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杜 越, 王 亚. [The association between preterm birth and hypertension]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:871-878. [PMID: 39148394 PMCID: PMC11334553 DOI: 10.7499/j.issn.1008-8830.2312129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/04/2024] [Indexed: 08/17/2024]
Abstract
In recent years, the number of premature births worldwide has been increasing, and their long-term prognoses, particularly the cardiovascular outcomes of preterm individuals in adulthood, have become a growing concern. Adults who were born prematurely are at a higher risk for cardiovascular diseases, which may be related to changes in cardiovascular structure, renal structure alterations, changes in body composition, and overactivation of the hypothalamic-pituitary-adrenal axis. To improve the outcomes for preterm individuals, long-term follow-up monitoring and effective prevention and treatment measures are necessary. This article aims to review the relevant literature, summarize the risks and mechanisms of hypertension during childhood and adulthood in those born prematurely, and enhance awareness and understanding of the risk of hypertension in adults who were born prematurely.
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Nagel EM, Super J, Marka NA, Demerath EW, Ramel SE. Body composition after implementation of an enhanced parenteral nutrition protocol in the neonatal intensive care unit: a randomised pilot trial. Ann Hum Biol 2024; 51:2306352. [PMID: 38293997 PMCID: PMC10964316 DOI: 10.1080/03014460.2024.2306352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Very low birthweight (VLBW) infants are at risk for growth failure and poor neurodevelopment. Optimised parenteral nutrition may help promote optimal growth and development, but concerns that provision of enhanced nutrition may contribute to increased early adiposity and later metabolic disease remain. AIM To determine associations between provision of an early enhanced parenteral nutrition protocol or standard parenteral nutrition protocol and growth and body composition for VLBW preterm infants in the neonatal intensive care unit. SUBJECTS This is a secondary analysis of data from a clinical trial aimed at assessing the feasibility and safety of randomising VLBW preterm infants to Standard (n = 45) or Intervention (n = 42) parenteral nutrition groups between August 2017 and June 2019. METHODS We evaluated associations between weekly infant growth and body composition measurements from n = 55 infants (Standard = 29, Intervention = 26) that were clinically stable enough to have body composition measurements taken before discharge using mixed effects linear regression models. RESULT No statistically significant associations between nutrition group and infant growth or body composition measures were observed (p >.05). CONCLUSION In this pilot trial, enhanced parenteral nutrition in the first week of life was not associated with significant differences in infant growth or body composition during hospitalisation.
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Affiliation(s)
- Emily M Nagel
- Division of Epidemiology and Community Health, School of Public Health, University of MN, Minneapolis, MN, USA
| | - Jennifer Super
- Department of Pediatrics, Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas A Marka
- Clinicial and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, School of Public Health, University of MN, Minneapolis, MN, USA
| | - Sara E Ramel
- Department of Pediatrics, Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
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Martins BMR, de Abranches AD, Méio MDBB, Gomes-Junior SCS, Moreira MEL. Early growth and body composition assessed by air displacement plethysmography in infants born with simple gastroschisis. J Pediatr Surg 2023; 58:741-746. [PMID: 36588037 DOI: 10.1016/j.jpedsurg.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/29/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall malformation usually associated with impaired growth. OBJECTIVE To evaluate the growth and body composition of infants born with simple gastroschisis in a referral center. METHODS This was a single-center, prospective case series of infants with simple gastroschisis who were measured at birth, at discharge, and at 3 months. Body composition was assessed via air-displacement plethysmography at discharge and at 3 months. The results were compared with those reported for healthy infants at an equivalent gestational age. RESULTS Simple gastroschisis infants were lighter and smaller at birth and remained similar at 3 months. All anthropometric z scores decreased from birth to discharge, followed by an increase but not a full recovery toward 3 months. Overall, gastroschisis infants had a similar FM percentage, FM% (11.1 ± 4.7), but a lower FFM, FFM (2481 ± 478 g), at discharge. FM% (18.5 ± 5.3) decreased at 3 months, and FFM remained lower (3788 ± 722 g) but improved between the two exams. Boys had significantly more FFM than girls at both evaluations. The multiple regression analysis showed that male sex, prematurity, total parenteral nutrition duration, and exclusive breast milk diets were associated with differences in body composition. CONCLUSIONS Infants with simple gastroschisis cared for in a referral center experienced growth failure at discharge and showed a similar FM% but lower FFM than healthy infants. At 3 months, they exhibited smaller FM% and FFM, but FFM improved after the first exam, representing a better protein accretion. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bianca M R Martins
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Andrea Dunshee de Abranches
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria D B B Méio
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Saint Clair S Gomes-Junior
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria E L Moreira
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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Perrin T, Pradat P, Larcade J, Masclef-Imbert M, Pastor-Diez B, Picaud JC. Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study. Eur J Pediatr 2023; 182:1143-1154. [PMID: 36598567 PMCID: PMC10023649 DOI: 10.1007/s00431-022-04775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
This cohort study aimed to evaluate the impact of an individualised nutritional care approach combining standardised fortification with adjustable fortification on postnatal growth and body composition in extremely low birth weight (ELBW) infants. We included ELBW infants admitted to a neonatal intensive care unit and still hospitalised at 35 weeks postmenstrual age (PMA). The fortification of human milk was standardised (multicomponent fortifier) between 70 mL/kg/day and full enteral feeding, and then individualised using adjustable fortification. When weight gain was below 20 g/kg/day, protein or energy was added when serum urea was below or above 3.5 mmol/L, respectively. Postnatal growth failure (PNGF) was defined as being small for gestational age at discharge and/or when the Z-score loss between birth and discharge was higher than 1. Body composition was assessed between 35 and 41 weeks of PMA. Among the 310 ELBW infants included, the gestational age of birth was 26.7 ± 1.8 weeks, and the birth weight was 800 ± 128 g. The mean Z-score difference between birth and discharge was moderately negative for the weight (-0.32), more strongly negative for length (-1.21), and almost nil for head circumference (+ 0.03). Only 27% of infants presented PNGF. At discharge, fat mass was 19.8 ± 3.6%. Multivariable analysis showed that the proportion of preterm formula received and gestational age at birth were independently associated with the percentage of fat mass. Conclusion: The individualised nutritional care approach applied herein prevented postnatal weight loss in most infants, limited length growth deficit, and supported excellent head circumference growth. What is Known: • At least half of extremely low birth weight infants are small for gestational age at discharge and postnatal growth deficit has been associated with impaired neurocognitive and renal development. • Human milk is the main milk used in neonatology and, although fortification of human milk is a standard of care, there is no consensus regarding the optimal fortification strategy to be adopted. What is New: • Using an approach combining standardised fortification followed by individualised adjustable fortification limited postnatal growth deficit for body weight and head circumference. Postnatal growth failure is not a fatality in extremely low birth weight infants. • Each additional gestational age week at birth resulted in a decrease in fat mass percentage at discharge, which was higher than in foetuses of the same gestational age, likely representing a necessary adaptation to extra-uterine life.
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Affiliation(s)
- Tania Perrin
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, Lyon, 69004, France
| | - Julie Larcade
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Marion Masclef-Imbert
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Blandine Pastor-Diez
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Jean-Charles Picaud
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France.
- Laboratoire CarMen, INSERM, INRA, Université Claude Bernard Lyon1, Pierre-Bénite, Lyon, 69310, France.
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Durda-Masny M, Stróżewska W, Szwed A. Catch-Up Growth as a Risk Factor for Rapid Weight Gain, Earlier Menarche and Earlier Pubertal Growth Spurt in Girls Born Small for Gestational Age (SGA)-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16808. [PMID: 36554686 PMCID: PMC9778860 DOI: 10.3390/ijerph192416808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Most children born small for gestational age (SGA) have rapid postnatal growth. Despite its positive aspects, catch-up growth may affect the level of adipose tissue in the pre-pubertal and pubertal periods and therefore affect the age of puberty. The aim of this study was to determine the associations between size at birth, catch-up growth in infancy, BMI in peripubertal period, age at menarche, and the parameters of adolescent growth spurt of body height in girls born SGA. For 297 girls (22.6% SGA; 77.4% appropriate for gestational age (AGA)) complete body weight and height measurements and age at menarche were obtained. Adolescent growth spurt parameters were estimated using the JPA2 model (AUXAL SSI 3.1). Calculations were made in the Statistica 13 program using the Kruskal-Wallis and Kaplan-Meier tests. Girls born SGA with catch-up had the highest BMIs at the age of 8 years (H = 94.22, p < 0.001) and at menarche (H = 58.21, p < 0.001), experienced menarche earliest (H = 21.77, p < 0.001), same as the onset (H = 6.54, p = 0.012) and peak height velocity (H = 11.71, p = 0.003) of their adolescent growth spurt compared to SGA girls without catch-up and AGA girls. In SGA girls, catch-up growth has far-reaching consequences such as increased risk of fat accumulation and a rapid transition to puberty.
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Ramirez CB, McCoy KL, Jacob R, Lavender E, Bonagurio K, Guerra DA, Karottakuttu S, Gelfond J, McCurnin D, Blanco CL, Moreira AG. Effects of human milk on body composition and growth in very low birthweight infants. Pediatr Res 2022:10.1038/s41390-022-02364-6. [PMID: 36357574 PMCID: PMC10169533 DOI: 10.1038/s41390-022-02364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare body composition and growth in very low birthweight infants according to their source of human milk: maternal expressed breast milk (MEBM) versus donor breast milk (DBM). We hypothesized that infants fed predominately MEBM would exhibit reduced body fat percentage compared to those fed predominately DBM. METHODS Premature infants weighing ≤1500 g on an exclusive human milk diet were enrolled in a single-center study between 2017 and 2021. Demographic data and anthropometric measurements were collected. All infants underwent body composition analysis via dual energy x-ray absorptiometry at 36 weeks corrected post menstrual age. RESULTS A total of 60 infants were enrolled and 48 were included in the primary analysis. No differences were detected in percent body fat (14 vs. 12%, p = 0.7) or fat-free mass (2050 vs. 2130 g, p = 0.7). Both groups displayed similar growth and anthropometric measurements. Caloric and macronutrient intake between groups was similar. CONCLUSION In the cohort of patients studied, no differences were observed in percent body fat based on primary human milk type intake in the first 28 postnatal days. Further investigation is required in a larger population of exclusive human milk fed preterm infants to determine if body composition differences exist based on an infant's primary human milk source. IMPACT Premature infants are at risk for altered body composition at term corrected age, specifically increased body fat percentage, which may have implications for the future. To our knowledge this is the first study exploring body composition outcomes based on an infant's primary human milk source. Infants fed exclusive human milk (e.g., donor vs. maternal) displayed similar percent body fat and growth outcomes.
