[Show abstract][Hide abstract] ABSTRACT: Preterm infants are at risk for adverse neurodevelopment. Furthermore, nutrition may play a key role in supporting neurodevelopment. The aim of this study was to evaluate whether a nutrient-enriched formula fed to preterm infants after hospital discharge could improve their neurodevelopment at 24 months (term-corrected age).
We conducted an observer-blinded, single-center, randomized controlled trial in infants admitted to the Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan, Italy between 2009 and 2011. Inclusion criteria were gestational age < 32 weeks and/or birth weight < 1500 g, and being fed human milk for < 20% of the total milk intake. Exclusion criteria were congenital malformations or conditions that could interfere with growth or body composition. Included infants were randomized to receive a standard full-term formula or a nutrient-enriched formula up until 6 months of corrected age, using two computer-generated randomization lists; one appropriate for gestational age (AGA) and one for small for gestational age (SGA) infants. We assessed neurodevelopment at 24 months of corrected age using the Griffiths Mental Development Scale and related subscales (locomotor, personal-social, hearing and speech, hand and eye coordination, and performance).
Of the 207 randomized infants, 181 completed the study. 52 AGA and 35 SGA infants were fed a nutrient-enriched formula, whereas 56 AGA and 38 SGA infants were fed a standard full-term formula. The general quotient at 24 months of corrected age was not significantly different between infants randomized to receive a nutrient-enriched formula compared with a standard term formula up until 6 months of corrected age (AGA infants: 93.8 +/- 12.6 vs. 92.4 +/- 10.4, respectively; SGA infants: 96.1 +/- 9.9 vs. 98.2 +/- 9, respectively). The scores of related subscales were also similar among groups.
This study found that feeding preterm infants a nutrient-enriched formula after discharge does not affect neurodevelopment at 24 months of corrected age, in either AGA or SGA infants, free from major comorbidities.Trial registration: Current Controlled Trials (http://www.controlledtrials.com/ISRCTN30189842) London, UK.
[Show abstract][Hide abstract] ABSTRACT: AimEarly nutrition may affect body composition development. This study assessed body composition changes in healthy term infants in the first four months of life, comparing the results for breastfed and formula-fed babies.MethodsA longitudinal, observational study was conducted with healthy term infants, who had a birth weight of more than 2,500g and were aged up to three weeks at enrolment. Infants were either exclusively breastfed or formula-fed. Growth and body composition were assessed by air-displacement plethysmography at enrolment and four months.ResultsA total of 158 infants were enrolled (72 exclusively breastfed and 86 exclusively formula-fed). Body composition was similar between the two feeding groups at enrolment, but fat free mass (4831±538g vs 4641±461g; p=0.036) at four months and the fat free mass changes between enrolment and four months (80.3±16.4% vs 67.6±18.4%; p<0.001) were higher in formula-fed infants than breastfed ones.Conclusions
Our findings suggest that formula-fed infants show different body composition development during the first four months of life to breastfed ones, with higher fat free mass content.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Background:Early feeding choices may affect long-term health outcomes. Therefore, understanding body composition changes in healthy breastfed infants has become an important research focus.Objectives:The aims of this review were to investigate the body composition changes that occur during weight loss in breastfed term newborns and to examine body composition differences between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 6 months of life.Methods:We performed a review of the existing literature using PubMed. We searched for studies published in English since January 1, 2000, that involved human infants ranging in age from birth to 6 months. We used the following MEDLINE Medical Subject Headings: ((breastfeeding) OR (infant formula)) AND ((body composition) OR (bioelectrical impedance) OR (absorptiometry, photon) OR (total body potassium) OR (isotope dilution) OR (air-displacement plethysmography)). Our search yielded 6 studies.Results:Two studies reported that newborn weight loss was due to a reduction in the quantity of both fat mass and fat-free mass. Three out of 4 articles that evaluated body composition changes according to method of feeding reported no differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 4.5 months of life. One study reported that exclusively breastfed infants at 3 months of age and exclusively breastfed boys at 6 months of age had higher fat mass contents compared to exclusively formula-fed infants.Conclusion:Because of the limited number of studies available, larger studies are needed to clarify the differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants.
