Changes of leptin and metabolic hormones in preterm infants: a longitudinal study in early postnatal life

Glucose-regulatory hormones and growth in very preterm infants fed fortified human milk

BACKGROUND

Bovine colostrum (BC) contains a range of milk bioactive components, and it is unknown how human milk fortification with BC affects glucose-regulatory hormones in very preterm infants (VPIs). This study aimed to investigate the associations between hormone concentrations and fortification type, birth weight (appropriate/small for gestational age, AGA/SGA), milk intake, postnatal age, and body growth.

METHODS

225 VPIs were randomized to fortification with BC or conventional fortifier (CF). Plasma hormones were measured before, one and two weeks after start of fortification. ΔZ-scores from birth to 35 weeks postmenstrual age were calculated.

RESULTS

Compared with CF, infants fortified with BC had higher plasma GLP-1, GIP, glucagon, and leptin concentrations after start of fortification. Prior to fortification, leptin concentrations were negatively associated with growth, while IGF-1 concentrations associated positively with growth during fortification. In AGA infants, hormone concentrations generally increased after one week of fortification. Relative to AGA infants, SGA infants showed reduced IGF-1 and leptin concentrations.

CONCLUSION

Fortification with BC increased the plasma concentrations of several glucose-regulatory hormones. Concentrations of IGF-1 were positively, and leptin negatively, associated with growth. Glucose-regulatory hormone levels were affected by birth weight, milk intake and postnatal age, but not closely associated with growth in VPIs.

IMPACT

Little is known about the variation in glucose-regulatory hormones in the early life of very preterm infants (VPIs). This study shows that the levels of glucose-regulatory hormones in plasma of VPIs are highly variable and modified by birth weight (appropriate or small for gestational age, AGA or SGA), the type of fortifier, enteral nutritional intake, and advancing postnatal age. The results confirm that IGF-1 levels are positively associated with early postnatal growth in VPIs, yet the levels of both IGF-1 and other glucose-regulatory hormones appeared to explain only a small part of the overall variation in growth rates.

Insulin resistance prior to term age in very low birthweight infants: a prospective study

OBJECTIVE

To explore the glucose-related hormone profile of very low birthweight (VLBW) infants and assess the association between neonatal hyperglycaemia and insulin resistance during the admission period.

DESIGN

A prospective observational study-the Very Low Birth Weight Infants, Glucose and Hormonal Profiles over Time study.

SETTING

A tertiary neonatal intensive care unit and four neonatal units in county hospitals in Sweden.

PATIENTS

48 infants born <1500 g (VLBW) during 2016-2019.

OUTCOME MEASURES

Plasma concentrations of glucose-related hormones and proteins (C-peptide, insulin, ghrelin, glucagon-like peptide 1 (GLP-1), glucagon, leptin, resistin and proinsulin), insulin:C-peptide and proinsulin:insulin ratios, Homoeostatic Model Assessment 2 (HOMA2) and Quantitative Insulin Sensitivity Check (QUICKI) indices, measured on day of life (DOL) 7 and at postmenstrual age 36 weeks.

RESULTS

Lower gestational age was significantly associated with higher glucose, C-peptide, insulin, proinsulin, leptin, ghrelin, resistin and GLP-1 concentrations, increased HOMA2 index, and decreased QUICKI index and proinsulin:insulin ratio. Hyperglycaemic infants had significantly higher glucose, C-peptide, insulin, leptin and proinsulin concentrations, and lower QUICKI index, than normoglycaemic infants. Higher glucose and proinsulin concentrations and insulin:C-peptide ratio, and lower QUICKI index on DOL 7 were significantly associated with longer duration of hyperglycaemia during the admission period.

CONCLUSIONS

VLBW infants seem to have a hormone profile consistent with insulin resistance. Lower gestational age and hyperglycaemia are associated with higher concentrations of insulin resistance markers.

Birth anthropometry and cord blood leptin in Korean appropriate-for-gestational-age infants born at ≥ 28 weeks' gestation: a cross sectional study

Background

We investigated whether leptin during the third trimester was associated with fetal growth compared to IGF-1.

