Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Clin Endocrinol Metab. 2021 May 13;106(6):1793-1803. doi: 10.1210/clinem/dgab001.
Human milk contains hormones that regulate metabolism. Extrauterine growth restriction remains common among preterm infants, but the effect of ingesting milk hormones on preterm infant growth is poorly understood.
To quantify associations of longitudinal exposure to leptin, adiponectin, and insulin in milk with physical growth of preterm infants.
DESIGN/METHODS: In 50 preterm neonates (median gestational age 29.4 weeks), we sampled maternal milk on day-of-life 7, 14, 21, and 28 and measured hormone levels in whole milk by ELISA. Milk leptin levels were available for a subset of 18 infants. We calculated milk hormone doses by multiplying the hormone level by the milk volume ingested on each day and estimated the area under the curve (AUC) to reflect longitudinal exposure. We analyzed associations of milk hormone exposure with growth outcomes in generalized estimated equations.
Weight gain velocity and z-scores in weight, length, head circumference, and body mass index at 36 weeks' postmenstrual age (PMA).
Higher leptin intake was associated with greater weight gain (2.17g/kg/day [95% CI, 1.31, 3.02]) and weight z-score at 36 weeks' PMA (0.30 [0.08, 0.53] higher z-score per tertile). Higher adiponectin intake was associated with greater length z-score (0.41 [0.13, 0.69]), however, this association was nullified after adjustment of protein and calorie intake. Higher adiponectin was associated with smaller head circumference z-score (-0.36 [-0.64, -0.07]). Insulin was not associated with growth outcomes.
Milk leptin and adiponectin exposures may affect growth of preterm infants. The long-term effects of milk hormones warrant further investigation.
人乳中含有调节代谢的激素。宫外生长受限在早产儿中仍很常见，但摄入乳源激素对早产儿生长的影响知之甚少。
定量分析乳中瘦素、脂联素和胰岛素的纵向暴露与早产儿体格生长的关系。
设计/方法：对 50 例早产儿（中位胎龄 29.4 周），于生后第 7、14、21 和 28 天采集母乳样本，采用 ELISA 法检测全乳中激素水平。18 例婴儿的母乳瘦素水平可用。通过将激素水平乘以每天摄入的奶量来计算奶中激素剂量，并计算曲线下面积（AUC）来反映纵向暴露。采用广义估计方程分析母乳激素暴露与生长结局的关系。
生后 36 周校正胎龄时的体重增加速度和体重、身长、头围及体质量指数的 z 评分。
瘦素摄入量与体重增加（2.17g/kg/d[95%CI，1.31，3.02]）和 36 周校正胎龄时体重 z 评分（每三分位增加 0.30[0.08，0.53]）呈正相关。脂联素摄入量与身长 z 评分（0.41[0.13，0.69]）呈正相关，但调整蛋白和热量摄入后该相关性消失。脂联素与头围 z 评分呈负相关（-0.36[-0.64，-0.07]）。胰岛素与生长结局无关。
母乳中瘦素和脂联素的暴露可能影响早产儿的生长。需要进一步研究乳源激素的长期影响。
