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Erschienen in: Pediatric Nephrology 10/2004

01.10.2004 | Original Article

Increased kidney growth in formula-fed versus breast-fed healthy infants

verfasst von: Ida M. Schmidt, Ida N. Damgaard, Kirsten A. Boisen, Claudia Mau, Marla Chellakooty, Klaus Olgaard, Katharina M. Main

Erschienen in: Pediatric Nephrology | Ausgabe 10/2004

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Abstract

A high protein intake results in increased kidney growth and glomerular filtration rate in human adults and young rats. It is unknown whether kidney size in young infants is influenced by increased protein intake in formula-fed compared with breast-fed infants. We investigated the effect of formula versus breast feeding on kidney growth in a cohort of 631 healthy children examined at birth, and at 3 and 18 months of age. Kidney size was determined by ultrasonography and related to gender, age, body size, and feeding category (fully breast fed, partially breast fed, or fully formula fed at 3 months). Serum urea nitrogen, serum creatinine, and estimated creatinine clearance were measured at 3 months of age. Kidney growth and serum urea nitrogen were significantly increased in partially or fully formula-fed 3-month-old infants. This effect was more pronounced in boys than in girls. The changes in relative kidney size were temporary, as they did not persist at 18 months of age, when all children received a normal mixed diet. The immediate renal effects of formula feeding should be taken into consideration for recommendations concerning infant feeding. Whether there are any long-term effects of early increased protein intake on later kidney function remains to be seen.
Literatur
1.
Zurück zum Zitat Jakobsson B, Celsi G, Lindblad BS, Aperia A (1987) Influence of different protein intake on renal growth in young rats. Acta Paediatr Scand 76:293–299PubMed Jakobsson B, Celsi G, Lindblad BS, Aperia A (1987) Influence of different protein intake on renal growth in young rats. Acta Paediatr Scand 76:293–299PubMed
2.
Zurück zum Zitat Michaelsen KF (1997) Nutrition and growth during infancy. The Copenhagen Cohort Study. Acta Paediatr [Suppl] 420:1–36 Michaelsen KF (1997) Nutrition and growth during infancy. The Copenhagen Cohort Study. Acta Paediatr [Suppl] 420:1–36
3.
Zurück zum Zitat Janas LM, Picciano MF, Hatch TF (1985) Indices of protein metabolism in term infants fed human milk, whey-predominant formula, or cow’s milk formula. Pediatrics 75:775–784PubMed Janas LM, Picciano MF, Hatch TF (1985) Indices of protein metabolism in term infants fed human milk, whey-predominant formula, or cow’s milk formula. Pediatrics 75:775–784PubMed
4.
Zurück zum Zitat Davies DP, Saunders R (1973) Blood urea. Normal values in early infancy related to feeding practices. Arch Dis Child 48:563–565PubMed Davies DP, Saunders R (1973) Blood urea. Normal values in early infancy related to feeding practices. Arch Dis Child 48:563–565PubMed
5.
Zurück zum Zitat Axelsson IE, Jakobsson I, Raiha NC (1988) Formula with reduced protein content: effects on growth and protein metabolism during weaning. Pediatr Res 24:297–301PubMed Axelsson IE, Jakobsson I, Raiha NC (1988) Formula with reduced protein content: effects on growth and protein metabolism during weaning. Pediatr Res 24:297–301PubMed
6.
Zurück zum Zitat Raiha N, Minoli I, Moro G (1986) Milk protein intake in the term infant. I. Metabolic responses and effects on growth. Acta Paediatr Scand 75:881–886PubMed Raiha N, Minoli I, Moro G (1986) Milk protein intake in the term infant. I. Metabolic responses and effects on growth. Acta Paediatr Scand 75:881–886PubMed
7.
Zurück zum Zitat Jarvenpaa AL, Raiha NC, Rassin DK, Gaull GE (1982) Milk protein quantity and quality in the term infant. I. Metabolic responses and effects on growth. Pediatrics 70:214–220PubMed Jarvenpaa AL, Raiha NC, Rassin DK, Gaull GE (1982) Milk protein quantity and quality in the term infant. I. Metabolic responses and effects on growth. Pediatrics 70:214–220PubMed
8.
