First taste, lasting impact: early-life exposure to added sugars from infant formula and complementary foods on glucose variability and obesity risk

The National Institute of Diabetes and Digestive and Kidney Diseases awarded Children's Mercy Hospital $532,087 on August 28, 2026, under the Diabetes, Digestive, and Kidney Diseases Extramural Research program (CFDA 93.847) to examine the association between added sugar exposure in infant formula and complementary foods and glucose variability during early childhood.

The award funds a prospective cohort study recruiting 200 infants at three months of age and following them through 24 months to evaluate whether higher added sugar intake correlates with greater glucose variability and excessive weight gain. The study will conduct continuous glucose monitoring using the Dexcom G7 system at three, six, and twelve months of age, measuring mean glucose concentration, mean amplitude of glycemic excursions (MAGE), and percent coefficient of variation (CV). At each timepoint, researchers will collect infant anthropometrics (weight and length) and dietary intake via three-day caregiver-reported dietary records. A follow-up assessment at 24 months will evaluate obesity risk. The research hypothesis links early added sugar exposure to increased glucose variability as an early marker of metabolic dysfunction and examines whether this pattern predicts later obesity.

The period of performance runs from August 28, 2026, through June 30, 2031. Work is performed in Kansas City, Missouri.

Abstract

Obesity and type 2 diabetes are global public health crises with origins rooted in early-life nutrition. While breastfeeding confers long-term metabolic protection, most U.S. Infants are introduced to formula within the first 6 months of life. Our recent work shows that infants consuming formula with higher added sugar content gain weight more rapidly and later consume more added sugars from complementary foods. However, no study has directly linked early added sugar exposure to real-time glycemic patterns-a critical GAP given that glucose variability (GV) is a well-established early marker of metabolic dysfunction. Emerging evidence links early sugar exposure with increased risk of metabolic syndrome, insulin resistance, and type 2 diabetes, findings consistent with historical data showing reduced adult diabetes risk among populations with early-life sugar restriction (e.g., during wartime rationing). The overall goal of this proposal is to evaluate whether exposure to added sugars in infant formula and complementary foods is associated with greater GV and whether GV predicts excessive weight gain during the first two years of life. We will recruit 200 infants at 3 months of age and follow them, with glucose monitoring conducted at 3, 6, and 12 months using the dexcom G7 continuous glucose monitoring (CGM) system. GV will be assessed using mean glucose concentration, mean amplitude of glycemic excursions (mage), and percent coefficient of variation (CV). At each timepoint, infant anthropometrics (weight and length) and dietary intake (3-day caregiver-reported dietary records) will also be collected. A follow-up visit at 24 months will assess obesity risk. We propose to examine the association between added sugar intake from infant formula and complementary foods and GV during infancy. We hypothesize that higher percentage of daily energy from added sugars in formula and complementary foods will be associated with increased GV, reflecting poorer glucose control (specific aim 1). We also propose to examine the longitudinal association between GV and rapid weight gain through 24 months (specific aim 2). Rapid weight gain will be operationalized as upward weight-for-age percentile crossing. We hypothesize that increased GV will predict greater weight gain and higher weight-for-length z-scores at 12 and 24 months of age. This study is the first to link real-time glycemic responses with early added sugar exposure from infant formula and complementary foods. IT directly aligns with the recent U.S. Department of health and human services (HHS) and food and drug administration (FDA) initiative to review nutrients in infant formula, underscoring the urgent need for stronger oversight and transparency in infant nutrition. By identifying the role of added sugars-a currently underregulated component-this research will generate critical evidence to inform regulatory updates and improve formula standards.