Impact of breast milk intake on body composition at term in very preterm babies: secondary analysis of the Nutritional Evaluation and Optimisation in Neonates randomised controlled trial

Abstract

ObjectiveTo investigate the impact of breast milk (BM) intake on body composition at term in very preterm infants.DesignPreplanned secondary analysis of the Nutritional Evaluation and Optimisation in Neonates Study, a 2-by-2 factorial randomised controlled trial of preterm parenteral nutrition (PN).SettingFour National Health Service hospitals in London and South-East England.PatientsInfants born at <31 weeks of gestation; infants with life-threatening congenital abnormalities and those unable to receive trial PN within 24 hours of birth were ineligible. 133 infants survived and underwent whole-body MRI at term (37–44 weeks postmenstrual age).Main outcome measuresNon-adipose tissue mass (non-ATM), ATM and ATM as a percentage of body weight (% ATM) at term.ResultsCompared with the exclusively BM group (proportion of BM=100% milk, n=56), predominantly formula-fed infants (BM ≤50%, n=38) weighed 283.6 g (95% CI 121.6 to 445.6) more, had 257.4 g (139.1–375.7) more non-ATM and a greater positive weight Z-score change between birth and term. There were no significant differences in weight, non-ATM and weight Z-score change between the exclusively and predominantly BM (BM 51%–99%, n=39) groups. Compared with the exclusively BM group no significant differences were observed in ATM and %ATM in the predominantly BM and predominantly formula-fed groups.ConclusionsThe slower weight gain of preterm infants fed BM appears to be due to a deficit in non-ATM and may reflect lower protein intake. Whether this pattern persists into childhood, is altered by BM fortification or later diet, or relates to functional outcomes, are important research questions.Clinical trial registration ISRCTN29665319, post results.

Human Milk Feeding and Preterm Infants’ Growth and Body Composition: A Literature Review

“…These results indicate that, once adequate energy is provided, own mother's milk protein can be utilized for anabolic purposes [10] as suggested by the direct relationship between own mother's milk feeding and preterm infants' fat-free mass content evaluated at term-corrected age [16]. On the contrary, Li et al [20] conducted a secondary analysis of a randomized controlled trial and reported a higher weight and fat-free mass deposition in formula-fed preterm infants than in human milk-fed ones whereas no difference in fat mass content was found according to the mode of feeding. These results may be partially due to the fact that fortification was performed by the attending clinician without following a specific protocol, thus leading to the provision of protein and energy intakes that were inadequate to allow for fat-free mass deposition.…”

“…They concluded that, at 2 years of age, SGA premature infants who exclusively received human milk demonstrated greater compensatory growth with no rise in adipose tissue mass when compared to AGA infants. On the contrary, in the randomized controlled trial of Li et al [20], predominantly formula fed infants weighted more than the exclusively human milk fed group at term corrected age and their greater change in weight Z-score throughout the study was accompanied by a higher non-adipose tissue mass deposition. No association was found between formula feeding and greater adiposity at term age.…”

“…According to the majority of the included studies assessing growth from birth either to discharge or term-corrected age [11,13,18], human milk feeding appears to be associated with suboptimal growth, with an inverse relationship between growth and the amount of human milk consumed, which becomes more pronounced with the use of donor milk as supplementation of own mother's milk. On the other hand, all the authors [14][15][16][17][18], except one [20], reported that human milk feeding in preterm infants is positively associated with fat-free mass deposition, thus contributing to a positive recovery of body composition in this population. Moreover, catch-up growth following hospital discharge appears not to be associated with an increased deposition of fat mass when preterms infants either born small for gestational age or adequate for gestational age are exclusively fed human milk [19].…”

A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

“…The search and selection processes are presented in Supplementary Materials (Figure S1) . Forty-four papers were identified for this review and included nine RCTs [ 15 , 19 , 20 , 21 , 31 , 32 , 33 , 34 , 35 ], one non-randomised intervention trial [ 36 ], three secondary analyses of RCTs [ 9 , 37 , 38 ], six interrupted time series studies [ 8 , 28 , 39 , 40 , 41 , 42 ], and 25 cohort studies [ 7 , 22 , 29 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. Thirty-seven studies could be included in the meta-analyses [ 7 , 8 , 9 , 15 , 19 , 20 , 21 …”

It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: “Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants” Nutrients 2019, 11, 2772

“…In a very recent paper, Li et al found that VPN with breast feeding exclusively had significantly less body weight at discharge, comparing to predominantly formula-fed neonates without any difference in adipose tissue mass. Authors concluded that the slower weight gain at discharge of VPN fed with breast milk appears to be due to a deficit in nonadipose tissue mass and may reflect the lower protein intake [8].…”