Zurück zum Zitat Raiha N, Minoli I, Moro G, Bremer HJ (1986) Milk protein intake in the term infant. II. Effects on plasma amino acid concentrations. Acta Paediatr Scand 75:887–892PubMed Raiha N, Minoli I, Moro G, Bremer HJ (1986) Milk protein intake in the term infant. II. Effects on plasma amino acid concentrations. Acta Paediatr Scand 75:887–892PubMed
9.
Zurück zum Zitat Axelsson I, Borulf S, Raiha N (1987) Protein intake during weaning. II. Metabolic responses. Acta Paediatr Scand 76:457–462PubMed Axelsson I, Borulf S, Raiha N (1987) Protein intake during weaning. II. Metabolic responses. Acta Paediatr Scand 76:457–462PubMed
10.
Zurück zum Zitat Jarvenpaa AL, Rassin DK, Raiha NC, Gaull GE (1982) Milk protein quantity and quality in the term infant. II. Effects on acidic and neutral amino acids. Pediatrics 70:221–230PubMed Jarvenpaa AL, Rassin DK, Raiha NC, Gaull GE (1982) Milk protein quantity and quality in the term infant. II. Effects on acidic and neutral amino acids. Pediatrics 70:221–230PubMed
11.
Zurück zum Zitat Cochran ST, Pagani JJ, Barbaric ZL (1979) Nephromegaly in hyperalimentation. Radiology 130:603–606PubMed Cochran ST, Pagani JJ, Barbaric ZL (1979) Nephromegaly in hyperalimentation. Radiology 130:603–606PubMed
12.
Zurück zum Zitat Skov AR, Toubro S, Bulow J, Krabbe K, Parving HH, Astrup A (1999) Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord 23:1170–1177CrossRefPubMed Skov AR, Toubro S, Bulow J, Krabbe K, Parving HH, Astrup A (1999) Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord 23:1170–1177CrossRefPubMed
13.
Zurück zum Zitat Schmidt IM, Main KM, Damgaard IN, Mau C, Haavisto AM, Chellakooty M, Boisen KA, Petersen JH, Scheike T, Olgaard K (2004) Kidney growth in 717 healthy children aged 0–18 months: a longitudinal cohort study. Pediatr Nephrol 19:992–1003 Schmidt IM, Main KM, Damgaard IN, Mau C, Haavisto AM, Chellakooty M, Boisen KA, Petersen JH, Scheike T, Olgaard K (2004) Kidney growth in 717 healthy children aged 0–18 months: a longitudinal cohort study. Pediatr Nephrol 19:992–1003
14.
Zurück zum Zitat Schmidt IM, Chellakooty M, Haavisto AM, Boisen KA, Damgaard IN, Steendahl U, Toppari J, Skakkebaek NE, Main KM (2002) Gender difference in breast tissue size in infancy: correlation with serum estradiol. Pediatr Res 52:682–686CrossRefPubMed Schmidt IM, Chellakooty M, Haavisto AM, Boisen KA, Damgaard IN, Steendahl U, Toppari J, Skakkebaek NE, Main KM (2002) Gender difference in breast tissue size in infancy: correlation with serum estradiol. Pediatr Res 52:682–686CrossRefPubMed
15.
Zurück zum Zitat Chellakooty M, Schmidt IM, Haavisto AM, Boisen KA, Damgaard IN, Mau C, Petersen JH, Juul A, Skakkebaek NE, Main KM (2003) Inhibin A, inhibin B, follicle-stimulating hormone (FSH), lutenizing hormone (LH), estradiol and sex hormone-binding globulin (SHBG) levels in 473 healthy infant girls. J Clin Endocrinol Metab 88:3515–3520CrossRefPubMed Chellakooty M, Schmidt IM, Haavisto AM, Boisen KA, Damgaard IN, Mau C, Petersen JH, Juul A, Skakkebaek NE, Main KM (2003) Inhibin A, inhibin B, follicle-stimulating hormone (FSH), lutenizing hormone (LH), estradiol and sex hormone-binding globulin (SHBG) levels in 473 healthy infant girls. J Clin Endocrinol Metab 88:3515–3520CrossRefPubMed
16.
