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Improved growth and adipose tissue partitioning in preterm infants receiving exclusive enteral feeds of fortified human milk in comparison with infants receiving human milk and formula

Presented at the Neonatal Society 2007 Summer Meeting (programme).

Uthaya S1, Thomas EL2, Bell J2, Modi N1 for the LCPUFA Study Group

1 Chelsea & Westminster Hospital Campus, Imperial College London, UK
2 Medical Research Council Clinical Sciences Centre, Imperial College London, UK

Background: Human milk is associated with slower growth in preterm infants in comparison to formula. We conducted an exploratory, randomised, double- blind, controlled trial in preterm infants of breast milk fortifier containing LCPUFA to determine effects on body composition at term. No differences were found between the randomised groups. Data were therefore pooled in order to compare this unique group that had received exclusive enteral feeds of fortified donor or maternal breast milk to term (BF) with a cohort of preterm-at-term infants in whom we have previously demonstrated altered adipose tissue partitioning (1) who had received feeds of breast milk and formula, formula alone or breast milk without consistent fortification (MF).

Methods: Whole body magnetic resonance imaging during natural sleep was carried out at termequivalent age to quantify adipose tissue (AT) volume and distribution as previously described (2) . Studies were approved by the institutional research ethics committees and informed written parent consent was obtained.

Results: There was no significant difference between the groups BF and MF in gestational age at birth (median and IQR 29.6 (27.1, 30.6) vs 29.1 (26.8,30.6) weeks), birth weight (1.19 (0.92,1.4) vs 1.13 (0.87,1.49) kg), birth OFC (27 (24,28) vs 27 (25,29) cm), or illness severity (proportion of time receiving level 1 intensive care) (10.3 (0,31.6) vs 9.7 (3.7,33.4) %). There was no significant difference in term percentage whole body adiposity, weight or length having adjusted for actual postmenstrual age at imaging, but head circumference was greater in BF infants (36 (35,38) cm vs 34 (33,35), p=0.04). MF infants had a significant increase in the deep subcutaneous abdominal (DSCA) and intra-abdominal (IA) adipose tissue compartments and a significant decrease in the superficial subcutaneous (SSC) compartment (table).

Conclusions: Fortified human milk appears to sustain somatic, linear growth and head growth and attenuate aberrant adipose tissue partitioning in extremely preterm infants. An increase in deep subcutaneous and intra-abdominal adiposity is a marker of metabolic risk. Preterm infants demonstrate insulin resistance and other metabolic derangements in later life. The potential impact of fortified human milk upon long-term metabolic health should be explored.

Acknowledgements: We acknowledge support from Numico Research Germany and the UK Medical Research Council.

1. Uthaya et al 2005 Pediatr Res 57:211-215
2. Harrington et al 2002 Lipids 37:95-100

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