At a supermarket in Thrissur, Kerala, Meera Menon stood in the baby aisle with her four-month-old son Adhvik on her hip, working her way along the shelves. Milk powders and other infant foods lined both sides, each pack promising stronger bones, a sharper brain or steady weight gain, and every claim seemed aimed squarely at a first-time mother’s worries. She turned one pack over and scanned the ingredient list, attempting to identify which unfamiliar terms masked added sugars. Her routine shopping trip had taken on a new urgency. On October 16, the Food Safety and Standards Authority of India (FSSAI) issued a draft proposal to ban added sucrose and fructose in foods for infants up to six months of age, a move that could change what is sold to families like hers. The proposal is yet to be finalised.
For Meera, the first surprise was that “sugar” is not one thing. “In scientific terms, all carbohydrates are sugars,” says Dr George Jose, senior consultant, neonatology, Aster Medcity, Kochi. Lactose, the main carbohydrate in breast milk, is also a sugar, and a necessary one. “If the added sugar is lactose, then that is required for the appropriate growth of the infant.” The concern, he explains, is with sucrose and fructose. “That is not recommended in infants less than six months old since added sucrose and fructose supply calories without essential micronutrients.”
That is the heart of the “empty calories” worry. If sweet feeds or drinks crowd out nutrient-dense milk, overall diet quality falls, and the supply of nutrients for bone and tissue growth can suffer indirectly. “I think the concern is primarily unnecessary sweetness, dietary displacement and excess energy exposure,” Dr Jose says.
Immunity and sweet tooth
Meera had also heard that most of the immune system lives in the gut. Dr Jose says the figure is often misquoted. “What is true is that about 70-80% of the body’s antibody-making cells are found there, which makes the infant gut the main organ for our defences.” The key player is a bacterium called Bifidobacteria, found in large numbers in breastfed babies, which seems to thrive on lactose. When lactose is replaced with sucrose or fructose in formula, studies suggest the gut moves away from this Bifidobacteria-rich balance. “Some studies show that this weakens a baby’s immunity, although this fact is still controversial,” he says. His bottom line: breast milk remains the gold standard.
There is also the matter of taste. Babies are born liking sweetness, Dr Jose notes, but added sugar early on may push that liking higher through “flavour programming”, in which repeated early exposure teaches a baby what food should taste like. Children who are given sweetened water in their first months showed a stronger preference for it at age two, and early sugar-water exposure was linked to the sugar level children preferred at ages 6 to 10. In a study of Hispanic infants, those fed with corn syrup added formula solids became fussier eaters between 12-24 months and enjoyed food less, while breastfed infants stayed stable.
He is candid about the limits. “Most studies cover infants aged about 6-24 months, so direct evidence for the under-6-month period is limited.” The advice for parents is to avoid added sugar or sweetened water for six months, then offer plain vegetables repeatedly and in variety once solids begin, because familiarity builds liking. A trial follow-up found that trying more vegetables at 14 months was linked to less fussiness at age 3.7 years.
The protein question
The FSSAI discussion has also put infant formula protein under the lens. Human milk is whey-predominant and, in its mature form, contains roughly 0.8-1.0 g of protein per 100 ml, a level that falls as lactation progresses. Formula usually carries somewhat more, because cow’s-milk protein is not used by the body in quite the same way. “Higher formula-protein intake has been associated with more rapid early weight gain,” Dr Jose says.
This is the Early Protein Hypothesis, which Dr Shruti Sastry, consultant, paediatric endocrinology, Aster RV Hospital, Bengaluru, describes as the idea that excess protein in infancy can cause faster weight gain and raise the chance of being overweight in later childhood. The key evidence is the European Childhood Obesity Trial, in which formula-fed babies were randomised to different protein levels. At six years, children who had received the higher-protein formula had a BMI 0.51 points higher and 2.43 times the odds of obesity.
The proposed mechanism runs through hormones. Higher protein intake may raise insulin-releasing amino acids and the growth-promoting hormone IGF-1, encouraging faster weight gain and fat-building activity. Dr Sastry adds a caution: in one randomised study comparing 1.8 g and 2.7 g of protein per 100 kcal, growth differed but IGF-1 did not vary between the formula groups, though both were higher than in breastfed babies. Formula protein is also only one factor, alongside feeding volume, responsive feeding, parental weight, sleep, and family circumstances. “The scientific objective should be adequate protein quality and quantity to support normal growth, rather than unnecessarily high protein intake,” says Dr Jose. Indian formulas must already meet prescribed compositional standards.
Meera put the pack back on the shelf. Adhvik will get nothing but breast milk until he is six months old, and she now reads every label twice. If finalised, the draft rule would make that second reading a little less necessary.
How an infant’s body processes sugar
The difference begins in the gut. Dr Shruti Sastry, consultant, paediatric endocrinology, Aster RV Hospital, Bengaluru, explains that the enzyme lactase splits lactose into glucose and galactose, which are absorbed to fuel the growth of tissues and the brain. Sucrose is broken down by sucrase into glucose and fructose. The glucose prompts the pancreas to release insulin, while fructose is processed in the liver regardless of insulin activity. “Glucose helps in the provision of energy, while excess fructose can be converted to fat by the liver,” she says, adding that this is dose dependent. She is careful not to overstate the case. “The direct evidence about the damaging effects of ordinary consumption of sugar on the health of liver and pancreas of healthy infants is quite poor,” Dr Sastry says. Results from adults or animal studies cannot be transferred automatically to babies, and currently there is no evidence that normal exposure to sucrose or fructose in infancy leads to insulin resistance or obesity. Her practical advice is simple: give age-appropriate feeds and monitor the baby’s growth.