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Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y
Charlotte A Ruys1, Monique van de Lagemaat2, Martijn Jj Finken3
1Departments of Pediatrics/Neonatology and c.ruys@vumc.nl.
Insights
A specialized postdischarge formula (PDF) for preterm infants did not show lasting benefits in body composition or metabolic health by age 8. Early nutritional interventions for preterm infants require further investigation for sustained effects.
Area of Science:
- Pediatric Nutrition
- Neonatology
- Growth and Development
Background:
- Early nutrition interventions can influence health risks in preterm infants.
- Previous research indicated improved lean mass with protein- and mineral-enriched postdischarge formula (PDF) compared to term formula (TF) up to 6 months corrected age (CA).
- Long-term follow-up is crucial to assess the sustainability of short-term nutritional benefits.
Purpose of the Study:
- To compare body size, body composition, and metabolic health at age 8 years in preterm children receiving PDF versus TF from term age to 6 months CA.
- To evaluate the long-term impact of a specialized postdischarge formula on growth and metabolic outcomes.
Main Methods:
- Follow-up of 79 children from a randomized controlled trial at age 8 years.
- Assessment of body size (weight, height, head circumference), body composition (DXA scan), bone variables, blood pressure, and metabolic markers (glucose, insulin, lipids, etc.).
- Evaluation of nutritional habits using a 3-day diary.
Main Results:
- No significant differences in body size, body composition, bone health, or metabolic variables were observed at age 8 years between the PDF and TF groups.
- Statistical adjustments for potential confounders did not alter these findings.
Conclusions:
- The favorable effects of the protein- and mineral-enriched postdischarge formula observed at 6 months corrected age were not maintained or confirmed at 8 years.
- Attrition in the follow-up study may have limited the ability to detect long-term effects.
- Future research should consider nutritional interventions during the pre- and postdischarge periods as a continuous process.
Abstract:
Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable.Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA.Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary.Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results.Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].
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