ESPE Yearbook of Paediatric Endocrinology

Diabetologia. 2021 May;64(5):1121-1132. doi: 10.1007/s00125-020-05379-y. PMID: 33495846.

Brief Summary: This longitudinal mother-infant dyad study assessed the risk of obesity at age 2-5 years in offspring who had been exposed to Gestational diabetes mellitus (GDM), were breastfed for either less or more than six months, and also exposed to sugar-sweetened beverages.

GDM, limited breastfeeding (BF) or exclusive BF (EBF), and other postnatal dietary habits may influence weight gain, obesity and metabolic disease among young children and adolescents. Early introduction of complementary foods, sugar-sweetened beverages (SSB) and unsweetened fruit juice have been associated with obesity in young children. The American Academy of Pediatrics (AAP) recommends breast milk to be the sole source of nutrition during the infant’s first 6 months of life and other nutrients introduced after 6 months of age. The AAP also recommends avoiding fruit juice and SSBs during the first 6 months of life because of the high sugar content.

The authors followed up infants of GDM mothers and obtained information about the frequency and duration of BF and exposure to fruit juice and SSB during the first 6 months. The risk of obesity at 2-5 years was higher if the infants had less breast milk and had intake of fruit juice and SSB in the first 6 months of life. Having less breast milk itself was associated with the risk of obesity but the introduction of fruit juice and SSB in the diet increased the odds of developing obesity (independent and joint associations).

The exact mechanism(s) how BF may confer protection from obesity are unclear. One possible theory is it encourages the infant’s emerging self-regulation of intake, reducing problematic feeding behaviors on the part of caregivers that interfere with the infant’s self-regulation of intake, and providing bioactive factors that regulate energy intake, energy expenditure, and cellular chemistry. How fruit juice and SSB intake during early infancy causes obesity is also unclear. Sweet taste and maternal feeding practices related to nutritional habits and soothing children with foods and liquid feeding may be associated with higher daily SSB intake and consequent child obesity.

In summary, infant feeding exposures, including sugary beverages, may play a major role in countering fetal life programming, and that modification of early postnatal infant feeding habits may be beneficial in ameliorating the risks to the child from intrauterine exposure to maternal hyperglycaemia.