Methods

One hundred five appropriate-for-gestational-age (AGA) infants born at ≥28 weeks’ gestation were enrolled. Cord blood leptin and insulin like growth factor 1 (IGF-1) were collected simultaneously during delivery. Enrolled infants were stratified into three groups according to GA as follows: 28 to < 34 weeks’ gestation, very preterm (VP); 34 to < 37 weeks’ gestation, late preterm (LP); and 37 to < 41 weeks’ gestation, term. Birth weight (BW), birth length (BL), head circumference (HC), and body mass index (BMI) were measured. Leptin and IGF-1 were logarithmically transformed to normalize their distributions in multivariable regression analysis.

Results

Sixty-eight infants out of 105 infants were preterm (32.5 ± 2.5 weeks), and 37 infants were term (37.8 ± 1.2 weeks). BW, BL, HC, and BMI were higher with increasing gestational age among the three gestational age-specific groups. With regard to hormones, leptin and IGF-1 were higher with increasing gestational age. Log cord serum leptin was independently associated with BW and BL in multivariable linear regression analysis, after adjustment for confounding factors including gestational age, delivery mode, multiple pregnancy, pregnancy induced hypertension, gestational diabetes mellitus, infant’s BMI, and log cord blood IGF-1 levels.

Conclusions

During the third trimester, cord serum leptin was independently associated with fetal growth.

Risk of hypertension following perinatal adversity: IUGR and prematurity

Consistent with the paradigm shifting observations of David Barker and colleagues that revealed a powerful relationship between decreased weight through 2 years of age and adult disease, intrauterine growth restriction (IUGR) and preterm birth are independent risk factors for the development of subsequent hypertension. Animal models have been indispensable in defining the mechanisms responsible for these associations and the potential targets for therapeutic intervention. Among the modifiable risk factors, micronutrient deficiency, physical immobility, exaggerated stress hormone exposure and deficient trophic hormone production are leading candidates for targeted therapies. With the strong inverse relationship seen between gestational age at delivery and the risk of hypertension in adulthood trumping all other major cardiovascular risk factors, improvements in neonatal care are required. Unfortunately, therapeutic breakthroughs have not kept pace with rapidly improving perinatal survival, and groundbreaking bench-to-bedside studies are urgently needed to mitigate and ultimately prevent the tsunami of prematurity-related adult cardiovascular disease that may be on the horizon. This review highlights our current understanding of the developmental origins of hypertension and draws attention to the importance of increasing the availability of lactation consultants, nutritionists, pharmacists and physical therapists as critical allies in the battle that IUGR or premature infants are waging not just for survival but also for their future cardiometabolic health.

Contribution of relative leptin and adiponectin deficiencies in premature infants to chronic intermittent hypoxia: Exploring a new hypothesis

Chronic intermittent hypoxia (CIH) occurs frequently in premature infants who have apnea of prematurity. Immaturity of the respiratory network from low central respiratory drive and the greater contribution of the carotid body on baseline breathing leads to respiratory instability in premature infants presenting as apnea and periodic breathing. During the 2nd week after birth, the smallest and the youngest premature infants have increased frequency of apnea and periodic breathing and associated oxygen desaturations that can persist for weeks after birth. CIH increases the production of reactive oxygen species that causes tissue damage. Premature infants have decreased capacity to scavenge reactive oxygen species. Oxidative injury is the cause of many of the co-morbidities that are seen in premature infants. In this review we discuss who low fat mass and the resulting relative deficiencies in leptin and adiponectin could contribute to the increase frequency of oxygen desaturations that occurs days after birth in the smallest and youngest premature infants. Leptin is a central respiratory stimulant and adiponectin protects the lung from vascular leak, oxidative injury and vascular remodeling.

Modeling the impact of growth and leptin deficits on the neuronal regulation of blood pressure