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Affiliation(s)
- Carina B Ramirez
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA. .,Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA.
| | - Karli L McCoy
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA.,Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Rachel Jacob
- Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Elizabeth Lavender
- Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Krista Bonagurio
- Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Diana Anzueto Guerra
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA
| | | | - Jonathon Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Donald McCurnin
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA.,Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Cynthia L Blanco
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA.,Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
| | - Alvaro G Moreira
- Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA.,Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA
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7
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Casirati A, Somaschini A, Perrone M, Vandoni G, Sebastiani F, Montagna E, Somaschini M, Caccialanza R. Preterm birth and metabolic implications on later life: A narrative review focused on body composition. Front Nutr 2022; 9:978271. [PMID: 36185669 PMCID: PMC9521164 DOI: 10.3389/fnut.2022.978271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Preterm newborn infants are characterized by low body weight and lower fat mass at birth compared with full-term newborn neonates. Conversely, at term corrected age, body fat mass is more represented in preterm newborn infants, causing a predisposition to developing metabolic syndrome and cardiovascular diseases in later life with a different risk profile in men as compared with women. Postnatal growth is a complex change in anthropometric parameters and body composition. Both quantity and quality of growth are regulated by several factors such as fetal programming, early nutrition, and gut microbiota. Weight gain alone is not an optimal indicator of nutritional status as it does not accurately describe weight quality. The analysis of body composition represents a potentially useful tool to predict later metabolic and cardiovascular risk as it detects the quality of growth by differentiating between fat and lean mass. Longitudinal follow-up of preterm newborn infants could take advantage of body composition analysis in order to identify high-risk patients who apply early preventive strategies. This narrative review aimed to examine the state-of-the-art body composition among born preterm children, with a focus on those in the pre-school age group.
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Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- *Correspondence: Amanda Casirati,
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | - Michela Perrone
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Vandoni
- Clinical Nutrition, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Federica Sebastiani
- Endocrinology and Metabolic Diseases, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Montagna
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Baldassarre ME, Panza R, Cresi F, Salvatori G, Corvaglia L, Aceti A, Giannì ML, Liotto N, Ilardi L, Laforgia N, Maggio L, Lionetti P, Agostoni C, Orfeo L, Di Mauro A, Staiano A, Mosca F. Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies. Ital J Pediatr 2022; 48:143. [PMID: 35932061 PMCID: PMC9354266 DOI: 10.1186/s13052-022-01275-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Nutrition in the first 1000 days of life is essential to ensure appropriate growth rates, prevent adverse short- and long-term outcomes, and allow physiologic neurocognitive development. Appropriate management of early nutritional needs is particularly crucial for preterm infants. Although the impact of early nutrition on health outcomes in preterm infants is well established, evidence-based recommendations on complementary feeding for preterm neonates and especially extremely low birth weight and extremely low gestational age neonates are still lacking. In the present position paper we performed a narrative review to summarize current evidence regarding complementary feeding in preterm neonates and draw recommendation shared by joint societies (SIP, SIN and SIGENP) for paediatricians, healthcare providers and families with the final aim to reduce the variability of attitude and timing among professionals.
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Affiliation(s)
- Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy. .,Neonatology and Neonatal Intensive Care Unit, "A. Perrino" Hospital, Brindisi, Italy.
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Corvaglia
- Department of Medical and Surgical Sciences - University of Bologna, Neonatal Intensive Care Unit - IRCCS AOUBO, Bologna, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences - University of Bologna, Neonatal Intensive Care Unit - IRCCS AOUBO, Bologna, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Nadia Liotto
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy
| | - Laura Ilardi
- Neonatology and Neonatal Intensive Care Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Laforgia
- Department of Interdisciplinary Medicine - Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, 70124, Bari, Italy
| | - Luca Maggio
- UOC Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Paolo Lionetti
- Gastroenterology Unit, NEUROFARBA Department, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Intermediate Care Unit, Milan, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Antonio Di Mauro
- Paediatric Primary Care, National Paediatric Health Care System, Via Conversa 12, Margherita di Savoia, BT, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
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Dai W, Liu X, Su H, Li X, Xu Y, Yu Y. Influence of adipose tissue immune dysfunction on childhood obesity. Cytokine Growth Factor Rev 2022; 65:27-38. [PMID: 35595599 DOI: 10.1016/j.cytogfr.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
In recent decades, a dramatic rise has been observed in the prevalence of obesity in childhood and adolescence, along with an increase in fetal microsomia rates. The increased risk of obesity during this key period in development negatively affects the health of the individual later in life. Immune cells residing and recruited to white adipose tissue have been highlighted as important factors contributing to the pathogenesis of childhood obesity. Immune dysfunction in the context of obesity begins early in childhood, which is different from the pathological characteristics and influencing factors of adipose immunity in adults. Here, we explore the current understanding of the roles of childhood and early life events that result in high risks for obesity by influencing adipose tissue immune dysfunction under the pathological condition of obesity. Such knowledge will help in determining the mechanisms of childhood and early life obesity in efforts to ameliorate chronic inflammation-related metabolic diseases.
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Affiliation(s)
- Wanlin Dai
- Health Sciences Institute, Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning, China; College of Basic Medical Science, Key Laboratory of Medical Cell Biology, Ministry of Education, Key Laboratory of Liaoning Province, China Medical University, Shenyang 110122, Liaoning, China; Innovation Institute, China Medical University, China Medical University, Shenyang 110122, Liaoning, China
| | - Xiyan Liu
- Health Sciences Institute, Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning, China; College of Basic Medical Science, Key Laboratory of Medical Cell Biology, Ministry of Education, Key Laboratory of Liaoning Province, China Medical University, Shenyang 110122, Liaoning, China
| | - Han Su
- Health Sciences Institute, Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning, China; College of Basic Medical Science, Key Laboratory of Medical Cell Biology, Ministry of Education, Key Laboratory of Liaoning Province, China Medical University, Shenyang 110122, Liaoning, China
| | - Xuan Li
- Health Sciences Institute, Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning, China; College of Basic Medical Science, Key Laboratory of Medical Cell Biology, Ministry of Education, Key Laboratory of Liaoning Province, China Medical University, Shenyang 110122, Liaoning, China; Innovation Institute, China Medical University, China Medical University, Shenyang 110122, Liaoning, China
| | - Yingxi Xu
- Department of Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China
| | - Yang Yu
- Health Sciences Institute, Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning, China; College of Basic Medical Science, Key Laboratory of Medical Cell Biology, Ministry of Education, Key Laboratory of Liaoning Province, China Medical University, Shenyang 110122, Liaoning, China.
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10
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Kryst Ł, Żegleń M, Woronkowicz A, Kowal M. Body composition of children with different gestation time. Am J Hum Biol 2021; 34:e23696. [PMID: 34726810 DOI: 10.1002/ajhb.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 10/24/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To examine the differences in body composition between prepubescent children, depending on the time of gestation. METHODS The study was conducted among children aged 3-10 years. The thickness of 5 (triceps, subscapular, suprailiac, abdominal, calf) skinfolds, mid-upper arm circumference, body height, weight and femur breadth was measured. Sum of 3 skinfolds, Body Mass Index (BMI) and muscle mass were calculated. Gestation time was obtained using a questionnaire. RESULTS Children in the short gestation time category were generally characterized by the greatest values of the analyzed characteristics, particularly above the ages of 6-8 years. Femur breadth and muscle mass were similar up to the mentioned age in all of the gestation time categories. BMI and all of the adiposity characteristics, below the age of 6 years, were the greatest in the long gestation time category. CONCLUSIONS Results of the present study are important, as excess body mass and adiposity are associated with increased risk of cardiovascular and metabolic abnormalities later in life. Special emphasis should be placed on the prevention of overweight and obesity among premature babies and the education of their parents.
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Affiliation(s)
- Łukasz Kryst
- Department of Anthropology, Faculty of Physical Education and Sport, University of Physical Education in Kraków, Kraków, Poland
| | | | - Agnieszka Woronkowicz
- Department of Anthropology, Faculty of Physical Education and Sport, University of Physical Education in Kraków, Kraków, Poland
| | - Małgorzata Kowal
- Department of Anthropology, Faculty of Physical Education and Sport, University of Physical Education in Kraków, Kraków, Poland
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Geddes DT, Gridneva Z, Perrella SL, Mitoulas LR, Kent JC, Stinson LF, Lai CT, Sakalidis V, Twigger AJ, Hartmann PE. 25 Years of Research in Human Lactation: From Discovery to Translation. Nutrients 2021; 13:3071. [PMID: 34578947 PMCID: PMC8465002 DOI: 10.3390/nu13093071] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
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Affiliation(s)
- Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Leon Robert Mitoulas
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
- Medela, AG, Lättichstrasse 4b, 6340 Baar, Switzerland
| | - Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Lisa Faye Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Vanessa Sakalidis
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | | | - Peter Edwin Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
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12
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Olhager E, Danielsson I, Sauklyte U, Törnqvist C. Different feeding regimens were not associated with variation in body composition in preterm infants. J Matern Fetal Neonatal Med 2021; 35:6403-6410. [PMID: 34098845 DOI: 10.1080/14767058.2021.1914575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The aim was to determine body composition and growth in preterm infants based on two different feeding regimens and to assess how standard and individual fortification (IF) affect energy and protein intake. Body composition was assessed at full term and at four months corrected age. METHODS Sixty preterm infants born before gestational week 32 were randomized either to IF of mother's breast milk after it had been analyzed or to standard fortification (SF) of mother's breast milk based on the average protein and energy content of breast milk. Body composition was measured at full term and at four months corrected age, using air displacement plethysmography. Growth rate and nutritional intake analyses were also conducted. RESULTS At 40 weeks gestational age, there was no difference between weight (g) (IF 3056 ± 472 vs. SF 3119 ± 564), body fat (%) (IF 19 ± 3.3 vs. SF 21 ± 5.6), fat mass, or fat-free mass between the two groups. Furthermore, there was no difference between the groups in weight, length, head circumference, or body composition at four months corrected age. CONCLUSIONS Fortification based on breast milk analysis may not improve growth in preterm infants compared to SF. However, both groups were smaller and had a different body composition at term corrected age compared to infants born at term.
