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Creed PV, Huff KA, Beard K, DiMeglio LA, Stefanescu BM. Metabolic bone disease of prematurity screening and individualized enteral mineral supplementation in high-risk neonates: a quality improvement initiative. J Perinatol 2024; 44:1369-1376. [PMID: 38321167 DOI: 10.1038/s41372-024-01892-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE Prompted by an alarmingly low screening rate for metabolic bone disease of prematurity (MBDP), we aimed to increase MBDP screening with serum calcium, phosphorous, and alkaline phosphatase at four to six weeks of life in infants born at <1500 g and <32 gestational weeks from a baseline of 27.37% to 90% within one year. STUDY DESIGN We used the Institute for Healthcare Improvement's Model for Improvement as a framework. A key driver diagram informed the interventions which were carried out through four Plan-Do-Study-Act cycles. RESULTS There were 129 and 130 neonates in the pre-intervention baseline group and post-intervention MBDP bundle group, respectively. MBDP bundled primary screening rates increased from 27.37% to 95.56% (p < 0.001). Furthermore, 20% of infants had an individualized change in their enteral mineral supplementation after the initiative. CONCLUSIONS An interdisciplinary team-based quality improvement approach was effective in altering clinical practice to improve screening and subsequent treatment for MBDP.
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Affiliation(s)
- Priya V Creed
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katie A Huff
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kate Beard
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Beatrice M Stefanescu
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
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Kuriyan R, Hills AP, Murphy-Alford A, Padmanabha R, Nyati LH, Byrne NM, Kurpad AV, Norris S. Body composition of infants at 6 months of age using a 3-compartment model. Eur J Clin Nutr 2023:10.1038/s41430-023-01351-2. [PMID: 37833566 DOI: 10.1038/s41430-023-01351-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND/OBJECTIVES Two compartment (2 C) models of body composition, including Air Displacement Plethysmography (ADP) and Deuterium Dilution (DD), assume constant composition of fat-free mass (FFM), while 3-compartment (3 C) model overcomes some of these assumptions; studies are limited in infants. The objective of the present study is to compare 3 C estimates of body composition in 6-mo. old infants from Australia, India, and South Africa, including FFM density and hydration, compare with published literature and to evaluate agreement of body composition estimates from ADP and DD. METHODS Body volume and water were measured in 176 healthy infants using ADP and DD. 3C-model estimates of fat mass (FM), FFM and its composition were calculated, compared between countries (age and sex adjusted) and with published literature. Agreement between estimates from ADP and DD were compared by Bland-Altman and correlation analyses. RESULTS South African infants had significantly higher % FM (11.5%) and density of FFM compared to Australian infants. Australian infants had significantly higher % FFM (74.7 ± 4.4%) compared to South African infants (71.4 ± 5.0) and higher FFMI (12.7 ± 0.8 kg/m2) compared to South African (12.3 ± 1.2 kg/m2) and Indian infants (11.9 ± 1.0 kg/m2). FFM composition of present study differed significantly from literature. Pooled three country estimates of FM and FFM were comparable between ADP and DD; mean difference of -0.05 (95% CI: -0.64, +0.55) kg and +0.05 (95% CI: -0.55, +0.64) kg. CONCLUSIONS 3C-model estimates of body composition in infants differed between countries; future studies are needed to confirm these findings and investigate causes for the differences.
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Affiliation(s)
| | | | | | | | | | | | | | - Shane Norris
- University of Witwatersrand, Johannesburg, South Africa
- University of Southampton, Southampton, UK
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Jerome ML, Valcarce V, Lach L, Itriago E, Salas AA. Infant body composition: A comprehensive overview of assessment techniques, nutrition factors, and health outcomes. Nutr Clin Pract 2023; 38 Suppl 2:S7-S27. [PMID: 37721459 PMCID: PMC10513728 DOI: 10.1002/ncp.11059] [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: 04/14/2023] [Revised: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 09/19/2023] Open
Abstract
Body composition assessment is a valuable tool for clinical assessment and research that has implications for long-term health. Unlike traditional measurements such as anthropometrics or body mass index, body composition assessments provide more accurate measures of body fatness and lean mass. Moreover, depending on the technique, they can offer insight into regional body composition, bone mineral density, and brown adipose tissue. Various methods of body composition assessment exist, including air displacement plethysmography, dual-energy x-ray absorptiometry, bioelectrical impedance, magnetic resonance imaging, D3 creatine, ultrasound, and skinfold thickness, each with its own strengths and limitations. In infants, several feeding practices and nutrition factors are associated with body composition outcomes, such as breast milk vs formula feeding, protein intake, breast milk composition, and postdischarge formulas for preterm infants. Longitudinal studies suggest that body composition in infancy predicts later body composition, obesity, and other cardiometabolic outcomes in childhood, making it a useful early marker of cardiometabolic health in both term and preterm infants. Emerging evidence also suggests that body composition during infancy predicts neurodevelopmental outcomes, particularly in preterm infants at high risk of neurodevelopmental impairment. The purpose of this narrative review is to provide clinicians and researchers with a comprehensive overview of body composition assessment techniques, summarize the links between specific nutrition practices and body composition in infancy, and describe the neurodevelopmental and cardiometabolic outcomes associated with body composition patterns in term and preterm infants.
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Affiliation(s)
| | | | - Laura Lach
- Medical University of South Carolina, Charleston, SC
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4
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Perrone S, Caporilli C, Grassi F, Ferrocino M, Biagi E, Dell’Orto V, Beretta V, Petrolini C, Gambini L, Street ME, Dall’Asta A, Ghi T, Esposito S. Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia. Nutrients 2023; 15:3515. [PMID: 37630705 PMCID: PMC10459154 DOI: 10.3390/nu15163515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the 'foetal programming' of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today's management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Mandy Ferrocino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Eleonora Biagi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Valentina Dell’Orto
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Virginia Beretta
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Lucia Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Maria Elisabeth Street
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Andrea Dall’Asta
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Tullio Ghi
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
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Lü KL, Xie SS, Hu Q, Yang ZY, Fan QL, Liu E, Zhang YP. Diagnostic markers of metabolic bone disease of prematurity in preterm infants. Bone 2023; 169:116656. [PMID: 36586528 DOI: 10.1016/j.bone.2022.116656] [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: 09/25/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
Due to the higher birth rate of preterm infants and improvements in their management, metabolic bone disease of prematurity (MBDP) has a high incidence and is attracting attention. However, clear indicators for the early diagnosis of MBDP are lacking. We aimed to explore simple and feasible early warning indicators for diagnosing MBDP. Our study collected case data of premature infants from two medical centers in Chongqing from January 2020 to February 2022. According to the inclusion and exclusion criteria, data from 136 cases were collected. The correlation between 14 variables in each case and the occurrence of MBDP was analyzed. According to area under the receiver operating characteristic curve (AUROC) analysis, the best cutoff value for each variable was determined. Potential predictors were selected, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to establish the association of two models with MBDP, whose results were used to develop a diagnostic nomogram. Furthermore, a model decision curve was analyzed. Four predictors were selected from 14 clinical variables by LASSO regression, and Model I was established, including the following characteristics: height (>36 cm), head circumference (≤29.49 cm), total serum calcium (Ca) (>2.13 mmol/L), and alkaline phosphatase (ALP) (>344 U/L) levels. A single predictor, the ALP level (>344 U/L), was used to establish Model II. The AUROC values of the two models were 0.959 for Model I and 0.929 for Model II. In conclusion, in this study, two diagnostic models of MBDP were developed using four combinations of predictors and ALP as a single predictor. Both models showed good sensitivity and specificity for the early diagnosis of metabolic bone disease (MBD), and an ALP level of 344 U/L was defined as a simple and effective diagnostic threshold. In future studies, using larger samples, diagnostic threshold values of ALP for premature infants of different ages should be established, and internal and external validations are needed to improve the adaptability of the current model.
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Affiliation(s)
- Kui-Lin Lü
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Shuang-Shuang Xie
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Qi Hu
- Department of Pediatrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Zhang-Ya Yang
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Qiong-Li Fan
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - En Liu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China.
| | - Yu-Ping Zhang
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China.
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6
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Yumani DFJ, de Jongh D, Ket JCF, Lafeber HN, van Weissenbruch MM. Body composition in preterm infants: a systematic review on measurement methods. Pediatr Res 2023; 93:1120-1140. [PMID: 35995939 DOI: 10.1038/s41390-022-02262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/20/2022] [Accepted: 07/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are several methods to measure body composition in preterm infants. Yet, there is no agreement on which method should be preferred. METHODS PubMed, Embase.com, Wiley/Cochrane Library, and Google Scholar were searched for studies that reported on the predictive value or validity of body composition measurements in preterms, up to 6 months corrected age. RESULTS Nineteen out of 1884 identified studies were included. Predictive equations based on weight and length indices, body area circumferences, skinfold thickness, bioelectrical impedance, and ultrasound did not show agreement with body composition measured with air displacement plethysmography (ADP), dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), or isotope dilution. ADP agreed well with fat mass density measured by isotope dilution (bias -0.002 g/ml, limits of agreement ±0.012 g/ml, n = 14). Fat mass percentage measured with ADP did not agree well with fat mass percentage measured by isotope dilution (limits of agreement up to ±5.8%) and the bias between measurements was up to 2.2%. DXA, MRI, and isotope dilution were not compared to another reference method in preterms. CONCLUSIONS DXA, ADP, and isotope dilution methods are considered trustworthy validated techniques. Nevertheless, this review showed that these methods may not yield comparable results. IMPACT Based on validation studies that were conducted in a limited number of study subjects, weight and length indices, body area circumferences, skinfold thickness, bioelectrical impedance, and ultrasound seem to be a poor representation of body composition in preterm infants. DXA, ADP, and isotope dilution methods are considered trustworthy and validated techniques. Nevertheless, these methods may not yield comparable results.
