Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers

• Published in: The Journal of nutrition 2021-06, Vol.151 (6), p.1572-1580
• Main Authors: Kong, Kai Ling, Burgess, Brenda, Morris, Katherine S, Re, Tyler, Hull, Holly R, Sullivan, Debra K, Paluch, Rocco A
• Format: Article
• Language: English
• Subjects: added sugars; Age; Babies; Baby foods; Beverages; Body mass index; Child, Preschool; childhood obesity; Children; complementary feeding; Cross-Sectional Studies; Diet; Dietary Sugars - administration & dosage; Editor's Choice; Energy Intake; Female; Food; Gestational age; Humans; Infant; Infant Formula; Infant formulas; Infant Nutritional Physiological Phenomena; infant rapid weight gain; Infants; Milk; Nutrition; Nutrition and Disease; Obesity; Pediatric Obesity - etiology; Pregnancy; Proteins; Sugar; Toddlers; Variance analysis; Weight; Weight Gain
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1093/jn/nxab044

Formulas often contain high amounts of added sugars, though little research has studied their connection to obesity. This study assessed the contribution of added sugars from formulas during complementary feeding on total added sugar intakes, and the association between these sugars and upward weight-for-age percentile (WFA%) crossing (i.e., participants crossing a higher threshold percentile were considered to have an upward crossing). Data from three 24-hour dietary recalls for infants (n = 97; 9–12 months) and toddlers (n = 44; 13–15 months) were obtained in this cross-sectional analysis. Foods and beverages with added sugars were divided into 17 categories. Pearson's correlations were used to test relations between added sugar intake and upward WFA% crossing, followed by multivariable regressions when significant. ANOVA compared intakes of all, milk-based, and table foods between primarily formula-fed compared with breastfed participants. Multivariable regressions were used to test effects of added sugars and protein from all foods compared with added sugars and protein from milk-based sources on upward WFA% crossing. Added sugars from formulas comprised 66% and 7% of added sugars consumed daily by infants and toddlers, respectively. A significant association was observed between upward WFA% crossing and added sugars from milk-based sources after controlling for gestational age, sex, age, introduction to solid foods, mean energy intakes, and maternal pre-pregnancy BMI and education (β = 0.003; 95% CI, 0.000–0.007; P = 0.046). Primarily formula-fed participants consumed nearly twice the energy from added sugars (P = 0.003) and gained weight faster (upward WFA% crossing = 1.1 ± 1.2 compared with 0.3 ± 0.6, respectively; P < 0.001) than their breastfed counterparts. Added sugars in formulas predict rapid weight gain in infants and toddlers. Educating mothers on lower-sugar options may enhance childhood obesity prevention.