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Lean mass and fat mass accretion between term age and
6 months post-term in growth-restricted preterm infants
M van de Lagemaat, J Rotteveel, HN Lafeber and MM van Weissenbruch
Early growth restriction followed by nutritional intakes that permit accelerated growth may result in adiposity and metabolic
disease in later life. This study compared growth, body composition and nutritional intake between term age and 6 months postterm in 83 appropriate-for-gestational-age preterm infants with growth restriction at term age (AGA GR+), 15 AGA without growth
restriction at term age (AGA GR ) and 33 small-for-gestational-age (SGA) preterm infants. AGA GR+ and SGA preterm infants had
higher protein intake, higher energy intake and higher gain in weight SDS between term age and 6 months post-term, with similar
lean mass (LM) and lower fat mass (FM) at 6 months post-term compared with AGA GR preterm infants. In conclusion, despite
higher energy and protein intake compared with AGA GR preterm infants during the rst 6 months post-term, AGA GR+ and SGA
preterm infants restore their LM without excessive FM.
European Journal of Clinical Nutrition (2014) 68, 12611263; doi:10.1038/ejcn.2014.182; published online 17 September 2014
INTRODUCTION
Growth without increased fat mass (FM) accumulation may be
especially important for infants who are prone for accelerated
growth during infancy, such as preterm infants born appropriatefor-gestational-age (AGA) with growth restriction before term age
(AGA GR+) and small-for-gestational-age (SGA) preterm infants.1,2
Accelerated infant growth is associated with adiposity and
metabolic consequences in later life, and may be related to
nutritional intakes.3,4 The present study compared growth, body
composition and nutritional intake until 6 months post-term
between AGA preterm infants with and without growth restriction
at term age (AGA GR+ and AGA GR , respectively) and SGA
preterm infants.
SUBJECTS AND METHODS
This study was part of a trial on postdischarge nutrition5 and
included 83 AGA GR , 15 AGA GR+ and 33 SGA preterm infants.
At birth, term age and 6 months post-term, weight (g) and length
(cm) were measured and expressed as standard deviation scores
(SDS).6,7 Infants were classied as AGA GR (weight and length at
birth and term age 2 SDS), AGA GR+ (weight and length at
birth 2 SDS and weight, length or both at term age o 2 SDS)
and SGA (weight, length or both at birth o 2 SDS).1,8 Energy
(kcal/kg/day), protein (g/kg/day), fat (g/kg/day) and carbohydrate
intakes (g/kg/day) were calculated in formula-fed infants between
term age and 6 months post-term based on data from the infants
medical record and parental diaries. Lean mass (LM; g) and FM (g)
were measured by whole-body dual-energy X-ray absorptiometry
(Hologic QDR4500A, Hologic, Bedford, MA, USA) at term age and
at 6 months post-term and analyzed by Infant Whole Body
Software version 12.3.3.5 Gain () in weight and length SDS and
LM and FM between term age and 6 months post-term were
calculated. Statistical analyses were performed with SPSS 17.0 for
Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands. Correspondence: Dr M van de Lagemaat, VU University Medical Center, PO Box 7057,
1007 MB Amsterdam, The Netherlands.
E-mail: m.vandelagemaat@vumc.nl
Received 13 November 2013; revised 12 July 2014; accepted 29 July 2014; published online 17 September 2014
1262
Table 1.
Growth and body composition in AGA GR , AGA GR+ and SGA infants
AGA GR (n = 83)
Birth
Weight
g
SDS
Length
cm
SDS
Term age
Weight
g
SDS
Length
cm
SDS
LM
g
FM
g
%FM
%
6 Months post-term
Weight
g
SDS
Length
cm
SDS
LM
g
FM
g
%FM
%
SGA (n = 33)
Absolute
Absolute
Absolute
83
83
1465 (371)a,b
0.12 0.67a,b
15
15
1182 (220)c
0.89 0.57c
33
33
1160 (468)
1.48 0.67
83
83
39.0 (3.5)a,b
0.27 0.84a,b
15
15
38.0 (2.0)c
0.86 0.73
33
33
36.0 (3.5)
2.51 0.46
83
83
3230 (465)a,b
0.45 0.8a,b
15
15
2641 (300)
2.25 0.48
33
33
2736 (574)
2.1 1.1
83
83
49.5 (2.0)a,b
0.55 0.85a,b
15
15
47.5 (3.0)c
1.78 0.98c
33
33
46.5 (3.5)
2.44 1.19
68
3112 (390)a,b
14
2652 (210)
28
2708 (430)
68
433 (240)a,b
14
146 (180)
28
142 (180)
68
a,b
14
5.1 (6.0)
28
4.9 (4.6)
11.8 (6.2)
83
83
7460 (1300)a,b
0.003 1.06a,b
15
15
6840 (1503)
0.91 1.01
33
33
6625 (1560)
1.13 1.12
83
83
67.0 (3.0)a,b
0.09 0.96a,b
15
15
66.0 (3.5)c
0.54 0.82c
33
33
64.0 (4.0)
1.16 1.1
66
5603 (730)
12
5442 (760)
24
5612 (890)
66
a,b
2082 (830)
12
1514 (660)
24
1628 (890)
66
25.5 (10.7)a,b
12
21.7 (9.4)
24
21.8 (7.7)
Abbreviations: AGA GR , appropriate-for-gestational-age without growth restriction at term age; AGA GR+, appropriate-for-gestational-age with growth
restriction at term age; FM, fat mass; LM, lean mass; SDS, standard deviation score; SGA, small-for-gestational-age. Values as median (interquartile range) or
median s.d. Differences compared by regression analyses adjusted for gender and gestational age. aAGA GR versus AGA GR+, P o0.05. bAGA GR versus
SGA, P o0.05. cAGA GR+ versus SGA, Po0.05.
Table 2.
Protein, energy, fat and carbohydrate intake between birth and 6 months post-term in formula-fed AGA GR , AGA GR+ and SGA infants
AGA GR
AGA GR+
SGA
Value
Value
Value
Protein intake
g/kg/day
g/day
52
52
2.38 0.25a,b
18.2 2.5
12
12
2.66 0.27
18.4 2.6
21
21
2.58 0.39
18.1 2.5
Energy intake
kcal/kg/day
kcal/day
52
52
12
12
109.6 10.0
758.2 101.1
21
21
106.9 13.5
753.1 83.9
Fat intake
g/kg/day
g/day
52
52
5.21 0.38a,b
39.7 4.8
12
12
5.65 0.54
39.1 5.0
21
21
5.56 0.68
39.2 4.7
Carbohydrate intake
g/kg/day
g/day
52
52
10.7 0.9a,b
81.4 10.7
12
12
11.8 1.2
81.7 11.8
21
21
11.5 1.6
80.7 8.9
99.8 7.5a,b
760.9 94.0
Abbreviations: AGA GR , appropriate-for-gestational-age without growth restriction at term age; AGA GR+, appropriate-for-gestational-age with growth
restriction at term age; SGA, small-for-gestational-age. Values as mean s.d. or median (interquartile range). Differences compared by regression analyses
adjusted for gender and gestational age. aAGA GR versus AGA GR+, P o0.05. bAGA GR versus SGA, Po 0.05.
1263
composition in preterm infants in order to prevent excessive FM
accretion that is associated with a higher risk of adiposity and
metabolic consequences in later life.
CONFLICT OF INTEREST
The authors declare no conict of interest.
ACKNOWLEDGEMENTS
This work was supported by an unrestricted research grant of FrieslandCampina,
Leeuwarden, The Netherlands.
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