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Affiliation(s)
- Dana F J Yumani
- Department of Pediatrics, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Dide de Jongh
- Faculty of Science, VU University, Amsterdam, The Netherlands
- Faculty of Medical Ethics and Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Harrie N Lafeber
- Department of Pediatrics, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Body composition measurement for the preterm neonate: using a clinical utility framework to translate research tools into clinical care. J Perinatol 2022; 42:1550-1555. [PMID: 36203085 PMCID: PMC9617782 DOI: 10.1038/s41372-022-01529-9] [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: 05/28/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022]
Abstract
Body composition analysis to distinguish between fat mass and fat-free mass is an established research approach to assess nutritional status. Within neonatal medicine, preterm infant body composition is linked with later health outcomes including neurodevelopment and cardiometabolic health. Mounting evidence establishing fat-free mass as an indicator of nutritional status, coupled with the availability of testing approaches that are feasible to use in preterm infants, have enhanced interest in measuring body composition in the neonatal intensive care unit (NICU) setting. In this paper, we use the concept of clinical utility-the added value of a new methodology over current standard care-as a framework for assessing several existing body composition methodologies with potential for clinical application to preterm neonates. We also use this framework to identify remaining knowledge gaps and prioritize efforts to advance our understanding of clinically-oriented body composition testing in the NICU.
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8
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Cramer MN, Gagnon D, Laitano O, Crandall CG. Human temperature regulation under heat stress in health, disease, and injury. Physiol Rev 2022; 102:1907-1989. [PMID: 35679471 PMCID: PMC9394784 DOI: 10.1152/physrev.00047.2021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022] Open
Abstract
The human body constantly exchanges heat with the environment. Temperature regulation is a homeostatic feedback control system that ensures deep body temperature is maintained within narrow limits despite wide variations in environmental conditions and activity-related elevations in metabolic heat production. Extensive research has been performed to study the physiological regulation of deep body temperature. This review focuses on healthy and disordered human temperature regulation during heat stress. Central to this discussion is the notion that various morphological features, intrinsic factors, diseases, and injuries independently and interactively influence deep body temperature during exercise and/or exposure to hot ambient temperatures. The first sections review fundamental aspects of the human heat stress response, including the biophysical principles governing heat balance and the autonomic control of heat loss thermoeffectors. Next, we discuss the effects of different intrinsic factors (morphology, heat adaptation, biological sex, and age), diseases (neurological, cardiovascular, metabolic, and genetic), and injuries (spinal cord injury, deep burns, and heat stroke), with emphasis on the mechanisms by which these factors enhance or disturb the regulation of deep body temperature during heat stress. We conclude with key unanswered questions in this field of research.
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Affiliation(s)
- Matthew N Cramer
- Defence Research and Development Canada-Toronto Research Centre, Toronto, Ontario, Canada
| | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Université de Montréal, Montréal, Quebec, Canada
| | - Orlando Laitano
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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Manapurath R, Gadapani B, Pereira-da-Silva L. Body Composition of Infants Born with Intrauterine Growth Restriction: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:1085. [PMID: 35268060 PMCID: PMC8912478 DOI: 10.3390/nu14051085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
Intrauterine growth restriction (IUGR) may predispose metabolic diseases in later life. Changes in fat-free mass (FFM) and fat mass (FM) may explain this metabolic risk. This review studied the effect of IUGR on body composition in early infancy. Five databases and included studies from all countries published from 2000 until August 2021 were searched. Participants were IUGR or small-for-gestational age (SGA) infants, and the primary outcomes were FFM and FM. Eighteen studies met the inclusion criteria, of which seven were included in the meta-analysis of primary outcomes. Overall, intrauterine growth-restricted and SGA infants were lighter and shorter than normal intrauterine growth and appropriate-for-gestational age infants, respectively, from birth to the latest follow up. They had lower FFM [mean difference −429.19 (p = 0.02)] and FM [mean difference −282.9 (p < 0.001)]. The issue of whether lower FFM and FM as reasons for future metabolic risk in IUGR infants is intriguing which could be explored in further research with longer follow-up. This review, the first of its kind can be useful for developing nutrition targeted interventions for IUGR infants in future.
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Affiliation(s)
- Rukman Manapurath
- Maternal and Child Health (Nutrition), Society for Applied Studies, Centre for Health Research and Development, 45-Kalusarai, New Delhi 110016, India;
| | - Barsha Gadapani
- Maternal and Child Health (Implementation Research), Society for Applied Studies, Centre for Health Research and Development, 45-Kalusarai, New Delhi 110016, India;
| | - Luís Pereira-da-Silva
- Comprehensive Health Research Centre, Medicine of Woman, Childhood and Adolescence, NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Nr 130, 1169-056 Lisbon, Portugal
- NICU, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisbon, Portugal
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Dong H, Yan Y, Liu J, Cheng H, Zhao X, Shan X, Huang G, Mi J, Mi J, Liu J, Cheng H, Zhao X, Shan X, Huang G, Hou D, Wang W, Meng L, Liu Q, Yi Y, Liu L, Ao L, Lu S, Sun J, Wang X, Li Y, Ding W, Zhang L, Jia L, Liu G, Enqing L, Lei P, Yan W, Liu F, Zhang Y, Cheng Y, Chen S, Zhao Q, Cao F, Mu K, Niu D, Xi B, Zhao M, Xiong F, Zhu G. Reference centiles for evaluating total body fat development and fat distribution by dual-energy x-ray absorptiometry among children and adolescents aged 3–18 years. Clin Nutr 2021; 40:1289-1295. [DOI: 10.1016/j.clnu.2020.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 08/14/2020] [Indexed: 11/27/2022]
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A comparative study using dual-energy X-ray absorptiometry, air displacement plethysmography, and skinfolds to assess fat mass in preterms at term equivalent age. Eur J Pediatr 2021; 180:919-927. [PMID: 33006007 PMCID: PMC7886735 DOI: 10.1007/s00431-020-03812-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 10/25/2022]
Abstract
The aim of this study was to compare whole body composition, generated by air displacement plethysmography (ADP) and dual-energy X-ray absorptiometry (DXA), and to evaluate the potential predictive value of the sum of skinfolds (∑SFT) for whole body composition, in preterm infants at term equivalent age. A convenience sample of sixty-five preterm infants with a mean (SD) gestational age of 29 (1.6) weeks was studied at term equivalent age. Fat mass measured by DXA and ADP were compared and the ability of the ∑SFT to predict whole body fat mass was investigated. There was poor agreement between fat mass percentage measured with ADP compared with DXA (limits of agreement: - 4.8% and 13.7%). A previously modeled predictive equation with the ∑SFT as a predictor for absolute fat mass could not be validated. Corrected for confounders, the ∑SFT explained 42% (ADP, p = 0.001) and 75% (DXA, p = 0.001) of the variance in fat mass percentage.Conclusions: The ∑SFT was not able to accurately predict fat mass and ADP and DXA did not show comparable results. It remains to be elucidated whether or not DXA provides more accurate assessment of whole body fat mass than ADP in preterm infants.Trial registration: NTR5311 What is Known: • Diverse methods are used to assess fat mass in preterm infants. What is New: • This study showed that there is poor agreement between dual-energy X-ray absorptiometry, air displacement plethysmography, and skinfold thickness measurements. • Our results affirm the need for consensus guidelines on how to measure fat mass in preterm infants, to improve the assimilation of data from different studies and the implementation of the findings from those studies.
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Avila-Alvarez A, Urisarri A, Fuentes-Carballal J, Mandiá N, Sucasas-Alonso A, Couce ML. Metabolic Bone Disease of Prematurity: Risk Factors and Associated Short-Term Outcomes. Nutrients 2020; 12:E3786. [PMID: 33321828 PMCID: PMC7764323 DOI: 10.3390/nu12123786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk infants. Multivariate logistic regression showed that birth weight was the only independent risk factor for MBD (odds ratio [OR]/100 g, 0.811; confidence interval [CI95%], 0.656-0.992; p = 0.045) and that birth weight (OR/100 g, 0.853; CI95%, 0.731-0.991; p = 0.039) and red blood cell transfusion (OR, 2.661; CI95%, 1.308-5.467; p = 0.007) were independent risk factors for high risk of MBD. Our findings provide evidence of risk factors for MBD that could help clinicians to individualize perinatal management. The association of red blood cell transfusion with MBD is a novel finding that may be related to iron overload and that merits further study.
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Affiliation(s)
- Alejandro Avila-Alvarez
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.F.-C.); (A.S.-A.)
