ESPE Yearbook of Paediatric Endocrinology

Lancet Glob Health 2018;6: e875–84. DOI: 10.1016/S2214-109X(18)30231-6

• Perinatal chronic undernutrition plays a role in adult-onset cardiometabolic disease.

• In this 40-year, longitudinal cohort in Guatemala, protein-energy nutritional supplementation during the first 2 years of life reduced the odds of diabetes but increased the risk of obesity and several obesity-related conditions in adulthood.

The Barker hypothesis proposes that intrauterine growth retardation plays a causal role in the origins of hypertension, coronary heart disease, and non-insulin-dependent diabetes in adulthood. In this study, the Barker hypothesis was tested in an original manner. Forty years ago, a randomized trial tested the effect of a nutritional supplement, made from dry skimmed milk, sugar, and a vegetable protein mixture (protein-rich, 90 kcal per 100 mL]) compared to a low-energy beverage made from sugar and water (all calories from sugar; 33 kcal per 100 mL) on growth during the first 2 years of life in rural Guatemala. Forty years later, the adults who participated to the study as infants were evaluated from a cardiometabolic risk point of view. The authors found that early exposure to a high protein/high calorie diet was associated with a 50% decrease in the risk of diabetes but with a significant increase in BMI, obesity and total and non-HDL cholesterol.

This study is important as it highlights the importance of early nutritional exposure in children (1). Of course, many environmental changes that may affect the results of this study can occur over 40 years but high protein intake in infants has been shown in prospective studies to lead to increased weight gain and higher adiposity in childhood. Recent data (not available when the original study was performed) have led pharmaceutical companies to progressively decrease the protein content of formula to match the lower protein content of breastmilk. Although the quality of the protein (humans vs cow) remains different, this quantitative change may decrease the risk of later obesity in formula-fed infants. This study is also an opportunity to remember that breastfeeding remains the first choice for infant nutrition.

Reference: (1) Prentice AM. Early life nutritional supplements and later metabolic disease. Lancet Glob Health 2018;6: e816.