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Affiliation(s)
- Elisabeth Olhager
- Department of Paediatrics, Institution of Clinical Science, Lund University, Lund, Sweden
| | - Ingela Danielsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Science, Linkoping University, Lund, Sweden
| | - Ugne Sauklyte
- Department of Paediatrics, Institution of Clinical Science, Lund University, Lund, Sweden
| | - Caroline Törnqvist
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Science, Linkoping University, Lund, Sweden
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13
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Associations of early nutrition with growth and body composition in very preterm infants: a prospective cohort study. Eur J Clin Nutr 2021; 76:103-110. [PMID: 33790398 DOI: 10.1038/s41430-021-00901-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE To investigate impacts of early postnatal macronutrient intakes on growth and body composition of preterm infants within the first 6 months. SUBJECTS/METHODS One hundred and thirty-three very preterm (VPT) and/or very low birth weight (VLBW) infants were consecutively included. Enteral and parenteral macronutrient intakes during the first 28 days were recorded and average daily intakes were calculated. Growth was measured at birth, term age, and 6 months of corrected age (CA). Body composition was examined by air displacement plethysmograph at term age and 6 months of CA. Associations of nutrient intakes with growth and body composition over time were analyzed using generalized estimating equation. RESULTS After adjusting for covariates, higher daily protein, lipid, and energy intake during the first 28 days was associated with higher weight at term age for every 1 g/kg/day increment of protein and lipid intake, and every 10 kcal/kg/day increment of energy intake was associated with 0.50 (95% CI 0.04, 0.96), 0.29 (95% CI 0.07, 0.51), and 0.27 (95% CI 0.10, 0.44) higher weight z-score, respectively. Higher protein intake was associated with lower z-score of fat mass (FM, β = -1.88, 95% CI -3.53, -0.23) and percentage of body fat (PBF, β = -2.18, 95% CI -3.98, -0.39) at 6 months of CA, but higher lipid and carbohydrate intake was associated with higher FM and PBF z-scores at 6 months of CA. CONCLUSIONS Macronutrient intakes during the first month of life have impacts on growth and body composition before 6 months of age. Higher daily protein intake is associated with a better growth and healthier body composition for VPT/VLBW infants.
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14
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Orsso CE, Colin-Ramirez E, Field CJ, Madsen KL, Prado CM, Haqq AM. Adipose Tissue Development and Expansion from the Womb to Adolescence: An Overview. Nutrients 2020; 12:E2735. [PMID: 32911676 PMCID: PMC7551046 DOI: 10.3390/nu12092735] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Prevalence rates of pediatric obesity continue to rise worldwide. Adipose tissue (AT) development and expansion initiate in the fetus and extend throughout the lifespan. This paper presents an overview of the AT developmental trajectories from the intrauterine period to adolescence; factors determining adiposity expansion are also discussed. The greatest fetal increases in AT were observed in the third pregnancy trimester, with growing evidence suggesting that maternal health and nutrition, toxin exposure, and genetic defects impact AT development. From birth up to six months, healthy term newborns experience steep increases in AT; but a subsequent reduction in AT is observed during infancy. Important determinants of AT in infancy identified in this review included feeding practices and factors shaping the gut microbiome. Low AT accrual rates are maintained up to puberty onset, at which time, the pattern of adiposity expansion becomes sex dependent. As girls experience rapid increases and boys experience decreases in AT, sexual dimorphism in hormone secretion can be considered the main contributor for changes. Eating patterns/behaviors and interactions between dietary components, gut microbiome, and immune cells also influence AT expansion. Despite the plasticity of this tissue, substantial evidence supports that adiposity at birth and infancy highly influences its levels across subsequent life stages. Thus, a unique window of opportunity for the prevention and/or slowing down of the predisposition toward obesity, exists from pregnancy through childhood.
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Affiliation(s)
- Camila E. Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | | | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | - Karen L. Madsen
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2C2, Canada;
| | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; (C.E.O.); (C.J.F.); (C.M.P.)
| | - Andrea M. Haqq
- Department of Pediatrics and Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R7, Canada
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15
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Roggero P, Liotto N, Menis C, Mosca F. New Insights in Preterm Nutrition. Nutrients 2020; 12:nu12061857. [PMID: 32580318 PMCID: PMC7353182 DOI: 10.3390/nu12061857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (C.M.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence:
| | - Nadia Liotto
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (C.M.); (F.M.)
| | - Camilla Menis
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (C.M.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (C.M.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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16
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Liotto N, Amato O, Piemontese P, Menis C, Orsi A, Corti MG, Colnaghi M, Cecchetti V, Pugni L, Mosca F, Roggero P. Protein Intakes during Weaning from Parenteral Nutrition Drive Growth Gain and Body Composition in Very Low Birth Weight Preterm Infants. Nutrients 2020; 12:nu12051298. [PMID: 32370158 PMCID: PMC7282247 DOI: 10.3390/nu12051298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022] Open
Abstract
Weaning from parenteral to enteral nutrition is a critical period to maintain an adequate growth in very low birth weight preterm infants (VLBWI). We evaluated the actual daily nutritional intakes during the transition phase (TP) in VLBWI with adequate and inadequate weight growth velocity (GV ≥ 15 vs. GV < 15 g/kg/day). Fat-free mass (FFM) at term-corrected age (TCA) was compared between groups. Based on actual nutritional intakes of infants with adequate growth, we defined a standardized parenteral nutrition bag (SPB) for the TP. One hundred and six VLBWI were categorized as group 1 (G1): [GV < 15 (n = 56)] and group 2 (G2): [GV ≥ 15 (n = 50)]. The TP was divided into two periods: main parenteral nutritional intakes period (parenteral nutritional intakes >50%) (M-PNI) and main enteral nutritional intakes period (enteral nutritional intakes >50%) (M-ENI). Anthropometric measurements were assessed at discharge and TCA, FFM deposition at TCA. During M-PNI, G2 showed higher enteral protein intake compared to G1 (p = 0.05). During M-ENI, G2 showed higher parenteral protein (p = 0.01) and energy intakes (p < 0.001). A gradual reduction in SPB volume, together with progressive increase in enteral volume, allowed nutritional intakes similar to those of G2. At TCA, G2 had higher FFM compared to G1 (p = 0.04). The reasoned use of SPB could guarantee an adequate protein administration, allowing an adequate growth and higher FFM deposition.
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Affiliation(s)
- Nadia Liotto
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Orsola Amato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Pasqua Piemontese
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Camilla Menis
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Anna Orsi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Maria Grazia Corti
- Pharmacy Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (IRCCS), 20122 Milan, Italy;
| | - Mariarosa Colnaghi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Valeria Cecchetti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.L.); (O.A.); (P.P.); (C.M.); (A.O.); (M.C.); (V.C.); (L.P.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence:
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Bergner EM, Shypailo R, Visuthranukul C, Hagan J, O'Donnell AR, Hawthorne KM, Abrams SA, Hair AB. Growth, Body Composition, and Neurodevelopmental Outcomes at 2 Years Among Preterm Infants Fed an Exclusive Human Milk Diet in the Neonatal Intensive Care Unit: A Pilot Study. Breastfeed Med 2020; 15:304-311. [PMID: 32298596 PMCID: PMC7360515 DOI: 10.1089/bfm.2019.0210] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Long-term outcomes of preterm infants fed an exclusive human milk-based (EHM) diet using a donor human milk-based fortifier are not well defined. Materials and Methods: Infants ≤1,250 g birth weight (BW) were studied prospectively at two outpatient visits: 12-15 and 18-22 months corrected age (CA). Dual-energy X-ray absorptiometry and Bayley Scales of Infant and Toddler Development III (BSID-III) were performed at 18-22 months CA. Results: In this pilot study, 51 preterm infants (gestational age 27.8 ± 2.6 weeks and BW 893 ± 204 g) were evaluated. While anthropometric z-scores were significantly lower at discharge compared with birth, z-scores returned to birth levels by 12-15 months CA (length and head circumference [HC]) and 18-22 months CA (weight). Body composition at 2 years of age was similar to term-matched controls. Inpatient growth was significantly correlated with bone density, lean mass (LM), and fat-free mass at 18-22 months CA. Increased mother's own milk (MOM) was significantly correlated with decreased fat mass indices. BSID-III showed that 0% of cognitive composite scores were <70. Conclusions: In addition to returning to BW, length, and HC z-scores by 2 years of age, body composition analysis revealed that increase in body size was appropriate as reflected by LM and bone density similar to matched term controls without an increase in fat mass. No child had severe cognitive developmental delay using a cutoff score of 70. Inpatient growth and increased receipt of MOM correlated with favorable growth and body composition outcomes. Positive outcomes as shown in this study to confirm postdischarge safety of an EHM diet during hospitalization.
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Affiliation(s)
- Erynn M Bergner
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Section of Neonatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Roman Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Chonnikant Visuthranukul
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Section of Nutrition, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Pediatric Nutrition STAR, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Andrea R O'Donnell
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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18
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Complementary Feeding in Preterm Infants: Where Do We Stand? Nutrients 2020; 12:nu12051259. [PMID: 32365485 PMCID: PMC7281965 DOI: 10.3390/nu12051259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 11/17/2022] Open
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19
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Chmielewska A, Farooqi A, Domellöf M, Ohlund I. Lean Tissue Deficit in Preterm Infants Persists up to 4 Months of Age: Results from a Swedish Longitudinal Study. Neonatology 2020; 117:80-87. [PMID: 31822002 DOI: 10.1159/000503292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND At term-equivalent age, infants born prematurely are shorter, lighter and have more adipose tissue compared to term counterparts. Little is known on whether the differences in body composition persist in later age. METHODS We prospectively recruited 33 preterm infants (<32 weeks gestational age, mean gestational age 28.1 weeks) and 69 term controls. Anthropometry and body composition (air displacement plethysmography) were monitored up to 4 months of age. Nutrient intakes from preterm infants were collected from clinical records. RESULTS At 4 months of age preterm infants were lighter and shorter than term controls (mean weight-for-age z-score: -0.73 vs. 0.06, p = 0.001; mean length-for-age z-score: -1.31 vs. 0.29, p < 0.0001). The significantly greater percentage of total body fat seen in preterm infants at term-equivalent age (20.2 vs. 11.7%, p < 0.0001) was no longer observed at 4 months. A deficit of fat-free mass persisted until 4 months of age (fat-free mass at term-equivalent age: 2.71 vs. 3.18 kg, p < 0.0001; at 4 months: 4.3 vs. 4.78 kg, p < 0.0001). The fat mass index and fat-free mass index (taking length into account) did not differ between the groups. Nutrition had little effect on body composition. Higher protein intake at week 2 was a negative predictor of fat-free mass at discharge. CONCLUSIONS At 4 months corrected age, preterm infants were both lighter and shorter than term controls and the absolute fat-free mass deficit remained until this age. Little effect of nutrition on body composition was observed.