- INIBIC-Health Research Institute of A Coruña, 15006 A Coruña, Spain
- Faculty of Medicine, Universidad de Santiago de Compostela, 15704 Santiago de Compostela, Spain;
| | - Adela Urisarri
- Faculty of Medicine, Universidad de Santiago de Compostela, 15704 Santiago de Compostela, Spain;
- Neonatology Department, University Clinical Hospital of Santiago de Compostela, 15704 Santiago de Compostela, Spain;
- IDIS-Health Research Institute of Santiago de Compostela, 15704 Santiago de Compostela, Spain
| | - Jesús Fuentes-Carballal
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.F.-C.); (A.S.-A.)
| | - Natalia Mandiá
- Neonatology Department, University Clinical Hospital of Santiago de Compostela, 15704 Santiago de Compostela, Spain;
| | - Andrea Sucasas-Alonso
- Neonatology Unit, Pediatrics Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.F.-C.); (A.S.-A.)
| | - María L. Couce
- Faculty of Medicine, Universidad de Santiago de Compostela, 15704 Santiago de Compostela, Spain;
- Neonatology Department, University Clinical Hospital of Santiago de Compostela, 15704 Santiago de Compostela, Spain;
- IDIS-Health Research Institute of Santiago de Compostela, 15704 Santiago de Compostela, Spain
- CIBERER, Instituto Salud Carlos III, 28029 Madrid, Spain
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13
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Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Premature Neonates: An Unmet Challenge. J Clin Res Pediatr Endocrinol 2020; 12:332-339. [PMID: 31674171 PMCID: PMC7711645 DOI: 10.4274/jcrpe.galenos.2019.2019.0091] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Metabolic bone disease (MBD) is an important cause of morbidity in premature, very low birth weight (VLBW) and sick infants and, if left undiagnosed, may lead to structural deformities and spontaneous fractures. MBD is defined as impaired bone mineralization in a neonate with lower than expected bone mineral levels in either a fetus or a neonate of comparable gestational age and/or weight, coupled with biochemical abnormalities with or without accompanying radiological manifestations. MBD has been reported to occur in 16% to 40% of extremely low birth weight neonates and presents by 6-16 weeks after birth. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to MBD in neonates along with the use of some medications such as caffeine or steroids, prolonged parenteral nutrition and chronic immobilization. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. These abnormalities may include hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypovitaminosis D can be additional complications. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include non-invasive bone densitometry by quantitative ultrasound over the mid-tibial shaft. The management of MBD includes adequate calcium, phosphorous and vitamin D supplementation, along with optimum nutrition and physical activity. Similarly, preventive strategies for MBD should target nutritional enhancement in combination with enhanced physical activity. MBD usually results in preventable morbidity in preterm and VLBW neonates. Treatment consists of optimum nutritional supplementation and enhanced physical activity.
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Affiliation(s)
- Swathi Chacham
- All India Institute of Institute of Medical Sciences, Rishikesh, India,* Address for Correspondence: All India Institute of Institute of Medical Sciences, Rishikesh, India Phone: +91-98494-47306 E-mail:
| | - Rachna Pasi
- Himalayan Institute of Medical Sciences, Dehradun, India
| | | | - Najeeb Ahmad
- All India Institute of Institute of Medical Sciences, Rishikesh, India
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14
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O'Reilly P, Saviani M, Tou A, Tarrant A, Capra L, McCallion N. Do preterm bones still break? Incidence of rib fracture and osteopenia of prematurity in very low birth weight infants. J Paediatr Child Health 2020; 56:959-963. [PMID: 32159889 DOI: 10.1111/jpc.14852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/01/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022]
Abstract
AIM Extremely premature babies are at risk of osteopenia of prematurity (OOP) as bone mineralisation in utero increases exponentially after 24 weeks gestation. Our aim was to assess the bone health of very low birth weight (VLBW) infants. We wanted to establish the incidences of OOP and rib fracture. We also looked at which biochemical markers best predicted OOP. Bone health in this vulnerable population is an important aspect of management which should not be overlooked. METHODS This was an observational study which included all VLBW infants, born in a national maternity hospital, over a 5-year period. All X-rays performed on these infants were reviewed. Data were also collected on biochemical markers associated with bone health. The medical records of infants with rib fractures were reviewed looking for causes of bone fragility. RESULTS Of the 609 VLBW infants included in the study, only two cases of definitive rib fractures were found. This represents a rib fracture incidence of 3 per 1000. Thirty-nine percent of VLBW babies showed radiological evidence suggestive of OOP. CONCLUSION Our findings show a lower rate of rib fracture in preterm infants compared to previous evidence. We also showed that these fractures were not evident on the final X-ray prior to discharge. This implies that when an ex-preterm infant presents to the emergency department with a rib fracture there should be an even higher suspicion for non-accidental injury than previously thought.
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Affiliation(s)
- Peter O'Reilly
- Neonatology Department, Rotunda Hospital, Dublin, Ireland
| | | | - Andrea Tou
- Neonatology Department, Rotunda Hospital, Dublin, Ireland
| | - Ailbhe Tarrant
- Neonatology Department, Rotunda Hospital, Dublin, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise Capra
- Children's Health Ireland at Temple Street, Dublin, Ireland
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15
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Baş EK, Bülbül A, Şirzai H, Arslan S, Uslu S, Baş V, Zubarioglu U, Celik M, Dursun M, Güran Ö, Kuran B. The long-term impacts of preterm birth and associated morbidities on bone health in preschool children: a prospective cross-sectional study from Turkey. J Matern Fetal Neonatal Med 2020; 35:677-684. [PMID: 32102581 DOI: 10.1080/14767058.2020.1730801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To evaluate the impact of preterm birth on bone health in preschool children.Methods: A total of 166 preschool children (aged 7-8 years) born preterm (n = 86, <37-week gestation) and at term (n = 80, ≥37 weeks of gestation) in our hospital were included in this prospective cross-sectional study. Data on antenatal, perinatal, and early postnatal characteristics and maternal obstetric history were obtained from medical records. Bone densitometry data including total bone mineral content (BMC), bone mineral density (BMD; total, lumbar, and femoral), z-scores, and bone loss were collected for each participant.Results: Current height, weight, and BMI values were significantly lower in the preterm group (p < .001). Serum calcium, phosphorus and alkaline phosphatase (ALP) levels did not differ among groups, whereas VitD3 levels were significantly higher in the preterm group (p = .039). The mean total BMC, total BMD, lumbar (L2-L4) BMD, femur BMD, total z-score, and L2-L4 z-score values were significantly lower for the preterm group, whereas the total, lumbar, and femoral bone loss were significantly higher (p < .001), regardless of the severity of prematurity. Intraventricular hemorrhage (IVH) and retinopathy were significantly associated with lower total BMC (p = .004, p = .012, respectively). Fortified breastfeeding was associated with lumbar bone loss (p = .043), and formula feeding was associated with both femur and lumbar bone loss (p = .006, p = .012, respectively).Conclusions: Our findings revealed long-term adverse effects of preterm birth on bone health, with significantly lower anthropometric values (weight, height, and BMI), lower scores for total BMC, BMD (total, lumbar, femoral), and z-scores (total, femur), along with higher bone loss (total, lumbar, femoral) and higher rates of osteopenia and osteoporosis in preschool children born preterm (whether moderate or very preterm) compared with those born at term. Exclusive breastfeeding appears to reduce the likelihood of long-term bone loss in preterm infants.
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Affiliation(s)
- Evrim Kıray Baş
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Bülbül
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hülya Şirzai
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selda Arslan
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Uslu
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Vedat Baş
- Department of pediatrics, Istanbul Arel University, Istanbul, Turkey
| | - Umut Zubarioglu
- Department of neonatology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Muhittin Celik
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Dursun
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ömer Güran
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Banu Kuran
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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16
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Abstract
Metabolic bone disease (MBD) of prematurity remains a significant comorbid condition in preterm, low birth weight infants. As the majority of in utero calcium (Ca) and phosphorus (Phos) accretion occurs during the third trimester, many of these children have inadequate mineral stores and are at risk for deficiencies of Ca and Phos. While fortification of formula has allowed for increased mineral delivery to premature infants, intestinal immaturity prevents optimal absorption. This is compounded by immobilization, delayed establishment of enteral feeds, long term parenteral nutrition and medications that may alter mineral levels. Over time, biochemical changes occur and accompany MBD, with poor bone mineralization during this period increasing the risk for complications such as osteopenia, rickets and fractures. Screening is largely based on risk factors, but despite the 2013 AAP Consensus Statement, there remains significant variation in screening practices across institutions. A combination of laboratory and radiologic testing is often used to diagnose and manage MBD of prematurity, but there exists a lack of consensus on which screening tests and thresholds to use. This is in part related to a lack of normative data and clinical trials for preterm infants, and a result, a lack of evidence-based guidelines on the diagnosis and timing of potential treatment. Biochemical markers, such as serum Phos, alkaline phosphatase (ALP) and parathyroid hormone (PTH), have shown some benefit in the diagnosis of MBD in some studies, but have not always been reproducible. Radiographs may identify different degrees of skeletal changes, but these changes may not be detected until later in MBD development. Other modalities, such as DXA and ultrasound, have also been used, but these may be limited by lack of standards in preterm infants or lack of availability in some centers. Further research, more specifically clinical trials, are needed to determine which combination of tests can detect MBD at its earliest, in order to promote early treatment and prevent short- and long-term complications of MBD.
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Affiliation(s)
- Arpana Rayannavar
- Division of Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Andrew C Calabria
- Division of Endocrinology and Diabetes Children's Hospital of Philadelphia, Associate Professor of Clinical Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3500 Civic Center Blvd, Buerger Center, 12th floor, Philadelphia, PA, USA.
