Nutrition, Illness and Body Composition in Very Low Birth Weight Preterm Infants: Implications for Nutritional Management and Neurocognitive Outcomes
Nutrition, Illness and Body Composition in Very Low Birth Weight Preterm Infants: Implications for Nutritional Management and Neurocognitive Outcomes
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DOI：
10.3390/nu12010145
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发表时间：
2020-01-01
期刊：
影响因子：
5.9
通讯作者：
Demerath, Ellen W.
中科院分区：
文献类型：
--
作者：
Ramel, Sara E.;Haapala, Jacob;Demerath, Ellen W.
与足月儿相比，早产儿的身体组成发生了变化，这影响了神经发育和代谢健康，但住院期间增加饮食摄入量是否会改善身体组成尚不清楚。这项前瞻性纵向研究（n = 103）测量了极低出生体重（VLBW）早产儿出院时和4个月早产校正年龄（CA）时的无脂肪质量（FFM）和体脂百分比（%BF）。记录疾病标志物和大量营养素摄入量（蛋白质和热量）。在这些婴儿的一个亚组中（分别为n = 66和n = 50），在12和24个月大时使用贝利婴儿发育量表-III（BSID）。使用最近开发的参考曲线计算身体组成z分数。使用线性回归来检验临床因素与身体成分z分数以及z分数与BSID分数之间的关联。出生后第一周摄入的卡路里和蛋白质增加以及住院期间蛋白质摄入量增加与出院时FFM z评分增加相关，但与%BF z评分无关。在调整早期急性和慢性疾病后，营养摄入与FFM z评分的相关性保持不变。出院时的FFM z评分与CA 12和24个月时的BSID评分呈正相关。总之，在住院早期和整个住院期间增加能量和蛋白质摄入与出院时较高的FFM相关，FFM是VLBW新生儿器官生长和神经发育的关键标志物。无论疾病如何，优化热量摄入对于提高早产儿的身体组成至关重要，并且通过扩展，对早产儿的神经发育结果至关重要。
Preterm infants have altered body composition compared to term infants, which impacts both neurodevelopment and metabolic health, but whether increased dietary intake during hospitalization, independent of illness, may improve body composition is unknown. This prospective, longitudinal study (n = 103) measured fat-free mass (FFM) and percent body fat (%BF) at discharge and four months corrected age for prematurity (CA) in very low birth weight (VLBW) preterm infants. Markers of illness and macronutrient intakes (protein and caloric) were recorded. Bayley Scales of Infant Development-III (BSID) were administered at 12 and 24 months of age in a subset of these infants (n = 66 and n = 50 respectively). Body composition z-scores were calculated using recently developed reference curves. Linear regression was used to test the associations between clinical factors and body composition z-scores, as well as z-scores and BSID scores. Increased calories and protein received in the first week after birth and protein intake throughout hospitalization were associated with increased FFM z-scores at discharge, but not with %BF z-scores. After adjustment for both early acute and chronic illness, associations of nutrient intake with FFM z-score remained unchanged. FFM z-scores at discharge were positively associated with scores on the BSID at 12 and 24 months CA. In conclusion, increased energy and protein intakes both early in hospitalization and across its entire duration are associated with higher FFM at discharge, a key marker for organ growth and neurodevelopment in the VLBW neonate. Optimizing caloric intake, irrespective of illness is critical for enhancing body composition, and by extension, neurodevelopmental outcomes for preterm infants.