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Affiliation(s)
- Anna Chmielewska
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,
| | - Aijaz Farooqi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Inger Ohlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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20
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Vereen RJ, Dobson NR, Olsen CH, Raiciulescu S, Kuehn D, Stokes TA, Hunt CE. Longitudinal growth changes from birth to 8-9 years in preterm and full term births. J Neonatal Perinatal Med 2020; 13:223-230. [PMID: 31796687 DOI: 10.3233/npm-190219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study is to assess the effect of age at adiposity rebound (AR) and changes in growth between birth and 6 months on growth status at 8-9 years in children born term and preterm. Age at AR is inversely correlated with risk for later obesity in children born full term, but has not been analyzed in children born preterm. METHODS Birth anthropometrics, and weight and length/height data from age 6 months through 8-9 years were recorded for 175 children born in 2008 in the military health system. Calculated variables include body mass index (BMI, kg/m2), Z-scores, and age at AR. RESULTS Age at AR could be calculated for 150 children (32% preterm); average age was 5.4 years and 5.3 years for children born term and preterm, respectively (NS). For children born term and preterm, there was a significant correlation between younger age at AR and higher BMI Z-score at 8-9 years (r = - 0.685), and a direct relationship between weight Z-score change from birth to 6 months and weight Z-scores at 8-9 years (p = 0.034). CONCLUSIONS Younger age at AR correlates with higher BMI Z-score at 8-9 years in children born both term and preterm. Weight gain from birth to 6 months correlates with weight Z-score at 8-9 years. These results emphasize the importance of younger age at AR in addition to greater early weight gain as an indicator of later obesity.
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Affiliation(s)
- Rasheda J Vereen
- National Capital Consortium Pediatrics Residency (Walter Reed National Military Medical Center), Bethesda, MD, USA
| | - Nicole R Dobson
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cara H Olsen
- Department Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sorana Raiciulescu
- Department Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Devon Kuehn
- Department of Pediatrics, East Carolina University, Greenville, NC, USA
| | - Theophil A Stokes
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Carl E Hunt
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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21
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Liotto N, Roggero P, Giuliani F, Morniroli D, Giannì ML, Bracco B, Menis C, Orsi A, Piemontese P, Amato O, Mosca F. How does gestational age affect growth and body composition of preterm twins? Pediatr Res 2020; 87:57-61. [PMID: 31401647 DOI: 10.1038/s41390-019-0530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 06/03/2019] [Accepted: 07/25/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Twins experience altered growth compared to singletons. The primary aim of this study was to compare growth and body composition (BC) of twin and singleton preterm infants from birth to 3 months according to gestational age (GA). Secondary aims were to evaluate the effect of chorionicity and mode of feeding on twins' BC. METHODS Anthropometric measurements and BC were performed at term and 3 months in preterm infants (GA < 37 weeks). Infants were categorized as: extremely, very, moderate and late preterm infants. Chorionicity was assigned as monochorionic, dichorionic or multichorionic. Mode of feeding was recorded as any human milk feeding vs formula feeding. RESULTS Five hundred and seventy-six preterm infants were included (223 twins). Late-preterm twins were lighter and shorter at each study point; fat-free mass (FFM) was lower in these infants at each study point, compared to singletons. No differences were found between twins and singleton on the other category. Multichorionic infants had an FFM deficit compared to monochorionic and dichorionic at term, whereas no differences were found at 3 months. FFM at term was negatively associated with being twin and formula-fed. CONCLUSIONS Twins and singletons born before 34 weeks' GA showed similar anthropometry and BC. Conversely, twin late-preterm infants showed different growth and BC compared to singletons.
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Affiliation(s)
- Nadia Liotto
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Paola Roggero
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Giuliani
- Department of Pediatrics, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Morniroli
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria L Giannì
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Beatrice Bracco
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Menis
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Orsi
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasqua Piemontese
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orsola Amato
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- NICU Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Bruckner M, Khan Z, Binder C, Morris N, Windisch B, Holasek S, Urlesberger B. Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age. Front Pediatr 2020; 8:61. [PMID: 32219084 PMCID: PMC7078645 DOI: 10.3389/fped.2020.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Early nutritional support of preterm infants is important because it influences long-term health and development. Body composition has an influence on cardiovascular disease, metabolic syndrome, and neurocognitive outcome in the long term. Objective: To assess body composition in preterm infants <32 weeks of gestation at term-equivalent age and to analyze the influence of an optimized nutritional approach. Methods: This is a prespecified secondary outcome analysis of a prospective observational study comparing the body composition in regard to gestational age. The preterm infants were classified according to gestational age as extremely preterm infants (<28 weeks gestation at birth) and very preterm infants (≥28 weeks gestation at birth) and according to weight percentile as appropriate for gestational age and small for gestational age. Body composition was determined by air displacement plethysmography using the PEA POD. The preterm infants obtained nutrition according to the ESPGHAN 2010 Guidelines. Results: Seventy-four preterm infants were analyzed. The mean (SD) gestational age was 28.7 (2.4) weeks, and birth weight was 1,162 (372) g. Fat mass percentage was significantly higher in extremely preterm infants in comparison to very preterm infants [17.0, 95% confidence interval (CI) 15.9-18.1 vs. 15.5, 95% CI 14.7-16.2]. There was no significant difference of fat mass percentage according to weight percentiles. Conclusions: Extremely preterm infants had a significantly higher fat mass percentage compared to very preterm infants at term-equivalent age. There was no significant difference of fat mass percentage according to weight percentiles.
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Affiliation(s)
- Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Zahra Khan
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicholas Morris
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernadette Windisch
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Centre, Medical University Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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23
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Environmental Exposures and Adverse Pregnancy-Related Outcomes. HEALTH IMPACTS OF DEVELOPMENTAL EXPOSURE TO ENVIRONMENTAL CHEMICALS 2020. [DOI: 10.1007/978-981-15-0520-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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24
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Li Y, Liu X, Modi N, Uthaya S. Impact of breast milk intake on body composition at term in very preterm babies: secondary analysis of the Nutritional Evaluation and Optimisation in Neonates randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F306-F312. [PMID: 30007939 DOI: 10.1136/archdischild-2017-314625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/11/2018] [Accepted: 06/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the impact of breast milk (BM) intake on body composition at term in very preterm infants. DESIGN Preplanned secondary analysis of the Nutritional Evaluation and Optimisation in Neonates Study, a 2-by-2 factorial randomised controlled trial of preterm parenteral nutrition (PN). SETTING Four National Health Service hospitals in London and South-East England. PATIENTS Infants born at <31 weeks of gestation; infants with life-threatening congenital abnormalities and those unable to receive trial PN within 24 hours of birth were ineligible. 133 infants survived and underwent whole-body MRI at term (37-44 weeks postmenstrual age). MAIN OUTCOME MEASURES Non-adipose tissue mass (non-ATM), ATM and ATM as a percentage of body weight (% ATM) at term. RESULTS Compared with the exclusively BM group (proportion of BM=100% milk, n=56), predominantly formula-fed infants (BM ≤50%, n=38) weighed 283.6 g (95% CI 121.6 to 445.6) more, had 257.4 g (139.1-375.7) more non-ATM and a greater positive weight Z-score change between birth and term. There were no significant differences in weight, non-ATM and weight Z-score change between the exclusively and predominantly BM (BM 51%-99%, n=39) groups. Compared with the exclusively BM group no significant differences were observed in ATM and %ATM in the predominantly BM and predominantly formula-fed groups. CONCLUSIONS The slower weight gain of preterm infants fed BM appears to be due to a deficit in non-ATM and may reflect lower protein intake. Whether this pattern persists into childhood, is altered by BM fortification or later diet, or relates to functional outcomes, are important research questions. CLINICAL TRIAL REGISTRATION ISRCTN29665319, post results.
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Affiliation(s)
- Yangmei Li
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Neena Modi
- Neonatal Medicine, Chelsea and Westminster National Health Service Foundation Trust, London, UK.,Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Sabita Uthaya
- Neonatal Medicine, Chelsea and Westminster National Health Service Foundation Trust, London, UK.,Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
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25
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Strydom K, Van Niekerk E, Dhansay MA. Factors affecting body composition in preterm infants: Assessment techniques and nutritional interventions. Pediatr Neonatol 2019; 60:121-128. [PMID: 29239827 DOI: 10.1016/j.pedneo.2017.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 07/26/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022] Open
Abstract
Limited research has been conducted that elucidates the growth and body composition of preterm infants. It is known that these infants do not necessarily achieve extra-utero growth rates and body composition similar to those of their term counterparts. Preterm infants, who have difficulty in achieving these growth rates, could suffer from growth failure. These infants display an increased intra-abdominal adiposity and abnormal body composition when they achieve catch-up growth. These factors affect the quality of weight gain, as these infants are not only shorter and lighter than term infants, they also have more fat mass (FM) and less fat-free mass (FFM), resulting in a higher total fat percentage. This could cause metabolic syndrome and cardiovascular problems to develop later in a preterm infant's life. The methods used to determine body composition in preterm infants should be simple, quick, non-invasive and inexpensive. Available literature was reviewed and the Dauncey anthropometric model, which includes skinfold thickness at two primary sites and nine body dimensions, is considered in this review the best method to accurately determine body composition in preterm infants, especially in resource-poor countries. It is imperative to accurately assess the quality of growth and body composition of this fragile population in order to determine whether currently prescribed nutritional interventions are beneficial to the overall nutritional status and quality of life-in the short- and long-term-of the preterm infant, and to enable timely implementation of appropriate interventions, if required.