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17
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Hamatschek C, Yousuf EI, Möllers LS, So HY, Morrison KM, Fusch C, Rochow N. Fat and Fat-Free Mass of Preterm and Term Infants from Birth to Six Months: A Review of Current Evidence. Nutrients 2020; 12:nu12020288. [PMID: 31973218 PMCID: PMC7070317 DOI: 10.3390/nu12020288] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 01/30/2023] Open
Abstract
To optimize infant nutrition, the nature of weight gain must be analyzed. This study aims to review publications and develop growth charts for fat and fat-free mass for preterm and term infants. Body composition data measured by air displacement plethysmography (ADP) and dual energy X-ray absorptiometry (DXA) in preterm and term infants until six months corrected age were abstracted from publications (31 December 1990 to 30 April 2019). Age-specific percentiles were calculated. ADP measurements were used in 110 studies (2855 preterm and 22,410 term infants), and DXA was used in 28 studies (1147 preterm and 3542 term infants). At term age, preterm infants had higher percent-fat than term-born infants (16% vs. 11%, p < 0.001). At 52 weeks postmenstrual age (PMA), both reached similar percent-fat (24% vs. 25%). In contrast, at term age, preterm infants had less fat-free mass (2500 g vs. 2900 g) by 400 g. This difference decreased to 250 g by 52 weeks, and to 100 g at 60 weeks PMA (5000 g vs. 5100 g). DXA fat-free mass data were comparable with ADP. However, median percent-fat was up to 5% higher with DXA measurements compared with ADP with PMA > 50 weeks. There are methodological differences between ADP and DXA measures for infants with higher fat mass. The cause of higher fat mass in preterm infants at term age needs further investigation.
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Affiliation(s)
- Constanze Hamatschek
- Department of Pediatrics, Paracelsus Medical University, General Hospital, 90471 Nuremberg, Germany; (C.H.); (L.S.M.); (C.F.)
| | - Efrah I. Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.I.Y.); (K.M.M.)
| | - Lea Sophie Möllers
- Department of Pediatrics, Paracelsus Medical University, General Hospital, 90471 Nuremberg, Germany; (C.H.); (L.S.M.); (C.F.)
| | - Hon Yiu So
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON L8S 4L8, Canada;
| | - Katherine M. Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.I.Y.); (K.M.M.)
| | - Christoph Fusch
- Department of Pediatrics, Paracelsus Medical University, General Hospital, 90471 Nuremberg, Germany; (C.H.); (L.S.M.); (C.F.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.I.Y.); (K.M.M.)
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, General Hospital, 90471 Nuremberg, Germany; (C.H.); (L.S.M.); (C.F.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada; (E.I.Y.); (K.M.M.)
- Department of Pediatrics, University Hospital, 18057 Rostock, Germany
- Correspondence:
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18
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Bronsky J, Campoy C, Embleton N, Fewtrell M, Mis NF, Gerasimidis K, Hojsak I, Hulst J, Indrio F, Lapillonne A, Molgaard C, Moltu SJ, Verduci E, Vora R, Domellöf M. Palm Oil and Beta-palmitate in Infant Formula: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 68:742-760. [PMID: 31022096 DOI: 10.1097/mpg.0000000000002307] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN-1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN-2 position (typical configuration in human milk). As there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN-2-palmitate in infant formulas. METHODS PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN-2-palmitate in infant formula on various health outcomes. RESULTS We identified 12 relevant studies using PO and 21 studies using SN-2-palmitate. Published studies have variable methodology, subject characteristics, and some are underpowered for the key outcomes. PO is associated with harder stools and SN-2-palmitate use may lead to softer stool consistency. Bone effects seem to be short-lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases. CONCLUSIONS There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN-2-palmitate fat blend in infant formulas may have short-term effects on stool consistency but cannot be considered essential.
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Affiliation(s)
- Jiri Bronsky
- Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Nicholas Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL GOS Institute of Child Health, London, UK
| | - Nataša Fidler Mis
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Iva Hojsak
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Jessie Hulst
- Department of Paediatric Gastroenterology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Flavia Indrio
- Ospedale Pediatrico Giovanni XXIII University of Bari, Bari, Italy
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France.,CNRC, Baylor College of Medicine, Houston, Texas
| | - Christian Molgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen.,Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Rakesh Vora
- Leeds teaching hospitals NHS trust, Leeds, UK
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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19
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Wells JCK, Davies PSW, Fewtrell MS, Cole TJ. Body composition reference charts for UK infants and children aged 6 weeks to 5 years based on measurement of total body water by isotope dilution. Eur J Clin Nutr 2019; 74:141-148. [PMID: 30809008 PMCID: PMC6949189 DOI: 10.1038/s41430-019-0409-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/18/2018] [Accepted: 01/02/2019] [Indexed: 02/03/2023]
Abstract
Background Until recently, pediatric body composition reference data were very limited, hindering interpretation of measurements. In the last decade, such data emerged for several techniques for children ≥ 5 years, but equivalent data for younger age groups remain lacking, due to their poor compliance with most techniques. Objectives To provide reference data for use in clinical practice and research from 6 weeks to 5 years, that are based on measurements of total body water (TBW) by isotope dilution. Design The data on anthropometry and TBW were available from studies of 463 infants and children aged 6 weeks to 7 years, conducted between 1988 and 2010. Both breast-fed and formula-fed infants were included. TBW was measured by 2H- or 18O-labeled water, and converted to fat-free mass (FFM) using published hydration coefficients. Reference charts and SD scores (SDS) were constructed for FFM, fat mass (FM), FFM index and FM index for each sex, using the lambda-mu-sigma method. Results Both sexes were significantly heavier and longer than UK 1990 reference data (p < 0.01), but did not differ in body mass index SDS. Breast-fed infants were longer than formula-fed infants but did not differ in body composition. Conclusions These reference data will enhance the ability of clinicians to assess and monitor body composition and FFM/FM accretion in clinical practice in younger age groups. Total body water can be measured in most patients, though abnormalities of hydration must be addressed. However, the centiles do not overlap exactly with those published for older age groups, limiting comparability between younger and older children.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK. .,Population, Policy, and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Peter S W Davies
- Child Health Research Center, Centre for Children's Health Research, University of Queensland, Brisbane, QLD, Australia
| | - Mary S Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Population, Policy, and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Tim J Cole
- Population, Policy, and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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20
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Measuring body composition in the preterm infant: Evidence base and practicalities. Clin Nutr 2019; 38:2521-2530. [PMID: 30737045 DOI: 10.1016/j.clnu.2018.12.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/28/2018] [Indexed: 12/15/2022]
Abstract
Preterm birth and body composition have demonstrable effects on growth and later health outcomes. Preterm infants reach term equivalent age with a lower proportion of lean mass and higher body fat percentage than their term equivalent counterparts. Weight and length do not give an accurate assessment of body composition. Tracking body composition rather than just weight is a fundamental part of improving nutritional outcomes. This is important given the ongoing controversies regarding the nutritional needs of preterm infants, as well as establishing suitable targets for their growth. In this review we describe current methodologies used in the measurement of body composition of the preterm infant and the review the recent published evidence for their accuracy and utility. Current measurement techniques employed include air displacement plethysmography, bioelectrical impedance analysis, isotope dilution techniques, MRI and a combination of manual measurements including skinfold thickness, body mass index and mid upper arm/mid-thigh circumference. These measures allow for the estimation of fat mass, fat-free mass and regional assessment of adiposity. Some methods, such as dual-energy X-ray absorptiometry and air displacement plethysmography do allow for comparison of change in body composition over time in cohorts of preterm infants that may be studied over a longer period of time and into adult life. However, none of the currently described methods give an accurate and practically achievable method of obtaining body composition measures in preterm infants in day to day routine clinical practise, although this remains a key priority when decisions are being made about how best to feed.
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21
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Faienza MF, D'Amato E, Natale MP, Grano M, Chiarito M, Brunetti G, D'Amato G. Metabolic Bone Disease of Prematurity: Diagnosis and Management. Front Pediatr 2019; 7:143. [PMID: 31032241 PMCID: PMC6474071 DOI: 10.3389/fped.2019.00143] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
Metabolic Bone Disease (MBD) of prematurity is a multifactorial disorder commonly observed in very low birth weight (VLBW, <1,500 g) newborns, with a greater incidence in those extremely low birth weight (ELBW, <1,000 g). MBD is characterized by biochemical and radiological findings related to bone demineralization. Several antenatal and postnatal risk factors have been associated to MBD of prematurity, although the main pathogenetic mechanism is represented by the reduced placental transfer of calcium and phosphate related to preterm birth. The diagnosis of MBD of prematurity requires the assessment of several biochemical markers, radiological, and ultrasonographic findings. However, the best approach is the prevention of the symptomatic disease, based on the screening of subjects exposed to the risks of developing MBD. Regarding the subjects who need to be screened, there is a substantial agreement on the potential risk factors for MBD. On the contrary, different recommendations exist on the diagnosis, management and treatment of this disorder of bone metabolism. This review was aimed at: (1) identifying the subjects at risk for MBD of prematurity; (2) indicating the biochemical findings to take in consideration for the prevention of MBD of prematurity; (3) suggesting practical recommendations on nutritional intake and supplementation in these subjects. We searched for papers which report the current recommendations for biochemical assessment of MBD of prematurity and for its prevention and treatment. The majority of the authors suggest that MBD of prematurity is a disease which tends to normalize overtime, thus it is not mandatory to mimic the rate of mineral fetal accretion through parenteral or enteral supplementation. The optimization of total parenteral nutrition (TPN) and the early achievement of a full enteral feeding are important goals for the prevention and management of MBD of prematurity.
