1. www.newfoodmagazine.com
Infantnutrition:
Thefirst1000daysandthe
long-termimpactonhealth
This article is reprinted from: New Food, Volume 19, Issue 1, 2016

2. Nutrition in this period is particularly crucial2,3
. Early nutrition wields both
short and long-term effects on the health of an infant, by programming
the infant’s development4
. Evidence suggests that this ‘developmental
programming’ has a long-lasting effect on the risk of obesity in later life,
and in turn, associated non-communicable diseases; type 2 diabetes,
hypertension and cardiovascular disease5
.
Childhood obesity is an increasingly concerning topic; in 2013 it was
estimated that over 42 million children under the age of five years
worldwide were overweight or obese6
. The latest figures in the UK found
that over a quarter of children aged 2-10 were overweight or obese7
.
Overweight and obese children are likely to remain overweight or obese
into adulthood, increasing their risks of developing non-communicable
diseases at a younger age6
.
Importance of breastfeeding
Global guidelines recommend exclusive breastfeeding for the first
six months of an infant’s life, and breastfeeding in combination
with suitable, nutritionally balanced complementary foods beyond
that8,9
. Breastfeeding is undoubtedly the best method of infant
feeding, not only because breast milk is nutritionally superior, but it
also has unique advantages that are not possible to replicate with
bottle-feeding10
.
Research into the benefits of breastfeeding for both the infant and
the mother, shows that these benefits are not due to the breast milk
alone, but rather breastfeeding as a whole. Benefits for the mother
include, but are not limited to, a reduced risk of breast and ovarian
cancers11,12
, and a strengthening of the emotional bond with their infant.
Breastfedinfantsareatareducedriskofdevelopingallergies,gastro-
intestinal and respiratory infections, and urinary tract infections
comparedtoformula-fedinfants13
.Additionally,breastfedinfantsareata
reduced risk of being overweight or obese in later life, and therefore at
a reduced risk of the associated health issues such as hypertension,
diabetes and cardiovascular disease14,15,16
. A meta-analysis has shown
that the risk of becoming overweight is reduced by 4% for each
additional month of breastfeeding and the benefits of breastfeeding are
still apparent with partial/combination feeding16
.
It has been recognised by health experts, that the first 1000 days – from conception to a child’s second birthday – is a
critical window of opportunity to influence the future health outcomes1
. This critical period is the most influential
timeinayoungchild’slife,theirbehavioursandthenutritiontheygetinthistimehelpstosettheirfuturefoundations
for life and can have an impact on their health and happiness later in life2
.
Thefirst1000daysandthe
long-termimpactonhealth
I N F A N T N U T R I T I O N
Reprinted from: New Food, Volume 19, Issue 1, 2016 2 www.newfoodmagazine.com
© Dmitry Lobanov / Shutterstock.com
■ Rosie Long
Nutrition Graduate, Nestlé UK

3. Breastmilk substitutes
Although it is thought that almost all mothers can
breastfeed successfully, it has been acknowledged that a
small number of health conditions may justify the
recommendation to cease breastfeeding temporarily or
permanently17
, in which case there is an explicit need for
suitable breastmilk substitutes. In addition to this medical
need, some women in the UK choose not to initiate
breastfeeding, and many of those who do start change to
formula feeding within six weeks of the baby’s birth, for
various reasons.
Thatbeingsaid,thedurationofbreastfeedingisonthe
increase in the UK, with one in three mothers found to be
still breastfeeding to some degree at six months in 2010,
compared to one in four mothers in 200518,19
. Additionally,
breastfeeding initiation is also on the rise, with figures
showing that in 2010 81% of mothers started breast-
feeding, compared to 76% in 200518,19
. Although 81% of
mothers across the UK initiated breastfeeding at birth in
2010, this dropped to 69% at one week, 55% at six weeks,
withjust34%ofmothersstillbreastfeedingatsixmonths18
.
Additionally, 92% of infants have received some infant formula by
the age of six months19
.
Infant formula is commercially known as ‘First’ Infant Milk, and is the
only recommended alternative to breastmilk for infants aged younger
than six months18,20
. Infant formula is nutritionally complete and usually
made from a base of cows’ milk. Breastmilk naturally contains all the
essential nutrients an infant needs, and is adaptable to the infant’s
requirements over time. Infant formula is
designed to mimic breast milk as closely as
scientifically possible21
, but does not have the
abilitytoadaptinresponsetotheinfant’sneeds.
