The human body cannot make protein from carbohydrate or fat. So, we must eat adequate protein everyday. Protein intake of both quantity and quality, during the first 2 years of life has important effects on growth, neurodevelopment, and long-term health. In early life, the diet of children and adolescents is characterized by a higher protein intake than recommended.

1. Protein Need Early in Life and Long
Term Health
Presented By
Shahzadi Rihas Sabah
MPH in Community Nutrition (BUHS), MSc and BSc in Food
and Nutrition (DU)

3. Outline
• Introduction
• Protein Need in the prenatal period
• Protein Need in Infancy and Childhood
• Protein Content of Foods for Infants and Toddlers
• FAAs and Appetite
• Protein and Growth (Evidence-based)
• Early Protein Intake and Hormonal Status
• Do obese children grow into obese adults?
• Prevalence of Overweight and Obese Children in Asia Region
• Renal Effect of Protein
• Recommendation
• Conclusion

4. Introduction
• The human body cannot make protein from carbohydrate or fat. So,
we must eat adequate protein everyday.
• Protein intake of both quantity and quality, during the first 2 years of
life has important effects on growth, neurodevelopment, and long-
term health.
• In early life, the diet of children and adolescents is characterized by
a higher protein intake than recommended.

5. Protein Need in the prenatal period
 Protein is required -
- To develop the body cells of the growing baby.
- For building of the placenta.
 Pregnant mother needs extra 10 grams of protein of her daily needs,
or about 70 grams of protein daily, compared with 60 grams for
women who are not pregnant.
 Ten grams of protein is equivalent to a an ounce-and-a-half serving of
lean meat, about 10 ounces of fat-free milk, or 1½ ounces of tuna
canned in water.

6. Protein Need in Infancy and Childhood
• - Ingestion of high-quality protein (such as milk and other animal
products) lowers the amount of total protein needed in the diet to
provide the essential amino acids
Age RDA (based on average
weight for age) g/kg/d
0-1 years 1.6 g/kg/day or 12 g/day
1-3 years 1.9 g/kg/day or 23 g/day
3-5 years 1.6 g/kg/day or 12 g/day
5- 10 years 1.5 g/kg/day or 30 g/day
RDA- Recommended dietary allowances -average daily dietary intake
levels sufficient to meet the nutrient requirements of nearly all (97%-
98%) healthy individuals in a population group

7. Protein Content of Foods for Infants
and Toddlers
• There is a large variation in the protein quality and quantity of foods
provided for infants and toddlers.
• The protein found in meat has fewer growth-promoting properties.
On the other hand Human milk contains ~4 times the amount of free
amino acids (FAAs) that are contained in cow-milk formula (3000
compared with 600–800 mmol/L) and soy-based infant formula, the
content is typically 1400 mmol/L.
Name of Food Protein
Breast Milk 1.1 g/100 ml
soy-based infant
formula
1.65 to 1.9 g/100 ml
Cow milk 3.2 g/100 ml
Egg 13 g/100 g

8. FAAs and Appetite
• The source of protein in infant formulas may have different
metabolic effects.
• A study showed that, glutamate, one of the most abundant FAAs
added to a cow-milk whole-protein infant formula which resulted in
significantly shorter meal times and lower energy intake.
• Though it is the most abundant FAA in breast milk. So, it might also
have a role in appetite regulation in breastfed infants.

9. Protein and Growth (Evidence-based)
• A longitudinal study conducted two decades ago, named French
ELANCE longitudinal study showed that high protein intake at the
age of 2 years was associated with an early adiposity rebound, a
high body mass index (BMI) and high skin fold thickness at the age
of 8 years.
• A multicenter European study found that, the high protein formula
fed infants had significantly higher weight gain and higher BMI level
at 12 and 24 years in the contrast of breast fed infants. Later on, the
study showed that, The low-protein formula fed infants had a growth
pattern that did not differ from the breast fed infants. Infact, infant
formula with a lower protein content reduced BMI and obesity risk at
6 years of age

10. Protein and Growth (Evidence-based)
• The quality of proteins is also play a vital role in the association
between early intakes and later fatness.
• DONALD study showed that the protein sources that are mostly
responsible for the association with adiposity are dairy products,
whereas proteins from meats or cereals do not seem to contribute
significantly to this effect.

11. Early Protein Intake and Hormonal
Status
• High early protein intakes stimulate the secretion of insulin and
insulin like growth factor 1 (IGF 1), which can enhance early growth
and adipogenic activity.
• High protein intakes may lead to lower growth hormone (GH) levels,
reduced lipolysis and the development and maintenance of fat
stores.
• Source is a factor. High intakes of milk, but not meat, increase IGF1
contributing to stimulate protein synthesis and cell proliferation.
High Protein
Intake
Insulin, IGF1
Early Growth
(first 2 y)
Adipogenic
Activity
Long Term
Risk of
Obesity and
Associated
Disorders

12. Do obese children grow into obese
adults?
 Tracking’ occurs throughout life
 10-20% obese infants
 40% obese children
 60-80% obese adolescents
“Adiposity rebound”
Obese Adults

13. Prevalence of Overweight and Obese
Children in Asia Region
• The rising number of overweight and obese children aged 0- 5 years
(In Millions) (de Onis M, et al.)
0
5
10
15
20
25
30
1990 2000 2010 2020
Asia
Southeast Asia

14. Renal Effect of Protein
• Very high protein intake during early infancy (before 4mo), which
occurs when undiluted cow milk is given at this age, the glomerular
filtration rate cannot cope with the renal solute load, which results in
hypernatremic dehydration.
• Continuous hyperfiltration attributable to a continuous high protein
intake results in glomerulosclerosis and hypertension in healthy term
infants, but this seems unlikely in infants with a normal number of
nephrons.

15. Recommendations
 Breast Feeding should be continued up to 6 months
 The use of formulae diet with reduced protein content during the
weaning period is preferred.
 It appears prudent to avoid other sources of very high protein
intakes during the first year of life.
 The use of cows’ milk as a drink should be avoided during the first
year of life, because it can markedly increase protein supply.

16. Conclusion
• Protein intake plays an vital role in growth, renal regulation and
body composition.
• High protein intake early in life is a risk factor for overweight
and obese in long term heath. So we should decrease the upper
allowable limit of the protein content of infant formulas for the
first year of life and limiting the intake of cow milk in the
second year of life.