Kaiser Permanente findings provide evidence for recommendations to avoid giving fruit juice and sugary beverages in first year of life
Children of mothers who develop diabetes during pregnancy have a higher risk of developing obesity as preteens if they are fed 100% natural fruit juice or sugary drinks in their first year of life, new Kaiser Permanente research shows.
The study, published in Obesity, is one of the first to focus on the relationship between breastfeeding and 100% natural fruit juice or sugar-sweetened beverage intake during infancy can affect risk of obesity through the preteen years. It included 850 mother-infant pairs taking part in the ongoing Kaiser Permanente Northern California Study of Women, Infant Feeding and Type 2 Diabetes After Gestational Diabetes (SWIFT), a prospective study of women with gestational diabetes. The children born to SWIFT mothers were followed from infancy up to age 11.
“What parents feed infants who were exposed to gestational diabetes during their first year of life may have lasting effects on their risk of developing obesity,” said senior author Erica P. Gunderson, PhD, MPH, a senior research scientist at the Kaiser Permanente Northern California Division of Research and a professor at the Kaiser Permanente School of Medicine. “Our study underscores the importance of educating parents that sugary beverages, including 100% natural fruit juice, should not be given to infants or toddlers. Breast milk, formula, and water are the only liquids kids need in their first year of life — especially kids whose mothers developed gestational diabetes.”
The researchers found a 2- to 3-fold higher risk of obesity by age 11 in the babies who were breastfed for less than 6 months and given 100% natural fruit juice or sugary beverages. The increased risk of obesity associated with infant diet persisted even after accounting for longer and greater fetal exposure to maternal diabetes, maternal obesity, low income, and mother’s pregnancy weight gain.
Sugary drinks and breastfeeding duration
Each year, more than 304,000 children in the U.S. are born to mothers who develop diabetes during their pregnancy, known as gestational diabetes. The condition causes hormonal changes during pregnancy that can have lasting effects on the mother and the baby, including premature birth, as well as increased risk of type 2 diabetes in the mother and the child.
The mothers completed monthly questionnaires for one year after delivery, and additional in-person interviews about their infant’s diet and breast or formula feeding. This included questions about breast milk, formula, fruit juice with or without added sugar, other sugary drinks such as Sunny Delight, Gatorade, fruit-flavored liquids, and soda, as well as introduction to solid foods.
What parents feed infants who were exposed to gestational diabetes during their first year of life may have lasting effects on their risk of developing obesity.
— Erica Gunderson, PhD, MPH
Medical records were used to gather information on birth outcomes, and weight and height from birth up to 11 years of age. By their preteen years, 480 (56.5%) of the children were normal weight; 150 (17.6%) were overweight; 155 (18.2%) had moderate obesity; and 65 (7.6%) had severe obesity.
Among the children who were breastfed for less than 6 months, 33% of those given 100% natural fruit juice or sugary drinks as infants were later categorized as having obesity, compared with 27.5% of the infants not fed these drinks. Among the infants who were breastfed 6 months or longer, 25.2% of those fed sugary drinks were obese as preteens compared with 13.9% of the children who were not fed fruit juice or sugar-sweetened drinks.
Lasting impact of sugary drinks
Breastfeeding has been associated with a lower risk of child obesity. The study was designed to look at whether the benefits of breast milk were offset in babies fed fruit juice or sugary beverages.
“When we looked at the group of infants adequately breastfed, obesity rates were higher among those also given fruit juice or sugar-added drinks,” said lead author Baiyang Sun, PhD, a data analyst with the Division of Research.
A previous SWIFT study led by Gunderson found increased risk of obesity in toddlers who drank 100% fruit juice or sugary beverages. However, that study did not account for the severity of the mother’s gestational diabetes. The new study shows the persistent impact of these beverages on risk of obesity through the preadolescent years.
The American Academy of Pediatrics recommends that babies be breastfed or given breast milk for at least 6 months or longer and not given fruit juice and other sugary beverages before age one.
“Early dietary behaviors fall within a critical developmental period for cardiometabolic health in young children,” said Gunderson. “Avoiding sugary drinks during a baby’s first year of life — including 100% fruit juice — is an action that parents can take to help overcome the effects of maternal diabetes on the metabolic programming of the developing fetus. It may help reduce child obesity risk, and, potentially, improve these children’s cardiometabolic health.”
The study was supported by The National Institute of Diabetes and Digestive and Kidney Diseases.
Coauthors include, Joan C. Lo, MD, Alexis S. King, MPH, Patricia Wakimoto, DrPH, Tamanjit Basi, BS, and Charles P. Quesenberry, Jr., PhD, of the Division of Research; Louise C. Greenspan, MD, of The Permanente Medical Group; Jaimie N. Davis, PhD, and Erin A. Hudson, JD, of the University of Texas, Austin; Myles S. Faith, PhD, of the University of Buffalo; and Jami L. Josefson, MD, William Lowe, PhD, and Boyd Metzger, MD, of Northwestern University.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org or follow us @KPDOR.
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