Growth and body composition of infants born moderate-to-late preterm fed a protein- and mineral-enriched postdischarge formula compared with a standard term formula ≤6 months corrected age, a randomized controlled trial

Monique van de Lagemaat; Charlotte A Ruys; Jacqueline Muts; Martijn Jj Finken; Joost Rotteveel; Johannes B van Goudoever; Harrie N Lafeber; Chris Hp van den Akker; LEGO study group; Nathalie S Schrijver-Levie; Venje Boonstra; Jeanette S von Lindern; Peter de Winter; Monique J van Brakel; Aernoud J Drewes; Matthijs Westra

doi:10.1016/j.ajcnut.2024.04.035

Growth and body composition of infants born moderate-to-late preterm fed a protein- and mineral-enriched postdischarge formula compared with a standard term formula ≤6 months corrected age, a randomized controlled trial

Am J Clin Nutr. 2024 May 6:S0002-9165(24)00461-1. doi: 10.1016/j.ajcnut.2024.04.035. Online ahead of print.

Authors

Monique van de Lagemaat¹, Charlotte A Ruys², Jacqueline Muts³, Martijn Jj Finken⁴, Joost Rotteveel⁴, Johannes B van Goudoever², Harrie N Lafeber², Chris Hp van den Akker²; LEGO study group; Nathalie S Schrijver-Levie⁵, Venje Boonstra⁶, Jeanette S von Lindern⁷, Peter de Winter⁸, Monique J van Brakel⁹, Aernoud J Drewes¹⁰, Matthijs Westra¹¹

Affiliations

¹ Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands. Electronic address: m.vandelagemaat@amsterdamumc.nl.
² Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
³ Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
⁴ Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Department of Pediatric Endocrinology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
⁵ Ziekenhuis Amstelland, Amstelveen, The Netherlands.
⁶ BovenIJ Ziekenhuis, Amsterdam, The Netherlands.
⁷ Groene Hart Ziekenhuis, Gouda, The Netherlands.
⁸ Spaarne Gasthuis, Haarlem, The Netherlands.
⁹ Tergooiziekenhuizen, Hilversum.
¹⁰ Dijklander Ziekenhuis, Hoorn and Purmerend, The Netherlands.
¹¹ Zaans Medisch Centrum, Zaandam, The Netherlands.

PMID: 38719093
DOI: 10.1016/j.ajcnut.2024.04.035

Abstract

Background: Infants born moderate-to-late preterm (i.e., 32 wk-35 wk 6 d gestation) are, analogous to those born very preterm, at risk of later obesity, hypertension, and diabetes. Appropriate early life nutrition is key for ensuring optimal growth and body composition, thereby mitigating potential cardiometabolic risks.

Objectives: We aimed to compare growth and body composition between infants born moderate-to-late preterm fed isocaloric but protein- and mineral-enriched postdischarge formula (PDF) or standard term formula (STF) until 6 mo corrected age (CA; i.e., after term equivalent age [TEA]).

Methods: After enrollment (≤7 d postpartum), infants received PDF if (fortified) mother's own milk (MOM) was insufficient. At TEA, those receiving >25% of intake as formula were randomized to either continue the same PDF (n = 47) or switch to STF (n = 50); those receiving ≥75% of intake as MOM (n = 60) served as references. At TEA and 6 mo CA, we assessed anthropometry and body composition using both dual-energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP).

Results: Feeding groups had similar gestational age (median [25th percentile;75th percentile]: 34.3 [33.5; 35.1] wk), birthweight (mean ± standard deviation [SD]: 2175 ± 412 g), anthropometry, and body composition at TEA. At 6 mo CA, infants fed PDF had slightly, but significantly, greater length (67.6 ± 2.5 and 66.9 ± 2.6 cm, P < 0.05) and larger head circumference (43.9 ± 1.3 and 43.4 ± 1.5 cm, P < 0.05) compared to infants fed STF. Also, infants fed PDF had higher lean mass (LM) and bone mineral content estimated by DXA (4772 ± 675 and 4502 ± 741 g; 140 ± 20 and 131 ± 23 g, respectively; P < 0.05). ADP estimates, however, were not statistically different between feeding groups.

Conclusions: Infants born moderate-to-late preterm demonstrated modest increases in length, head circumference, LM, and bone mineral content when fed PDF compared to STF for 6 mo after TEA. This trial was registered at the International Clinical Trial Registry Platform as NTR5117 and NTR NL4979.

Keywords: air displacement plethysmography; body composition; dual-energy x-ray absorptiometry; growth; infants; moderate-to-late preterm; mother’s own milk; nutrition; postdischarge; protein; protein-enriched.