Departments of Pediatrics/Neonatology and
Departments of Pediatrics/Neonatology and.
Am J Clin Nutr. 2017 Aug;106(2):549-558. doi: 10.3945/ajcn.116.145375. Epub 2017 Jun 21.
Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable. The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA. A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary. At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results. In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].
早期营养干预可能调节早产儿的健康风险。此前，我们发现，与接受足月配方奶粉（TF）的早产儿相比，从足月年龄到 6 个月校正年龄（CA）接受等热量蛋白质和矿物质丰富的出院后配方（PDF）喂养的早产儿获得了更多的瘦体重。对随机营养试验进行长期随访对于检验短期对健康的积极影响是否可持续的假设很重要。本随访研究的目的是比较随机分配接受 PDF 或 TF 从足月年龄至 6 个月 CA 的早产儿在 8 岁时的身体大小、身体成分和代谢健康。原始随机对照试验中共有 152 名儿童中的 79 名（52%）入组进行 8 岁时的随访。体重、身高和头围采用标准方法测量。采用双能 X 射线吸收法测定身体成分，包括脂肪量、瘦体重、骨矿物质含量和骨矿物质密度。采用自动装置仰卧位测量血压。空腹后测定代谢变量，包括血糖、胰岛素、胰岛素样生长因子 I、甘油三酯、胆固醇、皮质醇和瘦素。通过 3 天的营养日记评估 8 岁时的营养习惯。在 8 岁时，与接受 TF 喂养的儿童相比，接受 PDF 喂养的儿童在体型、身体成分、骨骼变量和代谢健康变量方面没有差异。调整已知和可能的混杂因素并没有改变这些结果。在这项对早产儿的随访研究中，我们表明，在 6 个月 CA 时 PDF 的有利影响要么没有维持，要么由于 8 岁时的流失而无法确认。我们建议，未来的研究应将重点放在作为一个连续体的出院前和出院后营养干预上，而不是作为独立的实体。这项试验在 www.trialregister.nl 上注册为 NTR 2972（随访研究[STEP-2（研究出院后营养效果 2）]）和 NTR 55（原始随机对照试验[STEP]）。
