Protein intake in early childhood and body composition at the age of 6 years: The Generation R Study



Previous studies suggest that high protein intake in infancy leads to a higher body mass index (BMI) in later childhood. We examined the associations of total, animal and vegetable protein intake in early childhood with detailed measures of body composition at the age of 6 years.


This study was performed in 2911 children participating in a population-based cohort study. Protein intake at the age of 1 year was assessed with a validated food-frequency questionnaire and was adjusted for total energy intake. At the children’s age of 6 years, we measured their anthropometrics and body fat (with dual-energy X-ray absorptiometry). We calculated age- and sex-specific s.d. scores for BMI, fat mass index (FMI) and fat-free mass index (FFMI).


After adjustment for confounders, a 10 g per day higher total protein intake at 1 year of age was associated with a 0.05 s.d. (95% confidence interval (CI) 0.00, 0.09) higher BMI at age 6. This association was fully driven by a higher FMI (0.06 s.d. (95%CI 0.01, 0.11)) and not FFMI (−0.01 s.d. (95%CI −0.06, 0.05)). The associations of protein intake with FMI at 6 years remained significant after adjustment for BMI at the age of 1 year. Additional analyses showed that the associations of protein intake with FMI were stronger in girls than in boys (P for interaction=0.03), stronger among children who had catch-up growth in the first year of life (P for interaction<0.01) and stronger for intake of animal protein (both dairy and non-dairy protein) than protein from vegetable sources.


Our results suggest that high protein intake in early childhood is associated with higher body fat mass, but not fat-free mass. Future studies are needed to investigate whether these changes persist into adulthood and to examine the optimal range of protein intake for infants and young children.

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  1. 1

    Rolland-Cachera MF, Deheeger M, Akrout M, Bellisle F . Influence of macronutrients on adiposity development: A follow up study of nutrition and growth from 10 months to 8 years of age. Int J Obes 1995; 19: 573–578.

  2. 2

    Weber M, Grote V, Closa-Monasterolo R, Escribano J, Langhendries JP, Dain E et al. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Am J Clin Nutr 2014; 99: 1041–1051.

  3. 3

    Gunther ALB, Buyken AE, Kroke A . Protein intake during the period of complementary feeding and early childhood and the association with body mass index and percentage body fat at 7 y of age. Am J Clin Nutr 2007; 85: 1626–1633.

  4. 4

    Westerterp-Plantenga MS, Lemmens SG, Westerterp KR . Dietary protein - its role in satiety, energetics, weight loss and health. Br J Nutr 2012; 108 (Suppl 2): S105–S112.

  5. 5

    Halton TL, Hu FB . The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr 2004; 23: 373–385.

  6. 6

    Socha P, Grote V, Gruszfeld D, Janas R, Demmelmair H, Closa-Monasterolo R et al. Milk protein intake, the metabolic-endocrine response, and growth in infancy: Data from a randomized clinical trial. Am J Clin Nutr 2011; 94: 1776S–1784S.

  7. 7

    Hoppe C, Udam TR, Lauritzen L, Molgaard C, Juul A, Michaelsen KF . Animal protein intake, serum insulin-like growth factor I, and growth in healthy 2.5-y-old Danish children. Am J Clin Nutr 2004; 80: 447–452.

  8. 8

    Gunther AL, Remer T, Kroke A, Buyken AE . Early protein intake and later obesity risk: Which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr 2007; 86: 1765–1772.

  9. 9

    Dulloo AG, Jacquet J, Seydoux J, Montani JP . The thrifty 'catch-up fat' phenotype: its impact on insulin sensitivity during growth trajectories to obesity and metabolic syndrome. Int J Obes (Lond) 2006; 30 (Suppl 4): S23–S35.

  10. 10

    Thorisdottir B, Gunnarsdottir I, Palsson GI, Halldorsson TI, Thorsdottir I . Animal protein intake at 12 months is associated with growth factors at the age of six. Acta Paediatr 2014; 103: 512–517.

  11. 11

    Wells JC . A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 2000; 24: 325–329.

  12. 12

    Jaddoe VW, van Duijn CM, Franco OH, van der Heijden AJ, van Iizendoorn MH, de Jongste JC et al. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012; 27: 739–756.

  13. 13

    Kiefte-de Jong JC, de Vries JH, Bleeker SE, Jaddoe VW, Hofman A, Raat H et al. Socio-demographic and lifestyle determinants of 'Western-like' and 'Health conscious' dietary patterns in toddlers. Br J Nutr 2013; 109: 137–147.

  14. 14

    Voortman T, Kiefte-de Jong JC, Geelen A, Villamor E, Moll HA, de Jongste JC et al. The development of a diet quality score for preschool children and its validation and determinants in the Generation R Study. J Nutr 2015; 145: 306–314.

  15. 15

    Netherlands Nutrition Centre Dutch Food Composition Database 2006 (NEVO-tabel 2006). Netherlands Nutrition Centre (Voedingscentrum): Den Haag, 2006.

  16. 16

    Wells JC, Cole TJ . Adjustment of fat-free mass and fat mass for height in children aged 8 y. Int J Obes Relat Metab Disord 2002; 26: 947–952.