The risk of hypertension is increased by intrauterine growth restriction (IUGR) and preterm birth. In the search for modifiable etiologies for this life-threatening cardiovascular morbidity, a number of pathways have been investigated, including excessive glucocorticoid exposure, nutritional deficiency and aberration in sex hormone levels. As a neurotrophic hormone that is intimately involved in the cardiovascular regulation and whose levels are influenced by glucocorticoids, nutritional status and sex hormones, leptin has emerged as a putative etiologic and thus a therapeutic agent. As a product of maternal and late fetal adipocytes and the placenta, circulating leptin typically surges late in gestation and declines after delivery until the infant consumes sufficient leptin-containing breast milk or accrues sufficient leptin-secreting adipose tissue to reestablish the circulating levels. The leptin deficiency seen in IUGR infants is a multifactorial manifestation of placental insufficiency, exaggerated glucocorticoid exposure and fetal adipose deficit. The preterm infant suffers from the same cascade of events, including separation from the placenta, antenatal steroid exposure and persistently underdeveloped adipose depots. Preterm infants remain leptin deficient beyond term gestation, rendering them susceptible to neurodevelopmental impairment and subsequent cardiovascular dysregulation. This pathologic pathway is efficiently modeled by placing neonatal mice into atypically large litters, thereby recapitulating the perinatal growth restriction-adult hypertension phenotype. In this model, neonatal leptin supplementation restores the physiologic leptin surge, attenuates the leptin-triggered sympathetic activation in adulthood and prevents leptin- or stress-evoked hypertension. Further pathway interrogation and clinical translation are needed to fully test the therapeutic potential of perinatal leptin supplementation.

Relationship between fat mass measured by dual-energy X-ray absorptiometry and leptin in preterm infants between term age and 6 months' corrected age

BACKGROUND/AIMS

In term subjects, fat mass (FM) is positively associated with leptin, whereas studies in preterm infants show conflicting results. However, none of these studies measured FM by dual-energy X-ray absorptiometry (DEXA). This study aims to relate FM measured by DEXA in relation to leptin and growth in preterm infants.

METHODS

In 139 preterm infants, weight (kg) and length (cm) were measured at birth, term age, and 6 months' corrected age (CA). FM (kg), measured by whole-body DEXA, and leptin (µg/l) were measured at term age and 6 months' CA.

RESULTS

At term age and 6 months' CA, FM was associated with leptin (β = 1.94, 95% CI: 1.51-2.36, and β = 0.37, 95% CI: 0.26-0.48, respectively; p < 0.001). Gain in weight standard deviation score (SDS) between term age and 6 months' CA was associated with FM and leptin at 6 months' CA (β = 0.24, 95% CI: 0.18-0.30, and β = 0.25, 95% CI: 0.16-0.33, respectively; p < 0.001).

CONCLUSION

In preterm infants, FM measured by DEXA is associated with leptin, which indicates that leptin is a marker of body FM during the first 6 months after term age. Gain in weight SDS between term age and 6 months' CA results in higher FM and higher leptin at 6 months' CA.

Practical application of kangaroo mother care in preterm infants: clinical characteristics and safety of kangaroo mother care

AIM

To determine the clinical characteristics and safety of kangaroo mother care (KMC) according to the gestational age (GA) or postmenstrual age (PMA).

METHODS

We conducted a prospective clinical study in 31 infants between 25 and 32 weeks' GA. The subjects were categorized into two groups (25-28 weeks' and 29-32 weeks' GA groups) to compare the clinical characteristics associated with KMC. Heart rate, respiratory rate, oxygen saturation, blood pressure and body temperature (BT) were longitudinally assessed for 60 min with respect to the PMA group (29-32 weeks' and 33-36 weeks' PMA groups).

RESULTS

The authors analyzed 70 sessions with 31 infants (25-32 weeks' GA, birth weight 760-1740 g, 29-36 weeks' PMA). All infants had statistically significant higher temperatures during KMC than before KMC within clinically acceptable limits (P<0.001). We found a significantly lower variation of BT in the 25-28 weeks' GA group compared with the 29-32 weeks' GA group at 33-36 weeks' PMA, suggesting accelerated skin maturation in more premature infants (P<0.001).

CONCLUSION

Our intermittent KMC was a safe and feasible method for preterm infants. Notably, at the same PMA, preterm infants in the lower at-birth GA group showed an advanced maturation of thermoregulation compared with those in the higher GA group.

Massage improves growth quality by decreasing body fat deposition in male preterm infants

OBJECTIVES

To assess the effect of massage on weight gain and body fat deposition in preterm infants.

STUDY DESIGN

Preterm infants (29-32 weeks) were randomized to the massage group (n = 22, 12 girls, 10 boys) or the control group (n = 22, 12 girls, 10 boys). Treatment was masked with massage or control care administered twice-daily by licensed massage therapists (6 d/wk for 4 weeks). Body weight, length, Ponderal Index (PI), body circumferences, and skinfold thickness (triceps, mid-thigh, and subscapular [SSF]) were measured. Circulating insulin-like growth factor I, leptin, and adiponectin levels were determined by enzyme-linked immunosorbent assay. Daily dietary intake was collected.

