Association of Early Nutrition and Growth and Metabolic Parameters in Very Low Birth Weight Infants

Early nutrition is crucial for postnatal growth and metabolic status in preterm very low birth weight (VLBW) infants; however, the optimal macronutrient proportions remain unclear. We aimed to investigate how early nutrition influences long-term outcomes in extremely preterm (EP) and very/moderately preterm (VP) infants.

We included 120 preterm infants in the prospective follow-up study. Anthropometric and metabolic parameters (fasting glycemia, insulin, and IGF-1) were assessed at birth, on the 28th day after birth, and once a year until 3-4 years (N = 65). Total daily parenteral and enteral nutrient intake was calculated. Standard deviation scores (SDS) for anthropometric measurements were calculated using Swedish growth reference data.

Although there was no difference in weight-adjusted macronutrient intake, EP newborns grew more slowly in the first 28 days than VP newborns. At the age of 1 year, the central-to-peripheral subcutaneous fat ratio was higher in children born EP compared to children born VP. No other anthropometric differences were found between groups at 1 year of age, and later between both groups. On the 28th day after birth, infants born EP had higher glucose and insulin levels, HOMA-IR, and lower IGF-1 levels compared to infants born VP. No relation was found between macronutrient intake and increases in weight SDS and height SDS in VP newborns. In the EP subgroup, carbohydrate and protein intake during the first 28 days were directly related to central-to-peripheral subcutaneous fat at 1 and 3-4 years.

Early nutrition affects children's growth up to 1 year of age, while later on, other factors seem to interfere. Higher protein and carbohydrate intake does not have a positive effect on the growth of preterm infants but is related to more central adipose tissue distribution.