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.

  • Article
  • Published:

Nutrition during the early life cycle

Associations of early nutrition with growth and body composition in very preterm infants: a prospective cohort study

European Journal of Clinical Nutrition volume 76, pages 103–110 (2022)Cite this article

Subjects

Abstract

Background/Objective

To investigate impacts of early postnatal macronutrient intakes on growth and body composition of preterm infants within the first 6 months.

Subjects/Methods

One hundred and thirty-three very preterm (VPT) and/or very low birth weight (VLBW) infants were consecutively included. Enteral and parenteral macronutrient intakes during the first 28 days were recorded and average daily intakes were calculated. Growth was measured at birth, term age, and 6 months of corrected age (CA). Body composition was examined by air displacement plethysmograph at term age and 6 months of CA. Associations of nutrient intakes with growth and body composition over time were analyzed using generalized estimating equation.

Results

After adjusting for covariates, higher daily protein, lipid, and energy intake during the first 28 days was associated with higher weight at term age for every 1 g/kg/day increment of protein and lipid intake, and every 10 kcal/kg/day increment of energy intake was associated with 0.50 (95% CI 0.04, 0.96), 0.29 (95% CI 0.07, 0.51), and 0.27 (95% CI 0.10, 0.44) higher weight z-score, respectively. Higher protein intake was associated with lower z-score of fat mass (FM, β = −1.88, 95% CI −3.53, −0.23) and percentage of body fat (PBF, β = −2.18, 95% CI −3.98, −0.39) at 6 months of CA, but higher lipid and carbohydrate intake was associated with higher FM and PBF z-scores at 6 months of CA.

Conclusions

Macronutrient intakes during the first month of life have impacts on growth and body composition before 6 months of age. Higher daily protein intake is associated with a better growth and healthier body composition for VPT/VLBW infants.

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: Flow chart of preterm infants.

Similar content being viewed by others

References

  1. Roth J, Resnick MB, Ariet M, Carter RL, Eitzman DV, Curran JS, et al. Changes in survival patterns of very low-birth-weight infants from 1980 to 1993. Arch Pediatr Adolesc Med. 1995;149:1311–7.

    Article  CAS  Google Scholar 

  2. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003;111:986–90.

    Article  Google Scholar 

  3. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics. 2001;107:E1.

    Article  CAS  Google Scholar 

  4. Ehrenkranz RA. Early, aggressive nutritional management for very low birth weight infants: what is the evidence? Semin Perinatol. 2007;31:48–55.

    Article  Google Scholar 

  5. Poindexter BB, Langer JC, Dusick AM, Ehrenkranz RA. Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. J Pediatr. 2006;148:300–5.

    Article  CAS  Google Scholar 

  6. Euser AM, Finken MJ, Keijzer-Veen MG, Hille ET, Wit JM, Dekker FW. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr. 2005;81:480–7.

    Article  CAS  Google Scholar 

  7. Johnson MJ, Wootton SA, Leaf AA, Jackson AA. Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis. Pediatrics. 2012;130:e640–9.

    Article  Google Scholar 

  8. Ramel SE, Gray HL, Ode KL, Younge N, Georgieff MK, Demerath EW. Body composition changes in preterm infants following hospital discharge: comparison with term infants. J Pediatr Gastroenterol Nutr. 2011;53:333–8.

    Article  Google Scholar 

  9. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2014;22:CD002971.

    Google Scholar 

  10. Gianni ML, Roggero P, Piemontese P, Morlacchi L, Bracco B, Taroni F, et al. Boys who are born preterm show a relative lack of fat-free mass at 5 years of age compared to their peers. Acta Paediatr. 2015;104:e119–23.

    Article  CAS  Google Scholar 

  11. Kensara OA, Wootton SA, Phillips DI, Patel M, Jackson AA, Elia M. Fetal programming of body composition: relation between birth weight and body composition measured with dual-energy X-ray absorptiometry and anthropometric methods in older Englishmen. Am J Clin Nutr. 2005;82:980–7.

    Article  CAS  Google Scholar 

  12. Christmann V, van der Putten ME, Rodwell L, Steiner K, Gotthardt M, van Goudoever JB, et al. Effect of early nutritional intake on long-term growth and bone mineralization of former very low birth weight infants. Bone. 2018;108:89–97.

    Article  CAS  Google Scholar 

  13. Tonkin EL, Collins CT, Miller J. Protein intake and growth in preterm infants: a systematic review. Glob Pediatr Health. 2014;1:2333794X14554698.

    PubMed  PubMed Central  Google Scholar 

  14. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

    Article  Google Scholar 

  15. Cormack BE, Bloomfield FH, Dezoete A, Kuschel CA. Does more protein in the first week of life change outcomes for very low birthweight babies? J Paediatr Child Health. 2011;47:898–903.

    Article  Google Scholar 

  16. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.

    Article  CAS  Google Scholar 

  17. Urlando A, Dempster P, Aitkens S. A new air displacement plethysmograph for the measurement of body composition in infants. Pediatr Res. 2003;53:486–92.

    Article  Google Scholar 

  18. Ellis KJ, Yao M, Shypailo RJ, Urlando A, Wong WW, Heird WC. Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model. Am J Clin Nutr. 2007;85:90–5.

    Article  CAS  Google Scholar 

  19. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr. 1982;35:1169–75.

    Article  CAS  Google Scholar 

  20. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva, Switzerland: World Health Organization; 2006. www.who.int/childgrowth/standards/en/.

  21. Editorial board of the Chinese Journal of Pediatrics, The Child Health Care subspecialty Groups of the Society of Pediatrics in Chinese Medical Association, Neonatology group of the Society of Pediatrics in Chinese Medical Association. Post-discharge feeding recommendations for preterm or low-birth-weight infants. Chin J Pediatr. 2016;54:6–12.

