A Bad Diet as an Adult May be the Result of Poor Feeding Habits in Infancy

Written by Dr. Steve Chaney on . Posted in Bad Diets Can Start in Infancy, Diets

“As The Twig Bends…”

Author: Dr. Stephen Chaney

infant bad dietYou have probably heard the saying “As the twig bends, so grows the tree.”  The origin of that quote is lost in lore of medieval England, but the saying absolutely rings true when we are talking about infant nutrition and a bad diet as an adult.

Most moms naturally assume that a healthy diet is important for their infants, but many new moms have questions:

  • What does a healthy diet for their infant look like?
  • What should they do if their infant is a fussy eater?
  • Could what they feed their infants influence their eating patterns and their health for years to come?

Of course, there is no shortage of advice. There are the family customs handed down from generation to generation. There is lots of advice on the internet, some of it offered by people who have no knowledge of nutrition. Your pediatrician’s advice may be based on what they learned in medical school, but it is just as likely to have come from their mother.

All of that advice is well meaning, but some of it is flat out wrong!

Fortunately, the Centers for Disease Control and the US Food and Drug Administration have sponsored a major study called the longitudinal Infant Feeding Practices Study II (IFPD II) to answer these and other important questions about infant feeding practices.

How The Study Was Set Up

The initial phase of the study was performed between May 2005 and June 2007, and the study design was reported in 2008 (Fein et al., Pediatrics, 122: S28-S35, 2008). During this phase of the study, investigators simply collected information on infant feeding practices from ~2000 mothers when their infants were between 1 month and 1 year of age.

The purpose of this phase of the investigation was simply to collect baseline data so that subsequent studies could correlate infant feeding practices with diet and health outcomes as these children got older.

This was a very comprehensive survey of infant feeding practices and health status:

  • The first neonatal feeding practices survey was sent when the infant was ~ 1 month old.
  • Between ages 2 to 7 months, nine more surveys were sent out on an approximately monthly basis.  These surveys asked about infant feeding, health, care, and related issues.
  • After 7 months additional surveys were sent out every 7 weeks until the infant was 12 months old.
  • In addition, the study included two maternal dietary surveys, one during pregnancy and a second one 4 months after delivery.

A Bad Diet Can Begin in Infancy

In phase 2 of the study multiple investigators followed up with ~1,500 of these children at age 6 to find out how infant feeding practices correlated with their diet and health as they reached early childhood. These studies were all published in a special edition of the journal Pediatrics in 2014 (Pediatrics, 134: Supplement 1, September 2014).  Key findings from these studies were:

breastfeedingDuration of Breastfeeding Is Positively Correlated With A Healthier Diet At Age 6(C.G. Perrine et al, Pediatrics, 134: S50-S55, 2014). Specifically:

  • Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.
  • Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.
  • However, no correlation was seen between the duration of breastfeeding and consumption of milk, sweets and salty snacks in this study.

The authors of this study made the interesting comment that the taste of breast milk varies somewhat depending on what the mother has eaten that day. In contrast, commercial infant formulas taste the same every time and are often somewhat sweeter than breast milk. They hypothesized that this normal variation in the taste of breast milk may make toddlers and young children more willing to accept new foods such as fruits and vegetables.  Here, you can already start to see breastfeeding longer may help avoid a bad diet later.

Of course, the authors cannot eliminate the possibility that mothers who breastfeed longer are also choosier about what they feed their children.

Fruit and Vegetable Intake In Infancy Is Positively Correlated With Fruit and Vegetable Intake At Age 6(K.A. Grimm et al, Pediatrics, 134: S63-S69, 2014).  Specifically:

  • 33% of 6-year-olds in their survey consumed fruit less than once daily and 20% consumed vegetables less than once daily.
  • More importantly, children in their study who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.

The authors of the study made the interesting observation that a liking of things that are sweet or salty is hardwired into the human brain.  A single exposure to sweet and salty foods during infancy may be all that it takes to create a lifelong craving for those kinds of foods and leading to a  bad diet.

In contrast, it may take repeated exposure to fruits and vegetables during infancy to develop a familiarity and preference for those kinds of foods. One of the authors of this study reported in a previous study that infants who were offered green beans for the first time squinted and wrinkled their noses. However, many of those same infants opened their mouths to try a spoonful if parents persisted.

Once again, there are other factors to consider, such as the kind of diet parents are modeling for their children.

Consumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Consuming Them At Age 6(S. Park et al, Pediatrics, 134: S56-S62, 2014).  This study speaks for itself, but it is troubling.  I shudder every time I see a young mother wheeling her baby through a store with a soft drink in their baby bottle.  Is this a bad diet for an infant?

The implication of these studies and several other studies published in that issue of Pediatrics is clear.  Bad diets do begin in infancy.  However, there is a positive side to these studies.  Good diets also begin in infancy, and you are in charge of what your infant puts in their mouth.

Bad Health Begins In Infancy

These studies are critically important because bad diets are not just a victimless crime.  Bad diets affect health.  Eventually, they kill people.  Here are two examples from this set of studies that show how an infant’s diet affects their health – one positively and one negatively.

Duration of Breastfeeding Is Positively Correlated With A Healthier Immune System At Age 6(R. Li et al, Pediatrics, 134: S13-S20, 2014). This study showed that longer breastfeeding and later introduction of foods was associated with lower rates of ear, throat, and sinus infections.  This conclusion is not exactly new.  It strongly supports what a number of previous studies have shown.

bad diet childConsumption of Sugar-Sweetened Beverages During Infancy Doubles The Odds Of Obesity At Age 6(L. Pan et al, Pediatrics, 134: S29-S35, 2014).  This finding is not surprising.  The study mentioned above showed that consumption of sugar-sweetened beverages during infancy doubles the odds of consuming them at 6.  Moreover, previous studies have clearly shown that consumption of sugar-sweetened beverages is associated with obesity in children.

However, this finding is troubling because obese children often become obese adults, and obesity is associated with many serious health issues.

Again, the implication of these studies is clear.  Both bad health and good health can be strongly influenced by feeding habits established in infancy.

 

The Bottom Line

 

  • A major clinical study supported by the Centers for Disease Control and Prevention and the US Food and Drug Administration monitored infant feeding patterns during the first year and compared those patterns with diet habits and health outcomes at age 6.
  • The duration of breastfeeding was positively associated with a healthier diet and a stronger immune system at age 6. Specifically:
  • Infants who were breastfed for 12 months or longer were significantly more likely to drink water and to eat fresh fruits and vegetables at age 6 than infants who were breastfed for 6 months or less.
  • Infants who were breastfed for 12 months or longer were also significantly less likely to consume juices and sugar-sweetened beverages at age 6.
  • Infants who were breastfed for 12 months or longer were significantly less likely to suffer from of ear, throat, and sinus infections.
  • The pattern of fruit and vegetable consumption established in late infancy was maintained through at least age 6. Specifically:
  • Children who consumed fruits and vegetables less than once daily during late infancy (10-12 months) were ~2.5 times less likely to eat fruits and vegetables more than once daily at age 6.
  • Consumption of sugar-sweetened beverages during infancy has a negative impact on both diet and health through at least age 6. Specifically:
  • Consumption of sugar-sweetened drinks during infancy doubles the chances that children will still be consuming sugar-sweetened beverages and will be obese at age 6.
  • This study strongly confirms what many smaller studies have suggested for years. It reinforces the importance of breastfeeding for at least the first 12 months and slowly transitioning to healthy foods rather than sugar-sweetened beverages and junk foods. It shows that what we feed our infants may influence their diet and their health for a lifetime.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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