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Infants born preterm are significantly lighter and shorter on reaching term equivalent age (TEA) than are those born at term, but the relation with body composition is less clear. We conducted a systematic review to assess the body composition at TEA of infants born preterm.
The databases MEDLINE, Embase, CINAHL, HMIC, "Web of Science," and "CSA Co...
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Context 1
... all language literature search was carried out using the key words and search strategy detailed in Table 1 Conference abstracts and other cita- tions were identified by searching the web sites "Web of Science" (wok.mimas. ac.uk) and CSA Conference Papers Index (www.csa.com) using the same search strategy outlined in Table 1, adapted for use in the web interface. ...
Context 2
... all language literature search was carried out using the key words and search strategy detailed in Table 1 Conference abstracts and other cita- tions were identified by searching the web sites "Web of Science" (wok.mimas. ac.uk) and CSA Conference Papers Index (www.csa.com) using the same search strategy outlined in Table 1, adapted for use in the web interface. Handsearching of conference proceedings was also carried out. ...
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Citations
... 86 Children born preterm, at term-equivalent age, often have lower weight, length and head circumference but higher adiposity than their term-born counterparts. [87][88][89][90] Many continue to show accelerated growth after initial postnatal growth faltering, maintaining this growth velocity until 36-40 weeks postmenstrual age, followed by a decrease and then a second increase in velocity during the infancy and toddler period. 86,[90][91][92][93] Consistent with this pattern, we found that children born preterm who received high protein intake had higher weight, fat mass and fat-free mass at discharge or 36 weeks and gained greater head circumference from birth to discharge or 36 weeks than those in the low protein group. ...
Background
Appropriate protein intake is crucial for growth and development in children born preterm. We assessed the effects of high (HP) versus low protein (LP) intake on neurodevelopment, growth, and biochemical anomalies in these children.
Methods
Randomised and quasi-randomised trials providing protein to children born preterm (<37 completed weeks of gestation) were searched following PRISMA guideline in three databases and four registers (PROSPERO registration CRD42022325659). Random-effects model was used for assessing the effects of HP (≥3.5 g/kg/d) vs. LP (<3.5 g/kg/d).
Results
Data from forty-four studies ( n = 5338) showed HP might slightly reduce the chance of survival without neurodisability at ≥12 months (four studies, 1109 children, relative risk [RR] 0.95 [95% CI 0.90, 1.01]; P = 0.13; low certainty evidence) and might increase risk of cognitive impairment at toddler age (two studies; 436 children; RR 1.36 [0.89, 2.09]; P = 0.16; low certainty evidence). At discharge or 36 weeks, HP intake might result in higher weight and greater head circumference z-scores. HP intake probably increased the risk of hypophosphatemia, hypercalcemia, refeeding syndrome and high blood urea, but reduced risk of hyperglycaemia.
Conclusions
HP intake for children born preterm may be harmful for neonatal metabolism and later neurodisability and has few short-term benefits for growth.
Impact statement
Planned high protein intake after birth for infants born preterm might be harmful for survival, neurodisability and metabolism during infancy and did not improve growth after the neonatal period.
Protein intake ≥3.5 g/kg/d should not be recommended for children born preterm.
... Existing evidence supporting that premature babies are more likely to develop metabolic diseases such as obesity, which had about 50% body fat than term-born controls after catching-up [33]. Compared with protein intake, excessive energy supplement is the mainly factor to cause obesity in premature infants. ...
Purpose: To investigated whether high protein intake in early life contribute to physical and mental development in preterm infants aged 0-24 months, then analyzed the association between protein intake and incidence of obesity.
Methods: A total of 174 preterm infants were recruited for a cohort study related to Guangzhou High-Risk Infant, and were divided into a high protein intake group (HP, n=21) and a common protein intake group (LP, n=153) based on their average protein intake at the age of 0~6 months. Body weight, body length, and BMI and their Z-scores was calculated, and the Gesell development and infant neuropsychological examination screening were used to assess child mental development. Multivariate Linear regression models were used to assess the correlation between protein intake and physical development, and the multivariate logistic regression was used to analyze the association between protein intake and the level of mental development and the incidence of obesity.
Results: The average protein intake in HP and LP group were 3.76±0.62g/kg/day and 1.67±0.49g/kg/day, respectively. The body weight, body length, BMI, and their Z-scores in the HP group was significantly lower than LP group during aged 6 to18 months. There a negatively correlation between protein intake and physical development level at aged 6~12 months. No significant association was found between protein intake and the mental development and the incidence of obesity.
Conclusions: A higher protein intake in early life (0~6th month) did not contribute to the development of physical and neuropsychological and have no effect on the incidence of obesity and Neuropsychological development in preterm infants aged 0-24 months.