RESULTS

Energy and protein intake as well as increase in weight, length, and body circumferences were similar. Male infants in the massage group had smaller PI, triceps skinfold thickness, mid-thigh skinfold thickness, and SSF and increases over time compared with control male infants (P < .05). Female infants in the massage group had larger SSF increases than control female infants (P < .05). Circulating adiponectin increased over time in control group male infants (group × time × sex interaction, P < .01) and was correlated to PI (r = 0.39, P < .01).

CONCLUSIONS

Twice-daily massage did not promote greater weight gain in preterm infants. Massage did, however, limit body fat deposition in male preterm infants. Massage decreased circulating adiponectin over time in male infants with higher adiponectin concentrations associated with increased body fat. These findings suggest that massage may improve body fat deposition and, in turn, growth quality of preterm infants in a sex-specific manner.

Breast milk hormones and regulation of glucose homeostasis

Growing evidence suggests that a complex relationship exists between the central nervous system and peripheral organs involved in energy homeostasis. It consists in the balance between food intake and energy expenditure and includes the regulation of nutrient levels in storage organs, as well as in blood, in particular blood glucose. Therefore, food intake, energy expenditure, and glucose homeostasis are strictly connected to each other. Several hormones, such as leptin, adiponectin, resistin, and ghrelin, are involved in this complex regulation. These hormones play a role in the regulation of glucose metabolism and are involved in the development of obesity, diabetes, and metabolic syndrome. Recently, their presence in breast milk has been detected, suggesting that they may be involved in the regulation of growth in early infancy and could influence the programming of energy balance later in life. This paper focuses on hormones present in breast milk and their role in glucose homeostasis.

Umbilical cord ghrelin in term and preterm newborns and its relation to metabolic hormones and anthropometric measurements

The aim of the study was to assess umbilical cord ghrelin level in term and preterm newborns and its relation to other metabolic hormones and anthropometric measurements. A cross sectional comparative study included 50 normal appropriate-for-gestational-age newborns (25 full-terms; 25 preterm). Assessment of anthropometric measurements, cord levels of ghrelin, leptin, insulin and glucose were done to all newborns. Umbilical cord ghrelin was detected in all newborns. There was no significant difference between term and preterm groups regarding ghrelin, insulin and glucose. Leptin was significantly lower in preterm than term group. Sex and mode of delivery had no effects regarding all studied variables. There was no overall correlation between ghrelin and gestational age, anthropometric measurements, leptin, insulin or glucose in all newborns. Preterm group demonstrated significant correlations between ghrelin and weight, body mass index and abdominal circumference. An overall significant correlation was found between leptin and gestational age and anthropometric measurements in all newborns. In preterm group leptin correlated with weight, length, subscapular skin-fold thickness and abdominal circumference. To conclude the umbilical cord ghrelin was relatively invariable at birth between 30 and 41 weeks gestation showing no gestational age-related variation, unlike leptin, which was lower in preterm group indicating increased adipose mass and placental maturation with increased gestational age.

Effects of intrauterine exposure to synthetic glucocorticoids on fetal, newborn, and infant hypothalamic-pituitary-adrenal axis function in humans: a systematic review

BACKGROUND

Synthetic glucocorticoids are commonly used in reproductive medicine. Fetal organ systems are highly sensitive to changes in the intrauterine environment, including overexposure to glucocorticoids. Structural and functional alterations resulting from such changes may persist throughout life and have been associated with diverse diseases. One system that could be particularly sensitive to fetal glucocorticoid overexposure is the hypothalamic-pituitary-adrenal (hpa) axis. Many human studies have investigated this possibility, but a systematic review to identify consistent, emergent findings is lacking.

METHODS

We systematically review 49 human studies, assessing the effects of intrauterine exposure to synthetic glucocorticoids on fetal, neonate, and infant hpa function.

RESULTS

Study quality varied considerably, but the main findings held true after restricting the analyses to higher-quality studies: intrauterine exposure to synthetic glucocorticoids reduces offspring hpa activity under unstimulated conditions after pain but not pharmacological challenge. Although reduced unstimulated hpa function appears to recover within the first 2 wk postpartum, blunted hpa reactivity to pain is likely to persist throughout the first 4 months of life. There is some evidence that the magnitude of the effects is correlated with the total amount of glucocorticoids administered and varies with the time interval between glucocorticoid exposure and hpa assessment.

