How Does Targeted Human Milk Fortification Influence Body Composition and Growth in Preterm Infants? A Narrative...

Preterm infants fed human milk (HM) require additional calories and nutrients, as unfortified HM alone is inadequate to support optimal growth and body composition. Fortification methods have evolved to include targeted fortification (TF), based on measured macronutrient content of HM, rather than standard fortification (SF), which relies on assumed HM composition. The energy, protein-to-energy ratio, and macronutrient content of HM influence fat mass (FM) and fat-free mass (FFM) accretion, key factors for neurodevelopment and long-term metabolic health. This narrative literature review evaluated the impact of TF versus SF on body composition among preterm infants.

A literature search of PubMed, CINAHL, and Google Scholar was conducted for original research published since 2015. Articles were screened for relevance, and reference lists were reviewed to identify additional studies. Articles were included through August 2025.

Of 177 records identified, 17 full-text articles were screened, and 6 were included. TF methods and HM analysis protocols varied across studies. Four studies reported differences in body composition and growth outcomes from TF; only two found significant differences between groups.

Current evidence does not consistently demonstrate a benefit of TF over SF for body composition outcomes in preterm infants. Findings across studies are inconsistent, and observed benefits were associated with complex TF protocols. This review provides suggestions based on limited evidence for clinical implementation when TF is utilized. Further research is needed to clarify the impact of TF on body composition and growth outcomes.