Is Growth in Early Childhood a Window of Opportunity for Programming Long-Term Health?

Background: Rapid growth characterizes early childhood, with the highest weight gain in early infancy and continued relatively high gains during preschool years.

Summary: Subnormal weight and length gain from birth to about 2 years of age predict increased childhood wasting and stunting, whereas excessive weight gain in infancy and early childhood is associated with increased later obesity. Breastfeeding attenuates the risk of high early weight gain and later obesity, adding another reason for promoting, protecting and supporting breastfeeding. Avoiding high infant protein intakes from infant formula and complementary foods is strongly recommended since it markedly reduces later obesity and adiposity. This can be achieved by avoiding cows' and other animal milks as a drink in infancy and choosing infant formula with a low protein content, more similar to breastmilk, for infants not (fully) breastfed. High weight gain in toddlers is also associated with increased later obesity, predicted by overfeeding, high intakes of sugary foods and beverages, and high intakes of protein, particularly animal protein. In an ongoing controlled trial in Germany and Spain, we randomized 1,618 toddlers to milk drinks in the second year of life, providing protein contents either similar to cows' milk or more similar to human milk. First results show high protein milk inducing high weight and length gains, deviating from normal growth trajectories, whereas reduced protein intakes support weight and length growth matching WHO growth standards. Follow-up until early school age is ongoing to explore a potential impact on later growth and overweight risk.