Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Effects of human milk on body composition and growth in very low birthweight infants

Pediatric Research volume 93, pages 2028–2035 (2023)Cite this article

Abstract

Objective

To compare body composition and growth in very low birthweight infants according to their source of human milk: maternal expressed breast milk (MEBM) versus donor breast milk (DBM). We hypothesized that infants fed predominately MEBM would exhibit reduced body fat percentage compared to those fed predominately DBM.

Methods

Premature infants weighing ≤1500 g on an exclusive human milk diet were enrolled in a single-center study between 2017 and 2021. Demographic data and anthropometric measurements were collected. All infants underwent body composition analysis via dual energy x-ray absorptiometry at 36 weeks corrected post menstrual age.

Results

A total of 60 infants were enrolled and 48 were included in the primary analysis. No differences were detected in percent body fat (14 vs. 12%, p = 0.7) or fat-free mass (2050 vs. 2130 g, p = 0.7). Both groups displayed similar growth and anthropometric measurements. Caloric and macronutrient intake between groups was similar.

Conclusion

In the cohort of patients studied, no differences were observed in percent body fat based on primary human milk type intake in the first 28 postnatal days. Further investigation is required in a larger population of exclusive human milk fed preterm infants to determine if body composition differences exist based on an infant’s primary human milk source.

Impact

  • Premature infants are at risk for altered body composition at term corrected age, specifically increased body fat percentage, which may have implications for the future.

  • To our knowledge this is the first study exploring body composition outcomes based on an infant’s primary human milk source.

  • Infants fed exclusive human milk (e.g., donor vs. maternal) displayed similar percent body fat and growth outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Enrollment flowchart.
Fig. 2: Body composition outcomes at 36 weeks PMA.
Fig. 3: Measured enteral and parenteral calories and macronutrient content at 7, 14, 21, and 28 postnatal days.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Guellec, I. et al. Effect of intra- and extrauterine growth on long-term neurologic outcomes of very preterm infants. J. Pediatr. 175, 93–99 (2016).

    Article  PubMed  Google Scholar 

  2. Ramel, S. E. et al. Greater early gains in fat-free mass, but not fat mass, are associated with improved neurodevelopment at 1 year corrected age for prematurity in very low birth weight preterm infants. J. Pediatr. 173, 108–115 (2016).

    Article  PubMed  Google Scholar 

  3. Ramel, S. E., Haapala, J., Super, J., Boys, C. & Demerath, E. W. Nutrition, illness and body composition in very low birth weight preterm infants: implications for nutritional management and neurocognitive outcomes. Nutrients 12, 145 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Giannì, M. L. et al. Adiposity in small for gestational age preterm infants assessed at term equivalent age. Arch. Dis. Child. Fetal Neonatal Ed. 94, F368–F372 (2009).

    Article  PubMed  Google Scholar 

  5. Parlapani, E., Agakidis, C. & Karagiozoglou-Lampoudi, T. Anthropometry and body composition of preterm neonates in the light of metabolic programming. J. Am. Coll. Nutr. 37, 350–359 (2018).

    Article  PubMed  Google Scholar 

  6. Roggero, P. et al. Is term newborn body composition being achieved postnatally in preterm infants? Early Hum. Dev. 85, 349–352 (2009).

    Article  PubMed  Google Scholar 

  7. Johnson, M. J., Wooten, S. A., Leaf, A. A. & Jackson, A. A. Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis. Pediatrics 130, e630–e649 (2012).

    Article  Google Scholar 

  8. Hair, A. B. et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet. Breastfeed. Med. 11, 70–74 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Eidelman, A. I. et al. Breastfeeding and the use of human milk. Pediatrics 129, 827–841 (2012).

    Article  Google Scholar 

  10. Rice, M. S. & Valentine, C. J. Neonatal body composition: measuring lean mass as a tool to guide nutrition management in the neonate. Nutr. Clin. Pract. 30, 625–632 (2015).

