Early nutritional predictors of long-term bone health in preterm infants

Early life nutrition may influence later osteoporosis risk. Preterm infants are at particular risk of suboptimal early nutrition, which is associated with poor neonatal bone mineralization and metabolic bone disease, but it is unclear whether this has long-term consequences for bone health. This review discusses the long-term effects of early diet in patients born preterm who participated in a nutritional intervention trial during the neonatal period and the role of vitamin D in this population.

Available data suggest that, despite large differences in neonatal mineral intake, no effect of neonatal diet on bone mass or bone turnover is detectable in early adult life. However, greater exposure to human milk in the neonatal period, despite its very low mineral content, is associated with higher peak bone mass. Studies in healthy term infants suggest that suboptimal maternal vitamin D status during pregnancy has adverse effects on offspring bone health in infancy and later childhood; however, effects in infants born preterm have not been investigated.

The findings suggest that early mineral intake may not influence later bone mass, with implications for the setting of recommended mineral intakes for contemporary preterm infants; these are currently high and based on achieving in-utero mineral accretion rates rather than on clinical outcome. Despite its low mineral content, human milk, perhaps via a non-nutrient effect, may have long-term benefits for bone health adding to other health benefits already identified in this vulnerable population. The role and optimal dose of vitamin D for later bone health in preterm infants requires further research.