Protein intake in children and growth and risk of overweight or obesity: A systematic review and meta-analysis

Erik Kristoffer Arnesen*, Birna Thorisdottir, Christel Lamberg-Allardt, Linnea Bärebring, Bright Nwaru, Jutta Dierkes, Alfons Ramel, Agneta Åkesson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)

Abstract

Objectives: The aim of this study was to examine the evidence for an association between the dietary protein intake in children and the growth and risk of overweight or obesity up to 18 years of age in settings relevant for the Nordic countries. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to February 26, 2021 for randomized controlled trials (RCTs) or prospective cohort studies assessing for protein intake from foods (total and from different sources) in children. The outcomes include weight, height/length, adiposity indices, and/or risk of overweight and/or obesity. The risk of bias was evaluated with instruments for each respective design (Cochrane’s Risk of Bias 2.0 and RoB-NObS). A meta-analysis of five cohort studies was performed. The evidence was classified according to the criteria of the World Cancer Research Fund. Results: The literature search resulted in 9,132 abstracts, of which 55 papers were identified as potentially relevant. In total, 21 studies from 27 publications were included, of which five were RCTs and 16 were cohort studies. The RCTs found generally null effects of high-protein intake in infants on weight gain, nor that lower protein diets negatively affected growth. All included RCTs had some concern regarding the risk of bias and were limited by small sample sizes. Total protein intake and BMI were assessed in 12 co-horts, of which 11 found positive associations. The meta-analysis revealed a pooled effect estimate of 0.06 (95% CI 0.03, 0.1) kg/m2 BMI per one E% increment in total protein (I2 = 15.5). Therefore, the evidence for a positive relationship between total protein intake and BMI was considered probable. Furthermore, there was probable evidence for an association between higher intake of animal protein and increased BMI. There was limited, suggestive evidence for an effect of total protein intake and higher risk of overweight and/or obesity, while no conclusions could be made on the associations between animal vs. plant protein intake and risk of overweight and/or obesity. Discussion: In healthy, well-nourished children of Western populations, there is probably a causal relationship between a high-protein intake in early childhood (≤ 18 months) – particularly protein of animal origin – and higher BMI later in childhood, with consistent findings across cohort studies. A lack of RCTs precluded a stronger grading of the evidence.

Original languageEnglish
Article number8242
JournalFood and Nutrition Research
Volume66
DOIs
Publication statusPublished - 21 Feb 2022

Bibliographical note

Funding Information:
The authors thank Hilde Strømme at the University of Oslo Library of Medicine and Science for performing the literature search and providing full-text articles, and Gun Brit Knutssön and Sabina Gillsund at Karolinska Institutet University Library for peer reviewing the search strategy.Conflicts of interest and funding The authors declare no potential conflicts of interest. Partial funding was received from the Nordic Council of Ministers and governmental food and health authorities of Norway, Finland, Sweden, Denmark, and Iceland.

Publisher Copyright:
© 2022 Erik Kristoffer Arnesen et al.

Other keywords

  • BMI
  • Dietary guidelines
  • Dietary protein
  • Early life nutrition
  • Growth
  • Infant feeding
  • Metabolic programming
  • Obesity
  • Overweight
  • Systematic review

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