Growth and bone mineralization of very preterm infants at term corrected age in relation to different nutritional intakes in the early postnatal period

Michelle N. Körnmann, Viola Christmann, Charlotte J.W. Gradussen, Laura Rodwell, Martin Gotthardt, Johannes B. Van Goudoever, Arno F.J. Van Heijst

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother's own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry', were not different between the groups. Nutritional intike of P was positively associated with length (ß; (95% confidence interval (Cl): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% Cl): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.

Original languageEnglish
Article number1318
JournalNutrients
Volume9
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Cite this

Körnmann, Michelle N. ; Christmann, Viola ; Gradussen, Charlotte J.W. ; Rodwell, Laura ; Gotthardt, Martin ; Van Goudoever, Johannes B. ; Van Heijst, Arno F.J. / Growth and bone mineralization of very preterm infants at term corrected age in relation to different nutritional intakes in the early postnatal period. In: Nutrients. 2017 ; Vol. 9, No. 12.
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title = "Growth and bone mineralization of very preterm infants at term corrected age in relation to different nutritional intakes in the early postnatal period",
abstract = "Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother's own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry', were not different between the groups. Nutritional intike of P was positively associated with length ({\ss}; (95{\%} confidence interval (Cl): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95{\%} Cl): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.",
keywords = "Bone mineral density, Calcium, Dual-X-ray absorptiometry, Fortification, Human milk, Length, Phosphorus, Preterm formula, Weight",
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Growth and bone mineralization of very preterm infants at term corrected age in relation to different nutritional intakes in the early postnatal period. / Körnmann, Michelle N.; Christmann, Viola; Gradussen, Charlotte J.W.; Rodwell, Laura; Gotthardt, Martin; Van Goudoever, Johannes B.; Van Heijst, Arno F.J.

In: Nutrients, Vol. 9, No. 12, 1318, 01.12.2017.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Growth and bone mineralization of very preterm infants at term corrected age in relation to different nutritional intakes in the early postnatal period

AU - Körnmann, Michelle N.

AU - Christmann, Viola

AU - Gradussen, Charlotte J.W.

AU - Rodwell, Laura

AU - Gotthardt, Martin

AU - Van Goudoever, Johannes B.

AU - Van Heijst, Arno F.J.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother's own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry', were not different between the groups. Nutritional intike of P was positively associated with length (ß; (95% confidence interval (Cl): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% Cl): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.

AB - Preterm infants often have a reduced bone mineral content (BMC) with increased risk of metabolic bone disease. After birth it is difficult to supply calcium (Ca) and phosphorus (P) comparable to the high fetal accretion rate. It is not known whether high supplementation of minerals in the early postnatal period improves growth and bone mineralization. The aim of this study was to evaluate growth and bone mineralization at term corrected age (TCA) in very and extremely preterm infants who received different enteral Ca and P intakes during the first 10 days of life. Infants (n = 109) with birth weights below 1500 g were randomly assigned to one of three groups that differed in the nutritional protocols delivered until day 10: Group A, mother's own milk (MOM) and donor milk (unfortified); Group B, MOM (unfortified) and preterm formula; Group C, MOM (start fortification >50 mL/day) and preterm formula. Due to the earlier commencement of fortification, Group C received higher intakes of calcium and phosphorus and protein (p < 0.001) until day 10. At TCA weight, length, BMC and bone mineral density (BMD), measured by dual-X-ray absorptiometry', were not different between the groups. Nutritional intike of P was positively associated with length (ß; (95% confidence interval (Cl): 0.20 (0.001; 0.393); p-value = 0.048), whereas Ca intake was negatively associated with BMC (−1.94 (−2.78; −1.09); p-value < 0.001). A small interaction between Ca and P intake was only found for BMD (0.003 (0.00002; 0.00006); p-value = 0.036). The volume of human milk per kg provided during the first 10 days was positively associated with BMC (β; (95% Cl): 0.013 (0.002; 0.023); p < 0.017). Higher intakes of Ca and P during the first 10 days, as provided in this study, did not improve bone mineralization at term corrected age.

KW - Bone mineral density

KW - Calcium

KW - Dual-X-ray absorptiometry

KW - Fortification

KW - Human milk

KW - Length

KW - Phosphorus

KW - Preterm formula

KW - Weight

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DO - 10.3390/nu9121318

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