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The Real Scoop: Exploring recently publicized statements about the link between Liver disease and Baby formula

I recently met with a patient who is currently contemplating transitioning from breastfeeding to formula while planning her return to work.  She mentioned a barrier to her plan for transitioning related to her fear of increasing her child’s risk for fatty liver disease.  She recently read an article published in The Washington Post which explores the rising rates of fatty liver disease in children. In this article, it is noted that children of mothers with obesity who consume high amounts of soda and processed foods have an increased risk of their children developing obesity, and fatty liver disease.  Seems like a pretty intuitive finding right? Really it is and this is a pretty tight finding that has been corroborated by a number of studies.

Importantly, fatty liver disease is highly associated with obesity.  If you’re overweight, child or adult, your risk for fatty liver disease goes up.  Way up.  

Michael Goran is a researcher currently at the University of Southern CA and Children’s hospital in LA.  He has investigated a gene variant in Latino populations that may be increasing the risk of fatty liver disease when combined with a high sugar diet.  His concern for the role of formula in infant diets began to rise and led to him leading an investigation into the role of different types of formula and its association with obesity in children.  

Here is a very brief overview of the study that he conducted in 2022 published in the American Journal of Clinical Nutrition.   

The researchers explored the differences in obesity rates between infants fed standard formula vs. a formula which substitutes some of the lactose with corn syrup solids.  This was in an attempt to reduce lactose exposure in children who may have difficulty digesting lactose.  The formula is often marketed as being indicated for babies that have sensitivities or GI irritation.  

They looked at 15,246 children who were in a WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children) that were dispensed regular formula or the Corn Syrup Solids containing formula (CSS formula) and examined weight and height outcomes up to age 4.  What they found was this:

             CSS formula      regular formula

age 2   16.4% obese     14.4% obese

age 3    21.2% obese     19.3% obese

age 4   23% obese          21% obese

When they controlled for differences between the groups that might influence the outcomes (weight of parent, race, socioeconomic status, etc) they found that these differences in rates of obesity still existed.  In this study, the authors state that there is a “10% higher obesity risk for children [exposed to CSS formula]”. While this may be alarming, it’s easy to see that the absolute differences in rates of obesity between the two groups is fairly small at each age group.  

The study results suggest that there may be a slightly higher rate of obesity with the CSS formula exposure compared to regular formula.  

Does this slightly higher obesity rate also correlate with higher risk of fatty liver disease?  We don’t know because the study doesn’t explore this.  We may theorize that higher rates of obesity may lead to higher rates of liver disease, though this would be an assumption only. 

Most importantly, do you need to worry about fatty liver disease or obesity in your child should you elect to formula feed? We don’t know whether certain types of formula are associated with fatty liver disease, so I would argue that there is no need for increased screening or concern.  I do, however, recommend that typical monitoring be conducted for all children, with the aim of keeping children healthy.  A “normal” BMI for your child would be a goal worth striving for.  

Should you select a formula that doesn’t contain CSS?  Well, it’s hard to say, since it’s possible some babies digest the CSS formula more easily.  If your baby is having an easier time with CSS containing formula, it may be worthwhile utilizing it while concurrently monitoring your baby's physical development using the pediatrician’s growth chart.

It's crucial to emphasize that many factors contribute to a child's health, and a balanced diet, regular check-ups, and a healthy lifestyle are essential for preventing obesity, and other health problems, including fatty liver disease.

A final thought: This is an example of a boldly stated conclusion that isn’t quite what it seems.  Conclusion statements in this study and the summary in the Washington Post article may be somewhat misleading.  When you really tease apart the data, it's not as exciting, right?

Anderson CE, Whaley SE, Goran MI. 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). Am J Clin Nutr. 2022 Oct 6;116(4):1002-1009. doi: 10.1093/ajcn/nqac173. PMID: 35998087; PMCID: PMC10157812.

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