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Affiliation(s)
- Maria Felicia Faienza
- Pediatric Section, Department of Biomedicine and Human Oncology, University of Bari A. Moro, Bari, Italy
| | - Elena D'Amato
- Department of Electric and Electronic Engineering, City University of London, London, United Kingdom
| | | | - Maria Grano
- Section of Human Anatomy and Histology, Department of Emergency and Organ Transplantation, University of Bari A. Moro, Bari, Italy
| | - Mariangela Chiarito
- Pediatric Section, Department of Biomedicine and Human Oncology, University of Bari A. Moro, Bari, Italy
| | - Giacomina Brunetti
- Section of Human Anatomy and Histology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari A. Moro, Bari, Italy
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22
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Högberg U, Andersson J, Högberg G, Thiblin I. Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study. PLoS One 2018; 13:e0208033. [PMID: 30566429 PMCID: PMC6300197 DOI: 10.1371/journal.pone.0208033] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis. Methods The design was a population-based register study in Sweden. Participants: Children born 1997–2014, 0–1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register. Main outcome measures were fractures of the skull, long bone, clavicle and ribs, categorized by age (younger or older than 6 months), and accident or not. Findings The incidence of fractures during infancy was 251 per 100 000 infants (n = 4663). Major fracture localisations were long bone (44·9%), skull (31·7%), and clavicle (18·6%), while rib fractures were few (1·4%). Fall accidents were reported among 71·4%. One-third occurred during the first 6 months. Metabolic bone disease risk factors, such as maternal obesity, preterm birth, vitamin D deficiency, rickets, and calcium metabolic disturbances, had increased odds of fractures of long bones and ribs in early infancy (0–6 months): birth 32–36 weeks and long bone fracture [AOR 2·13 (95%CI 1·67–2·93)] and rib fracture [AOR 4·24 (95%CI 1·40–12·8)]. Diagnosis of vitamin D deficiency/rickets/disorders of calcium metabolism had increased odds of long bone fracture [AOR 49·5 (95%CI 18·3–134)] and rib fracture [AOR 617 (95%CI 162–2506)]. Fractures without a reported accident had higher odds of metabolic risk factors than those with reported accidents. Abuse diagnosis was registered in 105 infants, with overrepresentation of preterm births, multiple births and small-for-gestational age. Interpretation Metabolic bone disease risk factors are strongly associated with fractures of long bone and ribs in early infancy. Fracture cases with abuse diagnosis had a metabolic bone risk factor profile.
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Affiliation(s)
- Ulf Högberg
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Jacob Andersson
- Forensic Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Högberg
- Formerly Department of Women’s and Children’s Health, Child and Adolescent Psychiatric Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Thiblin
- Forensic Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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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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Parlapani E, Agakidis C, Karagiozoglou-Lampoudi T. Anthropometry and Body Composition of Preterm Neonates in the Light of Metabolic Programming. J Am Coll Nutr 2018; 37:350-359. [PMID: 29425475 DOI: 10.1080/07315724.2017.1400479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The improved survival of preterm infants has led to increased interest regarding their health as adults. In the context of metabolic programming, the connection between perinatal and early postnatal nutrition and growth with health in later life has brought to the fore the role of catch-up growth during the first months of preterm infants' lives and its association with body fat and obesity in childhood or puberty. A state-of-the art review was conducted in order to assess the way catch-up is evaluated, in terms of timing and rate. Adequate growth is of major importance for neurodevelopment; however, it may compete with adiposity or metabolic health. Studies based on body composition assessment have given conflicting results as regards the effect of early versus late and rapid versus slow catch-up growth on later health, mainly attributed to the lack of established criteria and definitions. Given that adequate early nutrition is crucial for the neurodevelopment of preterm infants, further studies are needed on the role of catch-up growth in long-term outcome, using generally accepted qualitative and quantitative criteria.
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Affiliation(s)
- Elisavet Parlapani
- a Clinical Nutrition Lab, Nutrition/Dietetics Department , Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , Greece.,b 1st Department of Neonatology and NICU , Faculty of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital , Thessaloniki , Greece
| | - Charalampos Agakidis
- c 1st Department of Pediatrics , Faculty of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital , Thessaloniki , Greece
| | - Thomais Karagiozoglou-Lampoudi
- a Clinical Nutrition Lab, Nutrition/Dietetics Department , Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , Greece
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Anderson-Berry A, Thoene M, Wagner J, Lyden E, Jones G, Kaufmann M, Van Ormer M, Hanson C. Randomized trial of two doses of vitamin D3 in preterm infants <32 weeks: Dose impact on achieving desired serum 25(OH)D3 in a NICU population. PLoS One 2017; 12:e0185950. [PMID: 29016653 PMCID: PMC5634602 DOI: 10.1371/journal.pone.0185950] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/23/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recommendations for vitamin D supplementation for preterm infants span a wide range of doses. Response to vitamin D supplementation and impact on outcomes in preterm infants is not well understood. OBJECTIVE Evaluate serum 25(OH)D3 concentration changes after 4 weeks in response to two different doses of vitamin D3 supplementation in a population of premature infants and quantify the impact on NICU outcomes. DESIGN 32 infants born at 24-32 weeks gestation were prospectively randomized to receive 400 or 800 IU/day vitamin D3 supplementation. Serum 25(OH)D3 levels were measured every 4 weeks. The Wilcoxon signed rank test was used to compare serum levels of 25(OH)D3 at 4 weeks and each subsequent time point. A p-value of <0.05 was considered statistically significant. RESULTS Serum 25(OH)D3 levels at birth were 41.9 and 42.9 nmol/l for infants in the 400 IU group and 800 IU group, respectively (p = 0.86). Cord 25(OH)D3 concentrations significantly correlated with gestational age (r = 0.40, p = 0.04). After 4 weeks of D3 supplementation, median 25(OH)D3 levels increased in both groups (84.6vs. 105.3 nmol/l for 400 vs. 800 IU/day respectively, with significantly more improvement in the higher dose (p = 0.048). Infants in the 400 IU group were significantly more likely to have dual energy x-ray absorptiometry (DEXA) bone density measurements <10 percentile (56% vs 16%, p = 0.04). CONCLUSIONS Improvement in 25(OH)D3 levels at 4 weeks, bone density, and trends towards improvement in linear growth support consideration of a daily dose of 800 IU of vitamin D for infants <32 weeks cared for in the NICU.
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Affiliation(s)
- Ann Anderson-Berry
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Melissa Thoene
- Neonatal Intensive Care Unit, The Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Julie Wagner
- CHI Health, Omaha, Nebraska, United States of America
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Martin Kaufmann
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Van Ormer
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Corrine Hanson
- Division of Medical Nutrition Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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26
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Abstract
With advancements in the care of preterm infants, the goals in nutritional care have expanded from survival and mimicking fetal growth to optimizing neurodevelopmental outcomes. Inadequate nutritional support may be a risk factor for major complications of prematurity; conversely, higher disease burden is a risk for growth restriction. Early complete parenteral nutrition support, including intravenous lipid emulsion, should be adopted, and the next challenge that should be addressed is parenteral nutrition customized to fit the specific needs and metabolism of the extremely preterm infant. Standardized feeding protocols should be adopted.
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Affiliation(s)
- Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Ting Ting Fu
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Brenda Poindexter
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
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Shepherd JA, Sommer MJ, Fan B, Powers C, Stranix-Chibanda L, Zadzilka A, Basar M, George K, Mukwasi-Kahari C, Siberry G. Advanced Analysis Techniques Improve Infant Bone and Body Composition Measures by Dual-Energy X-Ray Absorptiometry. J Pediatr 2017; 181:248-253.e3. [PMID: 27866821 PMCID: PMC5274603 DOI: 10.1016/j.jpeds.2016.10.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/29/2016] [Accepted: 10/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate a novel technique designed to reduce the negative impact of motion artifacts in infant dual-energy X-ray absorptiometry (DXA) scans. STUDY DESIGN Using cross-sectional data from a large multicenter study, we developed and tested advanced methods for infant scan analysis. Newborns (n = 750) received spine and whole-body DXA scans with up to 3 attempts to acquire a motion free scan. Precision of infant DXA was estimated from visits with multiple valid scans. Accuracy of regional reflection, fusion, and omission techniques was estimated by comparing modified scans to unmodified valid scans. The effectiveness of the acquisition and analysis protocol was represented by the reduction in rate of failure to acquire valid results from infant visits. RESULTS For infant whole-body DXA, arm reflection and all fusion techniques caused no significant changes to bone mineral content, bone mineral density, bone area, total mass, fat mass, lean mass, and percentage fat. Leg reflection and arm/leg dual-reflection caused significant changes to total mass, but the percentage change remained small. For infant spine DXA, fusion and omission caused no significant changes. Advanced analysis techniques reduced the failure rate of whole-body scanning from 20.8% to 9.3% and the failure rate of spine scanning from 8.9% to 2.4%. CONCLUSIONS Advanced analysis techniques significantly reduced the impact of motion artifacts on infant DXA scans. We suggest this protocol be used in future infant DXA research and clinical practice.
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Affiliation(s)
- John A Shepherd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
| | - Markus J Sommer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Bo Fan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Cassidy Powers
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | | | - Amanda Zadzilka
- Frontier Science and Technology Research Foundation, Amherst, NY
| | - Michael Basar
- Frontier Science and Technology Research Foundation, Amherst, NY
| | - Kathy George
- Frontier Science and Technology Research Foundation, Amherst, NY
| | | | - George Siberry
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia. J Pediatr 2017; 181:12-28.e1. [PMID: 27908648 PMCID: PMC5562402 DOI: 10.1016/j.jpeds.2016.10.082] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 01/02/2023]
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Demerath EW, Johnson W, Davern BA, Anderson CG, Shenberger JS, Misra S, Ramel SE. New body composition reference charts for preterm infants. Am J Clin Nutr 2017; 105:70-77. [PMID: 27806978 DOI: 10.3945/ajcn.116.138248] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) has recommended that nutritional management of the preterm infant should aim to achieve body composition that replicates the in utero fetus, but intrauterine body composition reference charts for preterm infants are lacking. OBJECTIVE Our objective was to create body composition reference curves for preterm infants that approximate the body composition of the in utero fetus from 30 to 36 wk of gestation. DESIGN A total of 223 ethnically diverse infants born at 30 + 0 to 36 + 6 wk of gestation were enrolled. Inclusion and exclusion criteria were specified so that the sample would represent healthy appropriately growing fetuses (e.g., singleton, birth weight appropriate for their gestational age, and medically stable). Cross-sectional reference values were generated for fat mass (FM), fat-free mass (FFM), and percentage body fat (PBF) by gestational age (GA), with the use of air-displacement plethysmography (ADP) and the lambda-mu-sigma method for percentile estimation. RESULTS GA-specific percentile values and a percentile and z score calculator for FFM, FM, and PBF are presented. These values aligned closely with ADP centile values published for term infants from 36 to 38 wk of gestation. The medians were also similar to the mean values for the reference fetus derived from chemical analysis previously. CONCLUSIONS To our knowledge, these are the first body composition reference charts for total FM and FFM at birth in preterm infants to assist in following AAP guidelines. Future work will test the clinical utility of body composition monitoring for improving nutritional management in this population. This trial was registered at clinicaltrials.gov as NCT02855814.
