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Plasma amino acids after human milk fortification and associations with growth in preterm infants

Martin Bo Rasmussen1, Kristine Holgersen1,2, Tik Muk1

  • 1Comparative Pediatrics, Section for Biomedicine, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark.

Pediatric Research
|May 18, 2025
PubMed

Insights

Bovine colostrum fortification of human milk increased plasma amino acids in very preterm infants. These changes correlated with head growth and IGF-1 but had limited impact on overall growth outcomes.

Area of Science:

  • Neonatal Nutrition
  • Pediatric Gastroenterology
  • Biochemistry

Background:

  • Plasma amino acid (AA) levels and their impact on growth in very preterm infants (VPIs) receiving fortified human milk are not well understood.
  • The effects of different fortification types on AA concentrations and subsequent growth factors like insulin-like growth factor 1 (IGF-1) remain unclear.

Purpose of the Study:

  • To investigate how human milk fortification with bovine colostrum (BC) versus conventional fortifier (CF) affects plasma AA concentrations in VPIs.
  • To determine the association between changes in plasma AA concentrations and growth parameters (weight, length, head circumference) and IGF-1 levels in VPIs.

Main Methods:

  • A study involving 225 VPIs where human milk was fortified with either BC or CF.
  • Plasma samples were collected at baseline (~1 week of age) and at 1 and 2 weeks post-fortification.
  • Growth Z-scores and IGF-1 concentrations were monitored until 35 weeks postmenstrual age.

Main Results:

  • BC fortification led to increased concentrations of 12 AAs and decreased lysine compared to CF.
  • Increases in plasma AAs correlated positively with head circumference growth and IGF-1 levels.
  • AA changes were inversely associated with gestational age and birth weight, but the plasma proteome remained unaffected.

Conclusions:

  • Bovine colostrum fortification significantly alters plasma AA profiles in VPIs, increasing many AA concentrations.
  • Fortification-induced AA changes are linked to head growth and IGF-1 but show limited predictive value for body weight or length growth.
  • While fortification impacts AA levels, these variations appear to have minimal clinical implications for the early growth and health outcomes of VPIs.
Abstract

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