title: Dietary protein intake is associated with body mass index and weight up to 5 y of age in a prospective cohort of twins.
abstract: BACKGROUND
  Few large epidemiologic studies have investigated the role of postweaning protein intake in excess weight and adiposity of young children, despite children in the United Kingdom consistently consuming protein in excess of their physiologic requirements.
  
  
  OBJECTIVE
  We investigated whether a higher proportion of protein intake from energy beyond weaning is associated with greater weight gain, higher body mass index (BMI), and risk of overweight or obesity in children up to 5 y of age.
  
  
  METHODS
  Participants were 2154 twins from the Gemini cohort. Dietary intake was collected by using a 3-d diet diary when the children had a mean age of 21 mo. Weight and height were collected every 3 mo, from birth to 5 y. Longitudinal models investigated associations of protein intake with BMI, weight, and height, with adjustment for age at diet diary, sex, total energy intake, birth weight/length, and rate of prior growth and clustering within families. Logistic regression investigated protein intake in relation to the odds of overweight or obesity at 3 and 5 y of age.
  
  
  RESULTS
  A total of 2154 children had a mean ± SD of 5.7 ± 3.2 weight and height measurements up to 5 y. Total energy from protein was associated with higher BMI (β = 0.043; 95% CI: 0.011, 0.075) and weight (β = 0.052; 95% CI: 0.031, 0.074) but not height (β = 0.088; 95% CI: -0.038, 0.213) between 21 mo and 5 y. Substituting percentage energy from fat or carbohydrate for percentage energy from protein was associated with decreases in BMI and weight. Protein intake was associated with a trend in increased odds of overweight or obesity at 3 y (OR = 1.10; 95% CI 0.99, 1.22, P = 0.075), but the effect was not statistically significant at 5 y.
  
  
  CONCLUSIONS
  A higher proportion of energy from protein during the complementary feeding stage is associated with greater increases in weight and BMI in early childhood in this large cohort of United Kingdom children.
authors.affiliation: Medical Research Council Human Nutrition Research, Cambridge, United Kingdom;
authors.forename: Laura
authors.initials: L
authors.lastname: Pimpin
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom;
authors.forename: Susan
authors.initials: S
authors.lastname: Jebb
authors.affiliation: Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom;
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom; and.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Medical Research Council Human Nutrition Research, Cambridge, United Kingdom; School of Population Health, The University of Western Australia, Perth, Western Australia Gina.Ambrosini@uwa.edu.au.
authors.forename: Gina L
authors.identifier: http://orcid.org/0000-0003-1001-4265
authors.initials: GL
authors.lastname: Ambrosini
mesh_terms: D015992:Body Mass Index; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015331:Cohort Studies; D015930:Diet Records; D004044:Dietary Proteins / Q000008:administration & dosage / Q000009:adverse effects*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008137:Longitudinal Studies; D008297:Male; D050177:Overweight / Q000453:epidemiology / Q000209:etiology*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D006113:United Kingdom / Q000453:epidemiology; D015430:Weight Gain
chemical_list: D004044:Dietary Proteins
keywords: BMI; children; growth; longitudinal studies; macronutrients; obesity; protein; weaning