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Affiliation(s)
- Ellen W Demerath
- Division of Epidemiology and Community Health, School of Public Health, and
| | - William Johnson
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | - Bridget A Davern
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Sonya Misra
- Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA; and
| | - Sara E Ramel
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
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30
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Neonatal milk supplementation in lambs has persistent effects on growth and metabolic function that differ by sex and gestational age. Br J Nutr 2016; 116:1912-1925. [DOI: 10.1017/s0007114516004013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AbstractThe perinatal environment has a major influence on long-term health and disease risk. Preterm birth alters early-life environment and is associated with altered metabolic function in adulthood. Whether preterm birthper seor the early nutritional interventions used to support growth in preterm infants underpins this association is unknown. Lambs born preterm, following dexamethasone induction of labour, or spontaneously at term were randomised to receive nutrient supplementation, analogous to the milk fortifier used clinically or water as a control for the first 2 weeks after birth. Thereafter, nutrition was not different between groups. Growth was monitored, and the glucose–insulin axis function was assessed in juvenile (4 months) and adult life (14 months). Early nutrition influenced adult metabolic function and body composition to a greater extent than preterm birth. In supplemented females, arginine-stimulated insulin secretion was increased in preterm but reduced in term-born juveniles compared with controls (repeated-measures ANOVAP<0·01). In supplemented preterm males, adult weight, ponderal index (PI) and fasting insulin concentrations were elevated compared with preterm controls (weight, 75 (sem3)v. 69 (sem2) kg; PI, 48·0 (sem2·1)v. 43·7 (sem1·7) kg/m3; fasting insulin, 0·19 (sem0·02)v. 0·10 (sem0·02) ng/ml). Conversely, supplemented term-born males had reduced adult weight, PI and fasting insulin concentrations compared with term-born controls (weight, 64 (sem2)v. 70 (sem2) kg; PI, 44·4 (sem1·8)v. 48·2 (sem1·7) kg/m3; fasting insulin, 0·09 (sem0·02)v. 0·14 (sem0·02) ng/ml; all group×supplement interactionsP<0·05). Adult metabolic health may reflect both gestational age at birth and early nutrition. Human studies are urgently needed to investigate the adult sex-specific health implications of neonatal nutritional strategies.
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31
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Nguyen VB, De Matteo R, Harding R, Stefanidis A, Polglase GR, Black MJ. Experimentally Induced Preterm Birth in Sheep Following a Clinical Course of Antenatal Betamethasone: Effects on Growth and Long-Term Survival. Reprod Sci 2016; 24:1203-1213. [DOI: 10.1177/1933719116681514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vivian B. Nguyen
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Robert De Matteo
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Richard Harding
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Aneta Stefanidis
- Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - M. Jane Black
- Development and Stem Cells Program, Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
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32
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The Clinical and Biochemical Predictors of Bone Mass in Preterm Infants. PLoS One 2016; 11:e0165727. [PMID: 27806112 PMCID: PMC5091911 DOI: 10.1371/journal.pone.0165727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/17/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Metabolic bone disease of prematurity still occurs in preterm infants, although a significant improvement in neonatal care has been observed in recent decades. Dual-energy X-ray absorptiometry (DXA) is the precise technique for assessing bone mineral content (BMC) in preterm infants, but is not widely available. AIM To investigate the clinical and biochemical parameters, including bone metabolism markers as potential predictors of BMC, in preterm infants up to 3 months corrected age (CA). MATERIALS AND METHODS Ca-P homeostasis, iPTH, 25-hydroxyvitamin D, osteocalcin, N-terminal propeptide, cross-linked C-telopeptide and amino-terminal pro C-type natriuretic peptide and the DXA scans were prospectively performed in 184 preterm infants (≤ 34 weeks' gestation) between term age and 3 mo CA. Lower bone mass was defined as BMC below or equal to respective median value for the whole study group, rounded to the nearest whole number. RESULTS The appropriate quality DXA scans were available for 160 infants (87%) examined at term and for 130 (71%) tested at 3 mo CA. Higher iPTH level was the only independent predictor of lower BMC at term, whereas lower BMC at 3 mo CA was associated both with lower urinary phosphate excretion and higher serum osteocalcin level. ROC analysis showed that iPTH >43.6 pg/mL provided 40% sensitivity and 88% specificity in identification of preterm infants with lower BMC at term. In turn, urinary phosphate excretion (TRP>97% or UP/Cr ≤0.74 mg/mg) and serum osteocalcin >172 ng/mL provided 40% sensitivity and 93% specificity in identification of infants with decreased BMC at 3 mo CA. CONCLUSION Serum iPTH might to be a simple predictor of reduced BMC in preterm infants at term age, but urinary phosphate excretion and serum osteocalcin might predict reduced BMC at 3 mo CA. These results represent a promising diagnostic tool based on simple, widely available biochemical measurements for bone mass assessment in preterm infants.
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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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34
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Meneghelli M, Pasinato A, Salvadori S, Gaio P, Fantinato M, Vanzo V, De Terlizzi F, Verlato G. Bone status in preterm infant: influences of different nutritional regimens and possible markers of bone disease. J Perinatol 2016; 36:394-400. [PMID: 26765552 DOI: 10.1038/jp.2015.212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate possible influences of parenteral nutrition on growth and bone development in preterms and to search for markers of bone status. STUDY DESIGN Metacarpus bone transmission time (mc-BTT) was performed at birth, 21 days and 36 weeks of gestational age (GA) in preterms, receiving two different nutritional regimens, together with biochemical analysis. RESULT A total of 234 patients were studied. Newborns with aggressive nutrition had significantly better growth rate and higher values of mc-BTT until discharge. Mc-BTT at day 21 correlates positively with nutritional intakes and phosphatemia; lower limb length positively correlated with mc-BTT (P<0.01). Newborns with low energy intake in the first week of life (<70 kcal kg(-1) per day) and low serum phosphate level (<1.4 mmol l(-1)) at 21 days had lower mc-BTT at 36 weeks of GA (P<0.01). CONCLUSION Aggressive parenteral intakes in preterms improve growth and bone status in the short-medium term, suggesting that early nutrition could influence bone development.
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Affiliation(s)
- M Meneghelli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - A Pasinato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - S Salvadori
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - P Gaio
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - M Fantinato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - V Vanzo
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - F De Terlizzi
- Laboratory of Clinical Biophysics, IGEA, Modena, Italy
| | - G Verlato
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
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35
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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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36
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Rehman MU, Narchi H. Metabolic bone disease in the preterm infant: Current state and future directions. World J Methodol 2015; 5:115-121. [PMID: 26413483 PMCID: PMC4572023 DOI: 10.5662/wjm.v5.i3.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/15/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Neonatal osteopenia is an important area of interest for neonatologists due to continuing increased survival of preterm infants. It can occur in high-risk infants such as preterm infants, infants on long-term diuretics or corticosteroids, and those with neuromuscular disorders. Complications such as rickets, pathological fractures, impaired respiratory function and poor growth in childhood can develop and may be the first clinical evidence of the condition. It is important for neonatologists managing such high-risk patients to regularly monitor biochemical markers for evidence of abnormal bone turnover and inadequate mineral intake in order to detect the early phases of impaired bone mineralization. Dual-energy X-ray absorptiometry has become an increasingly used research tool for assessing bone mineral density in children and neonates, but more studies are still needed before it can be used as a useful clinical tool. Prevention and early detection of osteopenia are key to the successful management of this condition and oral phosphate supplements should be started as soon as is feasible.
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37
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Rice MS, Valentine CJ. Neonatal Body Composition: Measuring Lean Mass as a Tool to Guide Nutrition Management in the Neonate. Nutr Clin Pract 2015; 30:625-32. [PMID: 25908606 DOI: 10.1177/0884533615578917] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Neonatal nutrition adequacy is often determined by infant weight gain. The aim of this review is to summarize what is currently known about neonatal body composition and the use of body composition as a measure for adequate neonatal nutrition. Unlike traditional anthropometric measures of height and weight, body composition measurements account for fat vs nonfat mass gains. This provides a more accurate picture of neonatal composition of weight gain. Providing adequate neonatal nutrition in the form of quantity and composition can be a challenge, especially when considering the delicate balance of providing adequate nutrition to preterm infants for catch-up growth. Monitoring weight gain as fat mass and nonfat mass while documenting dietary intake of fat, protein, and carbohydrate in formulas may help provide the medical community the tools to provide optimal nutrition for catch-up growth and for improved neurodevelopmental outcomes. Tracking body composition in term and preterm infants may also provide critical future information concerning the nutritional state of infants who go on to develop future disease such as obesity, hypertension, and hyperlipidemia as adolescents or adults.