  17. 17

    Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P . An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977-1981). Acta Paediatr Scand 1991; 80: 756–762.

  18. 18

    Statistics Netherlands Immigrants in the Netherlands 2004 (Allochtonen in Nederland 2004). Statistics Netherlands (Centraal Bureau voor de Statistiek): Den Haag/Heerlen, 2004.

  19. 19

    Qi Q, Downer MK, Kilpelainen TO, Taal HR, Barton SJ, Ntalla I et al. Dietary intake, FTO genetic variants and adiposity: a combined analysis of over 16,000 children and adolescents. Diabetes 2015; 64: 2467–2476.

  20. 20

    Vogelezang S, Monnereau C, Gaillard R, Renders CM, Hofman A, Jaddoe VW et al. Adult adiposity susceptibility loci, early growth and general and abdominal fatness in childhood: the Generation R Study. Int J Obes (Lond) 2015; 39: 1001–1009.

  21. 21

    Speliotes EK, Willer CJ, Berndt SI, Monda KL, Thorleifsson G, Jackson AU et al. Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. Nature genetics 2010; 42: 937–948.

  22. 22

    Fredriks AM, van Buuren S, Burgmeijer RJ, Meulmeester JF, Beuker RJ, Brugman E et al. Continuing positive secular growth change in The Netherlands 1955-1997. Pediatr Res 2000; 47: 316–323.

  23. 23

    Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB . Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 2000; 320: 967–971.

  24. 24

    Voortman T, van den Hooven EH, Tielemans MJ, Hofman A, Kiefte-de Jong JC, Jaddoe VW et al. Protein intake in early childhood and cardiometabolic health at school age: The Generation R Study. Eur J Nutr e-pub ahead of print 2 September 2015.

  25. 25

    Kruithof CJ, Kooijman MN, van Duijn CM, Franco OH, de Jongste JC, Klaver CC et al. The Generation R Study: Biobank update 2015. Eur J Epidemiol 2014; 29: 911–927.

  26. 26

    Willett WC, Howe GR, Kushi LH . Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997; 65: 1220S–1228S; discussion 9S–31S.

  27. 27

    Closa-Monasterolo R, Ferre N, Luque V, Zaragoza-Jordana M, Grote V, Weber M et al. Sex differences in the endocrine system in response to protein intake early in life. Am J Clin Nutr 2011; 94: 1920S–1927S.

  28. 28

    van Rossem L, Hafkamp-de Groen E, Jaddoe VW, Hofman A, Mackenbach JP, Raat H . The role of early life factors in the development of ethnic differences in growth and overweight in preschool children: a prospective birth cohort. BMC Public Health 2014; 14: 722.

  29. 29

    Ong KK, Loos RJ . Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006; 95: 904–908.

  30. 30

    Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.

  31. 31

    Institute of Medicine Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. National Academy of Sciences: Washington, DC, USA, 2005.

  32. 32

    Hornell A, Lagstrom H, Lande B, Thorsdottir I . Protein intake from 0 to 18 years of age and its relation to health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food Nutr Res 2013; 57: 21083.

  33. 33

    Ocké MC, van Rossum CTM, Fransen HP, Buurma EM, de Boer EJ, Brants HAM et al. Dutch National Food Consumption Survey-Young Children 2005/2006. National Institute for Public Health and the Environment (RIVM), 2008.

  34. 34

    Voortman T, Bakker H, Sedaghat S, Kiefte-de Jong JC, Hofman A, Jaddoe VW et al. Protein intake in infancy and kidney size and function at the age of 6 years: The Generation R Study. Pediatr Nephrol 2015; 30: 1825–1833.

  35. 35

    Ohlund I, Hernell O, Hornell A, Stenlund H, Lind T . BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI. Eur J Clin Nutr 2010; 64: 138–145.

  36. 36

    Scaglioni S, Agostoni C, De Notaris R, Radaelli G, Radice N, Valenti M et al. Early macronutrient intake and overweight at five years of age. Int J Obes 2000; 24: 777–781.

  37. 37

    Gunnarsdottir I, Thorsdottir I . Relationship between growth and feeding in infancy and body mass index at the age of 6 years. Int J Obes 2003; 27: 1523–1527.

  38. 38

    Hoppe C, Molgaard C, Thomsen BL, Juul A, Michaelsen KF . Protein intake at 9 mo of age is associated with body size but not with body fat in 10-y-old Danish children. Am J Clin Nutr 2004; 79: 494–501.

  39. 39

    Robinson S, Crozier S, Marriott L, Harvey N, Inskip H, Godfrey K et al. Protein intake in infancy is not associated with adiposity at 4 years of age: findings from the Southampton Women’s Survey. Proceedings of the Nutrition Society 2008; E347.

  40. 40

    Assmann KE, Joslowski G, Buyken AE, Cheng G, Remer T, Kroke A et al. Prospective association of protein intake during puberty with body composition in young adulthood. Obesity (Silver Spring) 2013; 21: E782–E789.

