Does early nutrition program later bone health in preterm infants?

Abstract

Preterm infants are at risk of metabolic bone disease (MBD) because of an inadequate mineral intake. Although infants with MBD are frequently asymptomatic during the neonatal period, we previously reported that MBD predicted reduced linear growth in infancy and midchildhood. Nevertheless, some studies suggest that preterm infants undergo catch-up growth in bone mineralization during infancy. To examine the hypothesis that early nutrition programs affect later bone health and peak bone mass, we studied 20-y-old subjects who were born preterm and who were randomly assigned to a diet during the neonatal period; the diets used varied markedly in nutrient and mineral content, and phosphate supplements were not provided. Despite large variations in early nutrient and mineral intakes (and the occurrence of MBD) during the neonatal period, the randomly assigned diets did not influence peak bone mass or turnover. However, the proportion of (unsupplemented) human milk in the neonatal diet was significantly positively associated with later whole-body bone size and mineral content. Compared with population reference data, preterm subjects were significantly shorter and had lower lumbar spine bone mineral density; the deficits were greatest in those born small for gestational age (ie, a birth weight <1250 g). The lack of effect of the randomly assigned diets on peak bone mass suggests that the observed deficits in height and lumbar spine bone mass may not be related to suboptimal early nutrient or mineral intake. The higher whole-body bone mass associated with human milk intake, despite its very low nutrient content, may instead reflect nonnutritive factors in breast milk. These findings are relevant to discussions on the mineral requirements of preterm infants.

Metabolic Bone Disease Screening Practices Among U.S. Neonatologists

“…In a cohort of preterm infants (gestational age <37 weeks; birth weight <1850 g) recruited between 1982 and 1985 for randomization to various formula and breast milk regimens and studied again in young adulthood, shorter stature, higher body mass index, and lower lumbar spine bone mass compared with reference data was identified. 25 The extent to which radiographic or biochemical rickets impacted peak bone mass accrual is not clear from this study, nor is the extent to which bone mineral accrual in these preterm infants affected their risk of osteoporosis later in life.…”

Trial of Daily Vitamin D Supplementation in Preterm Infants

“…22 Lack of improvement in BMC could also be due to the fact that our study included a few (n = 7) very low birth weight infants (,1000 g), who are likely to have maximum changes in BMC and BMD due to higher risk of metabolic bone disease. 23,24 Even though daily supplementation with 800 IU significantly reduced the prevalence of VDD at 40 weeks and at 3 months' CA, there is concern that 800 IU/day could result in vitamin D excess in a small proportion of infants. We found an incidence of 2.4% (95% CI: 0.06%-12.5%) in the intervention group.…”

Factores de riesgo y marcadores bioquímicos de la enfermedad metabólica ósea del recién nacido prematuro

“…Some studies give us evidence of postnatal growth delays at 8-12 years of age 17,18 . Therefore, if it prevention fails, the presence of fractures, dolichocephaly and delays in growth rate, as well as other long-term effects, such as osteopenia in adulthood, would be favored 16,19 .…”