    Article  PubMed  Google Scholar 

  11. Lloyd, M. L., Malacova, E., Hartmann, B. & Simmer, K. A clinical audit of the growth of preterm infants fed predominantly pasteurised donor human milk v. those fed mother’s own milk in the neonatal intensive care unit. Br. J. Nutr. 121, 1018–1025 (2019).

    Article  CAS  PubMed  Google Scholar 

  12. Soldateli, B., Parker, M., Melvin, P., Gupta, M. & Belfort, M. Human milk feeding and physical growth in very low-birth-weight infants: a multicenter study. J. Perinatol. 40, 1246–1252 (2020).

    Article  CAS  PubMed  Google Scholar 

  13. Montjaux-Régis, N. et al. Improved growth of preterm infants receiving mother’s own raw milk compared with pasteurized donor milk. Acta Paediatr. 100, 1548–1554 (2011).

    Article  PubMed  Google Scholar 

  14. Cerasani, J. et al. Human milk feeding and preterm infants’ growth and body composition: a literature review. Nutrients 12, 1155 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Visuthranukul, C., Abrams, S. A., Hawthorne, K. M., Hagan, J. L. & Hair, A. B. Premature small for gestational age infants fed an exclusive human milk-based diet achieve catch-up growth without metabolic consequences at 2 years of age. Arch. Dis. Child. Fetal Neonatal Ed. 104, F242–F247 (2019).

    Article  PubMed  Google Scholar 

  16. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics and the Society forMaternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet. Gynecol. 133, e97–e109 (2019).

  17. Janisse, J. J., Bailey, B. A., Ager, J. & Sokol, R. J. Alcohol, tobacco, cocaine and marijuana use: relative contributions to preterm delivery and fetal growth restriction. Subst. Abus. 35, 60–67 (2014).

    Article  PubMed  Google Scholar 

  18. van Wyk, L. et al. Postnatal catch-up growth after suspected fetal growth restriction at term. Front. Endocrinol. 10, 274 (2019).

    Article  Google Scholar 

  19. Prolacta Bioscience®. Preterm nutrition products. Prolact HM® Product Specification Sheet. https://www.prolacta.com/en/products/preterm-nutrition-products/ (2018).

  20. Hologic. Horizon DXA System. Body composition. https://www.hologic.com/hologic-products/body-composition/horizon-dxa-system#230548828-3749065048 (2022).

  21. Brunton, J. A., Bayley, H. S. & Atkinson, S. A. Validation and application of dual-energy x-ray absorptiometry to measure bone mass and body composition in small infants. Am. J. Clin. Nutr. 58, 839–845 (1993).

    Article  CAS  PubMed  Google Scholar 

  22. Prolacta Bioscience®. Preterm nutrition products. Nutrition Information 100% Human milk-based neonatal nutritional products from prolacta bioscience. https://www.prolacta.com/en/products/preterm-nutrition-products/ (2021).

  23. Fenton, T. R. et al. Accuracy of preterm infant weight gain velocity calculations vary depending on method used and infant age at time of measurement. Pediatr. Res. 85, 650–654 (2019).

    Article  PubMed  Google Scholar 

  24. Ezz-Eldin, Z. M., Hamid, T. A. A., Youssef, M. R. L. & Nabil, H. E. Clinical Risk Index for Babies (CRIB II) Scoring System in prediction of mortality in premature babies. J. Clin. Diagnostic Res. 9, 8–11 (2015).

    Google Scholar 

  25. Fenton, T. R. & Kim, J. H. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 13, 1–13 (2013).

    Article  Google Scholar 

  26. Zhang, Z. Missing data imputation: focusing on single imputation. Ann. Transl. Med. 4, 1–9 (2016).

    CAS  Google Scholar 

  27. Mcnelis, K. et al. Body composition of very low-birth-weight infants fed fortified human milk: a pilot study. J. Parenter. Enter. Nutr. 45, 784–791 (2021).

    Article  CAS  Google Scholar 

  28. Perrin, M. T. et al. The nutritional composition and energy content of donor human milk: a systematic review. Adv. Nutr. 11, 960–970 (2021).

