比的纵向分析表明，与高蛋白组相比，低蛋白组体重>第85百分位数的婴儿发病率较低（p = 0.015）。在第二项试验中，该试验在智利进行，纳入了体重指数>25的母亲的婴儿，喂养低蛋白配方奶的婴儿在4至12个月（p = 0.022）以及直到24个月（（p = 0.031）时体重增加少于高蛋白组。体重增加与母乳喂养参考组相似。在两项试验中，低蛋白组的蛋白质代谢生物标志物（胰岛素样生长因子-Ⅰ和C肽）比高蛋白组各自的生物标志物更接近母乳喂养的婴儿。健康经济分析表明，给非母乳喂养的婴儿喂养低蛋白配方奶将为个人和社会节省成本。预防儿童期和成年期肥胖的措施应包括促进母乳喂养6个月或更长时间，以及在非母乳喂养的婴儿中使用低蛋白配方奶。
