Published online June 1, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1594-1601 (doi:10.1542/peds.2004-0997)
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Effects of Early Cholesterol Intake on Cholesterol Biosynthesis and Plasma Lipids Among Infants Until 18 Months of Age

Théa A. Demmers, MS, PDt*, Peter J. H. Jones, PhD*, Yanwen Wang, PhD*, Susan Krug, MS, RD{ddagger}, Vivian Creutzinger, BSN, RN{ddagger} and James E. Heubi, MD{ddagger}

* School of Dietetics and Human Nutrition, McGill University, Montreal, Québec, Canada
{ddagger} Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Background. The endogenous cholesterol fractional synthesis rate (FSR) is related inversely to infant dietary cholesterol at 4 months of age; however, it remains to be established whether this effect is permanent, possibly contributing to later hypercholesterolemia.

Objective. To determine whether levels of dietary cholesterol in infancy induced changes in FSR and plasma lipid levels that persisted at 18 months.

Methods. A prospective clinical trial was conducted with 47 infants, from their first week of life until 18 months of age, who received human milk (HM) until weaned (n = 15) or were randomized to receive modified cow's milk formula (MCF) with added cholesterol (n = 15) or cow's milk formula (CF) (n = 17) for 12 months. Cholesterol contents of HM, MCF, and CF were 120, 80, and 40 mg/L, respectively. FSR and plasma lipid levels were measured at 4 and 18 months.

Results. At 4 months, total cholesterol and low-density lipoprotein cholesterol levels were higher for infants fed HM and MCF, compared with CF. High-density lipoprotein cholesterol levels were higher in the MCF group than in the HM and CF groups. FSR in the HM group (0.034 ± 0.005 pools per day) was lower than that in the CF group (0.052 ± 0.005 pools per day). There was no difference between the HM and MCF (0.047 ± 0.005 pools per day) groups or between the MCF and CF groups. At 18 months, there were no differences in FSRs or plasma lipid profiles between the groups.

Conclusion. Although cholesterol intake before weaning affects FSRs and plasma lipid profiles at 4 months, these differences do not persist after weaning to an unrestricted diet at 18 months. This provides additional evidence that there is no imprinting of FSR in infancy with differing dietary levels of cholesterol.

Key Words: cholesterol • breastfed • formula-fed • fractional synthesis rate • deuterium

Abbreviations: FSR, fractional synthesis rate • HM, human milk • MCF, modified cow's milk formula • CF, cow's milk formula • CCHMC, Cincinnati Children's Hospital Medical Center • HDL, high-density lipoprotein • LDL, low-density lipoprotein

Accepted Oct 4, 2004.


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