    Google Scholar 

  22. Norris T, Ramel SE, Catalano P, Caoimh CN, Roggero P, Murray D, et al. New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life. Am J Clin Nutr. 2019;109:1353–60.

    Article  Google Scholar 

  23. Harding JE, Cormack BE, Alexander T, Alsweiler JM, Bloomfield FH. Advances in nutrition of the newborn infant. Lancet 2017;389:1660–8.

    Article  CAS  Google Scholar 

  24. Hay WW, Jr. Aggressive nutrition of the preterm infant. Curr Pediatr Rep. 2013;1. https://doi.org/10.1007/s40124-013-0026-4.

  25. Törer B, Hanta D, Özdemir Z, Çetinkaya B, Gülcan H. An aggressive parenteral nutrition protocol improves growth in preterm infants. Turk J Pediatr. 2015;57:236–41.

    PubMed  Google Scholar 

  26. Morgan C, McGowan P, Herwitker S, Hart AE, Turner MA. Postnatal head growth in preterm infants: a randomized controlled parenteral nutrition study. Pediatrics. 2014;133:e120–8.

    Article  Google Scholar 

  27. Weiler HA, Fitzpatrick-Wong SC, Schellenberg JM, Fair DE, McCloy UR, Veitch RR, et al. Minimal enteral feeding within 3 d of birth in prematurely born infants with birth weight < or = 1200 g improves bone mass by term age. Am J Clin Nutr. 2006;83:155–62.

    Article  CAS  Google Scholar 

  28. Moyses HE, Johnson MJ, Leaf AA, Cornelius VR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr. 2013;97:816–26.

    Article  CAS  Google Scholar 

  29. Amesz EM, Schaafsma A, Cranendonk A, Lafeber HN. Optimal growth and lower fat mass in preterm infants fed a protein-enriched postdischarge formula. J Pediatr Gastroenterol Nutr. 2010;50:200–7.

    Article  Google Scholar 

  30. Kerkhof GF, Willemsen RH, Leunissen RW, Breukhoven PE, Hokken-Koelega AC. Health profile of young adults born preterm: negative effects of rapid weight gain in early life. J Clin Endocrinol Metab. 2012;97:4498–506.

    Article  CAS  Google Scholar 

  31. Casey PH, Bradley RH, Whiteside-Mansell L, Barrett K, Gossett JM, Simpson PM. Evolution of obesity in a low birth weight cohort. J Perinatol. 2012;32:91–6.

    Article  CAS  Google Scholar 

  32. Brown LD, Hay WW Jr. The nutritional dilemma for preterm infants: how to promote neurocognitive development and linear growth, but reduce the risk of obesity. J Pediatr. 2013;163:1543–5.

    Article  Google Scholar 

  33. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F428–30.

    Article  CAS  Google Scholar 

  34. Rice MS, Valentine CJ. Neonatal body composition: measuring lean mass as a tool to guide nutrition management in the neonate. Nutr Clin Pract. 2015;30:625–32.

    Article  Google Scholar 

  35. Cooke RJ, Griffin I. Altered body composition in preterm infants at hospital discharge. Acta Paediatr. 2009;98:1269–73.

    Article  Google Scholar 

  36. Roggero P, Gianni ML, Amato O, Orsi A, Piemontese P, Puricelli V, et al. Influence of protein and energy intakes on body composition of formula-fed preterm infants after term. J Pediatr Gastroenterol Nutr. 2008;47:375–8.

    Article  CAS  Google Scholar 

  37. Roggero P, Gianni ML, Amato O, Orsi A, Piemontese P, Morlacchi L, et al. Is term newborn body composition being achieved postnatally in preterm infants? Early Hum Dev. 2009;85:349–52.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the other staff of Neonatal Department and Child Healthcare Department of Children’s Hospital of Fudan University who are not included in the authors’ list. The authors are also grateful for the time of families who participated.

Funding

This study is supported by CAMS Innovation Fund for Medical Sciences (2019-I2M-5-002).

Author information

Author notes

  1. These authors contributed equally: Yun Cao, Weili Yan

Authors and Affiliations

  1. Department of Clinical Epidemiology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China

    Junyan Han, Yi Zhang, Yuan Jiang, Xiaotian Chen, Yin Wang, Yalan Dou & Weili Yan

  2. Department of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China

    Junyan Han, Lan Zhang, Shujuan Li & Yun Cao

  3. Department of Child Healthcare, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China

    Ping Dong & Yujing Lv

  4. Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Disease (2018RU002), Chinese Academy of Medical Science, Shanghai, China

    Weili Yan

Authors
  1. Junyan Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shujuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuan Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaotian Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yalan Dou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ping Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yujing Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yun Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Weili Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WY and YC conceived and designed the study and guided the manuscript writing as corresponding authors. JH participated in the study design, data collection, and drafted the manuscript mainly. LZ and SL took part in the data collection at follow-up visits. YZ and YJ contributed in analyzing data and making charts. XC, YW, and YD merged the databases and participated in data analyses. PD and YL contributed in the body composition test. All authors were involved in results interpretation and final approval before the submission.

Corresponding authors

Correspondence to Yun Cao or Weili Yan.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval

This study was approved by the institution ethics committee. Oral informed consents were obtained from the guardians of eligible infants.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Han, J., Zhang, L., Li, S. et al. Associations of early nutrition with growth and body composition in very preterm infants: a prospective cohort study. Eur J Clin Nutr 76, 103–110 (2022). https://doi.org/10.1038/s41430-021-00901-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-021-00901-w

This article is cited by

Search

Advanced search

Quick links