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Association of Protein and Vitamin D Intake With Biochemical Markers in Premature Osteopenic Infants: A Case-Control
Mohamed Mohamed1,2, May Kamleh3, Julia Muzzy1,4
1Department of Pediatrics, Sanford Children's Hospital, Fargo, ND, United States.
Insights
Low protein and vitamin D intake are linked to osteopenia in preterm infants. Monitoring alkaline phosphatase levels can help predict this condition in premature babies.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Bone Metabolism
Background:
- Osteopenia in preterm infants (OP) is a significant clinical challenge.
- Nutritional intake, particularly protein and vitamin D, is crucial for bone mineralization in neonates.
Purpose of the Study:
- To investigate the role of protein and vitamin D intake in the development of osteopenia in very low birth weight (VLBW) neonates.
- To identify potential biomarkers for predicting osteopenia in this population.
Main Methods:
- A prospective case-control study involving 26 neonates with birth weight <1,250 g.
- Measurement of serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, phosphorus, vitamin D, and protein levels during the first six post-natal weeks.
- Radiographic assessment of osteopenia at 6 weeks of age.
Main Results:
- Infants who developed osteopenia had significantly lower daily protein intake and vitamin D concentrations.
- An alkaline phosphatase (ALP) level exceeding 619 IU/L was predictive of osteopenia with 76.9% sensitivity and 75% specificity.
- Higher PTH levels were observed in infants with osteopenia at 6 weeks post-natally.
Conclusions:
- Protein and vitamin D intake play a critical role in the development of osteopenia in VLBW infants.
- Early identification and nutritional support are essential for managing and preventing osteopenia in premature neonates.
- Further research into optimal nutritional strategies is warranted.
Abstract:
Osteopenia in preterm infants (OP) remains an important challenge and is largely dependent on nutritional post-natal intake of factors influencing bone mineralization. We conducted a prospective case-control study to evaluate the importance of protein and vitamin D intake in OP among neonates with birth weight <1,250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), vitamin D and protein levels were measured during the first six post-natal weeks. At 6 weeks of age, OP was evaluated using wrist radiographs. Comparisons were analyzed using multivariate linear regression, receiver operating characteristic curves, χ2 and Wilcoxon Rank Sum. Of the 26 premature infants enrolled, 13 developed radiographic OP. Daily protein intake (coef = -0.40, p = 0.001) and vitamin D concentrations (21 ± 5.7 ng/ml) were significantly lower in the OP group compared to non-OP subjects. ALP concentration exceeding 619 IU/L, sensitivity of 76.9% and specificity of 75%, was predictive of OP at 6 weeks post-natally. PTH levels were higher at 6 weeks in OP subjects (193 ± 102.5 pg/ml, p < 0.001) compared to non-OP subjects. The findings in this study support the role of vitamin D and protein intake in the development of OP in VLBW infants and inform future practice and research on best practices for OP management.
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