The optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks’ gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.

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Introduction Kidney transplant patients (KT) are at high risk for severe COVID‐19 and presented attenuated antibody responses to vaccination when compared to immunocompetent individuals. Torquetenovirus (TTV) has recently gained attention as a potential surrogate marker of the net state of immunosuppression. We evaluated the association between pre‐vaccination TTV viral load and anti‐spike total antibody response to SARS‐CoV‐2 vaccination in KT. Material and Methods The 114 adult KT recipients enrolled in this prospective single‐center cohort study received two doses of SARS‐CoV‐2 mRNA BNT162b2 vaccine. Serum samples were collected immediately before vaccination at the days when patients received both the first (T0) and the second dose (T1) and 16–45 days after the second dose (T2). Primary endpoint was the development of anti‐spike total antibodies after vaccination. Demographic, clinical, and laboratorial parameters were compared between patients with and without detectable SARS‐CoV‐2 antibodies at T2. Results Ninety‐nine patients (86.8%) were naïve for SARS‐CoV‐2 before vaccination. Fifty‐six (56.6%) patients developed anti‐spike total antibodies at T2. The use of mTOR inhibitors was associated with a favorable response (p = .005); conversely, mycophenolic acid (MPA) was associated with a negative response (p = .006). In a multivariable model, the presence of TTV at T0 ≥ 3.36 log10 cp/ml was associated with unfavorable vaccine response (OR: 5.40; 95% CI: 1.47–19.80; p = .011), after adjusting for age and eGFR at T0. Conclusions Higher TTV viral loads before vaccination are associated with reduced anti‐spike total antibody response in SARS‐CoV‐2 mRNA BNT162b2 vaccinated KT patients. The association between TTV viral load and vaccine response may be an added‐value in the optimization of vaccination regimens in KT.