Zurück zum Zitat Boisen KA, Kaleva M, Main KM, Virtanen HE, Haavisto AM, Schmidt IM, Chellakooty M, Damgaard IN, Mau C, Reunanen M, Skakkebaek NE, Toppari J (2004) Difference in prevalence of congenital cryptorchidism in infants between two Nordic countries. Lancet 363:1264–1269CrossRefPubMed Boisen KA, Kaleva M, Main KM, Virtanen HE, Haavisto AM, Schmidt IM, Chellakooty M, Damgaard IN, Mau C, Reunanen M, Skakkebaek NE, Toppari J (2004) Difference in prevalence of congenital cryptorchidism in infants between two Nordic countries. Lancet 363:1264–1269CrossRefPubMed
17.
Zurück zum Zitat Larsen T (2001) Intrauterine growth restriction—identification, correlation and causation evaluated by use of ultrasound. Dan Med Bull 48:256–274PubMed Larsen T (2001) Intrauterine growth restriction—identification, correlation and causation evaluated by use of ultrasound. Dan Med Bull 48:256–274PubMed
18.
Zurück zum Zitat Du Bois D, Du Bois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17:863–871 Du Bois D, Du Bois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17:863–871
19.
Zurück zum Zitat Zenkl M, Egghart G, Muller M (1990) The normal kidney size in children. An ultrasound study. Urologe A 29:32–38PubMed Zenkl M, Egghart G, Muller M (1990) The normal kidney size in children. An ultrasound study. Urologe A 29:32–38PubMed
20.
Zurück zum Zitat Michaelsen KF, Pedersen SB, Skafte L, Jaeger P, Peitersen B (1988) Infrared analysis for determining macronutrients in human milk. J Pediatr Gastroenterol Nutr 7:229–235PubMed Michaelsen KF, Pedersen SB, Skafte L, Jaeger P, Peitersen B (1988) Infrared analysis for determining macronutrients in human milk. J Pediatr Gastroenterol Nutr 7:229–235PubMed
21.
Zurück zum Zitat Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590PubMed Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590PubMed
22.
Zurück zum Zitat Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMed Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421PubMed
23.
Zurück zum Zitat MacKay LL, MacKay E, Addis T (1931) Factors which determine renal weight. XII. The nitrogen intake as varied by the addition of urea to the diet. J Nutr 4:479–483 MacKay LL, MacKay E, Addis T (1931) Factors which determine renal weight. XII. The nitrogen intake as varied by the addition of urea to the diet. J Nutr 4:479–483
24.
Zurück zum Zitat Hammond KA, Janes DN (1998) The effects of increased protein intake on kidney size and function. J Exp Biol 201:2081–2090PubMed Hammond KA, Janes DN (1998) The effects of increased protein intake on kidney size and function. J Exp Biol 201:2081–2090PubMed
25.
Zurück zum Zitat Murray BM, Campos SP, Schoenl M, MacGillivray MH (1993) Effect of dietary protein intake on renal growth: possible role of insulin-like growth factor-I. J Lab Clin Med 122:677–685PubMed Murray BM, Campos SP, Schoenl M, MacGillivray MH (1993) Effect of dietary protein intake on renal growth: possible role of insulin-like growth factor-I. J Lab Clin Med 122:677–685PubMed
26.
Zurück zum Zitat Fomon SJ (1991) Requirements and recommended dietary intakes of protein during infancy. Pediatr Res 30:391–395PubMed Fomon SJ (1991) Requirements and recommended dietary intakes of protein during infancy. Pediatr Res 30:391–395PubMed
27.
Zurück zum Zitat King AJ, Levey AS (1993) Dietary protein and renal function. J Am Soc Nephrol 3:1723–1737PubMed King AJ, Levey AS (1993) Dietary protein and renal function. J Am Soc Nephrol 3:1723–1737PubMed
28.