Journal of Human Lactation 12/2013; · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE:To investigate whether the consumption of a nutrient-enriched formula after hospital discharge determines different growth and weight gain composition in preterm infants according to intra- and extrauterine growth pattern.METHODS:Two hundred seven preterm infants were randomized at term-corrected age to receive treatment A (term formula) or B (nutrient-enriched formula) up to 6 months of corrected age, using 2 computer-generated randomization lists, 1 for adequate for gestational age (AGA) and 1 for small for gestational age (SGA) infants. Infants were weaned according to our clinical practice after 6 months' corrected age. Anthropometric parameters and body composition by an air displacement plethysmography system were assessed at term and 1, 3, and 6 months' corrected age. Anthropometric parameters were also assessed at 12 months.RESULTS:Protein intakes were higher in infants receiving treatment B than in infants receiving treatment A at each study point. There were no differences between the feeding groups in weight and length SD scores in either the AGA and SGA group through the study. The mean head circumference values were higher in AGA infants receiving treatment B than in AGA infants receiving treatment A at 6 and 12 months, whereas at 6 months, the percentage of fat mass was lower. No difference in body composition was detected among SGA infants through the study.CONCLUSIONS:This randomized controlled trial demonstrates the beneficial effect of the consumption of a nutrient-enriched formula after hospital discharge by AGA infants both in terms of head circumference growth and fat-free mass gain.
[Show abstract][Hide abstract] ABSTRACT: The optimization of the nutritional management of preterm infants has gained importance due to the increased survival of these vulnerable infants. In fact, the achievement of an adequate growth has been associated with a favourable neurodevelopment outcome. Nevertheless, preterm infants still develop severe nutrient deficiencies during the first few weeks of life so that they are frequently growth restricted upon discharge. In addition, preterm infants have been found to show an increased and aberrant adiposity at term-corrected age. The development of strategies immediately after birth has been found to produce excellent results in terms of growth without having any detrimental effect on body composition at term-corrected age. Continuing to monitor growth and body composition changes in relation to different nutrition interventions is essential as growth pattern and body composition appear to have a long term effect on health outcomes.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2012; 25 Suppl 3:49-52. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:Late preterm birth accounts for 70% of preterm births. The aim of the study was to investigate the postnatal weight gain and weight gain composition changes in a cohort of late preterm infants.Methods:A total of 49 late preterm infants (mean birth weight 2,496 ± 330 g and gestational age 35.2 ± 0.7 wks) underwent growth and body composition assessment by an air displacement plethysmography system on the fifth day of life, at term, and at 1 and 3 mo of corrected age. The reference group was composed of 40 healthy, full-term, breast-fed infants.Results:The late preterm infants showed a Δ fat mass gain between birth and term-corrected age equal to 182%. As compared with full-term infants, at term and 1 mo of corrected age mean weight (3,396 ± 390 vs. 3,074 ± 409 g and 4,521 ± 398 vs. 4,235 ± 673 g, respectively) and percentage of fat mass (16.1 ± 4.6 vs. 8.9 ± 2.9 and 22.6 ± 4.2 vs. 17.4 ± 4.0, respectively) were significantly higher in late preterm infants, whereas no difference among groups was found at 3 mo.Conclusion:Rapid postnatal catch-up fat was found in these infants. Further studies are needed to investigate whether this short-term increase in fat mass may modulate the risk of chronic diseases or represent an adaptive mechanism to extrauterine life.Pediatric Research (2012); doi:10.1038/pr.2012.128.
[Show abstract][Hide abstract] ABSTRACT: Adiposity may contribute to the future risk of disease. The aim of this study was to evaluate the accuracy and reliability of an air-displacement plethysmography (ADP) system to estimate percentage fat mass (%FM) in preterm infants and to evaluate interdevice reliability in infants.
A total of 70 preterm and 9 full-term infants were assessed. The accuracy of ADP measurements was assessed by determining reference %FM values using H(2)(18)O dilution measurement.
Mean %FM by ADP was 5.67 ± 1.84 and mean %FM by H(2)18O dilution was 5.99 ± 2.56. Regression analysis showed that %FM by ADP was associated with %FM by H(2)(18)O dilution (R2 = 0.63, SE of estimate (SEE) = 1.65, P = 0.006). Bland-Altman analysis showed no bias (r = -0.48, P = 0.16) and 95% limits of agreement were -3.40 to 2.76 %FM. There was no difference in mean interdevice reliability %FM values (8.97 vs. 8.55 %FM) between ADP 1 and 2. Regression analysis indicated a low SEE (1.14% FM) and high R2 (0.91); 95% limits of agreement were -1.87 to 2.71 %FM. The regression line did not differ significantly from the line of identity.