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Affiliation(s)
- Melissa S Rice
- Division of Neonatology, Perinatal and Pulmonary Biology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Parkview Regional Medical Center, Fort Wayne, Indiana. Dr Valentine is now employed by Mead Johnson Nutrition, Evansville, Indiana
| | - Christina J Valentine
- Division of Neonatology, Perinatal and Pulmonary Biology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Olsen IE, Lawson ML, Ferguson AN, Cantrell R, Grabich SC, Zemel BS, Clark RH. BMI curves for preterm infants. Pediatrics 2015; 135:e572-81. [PMID: 25687149 DOI: 10.1542/peds.2014-2777] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm infants experience disproportionate growth failure postnatally and may be large weight for length despite being small weight for age by hospital discharge. The objective of this study was to create and validate intrauterine weight-for-length growth curves using the contemporary, large, racially diverse US birth parameters sample used to create the Olsen weight-, length-, and head-circumference-for-age curves. METHODS Data from 391 681 US infants (Pediatrix Medical Group) born at 22 to 42 weeks' gestational age (born in 1998-2006) included birth weight, length, and head circumference, estimated gestational age, and gender. Separate subsamples were used to create and validate curves. Established methods were used to determine the weight-for-length ratio that was most highly correlated with weight and uncorrelated with length. Final smoothed percentile curves (3rd to 97th) were created by the Lambda Mu Sigma (LMS) method. The validation sample was used to confirm results. RESULTS The final sample included 254 454 singleton infants (57.2% male) who survived to discharge. BMI was the best overall weight-for-length ratio for both genders and a majority of gestational ages. Gender-specific BMI-for-age curves were created (n = 127 446) and successfully validated (n = 126 988). Mean z scores for the validation sample were ∼0 (∼1 SD). CONCLUSIONS BMI was different across gender and gestational age. We provide a set of validated reference curves (gender-specific) to track changes in BMI for prematurely born infants cared for in the NICU for use with weight-, length-, and head-circumference-for-age intrauterine growth curves.
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Affiliation(s)
- Irene E Olsen
- School of Nursing, University of Pennsylvania, Biology and Physics, and
| | - M Louise Lawson
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - A Nicole Ferguson
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Rebecca Cantrell
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Shannon C Grabich
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, and Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Departments of
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Pharande P, Pammi M, Collins CT, Zhou SJ, Abrams SA. Vitamin D supplementation for prevention of vitamin D deficiency in preterm and low birth weight infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Pramod Pharande
- Royal Hospital for Women; Newborn Care Centre; Barker Street Randwick NSW Australia 2032
| | - Mohan Pammi
- Baylor College of Medicine; Section of Neonatology, Department of Pediatrics; 6621, Fannin, MC.WT 6-104 Houston Texas USA 77030
| | - Carmel T Collins
- Women's and Children's Health Research Institute, Flinders Medical Centre and Women's and Children's Hospital; Discipline of Paediatrics, The University of Adelaide; Child Nutrition Research Centre; Flinders Medical Centre Bedford Park South Australia Australia 5042
| | - Shao J Zhou
- Women's and Children's Hospital; School of Agriculture, Food & Wine, University of Adelaide; Women's and Children's Health Research Institute; 72 King William Road North Adelaide Australia 5006
| | - Steven A Abrams
- Children's Nutrition Research Center; Neonatology and USDA/ARS; 1100 Bates Street Room 7066 Houston Texas USA 77030
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Ramel SE, Gray HL, Davern BA, Demerath EW. Body composition at birth in preterm infants between 30 and 36 weeks gestation. Pediatr Obes 2015; 10:45-51. [PMID: 24470220 DOI: 10.1111/j.2047-6310.2013.00215.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/04/2013] [Accepted: 11/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The American Academy of Pediatrics calls for aggressive management of preterm infants to achieve body composition approximating that of the healthy infant in utero. Air displacement plethysmography (ADP) has been validated for assessment of body composition in preterm infants and could be used to monitor their nutritional status during hospitalization. Comparative datasets on body composition at birth among healthy, live-born preterm infants are lacking. OBJECTIVE The aim of this study is to provide the first descriptive fat mass (FM) and fat-free mass (FFM) data from healthy newborn preterm infants at birth as a proxy for healthy in utero body composition. METHODS Body mass and volume were obtained using ADP within 72 h of birth in 98 singleton, appropriate-for-gestational-age preterm infants. FM and FFM were calculated using the Fomon equation. RESULTS Measurement with ADP was feasible and well tolerated by infants as young as 30 weeks gestation and <72 h of age. FFM and FM increased linearly over the gestational age range period at rates of 171 and 46 g week(-1) , respectively. Mean values obtained by ADP by gestational week were similar to the previously published reference data from chemical analysis on stillbirths. CONCLUSIONS Body composition assessment using ADP is feasible in newborn preterm infants and provides group estimates similar to that of the reference fetus. In the future, integrating body composition information into the nutritional management of preterm infants may help to identify new strategies to optimize growth and development in this vulnerable population.
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Affiliation(s)
- S E Ramel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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de Knegt VE, Carlsen EM, Bech Jensen JE, Lade Rasmussen AM, Pryds O. DXA performance in a pediatric population: precision of body composition measurements in healthy term-born infants using dual-energy X-ray absorptiometry. J Clin Densitom 2015; 18:117-23. [PMID: 25439455 DOI: 10.1016/j.jocd.2014.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/15/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) has been hailed as a golden standard for measuring body composition in adults but remains to be fully assessed for the infant population. A total of 64 newborn infants were allocated to 1 of 3 groups. All underwent 2 Hologic Discovery A DXA scans. Suboptimal scans were reconstructed, and an investigation into the success of adjustment was carried out. Depending on group, the factors of weight change and repositioning were investigated. Test-retest variation and coefficients of variation for DXA body composition estimates were calculated. Furthermore, the effects of flannel sheets and breast milk were investigated using a pediatric phantom. Reconstruction of suboptimal scans resulted in more accurate body weight estimates. Moderate weight change and repositioning had no significant effect on the variation between scans. No significant body composition changes occurred between scans. The test-retest variation varied between 6.3% and 11.8%. Flannel sheets and breast milk affected DXA results significantly. High precision of DXA measurements was obtained in our newborn population. Reconstructing scans is a viable way of correcting minor movement artifacts. Moderate weight changes and repositioning have no significant effect on DXA results, whereas flannel sheets and milk do.
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Affiliation(s)
| | | | | | | | - Ole Pryds
- Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Quintal VS, Diniz EMA, Caparbo VDF, Pereira RMR. Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life. J Pediatr (Rio J) 2014; 90:556-62. [PMID: 24950474 DOI: 10.1016/j.jped.2014.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age. METHODS A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank. RESULTS All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p<0.001, p<0.001, p=0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age. CONCLUSIONS This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs.
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Affiliation(s)
- Virginia S Quintal
- Human Milk Bank, Hospital Universitário, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | - Edna M A Diniz
- Department of Pediatrics, Hospital Universitário, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Valeria de F Caparbo
- Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Rosa M R Pereira
- Division of Rheumatology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Quintal VS, Diniz EM, Caparbo VDF, Pereira RM. Bone densitometry by dual‐energy X‐ray absorptiometry (DXA) in preterm newborns compared with full‐term peers in the first six months of life. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Milovanovic I, Njuieyon F, Deghmoun S, Chevenne D, Levy-Marchal C, Beltrand J. SGA children with moderate catch-up growth are showing the impaired insulin secretion at the age of 4. PLoS One 2014; 9:e100337. [PMID: 24979613 PMCID: PMC4076235 DOI: 10.1371/journal.pone.0100337] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/23/2014] [Indexed: 01/29/2023] Open
Abstract
Background Being born small for gestational age (SGA) is a risk factor for later development of type 2 diabetes. The development of glucose tolerance disorders in adults involves insulin resistance and impaired insulin secretion. Objective To evaluate insulin secretion and insulin sensitivity in a 4-yr old cohort of SGA. Methods 85 children were prospectively followed from mid-gestation to 4 years of age. Fetal growth velocity (FGV) was measured using ultrasound measurements. Body composition and hormonal profile were measured at birth, 1 and 4 years. Results 23 SGA babies had lower birth weight compared to 62 AGA (−1.9±0.3 vs. −0.6±0.8 z-score; p<0.0001) and they were thinner at birth (ponderal index 24.8±1.8 vs. 26.3±3.1 kg/m3; p = 0.01 and fat mass 11±2.6 vs. 12.9±3.1%; p = 0.01). No significant differences in other measured metabolic and hormonal parameters were observed between two groups at birth. SGA infants experienced an early catch-up growth in weight (mean gain of 1.1±0.6 SD) during the first year of life. At 4 years, SGA children remain lighter than AGA, but with weight z-score in the normal range (−0.1±1.3 vs. 0.5±1.3 z-score; p = 0.05). No excess of fat mass was observed (19±4.8 vs. 19.7±4.1%; p = 0.45). 120-min plasma glucose was significantly higher (6.2±1.1 vs. 5.6±0.9 mmol/l; p = 0.006) and insulinogenic index was significantly lower (0.28±0.15 vs. 0.40±2.4; p = 0.02) in the SGA group at 4-yrs of life contrasting with a preserved insulin sensitivity (QUICKI 0.47±0.09 vs. 0.43±0.05; p = 0.06). Conclusion SGA children with compensatory catch-up growth in first year of life show mild disturbances of glucose tolerance associated to a lower insulinogenic index at 4-yrs of age suggesting impairment of β-cell function.