Zurück zum Zitat Manz F, Remer T, Decher-Spliethoff E, Hohler M, Kersting M, Kunz C, Lausen B (1995) Effects of a high protein intake on renal acid excretion in bodybuilders. Z Ernahrungswiss 34:10–15PubMed Manz F, Remer T, Decher-Spliethoff E, Hohler M, Kersting M, Kunz C, Lausen B (1995) Effects of a high protein intake on renal acid excretion in bodybuilders. Z Ernahrungswiss 34:10–15PubMed
29.
Zurück zum Zitat Herin P, Zetterstrom R (1987) Studies in renal response to various protein intakes in preterm infants. Acta Paediatr Scand 76:447–452PubMed Herin P, Zetterstrom R (1987) Studies in renal response to various protein intakes in preterm infants. Acta Paediatr Scand 76:447–452PubMed
30.
Zurück zum Zitat Chan AY, Cheng ML, Keil LC, Myers BD (1988) Functional response of healthy and diseased glomeruli to a large, protein-rich meal. J Clin Invest 81:245–254PubMed Chan AY, Cheng ML, Keil LC, Myers BD (1988) Functional response of healthy and diseased glomeruli to a large, protein-rich meal. J Clin Invest 81:245–254PubMed
31.
Zurück zum Zitat Troell S, Berg U, Johansson B, Wikstad I (1988) Comparison between renal parenchymal sonographic volume, renal parenchymal urographic area, glomerular filtration rate and renal plasma flow in children. Scand J Urol Nephrol 22:207–214PubMed Troell S, Berg U, Johansson B, Wikstad I (1988) Comparison between renal parenchymal sonographic volume, renal parenchymal urographic area, glomerular filtration rate and renal plasma flow in children. Scand J Urol Nephrol 22:207–214PubMed
32.
Zurück zum Zitat Mogensen CE, Andersen MJ (1973) Increased kidney size and glomerular filtration rate in early juvenile diabetes. Diabetes 22:706–712PubMed Mogensen CE, Andersen MJ (1973) Increased kidney size and glomerular filtration rate in early juvenile diabetes. Diabetes 22:706–712PubMed
33.
Zurück zum Zitat Ladefoged J, Pedersen F (1968) Relationship between roentgenological size of the kidney and the kidney function. J Urol 99:239–240PubMed Ladefoged J, Pedersen F (1968) Relationship between roentgenological size of the kidney and the kidney function. J Urol 99:239–240PubMed
34.
Zurück zum Zitat Potter D, Jarrah A, Sakai T, Harrah J, Holliday MA (1969) Character of function and size in kidney during normal growth of rats. Pediatr Res 3:51–59PubMed Potter D, Jarrah A, Sakai T, Harrah J, Holliday MA (1969) Character of function and size in kidney during normal growth of rats. Pediatr Res 3:51–59PubMed
35.
Zurück zum Zitat Meek RL, Cooney SK, Flynn SD, Chouinard RF, Poczatek MH, Murphy-Ullrich JE, Tuttle KR (2003) Amino acids induce indicators of response to injury in glomerular mesangial cells. Am J Physiol Renal Physiol 285:F79–F86PubMed Meek RL, Cooney SK, Flynn SD, Chouinard RF, Poczatek MH, Murphy-Ullrich JE, Tuttle KR (2003) Amino acids induce indicators of response to injury in glomerular mesangial cells. Am J Physiol Renal Physiol 285:F79–F86PubMed
36.
Zurück zum Zitat Levey AS, Greene T, Beck GJ, Caggiula AW, Kusek JW, Hunsicker LG, Klahr S (1999) Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study Group. J Am Soc Nephrol 10:2426–2439PubMed Levey AS, Greene T, Beck GJ, Caggiula AW, Kusek JW, Hunsicker LG, Klahr S (1999) Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study Group. J Am Soc Nephrol 10:2426–2439PubMed
37.
Zurück zum Zitat Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D, Curhan GC (2003) The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med 138:460–467PubMed Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D, Curhan GC (2003) The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Ann Intern Med 138:460–467PubMed
38.
Zurück zum Zitat Hostetter TH, Meyer TW, Rennke HG, Brenner BM (1986) Chronic effects of dietary protein in the rat with intact and reduced renal mass. Kidney Int 30:509–517PubMed Hostetter TH, Meyer TW, Rennke HG, Brenner BM (1986) Chronic effects of dietary protein in the rat with intact and reduced renal mass. Kidney Int 30:509–517PubMed
39.
