Infant diet and cardiometabolic risk among children born preterm

项目总结/摘要 每年，超过63，000名美国婴儿在妊娠32周之前早产。现在90%以上 由于更好的产科和新生儿重症监护室（NICU）管理， 目前的挑战是减少幸存者经历的短期和长期发病率，包括两个- 肥胖、糖尿病、高血压和代谢综合征的风险增加四倍， 成年健康和疾病的发展起源（DOHaD）框架认为，慢性 在被称为“关键”的脆弱发育阶段， “敏感”时期。特别重要的是生命的前1000天， 为终身健康奠定基础。早产儿是一个特别脆弱的群体，因为他们需要 出生后2-4个月的NICU支持，与妊娠晚期一致-这是一个确定的敏感期， 肥胖和心脏代谢风险的规划。在这方面，最容易修改和最相关的 暴露是NICU住院期间的饮食，这可能导致脂肪量加速增加 相对于无脂肪质量。住院的极早产儿通常会出现体重增加受损、发育迟缓、 线性生长和相对于典型胎儿的过量脂肪积累。为了解决这些问题， 在发展过程中，提供母乳的膳食强化作为标准护理。然而，后果 对这一人群的心脏代谢健康的膳食强化了解甚少。该提案寻求 以揭示基于饮食的干预措施在多大程度上促进了身体生长和大脑发育 在敏感期也可能导致心脏代谢风险。我们将研究130名24-31岁的婴儿， 参与Nourish研究（R 01 HD 097327 l; PI：贝尔福特）的妊娠周， 一项随机对照试验，测试单独针对性母乳强化与标准母乳强化的效果。 NICU住院期间的护理。通过延长该队列的随访时间并增加心脏代谢 在2岁和5岁的生物标志物，我们有一个独特的机会来研究如何宏量营养素和能量 在敏感期分娩会增加或避免儿童期的心脏代谢风险。我们 进一步准备解决与心脏代谢健康有关的NICU生长模式的关键问题， 这个人口。这项工作的发现有很大的潜力通过告知饮食来影响临床护理。 在敏感的发展窗口期制定战略，以优化弱势人口的终身健康。

Project Summary / Abstract Each year, over 63,000 U.S. infants are born very preterm, prior to 32 weeks of gestation. With >90% now surviving to discharge due to better obstetrical and neonatal intensive care unit (NICU) management, the present challenge is to reduce short- and long-term morbidities experienced by survivors, including the two- to four-fold increased risk of obesity, diabetes, hypertension, and metabolic syndrome that manifest by young adulthood. The Developmental Origins of Health and Disease (DOHaD) framework posits that chronic conditions result from adverse exposures during vulnerable developmental stages known as “critical” or “sensitive” periods. Of particular importance is the first 1000 days of life, when key developmental processes set the stage for lifelong health. Very preterm infants are an especially vulnerable population, as they require NICU support for 2-4 months after birth, coinciding with the 3rd trimester – an established sensitive period for programming of obesity and cardiometabolic risk. In this context, the most highly modifiable and relevant exposure is diet during the NICU hospitalization, which may contribute to the accelerated accretion of fat mass relative to fat-free mass. Hospitalized very preterm infants typically experience impaired weight gain, stunted linear growth, and excess fat accretion relative to the typical fetus. To offset these issues and support brain development, dietary fortification of human milk is provided as standard of care. However, the consequences of dietary fortification for cardiometabolic health in this population are poorly understood. This proposal seeks to uncover the extent to which diet-based interventions that promote physical growth and brain development during a sensitive period may also contribute to cardiometabolic risk. We will study 130 infants born 24-31 weeks of gestation who are participating in the Nourish Study (R01HD097327l; PI: Belfort), an ongoing randomized controlled trial testing the effect of individually targeted human milk fortification vs. standard of care during the NICU hospitalization. By extending follow-up of this cohort and adding cardiometabolic biomarkers at 2 and 5 years of age, we have a unique opportunity to investigate how macronutrient and energy delivery during a sensitive period contributes to, or protects from, cardiometabolic risk during childhood. We are further poised to address key questions about NICU growth patterns in relation to cardiometabolic health in this population. Findings from this work have strong potential to impact clinical care by informing dietary strategies during a sensitive window in development to optimize lifelong health for a vulnerable population.