Abstract
Preterm infants have altered body composition compared to term infants, which impacts both neurodevelopment and metabolic health, but whether increased dietary intake during hospitalization, independent of illness, may improve body composition is unknown. This prospective, longitudinal study (n = 103) measured fat-free mass (FFM) and percent body fat (%BF) at discharge and four months corrected age for prematurity (CA) in very low birth weight (VLBW) preterm infants. Markers of illness and macronutrient intakes (protein and caloric) were recorded. Bayley Scales of Infant Development-III (BSID) were administered at 12 and 24 months of age in a subset of these infants (n = 66 and n = 50 respectively). Body composition z-scores were calculated using recently developed reference curves. Linear regression was used to test the associations between clinical factors and body composition z-scores, as well as z-scores and BSID scores. Increased calories and protein received in the first week after birth and protein intake throughout hospitalization were associated with increased FFM z-scores at discharge, but not with %BF z-scores. After adjustment for both early acute and chronic illness, associations of nutrient intake with FFM z-score remained unchanged. FFM z-scores at discharge were positively associated with scores on the BSID at 12 and 24 months CA. In conclusion, increased energy and protein intakes both early in hospitalization and across its entire duration are associated with higher FFM at discharge, a key marker for organ growth and neurodevelopment in the VLBW neonate. Optimizing caloric intake, irrespective of illness is critical for enhancing body composition, and by extension, neurodevelopmental outcomes for preterm infants.
Highlights
Fat-free mass (FFM) gains are closely linked to brain development and are important growth parameters for the study of nutritional and physiological stressors on the preterm infant
A few studies have shown that infants who received higher amounts of nutrients during hospitalization had improved FFM gains and neurodevelopment, it remains unclear if these associations are due to healthier infants receiving more nutrition and having improved outcomes [2,6,7,8] Nutritional provision in the first week after birth appears to be critical for both growth and neurodevelopment [2,6], nutrition provided throughout hospitalization has been shown to be associated with linear growth out to at least two years of age in preterm infants [9]
We evaluated the influence of both illness and nutrient provision on later body composition to allow a better understanding of whether an increased nutrient provision is beneficial in terms of FFM gains for both healthy and sick preterm infants
Summary
Fat-free mass (FFM) gains are closely linked to brain development and are important growth parameters for the study of nutritional and physiological stressors on the preterm infant. A few studies have shown that infants who received higher amounts of nutrients during hospitalization had improved FFM gains and neurodevelopment, it remains unclear if these associations are due to healthier infants receiving more nutrition and having improved outcomes [2,6,7,8] Nutritional provision in the first week after birth appears to be critical for both growth and neurodevelopment [2,6], nutrition provided throughout hospitalization has been shown to be associated with linear growth out to at least two years of age in preterm infants [9]. Markers of critical illness have been shown to influence short- and long-term growth and body composition amongst VLBW preterm infants [9,10]. We have previously reported on the prolonged negative influence of steroids, antibiotics/infection and days requiring oxygen (a surrogate for chronic lung disease) on linear growth out to two years CA [9]
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