... The body composition of preterm infants shows a deficit in fat-free mass and a higher adiposity at term equivalent ages when compared to full-term infants, which may influence metabolic changes throughout life [1][2][3]. It is possible that the high fat accretion early in life in very preterm infants is a postnatal adaptive event and does not persist beyond 3 to 4 months of corrected age [4,5]. ...
... preterm infants have a lower fat-free mass, greater body fat mass percentage, and lower weight, length, and head circumference at term equivalent age than full-term infants [1,5]. ...
Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500 g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3 months of life with fat-free mass and fat mass percentage at 4 to 7 years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3 months of corrected age, and at 4 to 7 years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7 years. The fat-free mass at 3 months and the gain in fat-free mass between term and 3 months showed positive associations with fat-free mass at 4 to 7 years.
Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3 months of life, a sensitive period for the risk of metabolic diseases. What is Known:
• Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants.
• Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome.
What is New:
•Fat-free mass gain in the first 3 months of corrected age is associated with fat-free mass at preschool and school ages.
•The first 3 months of life is a sensitive period to the risk of metabolic diseases.
... Numerous studies have revealed an altered body composition of preterm infants at term equivalent age compared to their term counterparts [1] and increased risk of metabolic consequences later in life [2][3][4]. Current feeding practices aim at a preterm body composition similar to that of term infants. ...
Preterm infants have increased body adiposity at term-equivalent age and risk of adverse metabolic outcomes. The aim of the study was to define how nutrient intake may impact body composition (BC) of very low-birth weight infants fed with early progressive enteral feeding and standard fortification. Eighty-six infants with <1500 g birth weight were included in the BC study and stratified into extremely preterm (EP) and very preterm (VP) groups. Nutrient intake was calculated during the first 28 days and BC assessed by dual X-ray absorptiometry at discharge and by skinfold thickness at 12 months of corrected age (CA). Total nutrient intake did not differ between the groups. EP infants had a higher fat mass percentage at discharge than VP infants (24.8% vs. 19.4%, p < 0.001); lean mass did not differ. None of the nutrients had any impact on BC of EP infants. Protein intake did not result in a higher lean mass in either group; fat intake was a significant predictor of increased fat mass percentage in VP infants at discharge (p = 0.007) and body adiposity at 12 months of CA (p = 0.021). Nutritional needs may depend on gestational age and routine fortification should be used with caution in more mature infants.
... Numerous studies revealed altered body composition of preterm infants at term equivalent age compared to their term counterparts [1] and increased risk of metabolic consequences later in life [2][3][4]. Current feeding practices aim at preterm body composition similar to that of term infants. ...
Preterm infants have increased body adiposity at term equivalent age and risk for adverse metabolic outcomes. The aim of the study was to define how nutrient intake may impact body composition (BC) of very low birth weight infants fed with early progressive enteral feeding and standard fortification. Eighty-six infants with
... The immature gastrointestinal tract can affect both the onset of and time needed to achieve full enteral feeding, and impaired renal function can limit full protein feeding [9,10]. However, insufficient protein intake impedes adequate growth and can alter body composition by mitigating lean mass deposition to a greater extent than adipose tissue deposition [11,12]. At term-corrected age, preterm infants often have less lean mass and relatively greater adiposity than infants born at term [11]. ...
... However, insufficient protein intake impedes adequate growth and can alter body composition by mitigating lean mass deposition to a greater extent than adipose tissue deposition [11,12]. At term-corrected age, preterm infants often have less lean mass and relatively greater adiposity than infants born at term [11]. Moreover, this lean mass deficit persists into early childhood [13]. ...
... These findings are directly relevant to the clinical care of preterm infants because current nutrition support often fails to support adequate rates of postnatal growth or body composition [57]. Such targeted nutritional therapies applied to preterm infants could support postnatal weight gain, overcome the deficit in lean mass in early childhood [11], and minimize the lifelong risk of developing insulin resistance and obesity [4]. ...
Background
Continuous feeding does not elicit an optimal anabolic response in skeletal muscle but is required for some preterm infants. We reported previously that intermittent intravenous pulses of leucine (Leu; 800 μmol Leu·kg–1·h–1 every 4 h) to continuously fed pigs born at term promoted mechanistic target of rapamycin complex 1 (mTORC1) activation and protein synthesis in skeletal muscle.
Objectives
The aim was to determine the extent to which intravenous Leu pulses activate mTORC1 and enhance protein synthesis in the skeletal muscle of continuously fed pigs born preterm.