    Article  Google Scholar 

  29. de Halleux, V. & Rigo, J. Variability in human milk composition: benefit of individualized fortification in very-low-birth-weight infants. Am. J. Clin. Nutr. 98, 529S–535S (2013).

    Article  PubMed  Google Scholar 

  30. Donath, S. M. & Amir, L. H. Does maternal obesity adversely affect breastfeeding initiation and duration? J. Paediatr. Child Health 36, 482–486 (2000).

    Article  CAS  PubMed  Google Scholar 

  31. Torloni, M. R. et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes. Rev. 10, 194–203 (2009).

    Article  CAS  PubMed  Google Scholar 

  32. Chu, S. Y. et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30, 2070–2076 (2007).

    Article  PubMed  Google Scholar 

  33. Borràs-Novell, C. et al. Infrared analyzers for the measurement of breastmilk macronutrient content in the clinical setting. Expert Rev. Mol. Diagnostics 20, 867–887 (2020).

    Article  Google Scholar 

Download references

Acknowledgements

We thank University Health Systems in San Antonio, Texas and the University Hospital Neonatal Nutrition and Bone Institute for their support and guidance throughout this study. We thank the University Hospital NICU respiratory therapists who supervised the subjects during the DXA scans to ensure patient safety. In addition, we thank the parents of the neonates enrolled and the patients who selflessly contributed of themselves to our scientific pursuit and knowledge acquisition.

Funding

This study was funded by Dr Cynthia Blanco’s Greehey Family Foundation Chair in Neonatology Research and University Health System Foundation Grant. A.G.M. is supported by Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number K23HD101701. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Author notes

  1. These authors contributed equally: Carina B. Ramirez, Karli L. McCoy.

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Texas Health San Antonio, San Antonio, TX, USA

    Carina B. Ramirez, Karli L. McCoy, Diana Anzueto Guerra, Donald McCurnin, Cynthia L. Blanco & Alvaro G. Moreira

  2. Department of Pediatrics, Division of Neonatology, University Health System, San Antonio, TX, USA

    Carina B. Ramirez, Karli L. McCoy, Rachel Jacob, Elizabeth Lavender, Krista Bonagurio, Donald McCurnin, Cynthia L. Blanco & Alvaro G. Moreira

  3. University of Texas at San Antonio, San Antonio, TX, USA

    Simon Karottakuttu

  4. Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, TX, USA

    Jonathon Gelfond

Authors
  1. Carina B. Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karli L. McCoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Lavender
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Krista Bonagurio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diana Anzueto Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Karottakuttu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonathon Gelfond
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donald McCurnin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cynthia L. Blanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alvaro G. Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C.B.R. was responsible for designing the study, obtaining IRB approval, screening and enrolling subjects, collecting data, interpreting results, and writing the manuscript. K.L.M. was responsible for completing IRB progress reports and amendments, screening and enrolling subjects, collecting data, interpreting results, and writing the manuscript. R.J., E.L., and K.B. contributed to screening and enrolling subjects, collecting data, and provided feedback on the manuscript. D.A.G. contributed to data extraction and analysis and provided feedback on the manuscript. S.K. contributed to data entry. J.G. assisted with statistical analysis. D.M. and C.L.B. contributed to the study design and provided feedback on the manuscript. A.G.M. is the primary investigator and provided feedback and assistance with the study design, statistical analysis, and manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Carina B. Ramirez.

Ethics declarations

Competing interests

C.L.B. has received financial support from Prolacta Bioscience® for an unrelated research project. The products described in this study were part of standard of care at University Health Systems. Prolacta Bioscience® provided no financial support or scientific input for this study. The remaining authors of this study have no conflicts of interest to disclose.

Consent to participate

Parental consent was obtained prior to enrollment, or any research activities were performed.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramirez, C.B., McCoy, K.L., Jacob, R. et al. Effects of human milk on body composition and growth in very low birthweight infants. Pediatr Res 93, 2028–2035 (2023). https://doi.org/10.1038/s41390-022-02364-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-022-02364-6

Search

Advanced search

Quick links