European Childhood Obesity Project: Early Programming by Infant Nutrition? (CHOP)

December 8, 2023 updated by: Prof. Berthold Koletzko, Ludwig-Maximilians - University of Munich

Childhood Obesity - Programming by Infant Nutrition

Primary hypothesis to be tested:

Early protein intake predicts infant growth and later risk of childhood obesity.

  • Childhood obesity is a major public health problem and is an identified priority concern for the health care. Infants fed formula are more likely to become obese than breastfed infants. The higher protein content of infant formulae, compared with breast milk, could be a causal factor.
  • The study will in a multicentre intervention trial on newborn infants investigate whether feeding infant formulae, which differ in their level of milk proteins, can influence the risk of later childhood obesity. The trial will take place in five countries with different habitual total protein intakes to increase the range of protein intakes
  • The investigators will study body composition, hormonal status, protein metabolism and anthropometric markers of childhood obesity. The whole cohort will be followed up until age 18 years, to assess the long term impact on the prevalence of obesity.
  • The investigators will explore the impact of consumer (parental) attitudes to, and perceptions of, different practices of infant feeding in relation to infant behaviour (satisfaction, crying, sleep duration). This consumer science information will help improve the understanding of consumer (infants and parents) acceptance of and preference for foods that contribute to healthy diets.
  • If a relationship between early dietary protein intake and later childhood obesity risk is confirmed, it offers possibilities for the prevention of obesity, for improving advice given to parents and for developing nutritionally improved dietary products for infants.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Obesity has become a global epidemic and is a major health challenge for children and ado-lescents in industrialised countries, with a high and steadily increasing prevalence. Individual obesity risk is strongly influenced by genetic disposition and lifestyle factors. But in addition, there are clear indications that metabolic events during pre- and postnatal development mark-edly modulate obesity risk in later life, known as metabolic programming. Epidemiological studies and animal experiments suggest a causal relationship between nutrition early in life and the risk of later obesity, e.g. breast feeding seems to reduce the risk of obesity.

One factor clearly different between breast and formula fed infants is the protein intake, and thus in the Childhood Obesity Project the influence of this factor will be tested by feeding in double blind random-ised clinical trial two formulas with different protein content (7.3 % vs. 12 % of energy) to infants from five European countries (Belgium, Germany, Italy, Poland, Spain). Protein supply via formula is defined for the first year of life, while additional food is only recorded. Until the age of 2 years the growth and development of the infants is followed by frequent stand-ardised measurements and data on socio-economic status, parental attitudes and medical his-tory are collected. The available data will be evaluated in respect to the influence of protein intake and all the other factors on anthropometric markers for later obesity. This seems justi-fied as the weight and length growth until the age of 2 years have been shown to predict the body mass index with 14 years, suggesting that this is a suitable and very early indicator for overweight later in life.

Furthermore, differences between the participating countries will be studied with the aim to identify further environmental factors influencing obesity risk. On a long term base it is planned to follow the study participants via mailed questionnaires until the age of eight years to validate the risk estimators in a huge well defined population.

Primary objectives:

  • To test the influence of the protein content of the infant formula fed during the first year of life on growth until the age of two years (main outcome measures: length and weight velocity).
  • First year protein intake predicts later risk of childhood obesity ('Early protein hypothe-sis'). Primary outcome measure: BMI at the age of 8 years.
  • Protein intake in the first year of life is associated to long-term metabolic outcomes: BMI and Body Composition at 18 years

Secondary objectives:

  • Evaluation of the effects of different habitual protein intakes with traditional complemen-tary feeding regimes in infants in 5 European countries.
  • Examination of the relationship between different types of infant feeding regimes with respect to Beikost on an early anthropometric markers of later obesity development.
  • Investigation of effects of these infant feeding regimes on body composition, energy ex-penditure, protein metabolism, renal function and size, leptin and its binding protein and on IGF-1.
  • Exploration of consumer attitudes and infant feeding practices in relation to parental obe-sity status.
  • Investigation of the mediation of the relationship between diet and later growth via bio-chemical parameters, which might become detectable by the plasma concentrations of the corresponding compounds at the age of 6 months.
  • Investigation of the effects of infant behaviour (esp. crying, sleeping and feeding behav-iour) on development of obesity.
  • Comparison of the weight and length development to a non randomised cohort of breast-fed infants.
  • Measurement of the effects of dietary regimes on body composition measured by stable dilution techniques (subgroup only).
  • Measurement of the effects of dietary regimes on total energy expenditure and exploration of relationships between TEE, body composition and obesity risk (subgroup only).