Zurück zum Zitat Hanson LA, Korotkova M, Haversen L, Mattsby-Baltzer I, Hahn-Zoric M, Silfverdal SA, Strandvik B, Telemo E (2002) Breast-feeding, a complex support system for the offspring. Pediatr Int 44:347–352CrossRefPubMed Hanson LA, Korotkova M, Haversen L, Mattsby-Baltzer I, Hahn-Zoric M, Silfverdal SA, Strandvik B, Telemo E (2002) Breast-feeding, a complex support system for the offspring. Pediatr Int 44:347–352CrossRefPubMed
40.
Zurück zum Zitat Fall CH, Barker DJ, Osmond C, Winter PD, Clark PM, Hales CN (1992) Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease. BMJ 304:801–805PubMed Fall CH, Barker DJ, Osmond C, Winter PD, Clark PM, Hales CN (1992) Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease. BMJ 304:801–805PubMed
41.
Zurück zum Zitat Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316:21–25PubMed Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316:21–25PubMed
42.
Zurück zum Zitat Taittonen L, Nuutinen M, Turtinen J, Uhari M (1996) Prenatal and postnatal factors in predicting later blood pressure among children: cardiovascular risk in young Finns. Pediatr Res 40:627–632PubMed Taittonen L, Nuutinen M, Turtinen J, Uhari M (1996) Prenatal and postnatal factors in predicting later blood pressure among children: cardiovascular risk in young Finns. Pediatr Res 40:627–632PubMed
43.
Zurück zum Zitat Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH (1997) Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 350:166–168CrossRefPubMed Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH (1997) Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 350:166–168CrossRefPubMed
44.
Zurück zum Zitat Oudar O, Elger M, Bankir L, Ganten D, Ganten U, Kriz W (1991) Differences in rat kidney morphology between males, females and testosterone-treated females. Ren Physiol Biochem 14:92–102PubMed Oudar O, Elger M, Bankir L, Ganten D, Ganten U, Kriz W (1991) Differences in rat kidney morphology between males, females and testosterone-treated females. Ren Physiol Biochem 14:92–102PubMed
45.
Zurück zum Zitat Murray BM, Brown GP, Schoenl M (1998) Interaction of gender and dietary protein on renal growth and the renal growth hormone-insulin-like growth factor axis. J Lab Clin Med 131:360–369CrossRefPubMed Murray BM, Brown GP, Schoenl M (1998) Interaction of gender and dietary protein on renal growth and the renal growth hormone-insulin-like growth factor axis. J Lab Clin Med 131:360–369CrossRefPubMed
46.
Zurück zum Zitat Mulroney SE, Woda C, Johnson M, Pesce C (1999) Gender differences in renal growth and function after uninephrectomy in adult rats. Kidney Int 56:944–953CrossRefPubMed Mulroney SE, Woda C, Johnson M, Pesce C (1999) Gender differences in renal growth and function after uninephrectomy in adult rats. Kidney Int 56:944–953CrossRefPubMed
47.
Zurück zum Zitat Attia DM, Goldschmeding R, Attia MA, Boer P, Koomans HA, Joles JA (2003) Male gender increases sensitivity to renal injury in response to cholesterol loading. Am J Physiol Renal Physiol 284:F718–F726PubMed Attia DM, Goldschmeding R, Attia MA, Boer P, Koomans HA, Joles JA (2003) Male gender increases sensitivity to renal injury in response to cholesterol loading. Am J Physiol Renal Physiol 284:F718–F726PubMed
Metadaten
Titel
Increased kidney growth in formula-fed versus breast-fed healthy infants
verfasst von
Ida M. Schmidt
Ida N. Damgaard
Kirsten A. Boisen
Claudia Mau
Marla Chellakooty
Klaus Olgaard
Katharina M. Main
Publikationsdatum
01.10.2004
Verlag
Springer-Verlag
Erschienen in
Pediatric Nephrology / Ausgabe 10/2004
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-004-1567-0

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