  41. 41

    Westerterp-Plantenga MS, Nieuwenhuizen A, Tome D, Soenen S, Westerterp KR . Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr 2009; 29: 21–41.

  42. 42

    Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND et al. The role of protein in weight loss and maintenance. Am J Clin Nutr 2015 e-pub ahead of print 29 April 2015 doi:10.3945/ajcn.114.084038.

  43. 43

    Krieger JW, Sitren HS, Daniels MJ, Langkamp-Henken B . Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1. Am J Clin Nutr 2006; 83: 260–274.

  44. 44

    Lang PO, Trivalle C, Vogel T, Proust J, Papazian JP . Markers of metabolic and cardiovascular health in adults: Comparative analysis of DEXA-based body composition components and BMI categories. J Cardiol 2015; 65: 42–49.

  45. 45

    Atlantis E, Martin SA, Haren MT, Taylor AW, Wittert GA, Members of the Florey Adelaide Male Ageing S. Inverse associations between muscle mass, strength, and the metabolic syndrome. Metabolism 2009; 58: 1013–1022.

  46. 46

    Srikanthan P, Karlamangla AS . Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab 2011; 96: 2898–2903.

  47. 47

    Koletzko B, von Kries R, Monasterolo RC, Subias JE, Scaglioni S, Giovannini M et al. Infant feeding and later obesity risk. Adv Exp Med Biol 2009; 646: 15–29.

  48. 48

    Grote V, von Kries R, Closa-Monasterolo R, Scaglioni S, Gruszfeld D, Sengier A et al. Protein intake and growth in the first 24 months of life. J Pediatr Gastroenterol Nutr 2010; 51 (Suppl 3): S117–S118.

  49. 49

    Ong K, Kratzsch J, Kiess W, Dunger D . Circulating IGF-I levels in childhood are related to both current body composition and early postnatal growth rate. J Clin Endocrinol Metab 2002; 87: 1041–1044.

  50. 50

    Michaelsen KF, Larnkjaer A, Molgaard C . Early diet, insulin-like growth factor-1, growth and later obesity. World Rev Nutr Dietetics 2013; 106: 113–118.

  51. 51

    Rolland-Cachera MF, Deheeger M, Maillot M, Bellisle F . Early adiposity rebound: causes and consequences for obesity in children and adults. Int J Obes (Lond) 2006; 30 (Suppl 4): S11–S17.

  52. 52

    Gunther AL, Buyken AE, Kroke A . The influence of habitual protein intake in early childhood on BMI and age at adiposity rebound: Results from the DONALD Study. Int J Obes 2006; 30: 1072–1079.

  53. 53

    Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol 2012; 26: 19–26.

  54. 54

    Monteiro PO, Victora CG . Rapid growth in infancy and childhood and obesity in later life—a systematic review. Obes Rev 2005; 6: 143–154.

  55. 55

    Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ . Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008; 9: 474–488.

  56. 56

    Kipnis V, Subar AF, Midthune D, Freedman LS, Ballard-Barbash R, Troiano RP et al. Structure of dietary measurement error: results of the OPEN biomarker study. Am J Epidemiol 2003; 158: 14–21; discussion 2–6.

  57. 57

    Freedman LS, Schatzkin A, Midthune D, Kipnis V . Dealing with dietary measurement error in nutritional cohort studies. J Natl Cancer Inst 2011; 103: 1086–1092.

  58. 58

    Abrams SA, Hawthorne KM, Pammi M . A systematic review of controlled trials of lower-protein or energy-containing infant formulas for use by healthy full-term infants. Adv Nutr 2015; 6: 178–188.

  59. 59

    Voortman T, Vitezova A, Bramer W, Ars C, Bautista P, Buitrago-Lopez A et al. Effects of protein intake on blood pressure, insulin sensitivity and blood lipids in children: a systematic review. Br J Nutr 2015; 113: 383–402.

  60. 60

    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMI 2000; 320: 1240–1243.

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We gratefully acknowledge the contributions of children and parents, hospitals, general practitioners and midwives who participated in the Generation R Study. We thank Nicole Erler for providing advice on the statistical analyses. The general design of the Generation R Study was made possible by financial support from Erasmus Medical Center, Rotterdam; the Erasmus University, Rotterdam; the Dutch Ministry of Health, Welfare and Sport; and the Netherlands Organization for Health Research and Development (ZonMw). TV, KVEB, JCKJ, OHF and EHH work in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.), Metagenics Inc. and AXA. The funders had no role in design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript.

Author contributions

The authors’ contributions to this study were as follows: TV, OHF and EHH designed the research project; VWVJ, AH and OHF were involved in the design and planning of the study and data collection; TV and KVE conducted the analyses; JCKJ, OHF and EHH provided consultation regarding the analyses and interpretation of the data; TV, KVE and EHH wrote the paper; and TV and EHH had primary responsibility for the final content. All authors critically reviewed and approved the final manuscript.

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Correspondence to T Voortman.

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Voortman, T., Braun, K., Kiefte-de Jong, J. et al. Protein intake in early childhood and body composition at the age of 6 years: The Generation R Study. Int J Obes 40, 1018–1025 (2016).

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