Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Nutr. 2020 Nov 19;150(11):2961-2968. doi: 10.1093/jn/nxaa281.
Very low birth weight (VLBW; <1500 g) infants have increased adiposity and metabolic disease risk in adulthood. Limited evidence suggests low-quality childhood diets are a predisposing risk factor. Despite this, to our knowledge no study has yet examined associations between diet quality and body composition in VLBW individuals.
The objective of this study was to determine associations between Healthy Eating Index-2010 (HEI-2010) scores and consumption of fruits/vegetables, added sugars, and macronutrients with body composition in 5.5-y-old children born VLBW. We hypothesized HEI-2010 scores were inversely associated with adiposity.
This cohort study leveraged the 5.5-y follow-up to the Donor Milk for Improved Neurodevelopmental Outcomes randomized controlled trial. From June 2016 to July 2018, participants attended a follow-up visit at The Hospital for Sick Children, Canada, or were visited in their home. All 316 surviving infants from the trial were eligible, and the caregivers of 158 children (50%; 53% male) consented to follow-up. Diet quality (HEI-2010) and usual intake of fruits/vegetables, added sugars, and macronutrients were determined from two 24-h dietary recalls (ASA24). Linear regressions evaluated associations of diet with BMI (kg/m2) and waist circumference z-scores, total fat, fat-free mass (air displacement plethysmography), and skinfolds.
Mean ± SD age at follow-up was 5.7 ± 0.2 y, birth weight was 1013 ± 264 g, and gestational age was 27.9 ± 2.5 wk. Dietary data and BMI z-scores were available for all children; 123 completed air displacement plethysmography. HEI-2010 score was 58.2 ± 12.4 out of 100, and 27% of children had poor quality diets (scores ≤50). HEI-2010 scores were inversely associated with BMI z-score, but only in children with obese mothers. A 10-point increase in HEI-2010 score was associated with reduced BMI (β: -0.5 SD; 95% CI: -0.7, -0.2) and subscapular (-0.3 SD; 95% CI: -0.6, -0.06) z-scores.
Improving diet quality in children born VLBW with obese mothers may be an important strategy to prevent excess adiposity. This trial was registered at clinicaltrials.gov as Optimizing Mothers' Milk for Preterm Infants (OptiMoM) Program of Research: Study 1-Impact of Donor Milk at Kindergarten, NCT02759809.
极低出生体重（VLBW；<1500 克）婴儿在成年后患肥胖症和代谢疾病的风险增加。有限的证据表明，低质量的儿童饮食是一个潜在的危险因素。尽管如此，据我们所知，尚无研究探讨 VLBW 个体的饮食质量与身体成分之间的关系。
本研究旨在确定健康饮食指数-2010（HEI-2010）评分与水果/蔬菜、添加糖和宏量营养素的摄入量与 5.5 岁 VLBW 儿童身体成分之间的关系。我们假设 HEI-2010 评分与肥胖呈负相关。
本队列研究利用了捐赠母乳改善神经发育结局的随机对照试验的 5.5 年随访结果。从 2016 年 6 月到 2018 年 7 月，参与者在加拿大 SickKids 医院进行了随访，或者在家中接受了随访。所有 316 名符合试验条件的存活婴儿均符合条件，其中 158 名儿童（50%；53%为男性）的照顾者同意进行随访。通过两次 24 小时膳食回顾（ASA24）来确定饮食质量（HEI-2010）和水果/蔬菜、添加糖和宏量营养素的日常摄入量。线性回归评估了饮食与 BMI（kg/m2）和腰围 z 评分、总脂肪、去脂体重（空气置换体积描记法）和皮褶厚度之间的关系。
随访时的平均年龄为 5.7±0.2 岁，出生体重为 1013±264 克，胎龄为 27.9±2.5 周。所有儿童均提供了饮食数据和 BMI z 评分；123 名儿童完成了空气置换体积描记法。HEI-2010 评分为 100 分中的 58.2±12.4 分，27%的儿童饮食质量较差（得分≤50 分）。HEI-2010 评分与 BMI z 评分呈负相关，但仅在肥胖母亲的儿童中存在。HEI-2010 评分增加 10 分与 BMI（β：-0.5 标准差；95%CI：-0.7，-0.2）和肩胛下（-0.3 标准差；95%CI：-0.6，-0.06）z 评分降低有关。
改善肥胖母亲所生 VLBW 儿童的饮食质量可能是预防肥胖的重要策略。本试验在 clinicaltrials.gov 注册为优化早产儿母乳（OptiMoM）计划的研究：研究 1-幼儿园期捐赠母乳的影响，NCT02759809。
