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Body composition assessment of preterm infants: is it time to switch from research to bedside?

Pediatric Research (2024)Cite this article

Postnatal growth is closely linked to health outcomes through the so-called developmental programming.1 Longitudinal assessment of growth is critical to monitor the nutritional status and derive personalized dietary interventions in preterm and low birth weight infants. A comprehensive approach, however, should include not only the standard measurements of anthropometrics but also the assessment of changes in body composition that contribute to the modulation of long-term outcomes.2 In light of this evidence, efforts have been made to implement growth and body composition assessments, aimed at tracking the quantity and quality of longitudinal growth patterns in premature infants.3

Growth is primarily supported by the supply of protein and energy (represented by fats and glucose), in adjusted amounts and ratio, through complex pathways that reflect adaptive changes during the deposition of fat tissue, muscle tissue, and other components. Fat mass deposition, physiologically increasing through the third trimester of pregnancy, peaks at 4th-6th months after birth in breastfed infants. After this period, the rate of fat mass accumulation slows down compared to lean mass, leading to a decrease in the percentage of fat mass.4 The trend in formula-fed infants is reversed, with an early higher deposition of fat free mass, possibly due to a greater protein intake in front of a higher resting energy expenditure, followed by a higher deposition of fats after the 6th month of life.5 The pattern of fat deposition in healthy-term infants represents the reference curve.

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References

  1. Koletzko, B. et al. Early influences of nutrition on postnatal growth. Nestle Nutr. Inst. Workshop Ser. 71, 11–27 (2013).

    Article  PubMed  Google Scholar 

  2. Isganaitis, E. Developmental programming of body composition: update on evidence and mechanisms. Curr. Diab. Rep. 19, 60 (2019).

    Article  PubMed  Google Scholar 

  3. Pereira-da-Silva, L., Virella, D. & Fusch, C. Nutritional assessment in preterm infants: a practical approach in the NICU. Nutrients 11, 1999 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Toro-Ramos, T., Paley, C., Pi-Sunyer, F. X. & Gallagher, D. Body composition during fetal development and infancy through the age of 5 years. Eur. J. Clin. Nutr. 69, 1279–1289 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gale, C. et al. Effect of breastfeeding compared with formula feeding on infant body composition: a systematic review and meta-analysis. Am. J. Clin. Nutr. 95, 656–669 (2012).

    Article  CAS  PubMed  Google Scholar 

  6. Johnson, M. J., Wootton, 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, 3e640–649.e640 (2012).

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Hamatschek, C. et al. Fat and fat-free mass of preterm and term infants from birth to six months: a review of current evidence. Nutrients 12, 288 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Uthaya, S. et al. Altered adiposity after extremely preterm birth. Pediatr. Res. 57, 211–215 (2005).

    Article  PubMed  Google Scholar 

  10. Andrews, E. T., Beattie, R. M. & Johnson, M. J. Measuring body composition in the preterm infant: Evidence base and practicalities. Clin. Nutr. 38, 2521–2530 (2019).

    Article  PubMed  Google Scholar 

  11. Nagel, E. et al. Clinical application of body composition methods in premature infants. JPEN 44, 785–795 (2020).

    Article  Google Scholar 

  12. Buck, C. O., Santoro, K. L., Shabanova, V., Martin, C. R. & Taylor, S. N. Establishing feasibility and reliability of subcutaneous fat measurements by ultrasound in very preterm infants. Pediatric Res. https://doi.org/10.1038/s41390-024-03439-2 (2024).

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Authors and Affiliations

  1. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Unit, Milan, Italy

    Carlo Agostoni

  2. Dipartimento di Scienze cliniche e di Comunità, Dipartimento di Eccellenza 2023-2027, University of Milan, Milan, Italy

    Carlo Agostoni & Maria L. Giannì

  3. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy

    Maria L. Giannì

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  1. Carlo Agostoni
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  2. Maria L. Giannì
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C.A. and G.M.L. conceptualized and wrote the manuscript.

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Correspondence to Carlo Agostoni.

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Agostoni, C., Giannì, M.L. Body composition assessment of preterm infants: is it time to switch from research to bedside?. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03567-9

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