If an infant is not being breastfed after six
months,follow-onformulaeareavailable.These
are fortified milks with increased levels of certain nutrients, such as iron
and vitamin D, designed to help meet infant’s needs at this age.
Regulations for infant formula and follow-on milks
All formulae intended for infants must be safe and suitable to meet the
nutritional needs of infants and promote healthy growth and
development when consumed exclusively during the first six months of
life. At six months, when complementary foods are introduced to an
infant’s diet, nutrients should be added to the formulae only in amounts
nutritionally beneficial to the infant22
.
Infant formulae and follow-on formulae are products designed
specifically to satisfy the nutritional needs of healthy infants.
The nutritional compositions, labelling, marketing and advertising of
these formulae are covered in the Commission Directive 2006/141/EC23
.
The composition of these products is tightly regulated; protein, fat,
carbohydrate, minerals, vitamins are controlled and include, when
necessary, minimum and maximum values.
Protein – what is it and why is it so important?
Childhoodobesityisaseriouspublichealthconcern.Itisrecognisedthat
breastfed infants are the benchmark for appropriate growth in infancy;
this is because breastfeeding is the ideal way for an infant to be
fed. This is reflected in the most recent WHO Growth Charts, which are
basedonbreastfedinfants24
.Breastfedinfantsgainweightmoreslowlyin
their first year of life than formula-fed infants, which could go some
way to contributing to their decreased risk of becoming overweight or
obese in later life21,25
.
There are various reasons why breastfed infants are less likely
to be overweight or obese in later life than
formula-fed infants. It has been suggested that
elevated intakes of protein in infancy, can
have adverse effects on weight in later life26
.
Research suggests that the lower protein
intake and slower growth of breastfed infants
could be partially responsible for the decreased risk of overweight and
obesity in breastfed infants.
Proteinisanessentialnutrientforgrowthandrepairofthebody,and
is important for the maintenance of good health. Proteins are
fundamental structural and functional components of every cell in the
body, and are made up of long chains of amino acids. Out of 20 amino
acids found in proteins, eight of these are defined as essential. In infants
and young children an additional seven are considered to be
conditionally essential. This is because infants and young children are
unable to make enough of these amino acids rapidly enough to meet
their high needs for growth27
. The amino acid content of breastmilk is the
best estimate of the requirements of an infant24
. Of the essential amino
acids, four – threonine, valine, leucine, and isoleucine – have been
shown, when supplied in excess, to be associated with an increased
secretion of insulin (insulinogenic amino acids)26
.
The accelerated growth hypothesis is a proposed explanation of the
contribution of protein to childhood obesity5
.
The ‘early protein’ hypothesis suggests that high protein intakes
duringearlylifehassubsequentimpactonoverweightandobesityriskin
later life. The proposed mechanism links excess protein intake – and
therefore excess insulinogenic amino acid intake – to hormonal
www.newfoodmagazine.com 3 Reprinted from: New Food, Volume 19, Issue 1, 2016
I N F A N T N U T R I T I O N
Breastfeeding is undoubtedly the
best method of infant feeding
©Rohappy/Shutterstock.com
Protein is an essential nutrient
for growth and repair of the body,
and is important for the maintenance
of good health

4. responses, such as the stimulation of insulin and insulin-like growth
factor-I (IGF-1). This insulin and IGF-1 release may result in accelerated
growth and increased adiposity5,28,29
.
Innovation and reformulation
of infant formula and follow-on milks
A study by Weber et al. (2014) on the effect of higher protein formu-
lae during the first year of life, in comparison to lower protein formulae
supports the option to lower the protein content of infant formulae and
follow-on formulae. It was concluded that infants fed a lower protein
formula were at a reduced risk of obesity at age six30
. In response to the
most recent science, the European Food Safety Authority has stated that
infants are generally receiving protein in excess, so the protein of infant
and follow-on formulae could be reduced22
.
In response to these statements, in recent years, some companies
have lowered the protein content of their infant formulae and
follow-on formulae. However, EU regulations place limitations for
protein reduction in these products, with a minimum protein level of
1.8g/100 calories required for both infant and follow-on formulae23
.