ADP is a noninvasive, reliable, and accurate technique to measure preterm infants' body composition in both research and clinical settings.
Pediatric Research 06/2012; 72(3):316-20. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of nutrition in neonatology is to achieve a healthy growth that mimics, both in terms of growth rates and quality of growth, that of a normal fetus of the same gestational age. In addition, providing an optimal amount and quality of nutrients significantly contributes to the attainment of a neurodevelopment similar to that of an infant born at term. Yet, a high risk of developing metabolic syndrome in relation to aggressive nutrition and accelerated postnatal growth velocity has been reported in former preterm infants. Considering the strict interrelationship that exists between early nutrition, growth, and subsequent health, the development of body composition in early infancy, in terms of fat mass, may contribute to the long-term "programming" process. Hence, accurate and non-invasive measurement of infant body composition, which evaluates the quality in addition to the amount of weight gain, represents a useful tool for gaining further insight into the relationship between birth weight or time in utero and future development. Preterm infants, including those born small for gestational age, have been reported to develop an increased and/or aberrant adiposity, in addition to postnatal growth retardation, when assessed at term-corrected age. However, within the first 5 months, preterm infants, either born adequate or small for gestational age, show a recovery of fat mass, and attain fat mass values comparable to those of full-term infants assessed at birth. The metabolic consequences of these findings on the long-term health need to be further clarified.
Early human development 01/2012; 88 Suppl 1:S13-7. · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prevention of postnatal growth restriction of very preterm infants still represents a challenge for neonatologists. As standard feeding regimens have proven to be inadequate. Improved feeding strategies are needed to promote growth. Aim of the present study was to evaluate whether a set of nutritional strategies could limit the postnatal growth restriction of a cohort of preterm infants.
We performed a prospective non randomized interventional cohort study. Growth and body composition were assessed in 102 very low birth weight infants after the introduction of a set of nutritional practice changes. 69 very low birth weight infants who had received nutrition according to the standard nutritional feeding strategy served as a historical control group. Weight was assessed daily, length and head circumference weekly. Body composition at term corrected age was assessed using an air displacement plethysmography system. The cumulative parenteral energy and protein intakes during the first 7 days of life were higher in the intervention group than in the historical group (530±81 vs 300±93 kcal/kg, p<0.001 and 21±2.9 vs 15±3.2 g/kg, p<0.01). During weaning from parenteral nutrition, the intervention group received higher parental/enteral energy and protein intakes than the historical control group (1380±58 vs 1090±70 kcal/kg; 52.6±7 vs 42.3±10 g/kg, p<0.01). Enteral energy (kcal/kg/d) and protein (g/kg/d) intakes in the intervention group were higher than in the historical group (130±11 vs 100±13; 3.5±0.5 vs 2.2±0.6, p<0.01). The negative changes in z score from birth to discharge for weight and head circumference were significantly lower in the intervention group as compared to the historical group. No difference in fat mass percentage between the intervention and the historical groups was found.
The optimization and the individualization of nutritional intervention promote postnatal growth of preterm infants without any effect on percentage of fat mass.
PLoS ONE 01/2012; 7(12):e51166. · 3.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and aims: Late preterm newborns account for 70% of preterm birth. Fat mass (FM) significantly accrues during the last trimester of pregnancy. To assess the FM changes through the first months of corrected age (CA) in a cohort of late preterm infants (LPI).
[Show abstract][Hide abstract] ABSTRACT: Background and aims: Male infants with BW> 1250 g benefit from PDF. Fetal growth seems to influence growth recovery whereas fat restoration occurs irrespective of BW. To evaluate whether being fed a PDF determines a growth benefit in two subgroups of infants.