CONCLUSIONS

This systematic review has allowed the demonstration of the way in which intrauterine exposure to various regimens of synthetic glucocorticoids affects various forms of hpa function. As such, it guides future studies in terms of which variables need to be focused on in order to further strengthen the understanding of such therapy, whilst continuing to profit from its clinical benefits.

Relationships between adrenocorticotropic hormone and cortisol are altered during clustered nursing care in preterm infants born at extremely low gestational age

BACKGROUND

Little is known about the effects of clustered nursing care on hypothalamic pituitary axis (HPA) responses in preterm infants in the neonatal intensive care unit.

AIMS

To examine facial responses, adrenocorticotropic hormone (ACTH) and cortisol levels, and the relationship between ACTH and cortisol in preterm infants in two gestational age groups (extremely low gestational age [ELGA: < or =28 weeks]; very low gestational age [VLGA: 29-31 weeks]) under basal conditions and in response to routine nursing procedures.

STUDY DESIGN

Within subjects' cross-over design in random order.

SUBJECTS

Ninety preterm infants with no postnatal steroid exposure were studied at 32+/-1 weeks postconceptional age.

OUTCOME MEASURES

Facial actions, ACTH and cortisol levels were measured after a 30 minute rest period and in response to routine clustered nursing care (CC). Changes in facial actions were analyzed using repeated measures ANOVA. MANOVA or Mann-Whitney U tests were used to determine differences in ACTH and cortisol between gestational age groups. Spearman rank correlations were used to examine relationships between perinatal variables and facial, ACTH and cortisol levels.

RESULTS

All infants had significantly increased facial responses to CC (p=0.001). Infants having experienced higher numbers of skin breaking procedures 24 h before basal assessment had higher basal cortisol levels (r=0.30, p=0.01). In response to CC, ELGA infants showed no correlation between ACTH and cortisol levels; VLGA infants showed a strong, positive correlation (r=0.62, p=0.02).

CONCLUSION

The pattern of relationship between ACTH and cortisol differs depending on gestational age at birth in response to clustered nursing care. Prior pain alters responsiveness and HPA dysregulation is apparent in ELGA infants.

Anthropometric and laboratory assessment of very low birth weight infants: the most helpful measurements and why

Very low birth weight (VLBW; < or =1500 g), preterm infants have numerous physiological and developmental concerns, including growth and the provision of adequate nutrients to sustain growth. Growth is an important health care outcome measure for VLBW infants. Provision of energy and nutrients at levels to support growth and development is the goal of nutrition support for VLBW infants. Anthropometry and laboratory data are useful components of growth and nutrition assessment. The objectives of this paper are to describe: 1) the clinical application and interpretation of anthropometric measures of growth, and 2) the utilization and interpretation of laboratory tests of nutritional status in VLBW infants.

Determinants of early life leptin levels and later life degenerative outcomes

The early (intrauterine and neonatal) life environment plays an important role in programming the susceptibility in later life to chronic degenerative diseases, such as obesity, cardiovascular diseases, diabetes mellitus, cancer and osteoporosis. Among other hormones, leptin plays a major role in the regulation of the overall metabolism and has multiple neuroendocrine (adeno- and neuro-hypophysis axes and the hypothalamus-pituitary-adrenal axis) and immune functions. The hormone exerts its actions beginning in the early life time period, regulating the intrauterine and early extrauterine life growth and development, as well as the adaptation to extrauterine life, neonatal thermogenesis and response to stress. Recent findings also support a role of leptin in the process of fetal bone remodeling and brain development. Therefore, it is of interest to explore the physiology of leptin in early life, as well as those factors that may perturb the balance of the hormone with pathological consequences in terms of confining an increased risk for disease in later life. This review aims to summarize reported findings concerning the role of leptin in early life, as well as the association of fetal, maternal and placental factors with leptin levels, while attempting to speculate mechanisms through which these factors may influence the risk for developing chronic diseases in later life.

Maternal BMI and serum leptin concentration of infants in the first year of life

AIM

To evaluate the relationship between serum leptin concentration in infants and infant and maternal BMI.

