Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term

BACKGROUND: Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking, recommendations for the mineral content of preterm infant formula differ greatly between committees. OBJECTIVE: The goal of the study was to assess the effects of an isocaloric, nutrient-enriched preterm formula, which was fed from the age when full enteral feedings were tolerated through expected term, on bone mineralization in preterm infants. DESIGN: We conducted a prospective, randomized, double-blind study in healthy, preterm infants (gestational age of 28-32 wk) who were fed either a control preterm formula (n=20) or an isocaloric, nutrient-enriched preterm formula (n=21) until 3 mo of age (ie, approximate expected term). Serum calcium indexes were taken throughout the study, and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term. RESULTS: A total of 37 infants (experimental formula, n=19; control formula, n=18) completed the study. Compared with control subjects, infants fed the experimental formula had 25% and 40% higher intakes of calcium and phosphorus, respectively. Serum calcium, phosphorus, osteocalcin, and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point. The bone mineral content of infants fed the experimental formula was 23% (P=0.039) and 35% (P=0.002) higher at hospital discharge and expected term, respectively. CONCLUSIONS: Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric, nutrient-enriched formula than in those fed control formula. Continuation of the experimental formula beyond hospital discharge, through expected term, further improved bone mineralization.     

Body composition in preterm infants fed standard term or enriched formula after hospital discharge

Summary. Background: Most preterm infants are still preterm and have a low birth weight when they are discharged from the hospital. An important issue is whether the long-term consequences of early growth restriction can be diminished by nutritional intervention in preterm infants after discharge from the hospital. Aim: To evaluate differences in growth and in weight gain composition of preterm infants fed standard term formula (SF) or enriched formula (PDF) after discharge from hospital during the first 2 months of life. Methods: Thirty-three healthy preterm infants, birth weight < 1750 g at gestational age < 35 weeks, were randomised to SF or PDF at the time of discharge from hospital. Anthropometric variables were studied longitudinally and body composition was measured using dual energy x-ray absorptiometry (DEXA) twice, before hospital discharge and two months later. Weight gain composition was calculated as the difference between the two determinations. Results: Seventeen infants were fed SF and 16 PDF. Anthropometric variables and whole body composition were similar at birth, at the start of the nutritional study (mean age 45 days), and at the end of the study 2 months later. Over the whole study period, weight gain and weight gain composition were similar in the two groups. Sex did not appear to influence weight gain and weight gain composition. In infants with growth restriction at discharge there was a significant reduction of weight gain, fat mass gain, and bone mineral content deposition independently of the formula provided. Conclusions: There is no immediate effect on preterm infants of a nutrient enriched formula compared with a standard formula on growth, weight gain, or weight gain composition. Received: 12 February 2002, Accepted: 18 July 2002     

出院后配方奶粉对早产儿发育迟缓的预防及治疗

目的 研究配方奶粉(PDF)对早产儿出院后实现追赶生长防止宫外发育迟缓(EUGR)的临床应用价值.方法 以2014年1月至2016年1月深圳市龙华新区人民医院新生儿科200例早产儿为研究对象,按随机数字表分为研究组及对照组各100例,研究组行PDF喂养,对照组母乳喂养(BM)或母乳和足月儿奶粉(TF),比较两组早产儿生长发育指标,并于6个月后比较两组神经行为评分(NBNA)及两组早产儿1年后EUGR的发生率.结果 两组研究对象于生后第1个月、第3个月以及第6个月体重(F=5 562.14,P<0.05)、身长(F=556.38,P<0.05)、头围(F=232.54,P<0.05)经方差分析均有统计学差异(P<0.05),组间两两比较经SNK法分析比较,对照组、研究组生后第1个月体重、身长、头围均无统计学差异(P>0.05);第3个月、第6个月研究组体重、身长均高于同期对照组;同期两组头围比较均无统计学差异(P>0.05);第6个月儿心量表评分中,研究组大动作(t=2.52,P<0.05)、精细动作(t=2.16,P<0.05)、适应能力(t=2.09,P<0.05)、语言(t=0.16,P<0.05)以及社交行为(t=2.58,P<0.05)均优于对照组;研究组1岁时EUGR发生率(24%)低于对照组,有统计学差异(χ2=5.81,P<0.05).结论 早产儿配方奶粉在实现追赶生长及防止EUGR有重要的临床应用价值.     