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Affiliation(s)
- K Strydom
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - E Van Niekerk
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - M A Dhansay
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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26
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The fortification method relying on assumed human milk composition overestimates the actual energy and macronutrient intakes in very preterm infants. Matern Health Neonatol Perinatol 2018; 4:22. [PMID: 30237896 PMCID: PMC6142318 DOI: 10.1186/s40748-018-0090-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022] Open
Abstract
Background To achieve recommended nutrient intakes in preterm infants, the target fortification method of human milk (HM) was proposed as an alternative to standard fortification method. We aimed to compare assumed energy and macronutrient intakes based on standard fortified HM with actual intakes relying on measured composition of human milk (HM), in a cohort of HM-fed very preterm infants. Methods This study is a secondary retrospective analysis, in which assumed energy and macronutrient contents of daily pools of own mother’s milk (OMM) from 33 mothers and donated HM (DHM) delivered to infants were compared with the measured values using a mid-infrared HM analyzer. A fortification method consisting of modular protein and/or fat supplements added to standard fortified HM was used to provide the minimum recommended daily intakes of energy 110 Kcal/kg and protein up to 4.0 g/kg. Assumed nutrient intakes were compared with actual nutrient intakes from full enteral feeding to 35 weeks plus 6 days postmenstrual age, using the Wilcoxon matched-pairs signed ranks test. Results The composition of 1181 samples of daily pools of HM were measured. For 90.2% of study days, infants were exclusively fed OMM and in remaining days fed OMM plus DHM. Comparing with reported preterm OMM composition, measured protein concentration was significantly lower, and energy and other macronutrient concentrations were lower only from the second to third postnatal week. Using fortified HM, the actual median daily intakes of energy, protein, and fat were significantly lower (113.3 vs. 120.7 Kcal/kg, 4.45 vs. 4.73 g/kg, and 4.96 vs. 5.35 g/kg, respectively) and the actual protein-to-energy ratio (PER) significantly higher than what was assumed (4.2 vs. 4.0), without differences in carbohydrate intake. Conclusions When fortifying the HM, we used conservative target intakes trying not to exceed the osmolarity recommended for infant feeds. Actual energy, protein and fat intakes in OMM were significantly lower than assumed. This resulted in inadequate intake using our fortification method, that did not compensate the suboptimal measured energy and macronutrient contents of OMM delivered. Further studies comparing assumed with the gold standard target fortification are needed to determine safe upper limits of assumed fortification.
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27
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Kotecha SJ, Lowe J, Kotecha S. Effect of foetal and infant growth and body composition on respiratory outcomes in preterm-born children. Paediatr Respir Rev 2018; 28:55-62. [PMID: 29343422 DOI: 10.1016/j.prrv.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/21/2023]
Abstract
Body composition and growth outcomes of preterm-born subjects have been studied by many researchers. In general, preterm-born children have lower height and weight especially in infancy. Despite showing potential for catch-up growth, they continue to lag behind their term counterparts in adolescence and adulthood. The various methods of studying body composition and the differing gestations and ages at which it is assessed may go some way to explaining the inconsistent results observed in different studies. In addition, there is a paucity of data on the effects of foetal and infant growth and of body composition on later respiratory outcomes. In largely term-born subjects, foetal growth and growth trajectories appear to have differential effects on later respiratory outcomes. Early weight gain in infancy appears to be associated with increased respiratory symptoms in childhood but catch-up growth in infancy appears to be associated with possible improved lung function status.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - John Lowe
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
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28
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Darmaun D, Lapillonne A, Simeoni U, Picaud JC, Rozé JC, Saliba E, Bocquet A, Chouraqui JP, Dupont C, Feillet F, Frelut ML, Girardet JP, Turck D, Briend A. Parenteral nutrition for preterm infants: Issues and strategy. Arch Pediatr 2018; 25:286-294. [PMID: 29656825 DOI: 10.1016/j.arcped.2018.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/26/2018] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.
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Affiliation(s)
- D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France.
| | | | - U Simeoni
- Université de Lausanne, CHUV, 1011 Lausanne, Suisse
| | - J-C Picaud
- Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - J-C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - E Saliba
- Université François-Rabelais, 37000 Tours, France
| | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | | | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Université Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J-P Girardet
- Université Pierre et Marie Curie-Paris 6, 75005 Paris, France
| | - D Turck
- Université Lille 2, LIRIC-Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
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29
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Abstract
OBJECTIVES Increasing evidence demonstrates that body composition in early life contributes to the programming of health later in life in both full-term and preterm infants. Given the important role of body composition, the increased availability of easy, noninvasive, and accurate techniques for its assessment has been recommended. The aim of the present study was to identify basic characteristics and anthropometric measurements that best correlate with body composition in infants. METHODS Anthropometric measurements and body composition assessed by air-displacement plethysmography were assessed either at birth or at term-corrected age in 1239 infants (654 full-term, 585 preterm). The associations of sex, GA (gestational age), and weight with FFM (fat-free mass) and FM (fat mass) adjusted by length (g/cm) were investigated by multiple linear regression models. Bland-Altman tests were performed, and an equation for calculating FFM was determined. RESULTS Preterm infants exhibited increased FM and reduced FFM compared with full-term infants (477.6 ± 204 vs 259.7 ± 147 g and 2583 ± 494 vs 2770 ± 364 g, respectively). GA, male sex, and weight were positively associated with FFM (r = 0.806, P < 0.0001; 6.1 g of average bias). GA and male sex were negatively associated with FM, whereas weight was positively associated with FM (r = 0.641, P < 0.0001; 4.9 g of average bias). CONCLUSIONS The assessment of body composition represents the criterion standard. When body composition assessment is not feasible, the equation based on sex, GA, and anthropometric measurements can be useful in predicting body composition in both full-term and preterm infants.
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30
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High-resolution rapid neonatal whole-body composition using 3.0 Tesla chemical shift magnetic resonance imaging. Pediatr Res 2018; 83:638-644. [PMID: 29168981 DOI: 10.1038/pr.2017.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/17/2017] [Indexed: 11/08/2022]
Abstract
BackgroundTo evaluate a whole-body rapid imaging technique to calculate neonatal lean body mass and percentage adiposity using 3.0 Tesla chemical shift magnetic resonance imaging (MRI).MethodsA 2-Point Dixon MRI technique was used to calculate whole-body fat and water images in term (n=10) and preterm (n=15) infants.ResultsChemical shift images were obtained in 42 s. MRI calculated whole-body mass correlated closely with measured body weight (R2=0.87; P<0.001). Scan-rescan analysis demonstrated a 95% limit of agreement of 1.3% adiposity. Preterm infants were born at a median of 25.7 weeks' gestation with birth weight 840 g. At term-corrected age, former preterm infants were lighter than term-born controls, 2,519 vs. 3,094 g regressing out age and group as covariates (P=0.005). However, this was not because of reduced percentage adiposity 26% vs. 24% (P=0.28). At term-corrected age, former preterm infants had significantly reduced lean body mass compared with that of term-born controls 1,935 vs. 2,416 g (P=0.002).ConclusionRapid whole-body imaging for assessment of lean body mass and adiposity in term and preterm infants is feasible, accurate, and repeatable. Deficits in whole-body mass in former preterm infants at term-corrected age are due to reductions in lean body mass not due to differences in adiposity.
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31
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Morniroli D, Dessì A, Giannì ML, Roggero P, Noto A, Atzori L, Lussu M, Fanos V, Mosca F. Is the body composition development in premature infants associated with a distinctive nuclear magnetic resonance metabolomic profiling of urine? J Matern Fetal Neonatal Med 2018; 32:2310-2318. [PMID: 29357769 DOI: 10.1080/14767058.2018.1432040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Preterm infants' body composition at term-corrected age differs from that of term infants but appears to be similar at the age of 3 months. The aim of this study was to compare the metabolomic pattern of preterm infants at term and at 3 months with that of term infants and to determine its association with body composition development. METHOD We designed a pilot study. Growth and body composition were evaluated by an air displacement plethysmography system in 13 preterm infants and seven term newborns at term and at 3 months of corrected age. Urine samples were collected at the same time points and analysed by nuclear magnetic resonance. RESULTS At term-corrected age, preterm infants showed a higher fat mass percentage compared with that of term newborns, whereas at 3 months of corrected age, the body composition parameters were similar between the groups. At the first time point, nuclear magnetic resonance analysis showed a urinary increase in choline/phosphocholine, betaine and glucose in preterm infants. At the second time point, the preterm group exhibited a urinary increase in choline/phosphocholine and a decrease in betaine. CONCLUSIONS The increased urinary excretion of choline, a betaine precursor, could reflect a potential altered metabolism in preterm infants.
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Affiliation(s)
- Daniela Morniroli
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Angelica Dessì
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Maria Lorella Giannì
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Paola Roggero
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Antonio Noto
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Luigi Atzori
- c Department of Biomedical Sciences , University of Cagliari , Cagliari , Italy
| | - Milena Lussu
- c Department of Biomedical Sciences , University of Cagliari , Cagliari , Italy
| | - Vassilios Fanos
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Fabio Mosca
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
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32
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Villela LD, Méio MDBB, de Matos Fonseca V, de Abranches AD, Junior SCG, da Costa ACC, Murta MM, Nehab SRG, Soares FVM, Moreira MEL. Growth and body composition of preterm infants less than or equal to 32 weeks: Cohort study. Early Hum Dev 2018; 117:90-95. [PMID: 29360048 DOI: 10.1016/j.earlhumdev.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/08/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. AIM To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. STUDY DESIGN COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. OUTCOME MEASURES Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. RESULTS Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. CONCLUSIONS The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not.
