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Original article
Impact of breast milk intake on body composition at term in very preterm babies: secondary analysis of the Nutritional Evaluation and Optimisation in Neonates randomised controlled trial
  1. Yangmei Li1,
  2. Xinxue Liu2,
  3. Neena Modi3,4,
  4. Sabita Uthaya3,4
  1. 1Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
  3. 3Neonatal Medicine, Chelsea and Westminster National Health Service Foundation Trust, London, UK
  4. 4Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Sabita Uthaya, Chelsea and Westminster National Health Service Foundation Trust, London SW10 9NH, UK; s.uthaya{at}imperial.ac.uk

Abstract

Objective To investigate the impact of breast milk (BM) intake on body composition at term in very preterm infants.

Design Preplanned secondary analysis of the Nutritional Evaluation and Optimisation in Neonates Study, a 2-by-2 factorial randomised controlled trial of preterm parenteral nutrition (PN).

Setting Four National Health Service hospitals in London and South-East England.

Patients Infants born at <31 weeks of gestation; infants with life-threatening congenital abnormalities and those unable to receive trial PN within 24 hours of birth were ineligible. 133 infants survived and underwent whole-body MRI at term (37–44 weeks postmenstrual age).

Main outcome measures Non-adipose tissue mass (non-ATM), ATM and ATM as a percentage of body weight (% ATM) at term.

Results Compared with the exclusively BM group (proportion of BM=100% milk, n=56), predominantly formula-fed infants (BM ≤50%, n=38) weighed 283.6 g (95% CI 121.6 to 445.6) more, had 257.4 g (139.1–375.7) more non-ATM and a greater positive weight Z-score change between birth and term. There were no significant differences in weight, non-ATM and weight Z-score change between the exclusively and predominantly BM (BM 51%–99%, n=39) groups. Compared with the exclusively BM group no significant differences were observed in ATM and %ATM in the predominantly BM and predominantly formula-fed groups.

Conclusions The slower weight gain of preterm infants fed BM appears to be due to a deficit in non-ATM and may reflect lower protein intake. Whether this pattern persists into childhood, is altered by BM fortification or later diet, or relates to functional outcomes, are important research questions.

Clinical trial registration ISRCTN29665319, post results.

  • nutrition
  • infant feeding
  • neonatology
  • prematurity
  • body composition

https://doi.org/10.1136/archdischild-2017-314625

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    Footnotes

    • Contributors YL, XL, NM and SNU conceptualised and designed the study. XL and SNU collected data. XL and YL performed the statistical analysis. YL, XL and SNU drafted the initial manuscript. YL, XL, NM and SNU critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

    • Funding The NEON trial was funded by the Efficacy and Mechanism Evaluation (EME) programme of the National Institute of Health Research (project number 08/99/04).

    • Competing interests SNU has received funding from the National Institute of Health Research and the Department of Health, UK and received speaker honoraria for an educational meeting held by Kabi Fresenius. NM in the last 5 years has received consultancy fees from Ferring Pharmaceuticals, speaker honorarium for an educational meeting funded by Nestle International in which they had no organisational involvement and grants from the National Institute of Heath Research, British Heart Foundation, Westminster Children’s Trust Fund, NHS England and Bliss.

    • Patient consent Not required.

    • Ethics approval The NEON trial was approved by the UK National Research Ethics Service.

    • Provenance and peer review Not commissioned; externally peer reviewed.