Serum myoinositol concentrations in premature infants fed human milk, formula for infants, and parenteral nutrition

Myoinositol concentration was studied in serum of 65 neonates and their mothers at the time of birth, in samples of various types of feedings for infants, and in serial serum samples of 15 premature infants receiving human milk, formulas for infants, or parenteral nutrition over a 3-wk period. At birth the serum concentration of myoinositol was greater in neonates than in their mothers (108 +/- 10 vs 52 +/- 6 mumol/L, respectively, means +/- SEM, p less than 0.01). In feedings for infants, the concentrations of myoinositol were significantly greater in human milk than in formulas or parenteral nutrition solutions (1840 +/- 451 vs 420 +/- 110 vs 100 +/- 8 mumol/L, respectively, p less than 0.001). Over a 3-wk period the serum concentration of myoinositol increased in infants receiving human milk but not in those receiving formulas or parenteral nutrition. Serum concentrations of myoinositol in neonates are greater than in adults and are directly influenced by myoinositol intake.     

Comparative metabolic study of older infants fed infant formula, transition formula, or whole cow's milk

“Transition” or “follow-up” formulas are formulas distinct in composition from “starter” infant formulas and are used in feeding infants six months of age or older. We have performed metabolic balance studies in nine children between the ages of six and nine months using a randomized double blind cross- over design. Three diets were fed: a cow's milk-based “follow-up” formula (FUF), a standard cow's milk-based infant formula (IF), or whole cow's milk (WCM). Weight gain (g/day) was equivalent among the three groups. Fecal excretion of energy was higher on WCM than on the other two diets, with the only significant difference being between WCM and IF. Fecal excretion of fat was greater on WCM and FUF than IF (20.4%, 17.8%, and 8.4% respectively). Carbohydrate excretion and nitrogen retention were similar on all 3 formulas. Although always normal, serum albumin significantly decreased at the end of the FUF dietary period. Urine osmolality was abnormally high during the WCM period, but always within normal limits while on FUF or IF. Within the context of this study, the FUF had metabolic advantages when compared to WCM but not to the IF.     

青少年跟骨骨密度与骨矿脂肪肌肉含量的关系

探讨青少年跟骨骨密度与骨矿、脂肪、肌肉含量的相关性,为增加青少年骨量与骨密度、促进骨骼健康提供参考.方法 选取368名在海南省人民医院接受健康体检的青少年作为研究对象,测定跟骨骨密度、骨矿含量、脂肪含量和肌肉含量,比较不同年龄段、不同性别青少年骨密度及体成分测试结果 ,并分析跟骨骨密度与骨矿、脂肪及肌肉含量的相关性.结果男生的宽频超声衰减值(BUA)、肌肉量、骨矿量均高于女生,脂肪量低于女生,差异均有统计学意义(t值分别为13.51,10.65,4.52,-7.55,P值均<0.05).青少年跟骨骨密度与体质量指数(BMI)、骨矿量、肌肉量均呈正相关(r值分别为0.39,0.42,0.69,P值均<0.05).不同年龄段男生的BUA,BMI,肌肉量及骨矿量差异均有统计学意义(F值分别为7.95,8.63,6.96,5.01,P值均<0.05).不同年龄段女生的BUA、脂肪量、肌肉量、骨矿量比较,差异均有统计学意义(F值分别为8.65,10.33,7.96,4.87,P值均<0.05).12,13岁青少年的跟骨BUA值与BMI、肌肉量相关均无统计学意义(P值均>0.05),而14,15,16岁青少年的跟骨BUA值与BMI、肌肉量均呈正相关(P值均<0.05).结论 青少年跟骨骨密度与骨矿、肌肉含量密切相关,与脂肪含量无关.     

