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Neonatal nutrition and early childhood body composition in infants born extremely preterm
Sofia Söderquist Kruth1, Vera Westin2, Boubou Hallberg3
1Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Solna, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Extremely preterm infants have different body composition in childhood, including lower fat-free mass. Neonatal nutrition intake affects their fat and fat-free mass differently, impacting long-term growth and development.
Area of Science:
- Pediatrics
- Neonatology
- Human Physiology
Background:
- Previous research on preterm infant body composition focused on moderate/very preterm infants and early childhood.
- Limited data exists on body composition differences in extremely preterm infants during early childhood.
Purpose of the Study:
- To compare body composition in extremely preterm infants versus term-born infants in early childhood.
- To investigate the association between early neonatal nutrition and body composition distribution in extremely preterm infants.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) used to assess body composition in 52 children (6-9 years old).
- Multivariate linear regression analyzed body composition differences between extremely preterm and term-born groups.
- Bayesian regression and Gradient Boosting Machine explored neonatal nutritional intake effects on body composition.
Main Results:
- Extremely preterm children had smaller head circumference, shorter height, higher waist-to-height ratio, and lower fat-free mass compared to term-born children.
- Neonatal fluid and macronutrient intake showed varied associations with fat mass index and fat-free mass index in extremely preterm infants.
- A bimodal response in fat mass index was observed, indicating individualized nutritional impacts.
Conclusions:
- Significant differences in childhood body composition exist between extremely preterm and term-born infants.
- Early neonatal nutrition intake influences body composition outcomes in extremely preterm infants in a non-uniform manner.
Background & Aims:
Previous studies have observed changes in fat and fat-free mass among preterm infants when compared to term-born infants. However, these studies have mainly focused on moderate or very preterm infants, with a scope limited to the first few years of life. We aimed to compare body composition in extremely preterm infants to term-born infants in early childhood. Additionally, we investigated whether early neonatal nutrition was associated with the distribution of fat- and fat-free mass in later life.
Methods:
The study used dual-energy x-ray absorptiometry to evaluate the body composition of 52 children aged 6-9-years, of whom 35 were born extremely preterm and 17 were born at term and was analyzed using multivariate linear regression. Nutritional intakes of fluids, energy, and macronutrients during the first eight postnatal weeks for 26 extremely preterm infants were investigated in relation to body composition at age 6-9 years using Bayesian regression analysis and Gradient Boosting Machine.
Results:
Children born extremely preterm had smaller head circumference (confidence interval -8.7 to -1.7), shorter height (confidence interval -2.7 to -0.6), higher waist to height ratio (confidence interval 0.01-0.05) and lower fat-free mass (confidence interval -3.9 to -0.49), compared to children born at full-term. Children born extremely preterm had a differing response to amount of fluid and macronutrient intake for both fat mass index and fat-free mass index. A bimodal response showed high intake of fluid and macronutrients as associated with high fat mass index for some children, whereas others demonstrated an inverse association, suggesting analysis on cohort-level as problematic.
Conclusions:
Childhood body composition differs between extremely preterm infants and term-born infants. Extremely preterm infants display differing responses in their body composition to varying levels of fluids and macronutrient intake during the neonatal period.
