Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y

Abstract

Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that pretermborn infants fed an isocaloric protein-and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Longterm follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable. Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in pretermborn children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA. Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary. Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results. Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre-and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].Am J Clin Nutr 2017;106:549-58.

Leptin and IGF‐1 in relation to body composition and bone mineralization of preterm‐born children from infancy to 8 years

“…Exclusion criteria were severe physical impairment or conditions known to affect growth or body composition. Participants and nonparticipants of the follow‐up were comparable in terms of perinatal and demographic characteristics as described previously . The cohort retrieval is described in detail elsewhere …”

“…Weight and length/height were measured during each study visit using standard methods, and absolute values were converted to standard deviation scores (SDS) with the use of appropriate reference data . Children with a weight and/or length at birth ≤−2SDS were classified as small‐for‐gestational‐age (SGA).…”

Nutritional management of preterm newborn after hospital discharge: energy and nutrients

“…13,26 So, short term advantages of PDF are demonstrated but on the contrary, at age 8 years no differences were found in body size, body composition, bone variables and metabolic health variables when comparing infants fed with PDF with those fed with standard formulas. 27 Cochrane, analyzing 16 trials with a total of 1251 preterm infants, does not find differences in growth and development between PDF fed infants and standard formula fed infants and does not support the recommendations to prescribe PDF after hospital discharge. Limited evidence suggests that feeding preterm formula after hospital discharge may increase growth rates up to 18 months post term.…”

Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

“…Nevertheless, a higher P:E ratio tends to be associated with improved growth and body composition during the first 6 months [ 46 , 81 – 86 ], albeit not unequivocally [ 87 – 90 ]. Long-term follow-up data among infants born very preterm and/or with VLBW show that the short-term benefits on body composition of a protein-enriched formula (with a P:E ratio of 2.52 g per 100 kcal) after discharge were no longer present at age 8 years [ 91 ]. In addition, their neurodevelopmental outcomes at 18 and 24 months CA and at age 8 years were no different from those fed a standard formula after discharge [ 80 , 89 , 92 , 93 ].…”

“…In addition, their neurodevelopmental outcomes at 18 and 24 months CA and at age 8 years were no different from those fed a standard formula after discharge [ 80 , 89 , 92 , 93 ]. However, post hoc analyses show that preterm infants with limited postnatal weight gain during the first 6 months after term age receiving protein-enriched formula were taller and had more lean mass at age 8 years [ 91 ]. Because of the large proportion of preterm infants that are growth-restricted at term age [ 12 , 13 ], we suggest a continuation of an (energy-and-)protein-enriched formula until at least 3 months CA in formula-fed preterm infants.…”