[Show abstract][Hide abstract] ABSTRACT: the addition of oligosaccharides to infant formula has been shown to mimic some of the beneficial effects of human milk. The aim of the study was to assess the tolerance and safety of a formula containing an innovative mixture of oligosaccharides in early infancy.
this study was performed as a multi-center, randomized, double-blind, placebo-controlled trial including healthy term infants. Infants were recruited before the age of 8 weeks, either having started with formula feeding or being fully breast-fed (breastfeeding group). Formula-fed infants were randomized to feeding with a regular formula containing a mixture of neutral oligosaccharides and pectin-derived acidic oligosaccharides (prebiotic formula group) or regular formula without oligosaccharides (control formula group). Growth, tolerance and adverse events were assessed at 8, 16, 24 and 52 weeks of age. The prebiotic and control groups showed similar mean weight, length and head circumference, skin fold thicknesses, arm circumference gains and stool frequency at each study point. As far as the anthropometric parameters are concerned, the prebiotic group and the control group did not attain the values shown by the breastfeeding group at any study point. The skin fold thicknesses assessed in the breastfeeding group at 8 weeks were strikingly larger than those in formula fed infants, whereas at 52 weeks were strikingly smaller. The stool consistency in the prebiotic group was softer than in the control group at 8, 16 and 24 weeks (p<0.001) and closer to that of the breastfeeding group. There was no difference in the incidence of adverse events between the two formula groups.
our findings demonstrate the tolerability and the long term safety of a formula containing an innovative mixture of oligosaccharides in a large cohort of healthy infants.
drks-neu.uniklinik-freiburg.de DRKS 00000201.
PLoS ONE 01/2011; 6(11):e28010. · 3.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Preterm small for gestational age (SGA) infants may be at risk for increased adiposity, especially when experiencing rapid postnatal weight gain. Data on the dynamic features of body weight and fat mass (FM) gain that occurs early in life is scarce. We investigated the postnatal weight and FM gain during the first five months after term in a cohort of preterm infants.
Changes in growth parameters and FM were prospectively monitored in 195 infants with birth weight ≤1500 g. The infants were categorized as born adequate for gestational age (AGA) without growth retardation at term (GR-), born AGA with growth retardation at term (GR+), born SGA. Weight and FM were assessed by an air displacement plethysmography system. At five months, weight z-score was comparable between the AGA (GR+) and the AGA (GR-), whereas the SGA showed a significantly lower weight.The mean weight (g) differences (95% CI) between SGA and AGA (GR-) and between SGA and AGA (GR+) infants at 5 months were -613 (-1215; -12) and -573 (-1227; -79), respectively. At term, the AGA (GR+) and the SGA groups showed a significantly lower FM than the AGA (GR-) group. In the first three months, change in FM was comparable between the AGA (GR+) and the SGA groups and significantly higher than that of the AGA (GR-) group.The mean difference (95% CI) in FM change between SGA and AGA (GR-) and between AGA (GR+) and AGA (GR-) from term to 3 months were 38.6 (12; 65); and 37.7 (10; 65). At three months, the FM was similar in all groups.
Our data suggests that fetal growth pattern influences the potential to rapidly correct anthropometry whereas the restoration of fat stores takes place irrespective of birth weight. The metabolic consequences of these findings need to be elucidated.
PLoS ONE 01/2011; 6(1):e14489. · 3.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nutrition in early life, growth, and subsequent health over a lifetime are significantly interrelated. The aim of this study was to assess body composition changes in exclusively breast-fed infants from birth up to 6 mo of age. An observational, prospective, cohort study was conducted. Fifty-nine full-term, healthy, exclusively breast-fed infants underwent assessment of growth and body composition, using air-displacement plethysmograph (i.e. PEA POD) by Life Measurement, Inc. (Concord, CA). Body composition was assessed at birth, 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Mean birth weight (g) and gestational age (wk) of the infants were 3170 ± 420 and 39.21 ± 1.29, respectively. Percentage of fat mass increased significantly over the first 4 mo (p < 0.001), both in boys and girls, with no differences detected between boys and girls at any time point. This article provides preliminary in-depth data on whole-body composition, in exclusively breast-fed infants during the first months of life. Further studies assessing larger sample sizes are desirable to develop reference body composition data.
Pediatric Research 12/2010; 68(6):542-4. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early amino acid administration has been recommended in preterm neonates to avoid protein catabolism. In the present work, blood urea nitrogen (BUN) was used to evaluate the quantity of protein intake in preterm infants. The aim of the study was to investigate the relation between protein intake and BUN during the entire duration of parenteral and enteral nutrition.