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Villar J, Giuliani F, Barros F, Roggero P, Coronado Zarco IA, Rego MAS, Ochieng R, Gianni ML, Rao S, Lambert A, Ryumina I, Britto C, Chawla D, Cheikh Ismail L, Ali SR, Hirst J, Teji JS, Abawi K, Asibey J, Agyeman-Duah J, McCormick K, Bertino E, Papageorghiou AT, Figueras-Aloy J, Bhutta Z, Kennedy S. Monitoring the Postnatal Growth of Preterm Infants: A Paradigm Change. Pediatrics 2018; 141:peds.2017-2467. [PMID: 29301912 DOI: 10.1542/peds.2017-2467] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 11/24/2022] Open
Abstract
There is no consensus regarding how the growth of preterm infants should be monitored or what constitutes their ideal pattern of growth, especially after term-corrected age. The concept that the growth of preterm infants should match that of healthy fetuses is not substantiated by data and, in practice, is seldom attained, particularly for very preterm infants. Hence, by hospital discharge, many preterm infants are classified as postnatal growth-restricted. In a recent systematic review, 61 longitudinal reference charts were identified, most with considerable limitations in the quality of gestational age estimation, anthropometric measures, feeding regimens, and how morbidities were described. We suggest that the correct comparator for assessing the growth of preterm infants, especially those who are moderately or late preterm, is a cohort of preterm newborns (not fetuses or term infants) with an uncomplicated intrauterine life and low neonatal and infant morbidity. Such growth monitoring should be comprehensive, as recommended for term infants, and should include assessments of postnatal length, head circumference, weight/length ratio, and, if possible, fat and fat-free mass. Preterm postnatal growth standards meeting these criteria are now available and may be used to assess preterm infants until 64 weeks' postmenstrual age (6 months' corrected age), the time at which they overlap, without the need for any adjustment, with the World Health Organization Child Growth Standards for term newborns. Despite remaining nutritional gaps, 90% of preterm newborns (ie, moderate to late preterm infants) can be monitored by using the International Fetal and Newborn Growth Consortium for the 21st Century Preterm Postnatal Growth Standards from birth until life at home.
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Affiliation(s)
- Jose Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
| | - Francesca Giuliani
- Azienda Ospedaliera, Ospedale Infantile Regina Margherita Sant'Anna, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fernando Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Paola Roggero
- NICU, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Milano, Italy
| | | | - Maria Albertina S Rego
- Departmento de Pediatria, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Lorella Gianni
- NICU, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Milano, Italy
| | - Suman Rao
- St John's Medical College Hospital, Bangalore, India
| | - Ann Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
| | - Irina Ryumina
- Center for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
| | - Carl Britto
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Deepak Chawla
- Department of Paediatrics, Government Medical College, Chandigarh, India
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
| | | | - Jane Hirst
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
| | - Jagjit Singh Teji
- Ann & Robert H. Lurie Children's Hospital of Chicago and Mercy Hospital and Medical Center, Chicago, Illinois
| | - Karim Abawi
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | | | | | | | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell'Adolescenza, Università degli Studi di Torino, Torino, Italy
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
| | | | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College and
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Abduljalil K, Johnson TN, Rostami-Hodjegan A. Fetal Physiologically-Based Pharmacokinetic Models: Systems Information on Fetal Biometry and Gross Composition. Clin Pharmacokinet 2017; 57:1149-1171. [DOI: 10.1007/s40262-017-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Pressure Injury Prevalence and the Rate of Hospital-Acquired Pressure Injury Among Pediatric Patients in Acute Care. J Wound Ostomy Continence Nurs 2017; 44:110-117. [PMID: 28267117 DOI: 10.1097/won.0000000000000306] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study was to describe the prevalence and rate of hospital-acquired pressure injuries (HAPIs) in pediatric patients. DESIGN Descriptive, secondary analysis of 2012 data on pressure injuries among pediatric patients from the National Database for Nursing Quality Indicators (NDNQI). SUBJECTS AND SETTING The sample included 39,984 patients 1 day to 18 years old from 678 pediatric acute care units (general pediatrics, pediatric critical care, neonatal intensive care, pediatric step-down, and pediatric rehabilitation units) in 271 US hospitals that submitted pressure injury data to the NDNQI for at least 3 quarters during 2012. RESULTS The pressure injury prevalence was 1.4% and the prevalence of HAPI was 1.1%. The rate of HAPI among males was 1.06%, and the rate among females was 1.14%. HAPI rates were highest among children ages 9 to 18 years (1.6%) and 5 to 8 years (1.4%) and lowest among patients 1 to 30 days of age (0.72%). By unit type, HAPIs were highest among patients in pediatric critical care units (3.7%) and pediatric rehabilitation units (4.6%) and lowest in general pediatrics units (0.57%). Most of the HAPIs were Stage 1 and Stage 2 (65.6%); 14.3% were deep tissue pressure injuries and 10.1% were unstageable pressure injuries. CONCLUSION Acutely ill children develop pressure injuries, including HAPI. Study findings provide data on HAPI from a large sample of hospitalized children and by pediatric unit type for comparison purposes.
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Ramel SE, Zhang L, Misra S, Anderson CG, Demerath EW. Do anthropometric measures accurately reflect body composition in preterm infants? Pediatr Obes 2017; 12 Suppl 1:72-77. [PMID: 27635625 DOI: 10.1111/ijpo.12181] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/19/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent literature suggests that neonatal adiposity is predictive of later metabolic health, while neonatal lean mass is predictive of later cognitive function amongst preterm infants. Anthropometric indices that accurately reflect neonatal body composition could improve clinical care and aid future research, but their validity has not been systematically tested in preterm infants. OBJECTIVE To determine the weight/length indices that best reflect neonatal body composition in preterm infants. METHODS Weight and length were measured, and body composition (fat-free mass (FFM), fat mass (FM) and percent body fat (%BF)) was assessed using air-displacement plethysmography within 72 h of birth in 218 preterm infants. The best weight/length proxy for FFM, FM and %BF were those with the highest proportion variance explained (R2 ) and lowest root mean square error (RMSE) in linear regression models. RESULTS Among all of the weight/length indices tested, weight/length2 was the best proxy for %BF, but nonetheless exhibited very low variance explained (R2 = 0.27) and high prediction error (RMSE = 3.5% fat). Body weight unadjusted for length was strongly associated with FFM (R2 = 0.97). CONCLUSIONS No weight/length index accurately reflected %BF. Weight/length indices are not appropriate for assessment of relative adiposity in preterm infants near birth. What's known on this subject: Compared with term infants, preterm infants have increased fat mass and diminished fat-free mass upon hospital discharge. Early adiposity predicts later metabolic health, while early lean mass is predictive of later neurodevelopmental outcomes. Optimal anthropometric proxies for preterm body composition at birth are not established. WHAT THIS STUDY ADDS Weight is an adequate surrogate for lean mass at birth in preterm infants. There are no weight/length indices that accurately reflect neonatal adiposity at birth.
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Affiliation(s)
- S E Ramel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - L Zhang
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - S Misra
- Neonatal-Perinatal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - C G Anderson
- Neonatal-Perinatal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - E W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Ashton JJ, Johnson MJ, Pond J, Crowley P, Dimitrov BD, Pearson F, Beattie RM. Assessing the growth of preterm infants using detailed anthropometry. Acta Paediatr 2017; 106:889-896. [PMID: 28240375 DOI: 10.1111/apa.13804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM Preterm infants display altered body composition compared to term infants, and weight gain is a crude indicator body composition. Childhood mid-upper arm circumference (MUAC) is a measure of nutritional status. This study investigates MUAC and mid-thigh circumference (MTC) to monitor growth in preterm infants. METHODS Preterm infants (<30-week gestation) were recruited. MUAC, MTC, weight, length and head circumference (HC) were measured at recruitment and weekly intervals until discharge. Descriptive, correlation and regression analyses were used. RESULTS Ninety-three infants were recruited. Median measurement duration was eight weeks (1-19). Median gestational age was 27 weeks (23-29). Analysis by curve estimation displayed a mean increase of 2.58 mm/week (left MUAC) (p ≤ 0.0001), 2.56 mm/week (right MUAC) (p ≤ 0.0001), 4.16 mm/week (left MTC) (p ≤ 0.0001), 4.20 mm/week (right MTC) (p ≤ 0.0001). Coefficients of determination (R2 ) were calculated using a growth regression model for MUAC and MTC (0.866-0.917); measures were comparable to growth modelling of weight (0.913), length (0.945) and HC (0.928). High concordance between left and right MUAC and MTC generated a Pearson's correlation coefficient of 0.999 (MUAC) (p ≤ 0.001) and 0.994 (MTC) (p ≤ 0.001). CONCLUSION Data demonstrate the potential utility of MUAC and MTC as additional measures of growth in preterm infants that are reproducible over time. There is potential to gain insights to improve lean-mass accretion in preterm infants.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark J. Johnson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Jenny Pond
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Philippa Crowley
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Borislav D. Dimitrov
- Primary Care and Population Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - Freya Pearson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
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Paviotti G, De Cunto A, Zennaro F, Boz G, Travan L, Cont G, Bua J, Demarini S. Higher growth, fat and fat-free masses correlate with larger cerebellar volumes in preterm infants at term. Acta Paediatr 2017; 106:918-925. [PMID: 28295577 DOI: 10.1111/apa.13829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 12/12/2022]
Abstract
AIM Smaller cerebellar volumes in very low-birthweight (VLBW) infants at term have been related to adverse cognitive outcomes, and this study evaluated whether these volumes were associated with a growth in body composition during hospital stays. METHODS We prospectively recruited 42 VLBW infants from an Italian neonatal unit between January 2013 and August 2015. Cerebellar volumes and body composition were measured by magnetic resonance imaging (MRI) and air-displacement plethysmography, respectively, at 40 weeks of gestational age and anthropometric and nutritional data were collected. We also included 20 term-born controls. RESULTS The mean gestational age and birthweight of the VLBW infants were 29.4 (±1.9) weeks and 1120 (±290) g. There was a positive correlation between cerebellar volumes and daily weight gain from birth to term (R2 = 0.26, p = 0.001), weight (R2 = 0.25, p = 0.001), length (R2 = 0.16, p = 0.01), fat mass (R2 = 0.15, p = 0.01) and fat-free mass at term (R2 = 0.20, p = 0.003). In multiple regression analysis, daily weight gain, mechanical ventilation and postconceptional age at MRI were independently associated with cerebellar volumes. Anthropometric data and cerebellar volumes were similar between VLBW and control infants. CONCLUSION Higher growth, higher fat mass and fat-free mass were associated with larger cerebellar volumes in VLBW infants at term.