早产儿出院后配方奶对早产/低出生体重儿生长发育影响的研究

目的探讨早产儿出院后配方奶对早产/低出生体重儿生长发育的影响。方法将59例早产/低出生体重儿根据出院后喂养方式分为母乳+早产儿配方奶混合喂养组(Ⅰ组)和早产儿出院后配方奶喂养组(Ⅱ组),监测入组后6个月内体重、身长、头围、Kaup指数及部分理化指标,并作组间比较,藉此评价早产儿出院后配方奶对出院后的早产/低出生体重儿生长发育影响的临床意义。结果入组时两组在性别比例、孕周和出生体重上差异无统计学意义(P0.05)。体重、Kaup指数,在喂养后2月内差异无统计学意义(P0.05),从3个月始Ⅱ组较Ⅰ组增长快(P0.05);身长从第4个月,头围从第5个月起,Ⅱ组较Ⅰ组增长快(P0.05);血色素从第5个月以后,Ⅱ组高于Ⅰ组(P0.05)。观测过程中两组的Ca、P、AKP差异无统计学意义(P0.05)。结论早产儿出院后配方奶是早产儿出院后喂养品的良好选择,有益于低体重早产儿实现追赶性生长。     

不同喂养方式对早产小于胎龄儿骨密度的影响

目的 研究不同喂养方式对早产小于胎龄儿（ SGA）骨密度的影响。方法 将215例小于胎龄儿按照喂养方式分为5组：早产儿出院后配方奶喂养组、母乳喂养组、足月儿配方奶喂养组、母乳＋早产儿出院后配方奶喂养组、母乳＋足月儿配方奶喂养组,比较各组在生后第6月、12月骨密度值。结果 5组小于胎龄儿的骨密度数值从高到低依次为：母乳＋早产儿出院后配方奶喂养组、母乳喂养组、早产儿出院后配方奶喂养组、母乳＋足月儿配方奶组、足月儿配方奶喂养组,差异具有统计学意义（6月龄时：F男＝2．845,F女＝2．570;12月龄时：F男＝2．737,F女＝7．461,均P＜0．05）。结论 对早产小于胎龄儿童进行母乳喂养或强化母乳喂养能改善其骨密度情况,适用于早产儿。     

Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition

BACKGROUND: Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge, its role in reversing growth deficits after hospital discharge remains poorly defined. OBJECTIVE: The aim was to determine the effect of different formulas on the growth, bone mass, and body composition of preterm infants after hospital discharge. DESIGN: This was a randomized, double blind comparison of a nutrient-enriched formula (EF) and a formula for term infants (TF) given for 1 y after hospital discharge. Compared with the TF, the EF had a higher energy density and higher contents of protein, calcium, and phosphorus (by 10%, 21%, 44%, and 11%, respectively) and higher contents of almost all other nutrients (by >or=10%). RESULTS: Birth weights of the infants were 630-1620 g (median: 1250 g) and gestational ages were 24-34 wk (median: 29 wk). TF resulted in significantly greater weight, length, head circumference measurements, and their respective z scores on the basis of age- and sex-specific norms. At the end of the study, the mean z scores for the corrected age of infants in the TF group were -0.37 for weight, 0.001 for length, and 0.50 for head circumference. The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group (P < 0.05 for all comparisons). CONCLUSIONS: The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth, bone mineralization, and body composition. More studies are needed to determine the optimal postdischarge nutrition support for preterm infants.     

Cognitive and visual development: influence of differences in breast and formula fed infants

Several recent studies document a beneficial effect of breast-feeding on later neurodevelopmental outcomes. The mechanisms involved are still in need of elucidation, but evidence is accruing that the fatty acid (FA) composition of human milk plays a role. The composition of body fats, from circulating erythrocyte lipids to brain phospholipids, is linked in infants to the early feeding mode and which FA predominates among circulating lipids influences visual and neurodevelopmental performance test scores. In these studies, greater differences were found between breast-fed and standard formula-fed infants, the latter showing low tissue long-chain polyunsaturated fatty acids (LCPUFA: arachidonic acid, AA, 20:4n-6; eicosapentaenoic acid, EPA, 20:5n-3; docosahexaenoic acid, DHA, 22:6n-3) accretion and lower visual and neurodevelopmental test scores. Human milk contains LCPUFA, while most available formulas, especially those intended for full-term infants, do not. With the progressive introduction of solid foods, the question arises whether a specific or "ideal" dietary lipid mixture can be found to meet growth requirements and ensure a lipid balance adequate for the early and effective preventive purposes. These complementary aspects are challenges for the paediatric nutrition researcher today.     