Additionally, protein reduction is a complex process which affects
the overall stability of the milk, as well as the mineral content31
. It is also
important when reducing the protein content of infant and follow-on
formulae that the overall quality of amino acids is considered, with
breastmilkbeingthebestmodelforquality24
.Manipulationoftheprotein
involves reducing the amount of insulinogenic essential amino acids to
ensure that these are not available in excess, whilst ensuring essential
amino acid needs are met. The aim of making these composition
changes to infant formulae and follow-on formulae, is to achieve a
slower growth rate of formula fed infants, comparable to that of
a breastfed infant, and in turn to reduce the risk of becoming overweight
or obese to formula-fed infants.
Conclusion
In conclusion, the first 1000 days – from conception to two years – is a
critical time period for shaping the future of an infant. In particular,
nutritioninthistimeframeiskeyforthefuturedevelopmentandhealthof
infants. The risk of childhood obesity may be significantly reduced
if infants breastfeed – which remains the best possible nutrition in early
life. However, when exclusive breastfeeding is not possible, or is not
chosen, infant formulae must support the nutritional needs of the infant.
Researchsuggeststhattheproteinquantityandqualityininfantformulae
and follow-on formulae should be addressed and adapted to more
closely mimic the protein composition of breastmilk, in an effort to
achieve a slower growth pattern, similar to that of breastfed infants.
I N F A N T N U T R I T I O N
Reprinted from: New Food, Volume 19, Issue 1, 2016 4 www.newfoodmagazine.com
1. United Nations System (2006). The double burden of Malnutrition- a challenge for
cities worldwide. Third World Urban Forum SCN Statement, Vancouver 19-23 June
http://www.unsystem.org/scn.
2. Save the Children (2012). Nutrition in the First 1000 Days: State of the World’s Mothers 2012.
Available: www.savethechildren.org.nz/assets/599/Mothers%202012%20Asia20lr.pdf. Accessed:
January 2016
3. Unicef. (2015). Breastfeeding and complementary feeding. Available: http://www.unicef.org/
nutrition/index_breastfeeding.html Accessed: January 2016
4. Isolauri E. (2011). Diet, Nutrition and Nutritional Status: From the Mother to the Infant.
The Nest. 31, 2-3.
5. Koletzko B, Brands B, Poston L et al. (2012). Early nutrition programming of long-term health.
Proceedings of the Nutrition Society. 71, 371–378.
6. World Health Organisation. 2016. Childhood Overweight and obesity. Available:
http://www.who.int/dietphysicalactivity/childhood/en/. Accessed: January 2016.
7. Public Health England. (2015). Child weight data factsheet. Available: http://www.unicef.org/
nutrition/index_breastfeeding.html Accessed: January 2016
8. World Health Organisation, 2002. Infant and young child nutrition Global strategy on infant and
young child feeding. Available: http://apps.who.int/gb/archive/pdf_files/WHA55/ea5515.pdf
Accessed: January 2016.
9. World Health Organisation (2015). Breastfeeding. WHO, Geneva
10. Nestlé Nutrition Institute. (2013). Breast milk: An evolving nutritional solution. Available:
https://www.nestlenutrition-institute.org/resources/library/Free/conference-
proceeding/Breast_milk_An_evolving_ritional_solution/Documents/NNI%20BROCHURE%201
6%20PAGES-LD.pdf. Accessed: January 2016.
11. Tung KH, Goodman MT, Wu AH et al. (2003). Reproductive Factors and Epithelial Ovarian Cancer
Risk by Histologic Type: A Multiethnic Case-control Study. Am J Epidemiol. 158 (7), 629- 638.
12. Stuebe AM, Willett WC and Michels KB. (2009) Lactation and incidence of premenopausal breast
cancer: a longitudinal study. Inter Med. 169, 1364- 1371.
13. UNICEF. (2010). Breastfeeding Research – An Overview. Available: http://www.unicef.org.uk/
BabyFriendly/News-and-Research/Research/Breastfeeding-research---An-overview/ Accessed:
January 2016.
14. Arenz S, Ruckerl R, Koletzko B et al. (2004). Breast-feeding and childhood obesity – a systematic
review. Int J Obes. 28, 1247- 1256.