Methods
Pigs delivered 10 d preterm was advanced to full oral feeding >4 d and then assigned to 1 of the following 4 treatments for 28 h: 1) ALA (continuous feeding; pulsed with 800 μmol alanine·kg–1·h–1 every 4 h; n = 8); 2) L1× (continuous feeding; pulsed with 800 μmol Leu·kg–1·h–1 every 4 h; n = 7); 3) L2× (continuous feeding; pulsed with 1600 μmol Leu·kg–1·h–1 every 4 h; n = 8); and 4) INT (intermittent feeding every 4 h; supplied with 800 μmol alanine·kg–1 per feeding; n = 7). Muscle protein synthesis rates were determined with L-[²H5-ring]Phenylalanine. The activation of insulin, amino acid, and translation initiation signaling pathways were assessed by Western blot.
Results
Peak plasma Leu concentrations were 134% and 420% greater in the L2× compared to the L1× and ALA groups, respectively (P < 0.01). Protein synthesis was greater in the L2× than in the ALA and L1× groups in both the longissimus dorsi and gastrocnemius muscles (P < 0.05) but not different from the INT group (P > 0.10). Amino acid signaling upstream and translation initiation signaling downstream of mTORC1 largely corresponded to the differences in protein synthesis.
Conclusions
Intravenous Leu pulses potentiate mTORC1 activity and protein synthesis in the skeletal muscles of continuously fed preterm pigs, but the amount required is greater than in pigs born at term.
... The early initiation of aggressive enteral feeding alongside appropriate parenteral support holds the potential to enhance the growth and overall development of very low-birth-weight and extremely premature infants. Conversely, excessive early nutritional support in preterm infants may lead to alterations in body composition and subsequently increase the risk of obesity and chronic non-communicable diseases later in life [1,4,5]. ...
Unlabelled:
Premature infants, given their limited reserves, heightened energy requirements, and susceptibility to nutritional deficits, require specialized care.
Aim:
To examine the complex interplay between nutrition and neurodevelopment in premature infants, underscoring the critical need for tailored nutritional approaches to support optimal brain growth and function.
Data sources:
PubMed and MeSH and keywords: preterm, early nutrition, macronutrients, micronutrients, human milk, human milk oligosaccharides, probiotics AND neurodevelopment or neurodevelopment outcomes. Recent articles were selected according to the authors' judgment of their relevance. Specific nutrients, including macro (amino acids, glucose, and lipids) and micronutrients, play an important role in promoting neurodevelopment. Early and aggressive nutrition has shown promise, as has recognizing glucose as the primary energy source for the developing brain. Long-chain polyunsaturated fatty acids, such as DHA, contribute to brain maturation, while the benefits of human milk, human milk oligosaccharides, and probiotics on neurodevelopment via the gut-brain axis are explored. This intricate interplay between the gut microbiota and the central nervous system highlights human milk oligosaccharides' role in early brain maturation.
Conclusions:
Individualized nutritional approaches and comprehensive nutrient strategies are paramount to enhancing neurodevelopment in premature infants, underscoring human milk's potential as the gold standard of nutrition for preterm infants.
... Measuring this outcome at term-equivalent age could help identify nutritional practices that prevent excessive weight gain from fat mass gains, especially with the increasing availability of reference values for FFM accretion at different gestational ages. 34,35 However, it is important to acknowledge that ADP-measured FFM can only be assessed in infants who do not require significant respiratory support. Therefore, information on FFM accretion in the most immature and sickest infants, who are most likely to develop nutritional deficits, is often missing. ...
Objectives:
Enteral nutrition with unfortified human milk during the first 2 postnatal weeks often leads to cumulative protein and energy deficits among preterm infants. Fortified human milk administered soon after birth could increase fat-free mass (FFM) and improve growth in these infants.
Methods:
This was a masked, randomized trial. Starting on feeding day 2, extremely preterm infants 28 weeks or younger fed maternal or donor milk were randomized to receive either a diet fortified with a human-based product (intervention group) or a standard, unfortified diet (control group). This practice continued until the feeding day when a standard bovine-based fortifier was ordered. Caregivers were masked. The primary outcome was FFM-for-age z score at 36 weeks of postmenstrual age (PMA).
Results:
A total of 150 infants were randomized between 2020 and 2022. The mean birth weight was 795±250 g, and the median gestational age was 26 weeks. Eleven infants died during the observation period. The primary outcome was assessed in 105 infants (70%). FFM-for-age z scores did not differ between groups. Length gain velocities from birth to 36 weeks PMA were higher in the intervention group. Declines in head circumference-for-age z score from birth to 36 weeks' PMA were less pronounced in the intervention group.