早产儿能量和蛋白质摄入及其体重增长的分析

目的 探讨早产儿早期的能量和蛋白质摄入特点以及体重增长状况.方法 对2007年10月～2008年10月入住安徽省立儿童医院新生儿科的157例早产儿进行定群研究,按出生胎龄不同,将研究对象分为出生胎龄<32w组与出生胎龄≥32w组,分别比较两组早产儿能量和蛋白质的摄入特点以及体重增长情况.结果 ①出生胎龄<32w组早产儿中给予肠外营养的比例明显多于出生胎龄≥32w组(χ2=12.279,P<0.01);在达足量喂养日龄上,出生胎龄<32w组明显晚于出生胎龄≥32w组(t=4.351,P<0.01);在第1周内,总能量摄入量两组之间比较差异无统计学意义,而在蛋白质的摄入量上出生胎龄<32w组低于出生胎龄≥32w组(t=-2.153,P<0.05),第2周内,出生胎龄<32w组在总能量和蛋白质的摄入量上均低于出生胎龄≥32w组(t分别为-2.143、-2.727,均P<0.05);②出生胎龄<32w组早产儿的体重下降幅度和恢复出生体重日龄均高于出生胎龄≥32w组早产儿(t分别为4.264、4.365,均P<0.01);③早产儿出生时体重越低,出生后发生生长迟缓的风险越高.结论 早产儿住院期间能量和蛋白质的摄入普遍不足,且体重增长状况不理想,应加强对早产儿进行早期合理的营养干预,以促进其健康生长.     

A follow-up study of nutrient intake, nutritional status, and growth in infants with cow milk allergy fed either a soy formula or an extensively hydrolyzed whey formula

BACKGROUND: Infants with cow milk allergy (CMA) are reported to have reduced growth and special nutritional needs. OBJECTIVE: The aim of the present study was to compare nutrient intake, nutritional status, and growth in infants with CMA who were fed either a soy formula or an extensively hydrolyzed whey formula. DESIGN: The study group comprised 168 double-blind challenge-proven infants with CMA. Eighty-four of the infants were fed a soy formula (mean starting age: 7.8 mo), and the other 84 infants were fed an extensively hydrolyzed whey formula (mean starting age: 7.5 mo). RESULTS: The length (SD score) of the infants was close to the mean Finnish reference growth by age 2 y in both groups. Weight-for-length measurements continued to reach the 50th percentile by age 4 y in both study groups. The mean nutrient intake followed the recommended intake in both groups, although most of the infants were supplemented with calcium and vitamin D. The observed serum transferrin receptor concentrations indicated a greater iron inadequacy in the tissue of infants in the soy formula group than in the hydrolyzed whey formula group (P = 0.08). However, there were no significant differences between the groups either in the percentages of abnormally low laboratory values (mean cell volume, hemoglobin, zinc, and ferritin) or in the percentages of high alkaline phosphatase activity, which indicates the comparable safety and effectiveness of the formulas studied. CONCLUSIONS: Both nutritional status and growth were well within reference values in the 2 groups, and the selection of a formula can largely be made on the basis of infant tolerance to the formulas.     

Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents

Summary Background Cobalamin deficiency is prevalent in vegetarians and has been associated with increased risk of osteoporosis. Aim of the study To examine the association between cobalamin status and bone mineral density in adolescents formerly fed a macrobiotic diet and in their counterparts. Methods In this cross–sectional study bone mineral density (BMD) and bone mineral content (BMC) were determined by DEXA in 73 adolescents (9–15 y) who were fed a macrobiotic diet up to the age of 6 years followed by a lacto–(–ovo–) vegetarian or omnivorous diet. Data from 94 adolescents having consumed an omnivorous diet throughout their lives were used as controls. Serum concentrations of cobalamin, methylmalonic acid (MMA) and homocysteine were measured and calcium intake was assessed by questionnaire. Analysis of covariance (MANCOVA) was performed to calculate adjusted means for vitamin B₁₂ and MMA for low and normal BMC and BMD groups. Results Serum cobalamin concentrations were significantly lower (geometric mean (GM) 246 pmol/L vs. 469 pmol/L) and MMA concentrations were significantly higher (GM 0.27 µmol/L vs. 0.16 µmol/L) in the formerly macrobiotic–fed adolescents compared to their counterparts. In the total study population, after adjusting for height, weight, bone area, percent lean body mass, age, puberty and calcium intake, serum MMA was significantly higher in subjects with a low BMD (p = 0.0003) than in subjects with a normal BMD. Vitamin B₁₂ was significantly lower in the group with low BMD (p = 0.0035) or BMC (p = 0.0038) than in the group with normal BMD or BMC. When analyses were restricted to the group of formerly macrobiotic–fed adolescents, MMA concentration remained higher in the low BMD group compared to the normal BMD group. Conclusion In adolescents, signs of an impaired cobalamin status, as judged by elevated concentrations of methylmalonic acid, were associated with low BMD. This was especially true in adolescents fed a macrobiotic diet during the first years of life, where cobalamin deficiency was more prominent.     