15. OwenCG,MartinRM,WhincupPHetal.(2005).Effectofinfantfeedingontheriskofobesityacross
the life course: a quantitative review of published evidence. Pediatrics. 115, 1367-1377.
16. Harder T, Bergmann R, Kallischnigg G et al. (2005). Duration of breast-feeding and risk of
overweight: a meta-analysis. Am J Epidemiol. 162, 397-403.
17. WorldHealthOrganisation.(2009).Acceptablemedicalreasonsforuseofbreast-milksubstitutes.
Available: http://apps.who.int/iris/bitstream/10665/69938/1/WHO_FCH_CAH_09.01_eng.pdf.
Accessed: January 2016.
18. McAndrew F, Thompson J, Fellows L et al. (2012). Infant Feeding Survey 2010. Health and Social
Care Information Centre. Available: http://www.hscic.gov.uk/catalogue/PUB08694/Infant-
Feeding-Survey-2010-Consolidated-Report.pdf Accessed: January 2016
19. Bolling K, Grant C, Hamlyn B et al. (2007). Infant Feeding Survey 2005. Health and Social Care
Information Centre. Available: http://www.hscic.gov.uk/catalogue/PUB00619/infa-feed-serv-
2005-chap1.pdf. Accessed: January 2016
20. Department of Health. (2003). Infant Feeding Recommendations. Available: http://webarchive.
nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh
_digitalassets/@dh/@en/documents/digitalasset/dh_4096999.pdf Accessed: January 2016
21. Lönnerdal B. (2008). Personalizing Nutrient Intakes of Formula-Fed Infants: Breast Milk as a
Model. Nestlé Nutr Workshop Ser Pediatr Program. 62, 189-203.
22. EuropeanFoodSafetyAuthority(EFSA),(2014).ScientificOpinionontheessentialcompositionof
infant and follow-on formulae. Available: http://www.efsa.europa.eu/sites/default/
files/scientific_output/files/main_documents/3760.pdf Accessed: January 2016.
23. European Commission. (2006) Directive 2006/141/EC on infant formulae and follow-on formulae
and amending Directive 1999/21/EC. European Commission.
24. World Health Organization. (2014). Protein and Amino Acid Requirements in Human Nutrition.
Report of a Joint WHO/FAO/UNU Expert Concensus 2007. WHO: Geneva
25. Dewey K, Heinig J, Laurie A et al. (1992) Growth of breastfed and formula-fed infants from
0-18 months: the DARLING Study. Pediatr. 89, 1035-1041.
26. Kirchberg FF, Harder U, Weber M et al. (2015). Dietary Protein Intake Affects Amino Acis and
Acylcarnitine Metabolism in Infants Aged 6 Months. J Clin Endrocrinol Metab. 100 (1), 149-158.
27. British Nutrition Foundation. (2015). Protein. Available: https://www.nutrition.org.uk/
nutritionscience/nutrients-food-and-ingredients/protein.html Accessed: January 2016
28. Singhal A, and Lucas A. (2004). Early origins of cardiovascular disease. Is there a unifying
hypothesis? Lancet. 363, 1642- 1645.
29. Rolland-CacheraMF,DeheegerM,AkroutMetal.(1995).Influenceofmacronutrientsonadiposity
development: a follow up study of nutrition and growth from 10 months to 8 years of age.
Int J Obes Rel Metab Dis. 19, 573- 578.
30. Weber M, Grote V, Closa-Monasterolo R et al. (2014). Lower protein content in infant formula
reduces BMI and obesity risk at school age: follow-up of a randomized control trial. Am Soci Nutr.
99, 1041- 1051
31. HardwickJandSidnellA.(2014).Infantnutrition–dietbetween6and24months,implicationsfor
paediatric growth, overweight and obesity. Nutrition Bulletin. 39, 354-363.
References
Rosie Long works as a Nutrition Graduate at Nestlé UK in
Gatwick, United Kingdom. She has recently graduated from
Bournemouth University with a BSc (Hons) in Nutrition, and is
an Associate Nutritionist on the UK Voluntary Register of
Nutritionists. She has worked on a number of projects within
SMA Nutrition and has developed a specific scientific
knowledge of infant nutrition.
About the Author