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Prävention der kindlichen Adipositas durch die Säuglingsernährung

Prevention of pediatric obesity through baby nutrition

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Zusammenfassung

Neben familiären Risikofaktoren und dem Lebensstil im Kindes- und Jugendalter beeinflussen prä- und postnatale Einflussfaktoren das spätere Adipositasrisiko. Prägende Auswirkungen metabolischer Faktoren während begrenzter, sensibler Zeitfenster der frühen Entwicklung auf die langfristige Gesundheit und das Krankheitsrisiko werden als frühe metabolische Programmierung der langfristigen Gesundheit bezeichnet. Die mögliche Bedeutung der Säuglingsernährung unterstreicht der Befund eines schützenden Effekts des Stillens auf das spätere Adipositasrisiko in zahlreichen Studien und drei Metaanalysen. Stillen könnte gegen spätere Adipositas durch eine geringere mittlere Gewichtszunahme im Säuglingsalter schützen, bedingt durch den geringeren Eiweißgehalt in Muttermilch im Vergleich zu Säuglingsnahrungen („frühe Proteinhypothese“). Wir prüften diese Hypothese in der European Childhood Obesity Study. Die erzielte Verminderung der Gewichtszunahme in den ersten beiden Lebensjahren könnte die Häufigkeit der Adipositas im Jugendalter um etwa 13% vermindern. Diese Ergebnisse sollten dazu ermuntern, derzeitige Empfehlungen zur Säuglingsernährung und deren Umsetzung zu überprüfen.

Abstract

The prevalence of overweight and obesity among children and adolescents in Germany has doubled in less than two decades. In addition to familial risk factors and children’s lifestyle, prenatal and postnatal factors modulate the long-term risk of obesity. The imprinting effects of metabolic variables during limited, sensitive time periods of prenatal and postnatal development on long-term health and disease risk is called early metabolic programming of long term health. The role of infant nutrition is supported by a reduced obesity risk in previously breastfed compared to formula fed subjects, documented in numerous studies and three meta-analyses. Breastfeeding might protect against later obesity by inducing lesser weight gain in infancy due to the lower protein content of human milk compared to infant formulas (the early protein hypothesis). We tested this hypothesis in the European Childhood Obesity Study, a double-blind randomized clinical trial enrolling 1,678 infants in 5 countries (Belgium, Germany, Italy, Poland and Spain). Reduced protein intake in infancy normalized growth achieved at 2 years of age relative to breastfed infants and the current WHO growth standard. The difference in weight gain up to 2 years old could reduce the prevalence of obesity in adolescence by some 13%. We conclude that infant feeding practice has a high potential for long-term health effects. The results obtained should stimulate the review of current recommendations and policies for infant formula composition.

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Dank

Den teilnehmenden Familien und Projektpartnern danken wir für ihre Unterstützung. Die dargestellten Untersuchungen wurden finanziell gefördert durch die Europäische Kommission, Generaldirektorat Forschung, Brüssel, im 5. Forschungsrahmenprogramm (Förderkennzeichen QLRT–2001–00389 und QLK1-CT-2002–30582), im 6. Forschungsrahmenprogramm (Förderkennzeichen 007036) und im 7. Forschungsrahmenprogramm (Förderkennzeichen 212652), durch das Bundesministerium für Bildung und Forschung, Klinisches Kompetenznetzwerk Adipositas, Verbundprojekt MEMORI, durch das Münchener Zentrum für Gesundheitswissenschaften McHealth und durch die Stiftung Kindergesundheit, München. BK ist der Empfänger eines Freedom to Discover Award der Bristol-Myers-Squibb-Stiftung, New York, NY, USA.

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Authors and Affiliations

  1. Abt. Stoffwechsel- und Ernährungsmedizin, Dr. von Haunersches Kinderspital,Klinikum der Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland

    B. Koletzko, V. Grote, S. Schiess, S. Verwied-Jorky, B. Brands & H. Demmelmair

  2. Institut für Soziale Pädiatrie und Jugendmedizin, Universität München, München, Deutschland

    V. Grote & R. von Kries

Authors
  1. B. Koletzko
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  2. V. Grote
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  3. S. Schiess
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  4. S. Verwied-Jorky
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  5. B. Brands
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  6. H. Demmelmair
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  7. R. von Kries
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Correspondence to B. Koletzko.

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Koletzko, B., Grote, V., Schiess, S. et al. Prävention der kindlichen Adipositas durch die Säuglingsernährung. Monatsschr Kinderheilkd 158, 553–563 (2010). https://doi.org/10.1007/s00112-009-2158-8

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  • DOI: https://doi.org/10.1007/s00112-009-2158-8

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