Growth, nutrient retention, and metabolic response of low-birth-weight infants fed supplemented and unsupplemented preterm human milk

Growth, nutrient retention, and metabolic response of low-birth-weight infants fed human milk provided by their mother; this milk supplemented with bovine milk protein, calcium, phosphorus, and sodium; or pasteurized term human milk with the same supplement were monitored from the time desired intake was tolerated until weight reached 2200 g. The supplement resulted in greater rates of weight gain (20.5 +/- 2.3 vs 16.4 +/- 2.2 g.kg-1.d-1) and nitrogen retention (353 +/- 76 vs 270 +/- 53 mg.kg-1.d-1), increase in plasma transthyretin (TTR) concentration (7 +/- 16 vs -3 +/- 9 mg.L-1.wk-1), a higher mean plasma albumin concentration (34 +/- 3 vs 32 +/- 4 g/L), and a higher plasma TTR concentration at discharge (100 +/- 22 vs 75 +/- 24 mg/L). All these variables correlated significantly with total nitrogen intake, suggesting that the differences are attributable to the protein content of the supplement. The supplement also resulted in greater rates of calcium and phosphorus accretion but the plasma alkaline phosphatase activity of the supplemented vs the unsupplemented groups did not differ.     

Effect of cereal-thickened formula and upright positioning on regurgitation, gastric emptying, and weight gain in infants with regurgitation

OBJECTIVE: We compared the effect of cereal-thickened formula or postural therapy on regurgitation and gastroesophageal reflux, weight gain, and gastric emptying in infants. METHODS: We performed a prospective trial in exclusively formula-fed infants 2 to 6 mo of age presenting with regurgitation or vomiting at least three times a day. Infants were randomized into two groups; group A received cereal-thickened formula versus group B who were placed in a postprandial upright position for 90 min and evaluated over an 8-wk period. A 90-min technetium 99m milk scintigraphy was performed before and at the end of the intervention period. RESULTS: Thirty-one infants were included in group A and 32 in group B; at inclusion, there were no anthropometric differences between groups (P = 0.813-0.955). After 4 and 8 wk, the difference in regurgitation frequency per day between groups A and B had become significant (at 4 wk, 2.39 +/- 0.86 for group A versus 2.84 +/- 0.81 for group B, P = 0.039; at 8 wk, 1.61 +/- 0.76 for group A versus 2.38 +/- 0.83 for group B, P < 0.001). The volume ingested per meal was not different between groups after 4 wk, although this parameter showed a larger intake in group A after 8 wk (156.8 +/- 23.5 mL for group A versus 143.4 +/- 25.1 mL for group B, P = 0.035), resulting in a significant difference in mean caloric intake. Gastric emptying after 8 wk showed no significant difference between groups A and B. Group A infants had significantly greater weight gain than did group B infants after 4 wk (636.2 +/- 103.4 g for group A versus 577.4 +/- 102.7 g for group B, P = 0.03) and 8 wk (1261.3 +/- 131.4 g for group A versus 1121.4 +/- 137.2 g for group B, P < 0.001). After 8 wk of intervention, the increase in length was significantly greater in group A than in group B (5.2 +/- 0.6 cm for group A versus 4.7 +/- 0.6 cm for group B, P = 0.032). CONCLUSION: Cereal-thickened formula is significantly more efficacious than postural therapy in decreasing the frequency of regurgitation in regurgitating infants. Treatment of regurgitation with cereal-thickened formula results in an increased caloric intake ( approximately 25%), related to increased gain in weight and length, in comparison with regular formula and positioning therapy.