A Longitudinal Observational Study of Skeletal Development Between Ages 3 Months and 6 Years in Children Fed Human Milk, Milk Formula or Soy Formula.

Abstract

BACKGROUND: Early infant feeding can impact skeletal development. Most children are fed breast milk (BF), dairy based infant formula (MF), or soy based infant formula (SF) during the first year of life. The National Health and Nutrition Examination Survey 2003-2010 reports that 12% of U.S. infants consume soy-based infant formula. Despite potential effects of soy-associated isoflavones on skeletal development, studies investigating bone metabolism and structural and functional bone indices in children are lacking. OBJECTIVE: The aim of this observational study was to investigate early effects of SF intake on bone metabolism and structure during the first 6 years of life by comparing infants fed BF, MF, or SF. DESIGN: A total of 433 healthy infants were followed from 3 months to 6 years of age. Children’s skeletal development was assessed using dual-energy X-ray absorptiometry (DXA, N=433) and peripheral quantitative computed tomography (pQCT, N=78). Urinary biomarkers of bone metabolism (N-terminal telopeptide of type I collagen [NTx] and osteocalcin) were evaluated by immunoassays at 6, 24, 60 and 72 months. RESULTS: No statistically significant group differences were observed in BMD between children who were BF, MF or SF using DXA or pQCT. At 6 years of age, children who consumed SF in infancy had significantly greater whole- body BMC measured by DXA compared to the MF group. Six-month-old SF boys had significantly greater levels of NTx compared to MF boys, as well as significantly greater osteocalcin levels compared to BF boys. CONCLUSIONS: Together, these data suggest that while SF infants at age 6 months may have some enhanced bone metabolism compared to BF and MF infants, as indicated by the urinary biomarkers, no differences in bone metabolism or BMD were noted between ages 2 and 6 years. CLINICAL TRIAL REGISTRY NUMBER: NCT00616395; https://clinicaltrials.gov/ct2/show/NCT00616395.