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Affiliation(s)
- Giulia Paviotti
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Angela De Cunto
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Floriana Zennaro
- Pediatric Radiology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Giulia Boz
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Laura Travan
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Gabriele Cont
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Jenny Bua
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Sergio Demarini
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
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Hawkes CP, Zemel BS, Kiely M, Irvine AD, Kenny LC, O'B Hourihane J, Murray DM. Body Composition within the First 3 Months: Optimized Correction for Length and Correlation with BMI at 2 Years. Horm Res Paediatr 2017; 86:178-187. [PMID: 27560149 DOI: 10.1159/000448659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Although early infant growth has implications for future health, body composition reference data in infancy are limited. The aim of this study was to describe reference data for fat mass (FM) and fat-free mass (FFM) corrected for length (L) within the first 3 months and to evaluate if these measures predict the body mass index (BMI) at 2 years. METHODS Term infants had air displacement plethysmography performed at birth (n = 1,063) and approximately 2 months later (n = 922, between 49 and 86 days). Age- and sex-specific reference data were generated for FM, FFM, FM/L3 and FFM/L2 and compared with BMI at 2 years. RESULTS FM/L3 and FFM/L2 were the optimal indices independent of length. In the first 3 months, mean FM/L3 increased (males, from 2.7 to 5.9 kg/m3; females, from 3.2 to 6.1 kg/m3), whereas FFM/L2 remained relatively stable (males, from 11.8 to 12.7 kg/m2; females, from 12.8 to 12.1 kg/m2). The odds of a BMI Z-score ≥2 at 2 years increased with increasing FM (OR 2.7, 95% CI 1.97-3.7) and weight (OR 2.27, 95% CI 1.64-3.13) Z-scores at 2 months. CONCLUSIONS FM/L3 and FFM/L2 provide length-independent measures of FM and FFM in infancy. During the first 3 months, there is an increase in FM/L3, but not in FFM/L2. The weight Z-score at 2 months is as good at predicting BMI at 2 years as body composition parameters. © 2016 S. Karger AG, Basel.
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Affiliation(s)
- Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA
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Finken MJJ, van der Voorn B, Heijboer AC, de Waard M, van Goudoever JB, Rotteveel J. Glucocorticoid Programming in Very Preterm Birth. Horm Res Paediatr 2017; 85:221-31. [PMID: 26943327 DOI: 10.1159/000443734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Very preterm (i.e., <32 weeks of gestation) infants admitted to the neonatal intensive care unit are compromised in their abilities to respond adequately to common threats like hemodynamic changes and reduced energy supplies, which is partly attributable to adrenocortical insufficiency. Conversely, later in life, these infants show features of increased glucocorticoid bioactivity, such as abdominal fat distribution, raised blood pressure, insulin resistance and diabetes mellitus type 2. It has been suggested that the very preterm newborn responds to the adverse postnatal environment with a sustained elevation in hypothalamus-pituitary-adrenal axis activity that persists beyond infancy. This has implications for subsequent growth, body composition, metabolism, neurodevelopment and, ultimately, long-term disease risk. The mechanisms underpinning these associations are not fully elucidated yet. This review gives a brief summary of studies that investigated adrenocortical function in very preterm newborns and how the axis changes with age, as a possible explanation for the association between prematurity and long-term outcome.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Finken MJJ, van der Voorn B, Hollanders JJ, Ruys CA, de Waard M, van Goudoever JB, Rotteveel J. Programming of the Hypothalamus-Pituitary-Adrenal Axis by Very Preterm Birth. ANNALS OF NUTRITION AND METABOLISM 2017; 70:170-174. [PMID: 28301846 DOI: 10.1159/000456040] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/08/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many very preterm (i.e., <32 weeks of gestation) newborns fail to mount an adequate adrenocortical response to stress or illness, termed relative adrenal insufficiency. Conversely, later in life these infants show features of increased glucocorticoid bioactivity, such as abdominal adiposity, insulin resistance, raised blood pressure, shorter stature and internalizing problem behavior. SUMMARY Studies suggested that very preterm newborns have impairments along multiple levels of the hypothalamus-pituitary-adrenal (HPA) axis. Among the impairment were defects in: (1) the pituitary responsiveness to exogenous corticotropin-releasing hormone, (2) 11β-hydroxylase activity, and (3) the interconversion between cortisol and inert cortisone. There is some evidence suggesting that later in life these infants have an increased basal secretion rate of cortisol and adrenal hyperandrogenism. However, the response to acute (psychosocial) stress was blunted rather than enhanced in them. The mechanisms explaining this switch in HPA axis activity are complex and not yet fully understood. Key Messages: Very preterm newborns have several impairments along the HPA axis that could impede an adequate adrenocortical response to stress or illness. Later in life, these infants are predisposed to increased HPA axis activity, which could partially explain their phenotype.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Ratnasingham A, Eiby YA, Dekker Nitert M, Donovan T, Lingwood BE. Review: Is rapid fat accumulation in early life associated with adverse later health outcomes? Placenta 2017; 54:125-130. [PMID: 28104278 DOI: 10.1016/j.placenta.2017.01.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 12/26/2022]
Abstract
This review discusses ways in which the maternal environment and placental function affect the birth weight and adult health outcomes of offspring. These maternal and placental factors have varying and sometimes opposing effects on birth weight, resulting in infants that are born small for gestational age (SGA), large for gestational age (LGA) or preterm. However, all these alterations in weight have similar effects on adult health, increasing the risk of obesity and its associated cardiovascular and metabolic disorders. While birth weight has been used as a marker for risk of adverse adult health, we propose that a common feature of all these scenarios - early accumulation of excess body fat - may be a better marker than birth weight alone. Furthermore, altered neonatal fat accumulation may be more closely related to the mechanism by which maternal environment and placental adaptation mediate effects on adult health. We suggest that more research should be focussed on early fat accretion, factors that promote fat accretion and if it can be avoided, and whether it would be beneficial to try to reduce fat accumulation in early life.
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Affiliation(s)
- Abirami Ratnasingham
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia.
| | - Yvonne A Eiby
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia.
| | - Marloes Dekker Nitert
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia; School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Timothy Donovan
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia; Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia.
| | - Barbara E Lingwood
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland 4029, Australia; Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia.
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Cormack BE, Embleton ND, van Goudoever JB, Hay WW, Bloomfield FH. Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies. Pediatr Res 2016; 79:810-20. [PMID: 26866908 DOI: 10.1038/pr.2016.26] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/09/2015] [Indexed: 11/09/2022]
Abstract
The ultimate goal of neonatal nutrition care is optimal growth, neurodevelopment, and long-term health for preterm babies. International consensus is that increased energy and protein intakes in the neonatal period improve growth and neurodevelopment, but after more than 100 y of research the optimum intakes of energy and protein remain unknown. We suggest an important factor contributing to the lack of progress is the lack of a standardized approach to reporting nutritional intake data and growth in the neonatal literature. We reviewed randomized controlled trials and observational studies documented in MEDLINE and the Web of Science from 2008 to 2015 that compared approximately 3 vs. 4 g.kg(-1).d(-1) protein for preterm babies in the first month after birth. Consistency might be expected in the calculation of nutritional intake and assessment of growth outcomes in this relatively narrow scope of neonatal nutrition research. Twenty-two studies were reviewed. There was substantial variation in methods used to estimate and calculate nutritional intakes and in the approaches used in reporting these intakes and measures of infant growth. Such variability makes comparisons amongst studies difficult and meta-analysis unreliable. We propose the StRONNG Checklist-Standardized Reporting Of Neonatal Nutrition and Growth to address these issues.
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Affiliation(s)
- Barbara E Cormack
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand.,Gravida: National Centre for Growth and Development, Auckland, New Zealand.,Auckland Academic Health Alliance, Auckland, New Zealand
| | - Nicholas D Embleton
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Neonatal Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital/AMC and VU University medical Center, Amsterdam, the Netherlands
| | - William W Hay
- Perinatal Research Center, University of Colorado School of Medicine, Aurora, Colorado
| | - Frank H Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand.,Gravida: National Centre for Growth and Development, Auckland, New Zealand.,Auckland Academic Health Alliance, Auckland, New Zealand
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Effects of breast-feeding compared with formula-feeding on preterm infant body composition: a systematic review and meta-analysis. Br J Nutr 2016; 116:132-41. [PMID: 27181767 DOI: 10.1017/s0007114516001720] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a systematic review and meta-analysis to compare the effect of breast-feeding and formula-feeding on body composition of preterm infants. We searched the literature using PubMed, Cochrane Central Library Issue, Ovid (Medline), Embase and other resources such as Google Scholar, electronic databases and bibliographies of relevant articles; two reviewers collected and extracted data independently. All the authors assessed risk of bias independently using the Newcastle-Ottawa Scale (NOS). A fixed-effects meta-analysis was undertaken with RevMan 5 software (The Cochrane Collaboration) using the inverse variance method (P≥0·05; χ 2 test). In contrast, a random-effects meta-analysis was carried out. Altogether, 630 articles were identified using search strategy, and the references within retrieved articles were also assessed. A total of six studies were included in this systematic review. In formula-fed infants, fat mass was higher at term (mean difference 0·24 (95 % CI 0·17, 0·31) kg), fat-free mass was higher at 36 weeks of gestational (mean difference 0·12 (95 % CI 0·04, 0·21) kg) and the percentage of fat mass was higher at 36 weeks of gestation (mean difference 3·70 (95 % CI 1·81, 5·59) kg) compared with breast-fed infants. Compared with breast-feeding, formula-feeding is associated with altered body composition from birth to term in preterm infants. The effects of formula-feeding on preterm infant body composition from term to 12-month corrected age are inconclusive in our study. Well-designed studies are required in the future to explore the effects of formula-feeding compared with breast-feeding.
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Kv RK, Hemalatha R, Mamidi RS, Jj BG, Balakrishna N. Do South Indian newborn babies have higher fat percentage for a given birth weight? Early Hum Dev 2016; 96:39-43. [PMID: 27038792 DOI: 10.1016/j.earlhumdev.2016.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND India is experiencing rapidly escalating epidemics of diabetes and cardiovascular disease. High fat percent in Indian adults may have its origins at birth (Fetal origin hypothesis). Conflicting evidence from India have shown increased or similar fat mass in Indian newborn babies compared to western countries. AIM To compare body composition of term infants with data from similar studies in India and developed countries. STUDY DESIGN Cross-sectional study in newborn infants at the antenatal ward of a tertiary care hospital in South India. SUBJECTS 626 mothers and their newborn babies. OUTCOME MEASURES Maternal body weight and height, baby weight, length, head circumference, skin folds at three sites. Body fat, arm muscle area and arm muscle index were calculated based on known methods. RESULTS Mean (SD) birth weight of newborn babies was 2.80 (0.37) kg and 43% of them were small for gestational age. Birth weight was significantly related to subscapular (r=0.445; p<0.001) and triceps (r=0.567; p<0.001) skin fold thickness. Mean (CI) Subscapular skin fold thickness and total body fat % was 3.81mm (3.74-3.97) and 10.5% (10.2-10.8). Mean total body fat % for small for gestational age (SGA) (9.57%) was significantly lower than appropriate for gestational age (AGA) babies (11.7%). CONCLUSIONS The mean body fat percent in AGA infants was similar to that of studies reported on term infants of developed countries, suggesting that South Indian babies may accumulate similar fat mass with increasing birth weight and gestational age.