We conducted a prospective, longitudinal, observational study. BUN was assessed in 92 preterm newborns on days 2, 5, and 15 of parenteral nutrition, on the day when infants consumed 160 mL/kg of milk, and at 36 weeks of postmenstrual infants' age. Protein intakes were calculated from the 24-hour period preceding the time the BUN specimens were collected. The effects of gestational age and protein intakes on BUN concentrations during parenteral nutrition were ascertained by multiple regression analyses. The relation between BUN and protein intakes during enteral feeding was evaluated by a simple correlation analysis.
Using linear regression analyses, gestational age showed a significant negative correlation with BUN concentrations during parenteral nutrition, whereas protein intakes at 2, 5, and 15 days did not correlate with BUN. A moderately positive correlation between BUN and protein intake was found when the infants consumed 160 mL/kg of milk and at 36 weeks of postmenstrual age (r = 0.5, P = 0.001 and r = 0.49, P = 0.012, respectively).
In the early postnatal period, high BUN could be the effect of many factors other than amino acid intolerance. In contrast, BUN may represent a useful index in monitoring the adequacy of protein intake during enteral nutrition.
Journal of pediatric gastroenterology and nutrition 08/2010; 51(2):213-5. · 2.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Weight loss during initial days of life in healthy infants is known to consist of loss of both body solids and total body water. However, the nature of these body composition changes needs further investigation.
To investigate the nature of changes in body composition that accompany weight loss during the first days of life in healthy term newborns.
Body composition of healthy full-term newborns was assessed using air-displacement plethysmography. Cross-sectional (n = 262) and longitudinal samples (n = 28) were assessed during the first 4 and 5 days after delivery, respectively.
In the cross-sectional sample, mean body weight decreased significantly through day 4 (p < 0.001), mean fat mass (FM) and %FM decreased significantly (p = 0.005 and p = 0.031, respectively) by day 3. There was a significant decrease in mean fat-free mass on days 3 and 4 (p = 0.01 and p < 0.001, respectively). In the longitudinal sample, there was a significant decrease in mean body weight, FM and %FM (p < 0.001, p = 0.001, p = 0.013, respectively) by day 4. On day 5 there was a significant increase in mean body weight, FM and %FM (p < 0.001, p = 0.024, p = 0.036, respectively) when compared to day 4. There was no significant difference in mean FM and %FM values between day 1 and day 5.
These results indicate that body composition changes are constituted by a reduction in both fat and fat free mass. However, a greater %FM is lost and consequently regained by day 5 when compared to fat-free mass.
[Show abstract][Hide abstract] ABSTRACT: Infants classified as small for gestational age are considered to have developed under adverse intrauterine conditions that lead to lack of fat mass accretion. The aim of this study was to test the null hypothesis that the fat mass in preterm small for gestational age infants assessed at term equivalent age was not different from that of full-term small for gestational age newborns.
67 small for gestational age preterm infants and 132 small for gestational age full-term newborns.
Growth and body composition, assessed by means of a paediatric air displacement plethysmography system, were measured at term equivalent age in the preterm infants and on the third day of life in the full-term newborns.
The mean (SD) gestational age of preterm infants was 30.6 (2.3) weeks and their mean (SD) birth weight was 1140 (237) g. At assessment weight was not different between the preterm and full-term infants, whereas the percentage of total body fat mass was higher in the preterm infants (14.3% (SD 4.7%) vs 5.8% (SD 3.5%), p<0.005).
Preterm infants, born small for gestational age, appear to be at risk for increased adiposity, which is a risk factor for the development of the metabolic syndrome.
Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2009; 94(5):F368-72. · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The American Academy of Pediatrics (AAP) recommends that preterm infants' growth duplicates fetal growth rates and that body composition replicates in utero body composition.
To compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.
Prospective observational study.
One hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.
Growth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.
Weight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P<0.0001]. Fat mass was negatively correlated with gestational age (P<0.001), and positively associated with weight increase (P< 0.05).
Our data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.
Early human development 01/2009; 85(6):349-52. · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate changes in body composition in 48 preterm infants in relation to protein and energy intakes from term up to 3 months of corrected age, using air displacement plethysmography. Protein intake (grams per kilogram per day) was negatively associated with percentage of fat mass at 1 month of corrected age. The high-protein-intake group showed greater gain in lean body mass gain than did the low-protein-intake group. This finding suggests that during the first month of corrected age, high protein intake results in a significantly different weight gain composition.
Journal of pediatric gastroenterology and nutrition 10/2008; 47(3):375-8. · 2.18 Impact Factor