Infant formula feeding may confer future high LDL vs. breastfeeding
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Cholesterol increases significantly in infants during the first year of life; however, high-sugar formula feeding vs. breastfeeding may be associated with dyslipidemia later in life, researchers wrote in the European Heart Journal.
“In the U.S.A., only 25% of infants are exclusively breastfed and simple carbohydrate-rich formulas are preferentially consumed,” Petra Zubin Maslov, MD, PhD, resident in internal medicine at the Icahn School of Medicine at Mount Sinai in New York, and colleagues wrote. “Spikes in fasting glucose and insulin have been reported in formula-fed infants and are associated with higher levels of proprotein convertase subtilisin/kexin type 9, suggesting a potential link between high simple sugar intake and consequent increase in LDL cholesterol in early childhood.”
Zubin Maslov and colleagues posited there may be a relationship between formula-feeding, PCSK9 and molecular pathways associated with the regulation of LDL metabolism.
According to the report, LDL receptors internalize LDL cholesterol, which is degraded within endosomes, and the receptor is recycled to the hepatocyte cell surface to internalize more cholesterol.
The researchers stated that human breast milk is higher in cholesterol compared with formula, which is higher in plant-based oils.
Five of eight top-selling formula brands in the U.S. use corn syrup solids and brown rice syrup as the main source of carbohydrate; however, lactose has a 50% lower glycemic index. According to the report, 3-month-old infants may consume up to 60 g of carbohydrates in 24 hours and could increase up to 80 g by 6 months.
“It has been proposed that the high cholesterol in breast milk induces nutritional programming wherein early exposure to exogenous cholesterol suppresses endogenous synthesis of cholesterol through downregulation of hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase,” the researchers wrote.
Clinical data suggest increased levels of PCSK9 and increased degradation of LDL receptors may be attributed to increased consumption of simple sugars. Zubin Maslov and colleagues wrote that the associated insulin spike and subsequent activate sterol regulatory element-binding protein 1a and 1c may, in turn, raise LDL.
Therefore, the researchers hypothesized that high-sugar formula may be associated with increased LDL levels in infancy and breast milk, which is high in cholesterol, may suppress endogenous cholesterol production and allow healthy expression of hepatocyte surface LDL receptor, according to the report.
“It is noteworthy that for the first time in history, the 2020 Dietary Guidelines Advisory Committee Report to the U.S. Secretary of Agriculture and Secretary of Health and Human Services has recommended to avoid foods and beverages with added sugars during the first 2 years of life,” the researchers wrote. “Breastfeeding is the preferred form of nutrition during the first 6 to 12 months of life and could help initiate CVD prevention at birth. More research, however, is needed to compare breastfeeding and formula feeding in terms of PCSK9 induction and LDL levels in infancy.”
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