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Affiliation(s)
- Ivana Milovanovic
- INSERM CIE 05 – Unité d'épidémiologie clinique, Hôpital Robert Debré, Paris, France
- * E-mail:
| | - Falucar Njuieyon
- INSERM CIE 05 – Unité d'épidémiologie clinique, Hôpital Robert Debré, Paris, France
| | - Samia Deghmoun
- INSERM CIE 05 – Unité d'épidémiologie clinique, Hôpital Robert Debré, Paris, France
| | - Didier Chevenne
- Service de biochimie et hormonologie, Hôpital Robert Debré, Paris, France
| | - Claire Levy-Marchal
- INSERM CIE 05 – Unité d'épidémiologie clinique, Hôpital Robert Debré, Paris, France
| | - Jacques Beltrand
- Endocrinologie et diabétologie pédiatrique, Hôpital Necker, Paris, France
- Université Paris 5, René Descartes, Paris, France
- INSERM U845, Imagine Affiliated, Paris, France
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DEMERATH ELLENW, FIELDS DAVIDA. Body composition assessment in the infant. Am J Hum Biol 2014; 26:291-304. [PMID: 24424686 PMCID: PMC5761669 DOI: 10.1002/ajhb.22500] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 12/04/2013] [Accepted: 12/09/2013] [Indexed: 01/22/2023] Open
Abstract
Body composition assessment provides a sharper picture of the human biological response to genetic and environmental influences than measures of body size and weight. Infant body composition is particularly important as a marker of fetal adaptation and developmental programming of subsequent health and disease, but until recently, the range of options for measuring infant body composition was relatively narrow. The purpose of this Toolkit: Methods in Human Biology review is to provide a comprehensive overview of methods of body composition methods currently used in infants 0 to 2 years of age, including anthropometric prediction equations, air displacement plethysmography (ADP), dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), isotope dilution, and magnetic resonance imaging (MRI). Information on the reliability, validity, and accuracy of the methods is provided. Unique aspects of infant physiology and behavior create challenges for body composition assessment, but this review provides guidance on suitable testing approaches and environments that may aid researchers in this important area of investigation.
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Affiliation(s)
- ELLEN W. DEMERATH
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota 55454
| | - DAVID A. FIELDS
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104
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Monitoring of urinary calcium and phosphorus excretion in preterm infants: comparison of 2 methods. J Pediatr Gastroenterol Nutr 2014; 58:404-8. [PMID: 24253368 DOI: 10.1097/mpg.0000000000000244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Premature babies require supplementation with calcium (Ca) and phosphorus (P) to prevent metabolic bone disease of prematurity. To guide mineral supplementation, 2 methods of monitoring urinary excretion of Ca and P are used: urinary Ca or P concentration and Ca/creatinine (Crea) or P/Crea ratios. We compare these 2 methods in regards to their agreement on the need for mineral supplementation. METHODS Retrospective chart review of 230 premature babies with birth weight <1500 g, undergoing screening of urinary spot samples from day 21 of life and fortnightly thereafter. Hypothetical cutoff values for urine Ca or P concentration (1 mmol/L) and urine Ca/Crea ratio (0.5 mol/mol) or P/Crea ratio (4 mol/mol) were applied to the sample results. The agreement on whether to supplement the respective minerals based on the results with the 2 methods was compared. Multivariate general linear models sought to identify patient characteristics to predict discordant results. RESULTS A total of 24.8% of cases did not agree on the indication for Ca supplementation, and 8.8% for P. Total daily Ca intake was the only patient characteristic associated with discordant results. CONCLUSIONS With the intention to supplement the respective mineral, comparison of urinary mineral concentration with mineral/Crea ratio is moderate for Ca and good for P. The results do not allow identifying superiority of either method on the decision as to which babies require Ca and/or P supplements.
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Figueras-Aloy J, Álvarez-Domínguez E, Pérez-Fernández JM, Moretones-Suñol G, Vidal-Sicart S, Botet-Mussons F. Metabolic bone disease and bone mineral density in very preterm infants. J Pediatr 2014; 164:499-504. [PMID: 24331689 DOI: 10.1016/j.jpeds.2013.10.089] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 10/01/2013] [Accepted: 10/31/2013] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To evaluate bone mineral density (BMD) in preterm neonates at discharge and identify the optimum cutoff values for serum alkaline phosphatase (ALP) and phosphorus (P) concentrations to diagnose the severity of metabolic bone disease of prematurity. STUDY DESIGN A total of 336 preterm neonates (≤ 31 weeks' gestation and birth weight ≤ 1500 g) were prospectively evaluated for BMD before discharge using dual-energy X-ray absorptiometry. RESULTS BMD reference values (at ALP ≤ 500 IU/L) were measured in 279 patients. BMD was classified as poor (<10th percentile) at <0.068 g/cm(2), fair (10th-25th percentile) at 0.068-0.081 g/cm(2), good (25th-75th percentile) at 0.081-0.112 g/cm(2), and very good (>75th percentile) at >0.112 g/cm(2). Increased BMD was associated with a higher birth weight, short duration of parenteral nutrition, and the absence of small for gestational age status, patent ductus arteriosus, intraventricular hemorrhage, and other clinical variables. Metabolic bone disease of prematurity was absent (ALP ≤ 500 IU/L) in 279 cases (83.0%), mild (ALP >500 IU/L and P ≥ 4.5 mg/dL) in 46 cases (13.7%), and severe (ALP >500 IU/L and P <4.5 mg/dL) in 11 cases (3.3%). CONCLUSIONS A BMD >0.068 g/cm(2) at discharge indicated a 90.3% probability of not developing metabolic bone disease of prematurity. The factors independently associated with increased BMD included higher birth weight, short duration of parenteral nutrition, absence of intraventricular hemorrhage, exclusive feeding of fortified breast milk, and older age at discharge.
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Affiliation(s)
- Josep Figueras-Aloy
- Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Enriqueta Álvarez-Domínguez
- Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José M Pérez-Fernández
- Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Gloria Moretones-Suñol
- Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francesc Botet-Mussons
- Neonatal Service, Biomedical Research Institute August Pii Sunyer, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Betto M, Gaio P, Ferrini I, De Terlizzi F, Zambolin M, Scattolin S, Pasinato A, Verlato G. Assessment of bone health in preterm infants through quantitative ultrasound and biochemical markers. J Matern Fetal Neonatal Med 2013; 27:1343-7. [PMID: 24215624 DOI: 10.3109/14767058.2013.858317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess bone status in preterm infants with quantitative ultrasound and to search for biochemical markers of bone health. METHODS Metacarpus bone transmission time (mcBTT) was prospectively performed during hospitalization, together with biochemical and clinical outcomes analysis. RESULTS 154 patients were studied. At 3rd week of life mcBTT positively correlated with serum phosphate. Urinary excretion of calcium and phosphate were assessed in a subgroup of 55 patients: on day 21 mcBTT positively correlated with phosphaturia, negatively with calciuria. Gestational age (GA), weight and length at 3rd week and at 36 weeks of GA correlated positively with mcBTT. We found negative correlation between mcBTT at 3rd week and days of parenteral nutrition, mechanical ventilation period and days to reach 1800 g. CONCLUSIONS Serum phosphate, phosphaturia and calciuria correlate most with mcBTT. Further studies are necessary to verify the possible influence of early bone status on future bone health.
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Affiliation(s)
- Martina Betto
- Women's and Children's Health Department, University of Padova , Padova , Italy and
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Using an Assessment Tool to Identify Risk of Osteopenia in Infants and Prevent Fractures. Jt Comm J Qual Patient Saf 2013; 39:228-32. [DOI: 10.1016/s1553-7250(13)39030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wilson JP, Strauss BJ, Fan B, Duewer FW, Shepherd JA. Improved 4-compartment body-composition model for a clinically accessible measure of total body protein. Am J Clin Nutr 2013; 97:497-504. [PMID: 23364008 DOI: 10.3945/ajcn.112.048074] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Muscle wasting is a consequence of many primary conditions including sarcopenia, cachexia, osteoporosis, HIV/AIDS, and chronic kidney disease. Unfortunately, there is not a clinically accessible method to measure total body protein, which is the functional mass of muscle. OBJECTIVE We sought to derive a simple method to measure total body protein by using dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA). DESIGN We retrospectively analyzed a clinical convenience sample of individuals with numerous metabolic conditions from the Monash Medical Centre, Melbourne, Australia, who had a concurrent protein measure by using neutron activation analysis-derived protein (NAA-TBPro), water measure by using BIA, and whole-body DXA scan. The study was split into calibration and validation data sets by using simple random sampling stratified by sex, BMI category, and age decade. We generated a protein estimate direct-calibration protein (DC-TBPro) derived from BIA water, bone mass, and body volume. We compared NAA-TBPro with DC-TBPro and 2 protein estimates from the literature, one that used the DC-TBPro equation with fixed coefficients [4-compartment Lohman method for analysis of total body protein (4CL-TBPro)] and another that used fat-free mass, age, and sex [Wang equation-derived protein (W-TBPro)]. RESULTS A total of 187 participants [119 women; mean (±SD) age: 37.0 ± 15.4 y; mean (±SD) BMI (in kg/m(2)) 24.5 ± 7.7] were included. When plotted against NAA-TBPro, DC-TBPro had the highest correlation [coefficient of determination (R(2)) = 0.87], lowest root mean squared error (RMSE; 0.87 kg), and fewest outliers compared with 4CL-TBPro (R(2) = 0.75; RMSE = 1.22 kg) and W-TBPro (R(2) = 0.80; RMSE = 1.10 kg). CONCLUSIONS A simple method to measure total body protein by using a DXA system and BIA unit was developed and compared with NAA as proof of principle. With additional validation, this method could provide a clinically useful way to monitor muscle-wasting conditions.
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