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Affiliation(s)
- Radha Krishna Kv
- Clinical Division, National Institute of Nutrition, Hyderabad, India
| | | | | | - Babu Geddam Jj
- Clinical Division, National Institute of Nutrition, Hyderabad, India
| | - N Balakrishna
- Department of Biostatistics, National Institute of Nutrition, Hyderabad, India
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Paviotti G, Monasta L, Ronfani L, Montico M, Copertino M, De Cunto A, Demarini S. Body mass index curves for Italian preterm infants are comparable with American curves for infants born before 34 weeks of gestational age. Acta Paediatr 2016; 105:483-9. [PMID: 26871711 DOI: 10.1111/apa.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
AIM Body mass index (BMI)-for-age curves have been developed in the USA, but not compared with other populations. This study created gender-specific intrauterine BMI-for-age curves for Italian preterm infants and compared them with the USA version. METHODS Data on 92 262 newborn infants, born at 26-42 weeks of gestational age in the north-eastern Italian region of Friuli Venezia Giulia between 2005 and 2013, were analysed to create gender-specific BMI-for-age curves. Gender-specific and age-specific BMI Z scores for Italian infants were calculated using the parameters of the USA growth curves and the World Health Organization charts. RESULTS Gender-specific BMI-for-age at birth curves were developed for premature Italian infants from 26 gestational weeks. The comparison with the USA charts showed no significant difference in BMI percentiles in Italian infants born at ≤33 gestational weeks, but infants born at ≥34 gestational weeks had a significantly higher BMI than the USA population, by 0.2 standard deviations. CONCLUSION We developed the first European BMI-for-age at birth curves for premature infants. According to our findings, the Italian curves were comparable to the USA curves for the subgroup of infants born at ≤33 gestational weeks, but not ≥34 gestational weeks.
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Affiliation(s)
- Giulia Paviotti
- Division of Neonatology; Department of Perinatal Medicine; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Marcella Montico
- Clinical Epidemiology and Public Health Research Unit; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Marco Copertino
- Division of Neonatology; Department of Perinatal Medicine; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Angela De Cunto
- Division of Neonatology; Department of Perinatal Medicine; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Sergio Demarini
- Division of Neonatology; Department of Perinatal Medicine; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
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Abstract
The goal of preterm nutrition in achieving growth and body composition approximating that of the fetus of the same postmenstrual age is difficult to achieve. Current nutrition recommendations depend largely on expert opinion, due to lack of evidence, and are primarily birth weight based, with no consideration given to gestational age and/or need for catch-up growth. Assessment of growth is based predominately on anthropometry, which gives insufficient attention to the quality of growth. The present paper provides a review of the current literature on the nutritional management and assessment of growth in preterm infants. It explores several approaches that may be required to optimise nutrient intakes in preterm infants, such as personalising nutritional support, collection of nutrient intake data in real-time, and measurement of body composition. In clinical practice, the response to inappropriate nutrient intakes is delayed as the effects of under- or overnutrition are not immediate, and there is limited nutritional feedback at the cot-side. The accurate and non-invasive measurement of infant body composition, assessed by means of air displacement plethysmography, has been shown to be useful in assessing quality of growth. The development and implementation of personalised, responsive nutritional management of preterm infants, utilising real-time nutrient intake data collection, with ongoing nutritional assessments that include measurement of body composition is required to help meet the individual needs of preterm infants.
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Piyasena C, Cartier J, Provençal N, Wiechmann T, Khulan B, Sunderesan R, Menon G, Seckl JR, Reynolds RM, Binder EB, Drake AJ. Dynamic Changes in DNA Methylation Occur during the First Year of Life in Preterm Infants. Front Endocrinol (Lausanne) 2016; 7:158. [PMID: 28018293 PMCID: PMC5156662 DOI: 10.3389/fendo.2016.00158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Preterm birth associates with a substantially increased risk of later cardiovascular disease and neurodevelopmental disorders. Understanding underlying mechanisms will facilitate the development of screening and intervention strategies to reduce disease risk. Changes in DNA methylation have been proposed as one mechanism linking the early environment with later disease risk. We tested the hypothesis that preterm birth associates with altered DNA methylation in genes encoding insulin-like growth factor 2 (IGF2) and FK506-binding protein 5 (FKBP5), which appear particularly vulnerable to early life adversity. METHODS Fifty preterm infants were seen and assessed at birth, term equivalent age, 3 months and 1-year corrected ages; 40 term infants were seen at birth, 3 months and 1 year. Saliva was collected for DNA extraction at birth, term, and 1 year. Pyrosequencing of bisulfite-converted DNA was performed to measure DNA methylation at specific CpG sites within the IGF2 and FKBP5 loci. RESULTS Weight and head circumference was reduced in preterm infants at all time points. Preterm infants had a higher percentage body fat at term-corrected age, but this difference was not persistent. DNA methylation at the differentially methylated region (DMR) of IGF2 (IGF2DMR2) and FKBP5 was lower in preterm infants at birth- and term-corrected age compared to term infants at birth. IGF2DMR2 and FKBP5 methylation was related to birthweight SD score in preterm infants. Among preterm infants, social deprivation was an independent contributor toward reducing DNA methylation at IGF2DMR2 at birth- and term-corrected age and maternal smoking was associated with reduced DNA methylation at FKBP5 at birth. There were no persistent differences in DNA methylation at 1 year of age. CONCLUSION Changes in DNA methylation were identified at key regions of IGF2/H19 and FKBP5 in preterm infants in early life. Potential contributing factors include maternal smoking and social deprivation. However, these changes did not persist at 1 year of age and further longitudinal studies are required to determine any associations between altered DNA methylation in the perinatal period of individuals born preterm and their long-term health.
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Affiliation(s)
- Chinthika Piyasena
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jessy Cartier
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Nadine Provençal
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Tobias Wiechmann
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Batbayar Khulan
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Raju Sunderesan
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gopi Menon
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jonathan R. Seckl
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rebecca M. Reynolds
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Elisabeth B. Binder
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Amanda J. Drake
- British Heart Foundation Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
- *Correspondence: Amanda J. Drake,
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Comparing different methods of human breast milk fortification using measured v. assumed macronutrient composition to target reference growth: a randomised controlled trial. Br J Nutr 2015; 115:431-9. [PMID: 26627899 DOI: 10.1017/s0007114515004614] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The variable content of human breast milk suggests that its routine fortification may result in sub-optimal nutritional intakes and growth. In a pragmatic trial, we randomised infants born below 30 weeks of gestation to either the intervention (Igp) of fortifying milk on measured composition according to birth weight criteria and postmenstrual age (PMA) or our routine practice (RPgp) of fortifying on assumed milk composition to target 3·8-4·4 g protein/kg per d and 545-629 kJ/kg per d. Milk composition was measured using the MIRIS® Human Milk Analyser. Percentage fat mass (%FM) was measured using PEA POD (COSMED). The effects of macronutrient intakes and clinical variables on growth were assessed using mixed model analysis. Mean measured protein content (1·6 g/100 ml) was higher than the assumed value (1·4 g/100 ml), often leading to lower amounts of fortifier added to the milk of intervention infants. At discharge (Igp v. RPgp), total protein (3·2 (SD 0·3) v. 3·4 (SD 0·4) g; P=0·067) and energy (456 (SD 39) v. 481 (SD 48) kJ; P=0·079) intakes from all nutrition sources, weight gain velocity (11·4 (SD 1·4) v. 12·1 (SD 1·6) g/kg per d; P=0·135) and %FM (13·7 (SD 3·6) v.13·6 (SD 3·5) %; P=0·984) did not significantly differ between groups. A protein intake >3·4 g/kg per d reduced %FM by 2%. Nutrition and growth was not improved by targeting milk fortification according to birth weight criteria and PMA using measured milk composition, compared with routine practice. Targeting fortification on measured composition is labour intensive, requiring frequent milk sampling and precision measuring equipment, perhaps reasons for its limited practice. Guidance around safe upper levels of milk fortification is needed.
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Villela LD, Mendes Soares FV, Abranches ADD, GOMES Junior SC, Méio MDBB, Moreira MEL. Antropometria e composição corporal de recém-nascidos pré-termo na idade gestacional e no peso equivalente ao termo. REV NUTR 2015. [DOI: 10.1590/1415-52732015000600005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJETIVO: Analisar o crescimento e a composição corporal de recém-nascidos pré-termo na idade gestacional corrigida de termo e ao alcançarem um peso entre 3,0 e 3,5 kg. MÉTODOS: Estudo longitudinal, realizado no Instituto Fernandes Figueira, Rio de Janeiro, com 39 recém-nascidos pré-termo e que apresentaram muito baixo peso ao nascer. Medidas antropométricas e água corporal total foram avaliadas no primeiro, no sétimo e no dia da recuperação do peso de nascimento, na idade gestacional corrigida do termo e em torno de três semanas de idade gestacional corrigida (correspondente ao tempo de vida para alcançar um peso entre 3,0 e 3,5 kg). O grupo de referência foi constituído por 32 recém-nascidos a termo, adequados para a idade gestacional, avaliados no segundo dia de vida. Considerou-se restrição de crescimento o escore-Z menor do que -2 para peso, comprimento e perímetro cefálico. RESULTADOS: Na idade de termo, 71,8% dos recém-nascidos pré-termo apresentaram restrição do crescimento para peso, 61,5% para comprimento e 25,6% para perímetro cefálico. Com três semanas de idade gestacional corrigida, esses recém-nascidos apresentaram a prega cutânea tricipital e a circunferência abdominal estatisticamente maiores que o grupo de referência enquanto o comprimento e a porcentagem de água corporal total foram menores. CONCLUSÃO: Os recém-nascidos pré-termo apresentaram perfil antropométrico e de água corporal diferente dos recém--nascidos a termo, sugerindo acúmulo de gordura. Houve recuperação do crescimento entre a idade de termo e três semanas de idade corrigida, sendo mais evidente esse crescimento em relação ao perímetro cefálico e peso.
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