Short- and longer-term growth and development of fat mass in preterm infants

Preterm infants typically experience faster growth rates than term-born infants, often doubling their weight in six to eight weeks. However, many face challenges leading to growth faltering and suboptimal neurodevelopment. To achieve optimal growth, these infants often require fortified breastmilk or high-nutrient formula. While meeting nutrition and growth targets are essential, concerns arise about rapid postnatal growth during their catch-up phase, particularly regarding increased body fat at term-corrected age, possibly increasing their risk for obesity and chronic health conditions later. However, evidence suggests that although preterm infants may have higher body fat at term-corrected age, this difference diminishes by three months corrected age, aligning more closely with term-born infants. Systematic reviews of more than 20,000 individuals observed that small for gestational age preterm infants do not have higher adiposity in childhood and adulthood; rather, they exhibit lower body mass indexes, waist circumferences, similar body and visceral fat and blood pressure compared to their appropriate for gestational age preterm-born peers. Therefore, it is reassuring that promoting early growth in preterm infants does not necessitate a trade-off when it comes to supporting long-term metabolic outcomes versus neurodevelopment. Healthcare providers should encourage a responsive feeding approach, even in preterm infants, guided by infants' physiological needs, hunger and satiety once they exhibit feeding cues. This approach respects the child's developmental needs and encourages healthy eating habits, fostering positive parent-child feeding relationships, and ultimately allowing the child to grow and develop to their full potential without compromising their long-term health outcomes.