Conclusions:
In infants born extremely preterm, human milk diets fortified soon after birth do not increase FFM accretion at 36 weeks' PMA, but they may increase length gain velocity and reduce declines in head circumference-for-age z scores from birth to 36 weeks' PMA.
... Also, preterm babies who experience accelerated growth early in life may have increased fat deposits and be at higher risk of metabolic and cardiovascular problems later in life (43). Therefore, when the babies reach term-corrected age they remain underweight but with proportionally more fat than fat-free mass compared with term babies (76). Having more fat than fat-free mass is linked to an increased risk of chronic diseases (77). ...
Preterm birth is one of the most important determinants of adverse infant outcomes, in terms of survival and quality of life. Adolescent pregnant is among the factors that are associated with an increased risk of preterm birth. However, despite its significant contribution, this age group has not received sufficient attention in efforts to prevent and reduce the burden of preterm births. The current efforts are generalized to all age groups and do not consider that adolescents have special age requirements even before becoming pregnant. This literature review summarizes some of the key nutrition and health challenges in pregnant adolescent that are linked to preterm birth as well as possible acute and chronic nutritional and health challenges to their preterm children. Electronic databases such as PubMed, Google Scholar, and MEDLINE were searched using keywords such as "adolescent", "health," "preterm", "Teen mothers", "nutrition" "preterm birth" and pertinent articles (N = 74) were retrieved and reviewed. Due to maternal young age, preterm children of adolescent mothers also have high risk of suffering from short and long adverse health and nutritional problems. Female adolescents should not only be viewed from one angle of growing girls but also as part of women of the reproductive age group. They should not receive any less of the benefits of this age group that include adequate education about reproductive health, pregnancy nutrition and use and choice of contraceptives. ABSTRACT Review
... Along with the increased risk of neonatal and postneonatal death, low birth weight piglets and infants are at increased risk for short-term adverse health outcomes such as respiratory distress, sepsis, decreased digestibility in the gut, and necrotizing enterocolitis, sometimes associated with parenteral feeding in low birth weight human infants, a necessary component of preterm infant management (Goldenberg and Culhane, 2007;Sondheimer et al., 1998;Kao et al., 2006). Extrauterine growth restriction is also a commonality between low birth weight piglets and infants, with growth curves faltering early in neonatal life and leading to decreased linear growth and an increased fat-to-lean mass body mass ratio, which likely contributes to an increased risk of undesirable carcass yields ("fatty carcass") in low birth weight piglets, and obesity and related metabolic disease in low birth weight infants (Johnson et al., 2012;Markopoulou et al., 2019). This underscores the importance of meeting neonatal protein requirements and understanding the nutritional regulation of muscle growth in the neonate, especially those born low birth weight. ...
Despite advances in the nutritional support of low birth weight and early-weaned piglets, most experience reduced extrauterine growth performance. To further optimize nutritional support and develop targeted intervention strategies, the mechanisms that regulate the anabolic response to nutrition must be fully understood. Knowledge gained in these studies represents a valuable intersection of agriculture and biomedical research, as low birth weight and early-weaned piglets face many of the same morbidities as preterm and low birth weight infants, including extrauterine growth faltering and reduced lean growth. While the reasons for poor growth performance are multifaceted, recent studies have increased our understanding of the role of nutrition in the regulation of skeletal muscle growth in the piglet. The purpose of this review is to summarize the published literature surrounding advances in the current understanding of the anabolic signaling that occurs after a meal and how this response is developmentally regulated in the neonatal pig. It will focus on the regulation of protein synthesis, and especially the upstream and downstream effectors surrounding the master protein kinase, mechanistic target of rapamycin complex 1 (mTORC1) that controls translation initiation. It also will examine the regulatory pathways associated with the postprandial anabolic agents, insulin and specific amino acids, that are upstream of mTORC1 and lead to its activation. Lastly, the integration of upstream signaling cascades by mTORC1 leading to the activation of translation initiation factors that regulate protein synthesis will be discussed. This review concludes that anabolic signaling cascades are stimulated by both insulin and amino acids, especially leucine, through separate pathways upstream of mTORC1, and that these stimulatory pathways result in mTORC1 activation and subsequent activation of downstream effectors that regulate translation initiation Additionally, it is concluded that this anabolic response is unique to the skeletal muscle of the neonate, resulting from increased sensitivity to the rise in both insulin and amino acid after a meal. However, this response is dampened in skeletal muscle of the low birth weight pig, indicative of anabolic resistance. Elucidation of the pathways and regulatory mechanisms surrounding protein synthesis and lean growth allow for the development of potential targeted therapeutics and intervention strategies both in livestock production and neonatal care.