METHODS

75 healthy term infants aged 0-12 mo, 51 exclusively breastfed (BF) for at least 4 mo and 24 formula fed (FF), were included in a cross-sectional study. Weight, length and cranial circumference of infants and their mothers were measured, body mass index (BMI) was calculated using the formula weight (kg)/height (m2) and infant serum leptin concentration was determined.

RESULTS

A significant positive correlation between infant serum leptin concentration and maternal BMI was observed in BF infants (r = 0.389, p = 0.005), confirmed in a multiple regression model adjusted for infant age and infant BMI (beta = 0.065, p = 0.006), but not in FF infants. As regards the first 4 mo of life, we have already observed a positive correlation between infant serum leptin concentration and maternal BMI in BF infants (beta = 0.113, p = 0.005), but not in FF infants.

CONCLUSION

In BF infants, serum leptin concentration correlates positively with maternal BMI. Higher maternal BMI values might increase leptin levels in breast milk, and maternal adiposity could be involved in infant energy balance.

Plasma leptin status in young calves: effects of pre-term birth, age, glucocorticoid status, suckling, and feeding with an automatic feeder or by bucket

Plasma leptin concentrations depend on energy intake and fat stores and are modified by hormones, such as glucocorticoids. We have measured plasma leptin concentrations in pre-term calves (born on day 277 of gestation) during the first week of life, in full-term calves (290 days of gestation), fed similar amounts of nutrients with colostrum or a milk-derived formula, combined with or without dexamethasone treatment (to simulate a high glucocorticoid status), during the first five days of life, and in calves fed with an automatic feeder or by bucket or suckling on dams up to day 28. Leptin concentrations increased (P<0.05) from birth to day 7 in pre-term calves. In full-term calves leptin concentrations were stable from day 1 to day 4 in colostrum-fed animals, but decreased (P<0.05) and were lower (P<0.05) if fed a formula with similar amounts of energy and macronutrients as colostrum. Concentrations increased (P<0.05) from day 1 to day 2 in calves suckling on dams and then remained elevated, but did not change and were lower in calves fed with the automatic feeder or by bucket than in suckling calves. Dexamethasone only slightly elevated leptin concentrations. There was no episodic secretion pattern, and there were no consistent associations of leptin with various metabolites and hormones. In conclusion, plasma leptin in young calves with respect to effects of nutrition (low energy intake) and hormones (glucocorticoids) and in association with metabolic changes behaved differently from what is known in mature cattle.

Early postnatal growth in preterm infants and cord blood leptin

Although circulating leptin and insulin concentration is linked to intrauterine growth, fetal development and birth weight in full-term infants, there has been no enquiry into the influence of cord blood insulin and leptin for catch-up growth in preterm infants. The study evaluated the association of cord blood leptin with growth and weight gain of 96 premature babies during 6 months (corrected age). The temporal changes of anthropometric indexes over this period were calculated by repeated random regression (PROC MIXED) using SAS. Cord blood leptin was negatively associated with the rate of change in BMI (p=0.01) and length (p<0.001), from birth until 64 postnatal weeks. Insulin was positively associated with the change rate in BMI (p=0.03); however, this disappeared when adjusted for birth weight. For the first time, the association between lower leptin levels with greater catch up growth is shown for both BMI and length among preterm children. In conclusion, leptin levels at birth, but not insulin levels, predict growth rates.

The effects of exercise on body weight and circulating leptin in premature infants

OBJECTIVE

To assess the effect of daily movements on weight gain, serum leptin, and insulin-like growth factor I (IGF-I) in premature infants.

STUDY DESIGN

Twenty very-low-birth-weight premature infants were matched and randomized to a daily movement (n = 10) and control groups (n = 10). Daily movement consisted of passive range of motion with gentle compression of both the upper and lower extremities 5 days per week for 4 weeks.

RESULTS

Daily movements led to a significant increase in weight gain (784 +/- 51 vs 608 +/- 26 g in movements and controls, respectively, p < 0.02), and to a significant increase in leptin (0.60 +/- 0.19 vs 0.13 +/- 0.06 ng/ml in movements and controls, respectively 18.8 +/- 4.1 vs 9.2 +/- 4.1 ng/ml in movements and controls, respectively); however, this increase was not statistically significant.

CONCLUSION

A relatively brief range of motion daily movement intervention was associated with greater weight gain and increased leptin levels in very-low-birth-weight premature infants. This may suggest that at least part of the daily movements associated with increase in body weight resulted from an increase in adipose tissue.