This summary is adapted from ‘Lactose-reduced infant formula with corn syrup solids and obesity risk among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)’ by Anderson et al. 2022.
The prevalence of childhood obesity is a huge public health issue, having increased significantly in recent times1. Rapid weight gain in the first two years of life gives a higher childhood obesity risk, which then predisposes to adulthood obesity2. Childhood obesity is much higher in low-income communities, with one study in Los Angeles showing childhood obesity was 35% in low-income communities and 5% in affluent communities3. Infant feeding is a contributor, including feeding formula instead of breastmilk, duration and amount of formula received, and what foods are introduced during the weaning period4.
Glucose-based lactose-reduced infant formulas made with corn syrup solids were created as they are easier to digest than cow’s milk-based formulas. This is especially true if the infant is sensitive to lactose, the predominant sugar form in cow’s milk. They are also one of the cheapest glucose sources. However, there have been some concerns about its use. Although it was found not to restrict normal growth, infants have been found to gain weight at a higher rate when receiving this type of formula5. It can also alter the infant gut microbiome to a specific composition associated with rapid growth, which may have implications for obesity in later life6.
The present study was undertaken to further clarify the relationship between corn syrup solids-based formula and obesity risk, particularly in a lower income group who are therefore at higher risk. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal nutrition assistance program for low-income families, serving approximately half of infants born in the United States. The majority of these infants are issued formula by 2 months of age. Corn syrup solids-based formula is an option in the WIC programme for most states as a reduced-lactose formula option. This study used data collected from those receiving support from WIC in Southern California between 2012 and 2020. Only infants who had stopped all breastfeeding by 3 months and were issued an infant formula were included. This totalled 15,246 participants, of which the majority were Hispanic and lived with a household income below the poverty line. Mothers supported by the WIC can select a formula for their infant from a range that are in contract with the WIC. Childhood obesity in this cohort was investigated with height and weight measurements collected by WIC staff, which were used to calculate BMI scores across the first 5 years of life.
In the results of this study, it was found that over one quarter of participating children were obese at 4 years old. The group of infants who received any corn syrup solids-based formula had a higher percentage of obesity at 2-4 years old than infants who did not receive corn syrup solids based formula. This was specified as a 10% higher risk of obesity at 2 years old if any corn syrup solids-based formula was issued to the infant. Each additional month that an infant received corn syrup solids-based formula was associated with a small increase in risk of obesity. These effects remained until 4 years old. The association was found to be independent of maternal weight status, total amount of formula issued, breastfeeding duration, race, and sex, meaning these environmental factors are not responsible for the increased obesity risk.
Despite its large sample size, the main limitation of this study is a lack of available data on the actual intake of the infant formula which was issued to the participants. This study was based on the formula the participants received, but there is no way of knowing how much of this formula the infants were fed. Participants may have received a different type of formula from other sources, which may have affected the results. However, this study does provide evidence that corn syrup solids formula is associated with obesity in children and future studies may help refine the size of the effect.
The association seen here between corn syrup solids and obesity risk in children may be explained by multiple mechanisms. As previously mentioned, this type of formula can alter the developing gut microbiome in infants which may predispose to obesity in later life. The risk may also be due to rapid weight gain in infancy, the ability of corn syrup solids formula to cause a greater increase in blood sugar, or that corn syrup solids as a glucose source contribute to the child developing a preference for sugary foods as they taste sweeter than lactose-based formulas. Corn syrup solids may also have different effects on appetite regulation due to being digested quicker than lactose. Further research is necessary to investigate these potential mechanisms and associated health effects. It would also be beneficial to study why a high proportion of mothers chose these formulas over lactose-based formulas and other lactose-reduced formulas.
- Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. 2018;141(3):e20173459
- 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(5):474–88.
- Shih M, Dumke KA, Goran MI, Simon PA. The association between community-level economic hardship and childhood obesity prevalence in Los Angeles. Pediatr Obes. 2013;8(6):411–7.
- Chaparro MP, Wang MC, Anderson CE, Crespi CM, Whaley SE. The association between the 2009 WIC food package change and early childhood obesity risk varies by type of infant package received. J Acad Nutr Diet. 2020;120(3):371–85.
- Lasekan JB, Jacobs J, Reisinger KS, Montalto MB, Frantz MP, Blatter MM. Lactose-free milk protein-based infant formula: impact on growth and gastrointestinal tolerance in infants. Clin Pediatr (Phila). 2011;50(4):330–7.
- Jones RB, Berger PK, Plows JF, Alderete TL, Millstein J, Fogel J et al. Lactose-reduced infant formula with added corn syrup solids is associated with a distinct gut microbiota in Hispanic infants. Gut Microbes. 2020;12(1):1813534.