Study Type

Interventional

Enrollment (Actual)

1678

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Belgium
      • Liège, Belgium, BE-4000
        • CHC St. Vincent, Liège / Universite Libre de Bruxelles
  • Germany
      • Muenchen, Germany, D 80337
        • Ludwig-Maximilians-Universitaet
  • Italy
      • Milan, Italy, I-20122
        • Universita degli Studi di Milano
  • Poland
      • Warsaw, Poland, P 04736
        • Children´s Memorial Healzj Institute
  • Spain
      • Tarragona, Spain, S 43003
        • Universitat Rovira i Virgili

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 1 month (Child)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Gestational age > 37 weeks
  • Appropriate for gestational age (above 10th percentile,Lubchenko)
  • Age of the mother at least 18 years
  • Singleton pregnancies
  • Residence in the study area
  • Maternal command of the language

Exclusion Criteria:

  • Gestational diabetes
  • Major malformations (of the child) which might interfere with nutrition or growth
  • Hormonal or metabolic diseases of the mother or the child, drug addiction during pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Lower protein formula
Intervention: Infant formula with relatively low protein content (1.25 g/ 100 ml) during the first year of life; described as "Lower protein formula"
Dietary supplement: Lower protein formula; Higher protein formula
During the intervention phase of the study, which is from inclusion in the study (latest age 2 weeks) until age 12 months, two experimental infant formulae with different protein content are fed to the enrolled infants; Lower protein formula and Higher protein formula. Additional a breastfed observational group without any intervention is included.
Placebo Comparator: Higher protein formula
Intervention: Infant formula with a relatively high protein content (2.05 g/ 100 ml) during the first year of life; described as "Higher protein formula"
Dietary supplement: Lower protein formula; Higher protein formula
During the intervention phase of the study, which is from inclusion in the study (latest age 2 weeks) until age 12 months, two experimental infant formulae with different protein content are fed to the enrolled infants; Lower protein formula and Higher protein formula. Additional a breastfed observational group without any intervention is included.
No Intervention: Breastfed reference group
Non-randomized breastfed group of infants at least 3 months exclusively breastfed

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Body mass index BMI: derived from measured body height (m) and body weight (kg) as body weight / height²
Time Frame: At age 11 years and 18 years
Body height (cm) will be determined with calibrated clinical equipment Body weight (kg) will be determined with calibrated clinical equipment BMI calculated
At age 11 years and 18 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Dietary intake
Time Frame: At 1-9,12,18 and 24 months, at 3, 4, 5, 6, 8, 11, 18 years
3 day dietary protocols and food frequency questionnaires, (at 11and 18 years only EFPQ)
At 1-9,12,18 and 24 months, at 3, 4, 5, 6, 8, 11, 18 years
Blood parameters
Time Frame: At age 6 months, 5.5 years, 8 years, 11 and 18 years
Partially: Plasma amino acids, hormones, NEFAs, Polar-Lipids, triglycerides
At age 6 months, 5.5 years, 8 years, 11 and 18 years
Physical activity
Time Frame: At age 2, 4, 6, 8, 11 years (questionnaires), at 6, 8, 11, 18 years accelerometer
Physical activity questionnaire and sensewear accelerometer data
At age 2, 4, 6, 8, 11 years (questionnaires), at 6, 8, 11, 18 years accelerometer
Body composition
Time Frame: at 3, 6, 12, 24 months, biannually from 3 to 6 years, at 7,8,11, 18 years
Skinfold measurements at all time points, additionally bioelectrical impedance at 5, 5.5, 6, 7,8 11 and years, partly additionaly air displacement plethysmography at 18 years
at 3, 6, 12, 24 months, biannually from 3 to 6 years, at 7,8,11, 18 years
Urine markers
Time Frame: At 6 months, 5.5, 8, 11 and 18 years
Uric acid, urea, creatinine, calcium secretion, C-peptide (not at 18 years)
At 6 months, 5.5, 8, 11 and 18 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ludwig-Maximilians - University of Munich

Collaborators

European Union

Investigators

  • Principal Investigator: Berthold Koletzko, Prof., Ludwig-Maximilians-Universitaet

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

October 1, 2002

Primary Completion (Actual)

August 1, 2006

Study Completion (Estimated)

December 1, 2024

Study Registration Dates

First Submitted

June 19, 2006

First Submitted That Met QC Criteria

June 19, 2006

First Posted (Estimated)

June 20, 2006

Study Record Updates

Last Update Posted (Estimated)

December 11, 2023

Last Update Submitted That Met QC Criteria

December 8, 2023

Last Verified

December 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 00389

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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