Early postnatal nutrition after preterm birth and cardiometabolic risk factors in young adulthood

Abstract

ObjectivesAdults born preterm at very low birthweight (VLBW; <1500 g) have a non-optimal cardiometabolic risk factor profile. Since higher protein intake during the first weeks of life predicted a healthier body composition in adulthood in our previous studies, we hypothesized that it would also predict a favorable cardiometabolic profile.Study designThe Helsinki Study of VLBW Adults includes 166 VLBW and preterm infants born between 1978 and 1985. We collected postnatal nutrition data among 125 unimpaired subjects, who attended two study visits at the mean ages of 22.5 and 25.1 years. We evaluated the effects of energy and macronutrient intakes during the first three 3-week periods of life on key cardiometabolic risk factors with multiple linear regression models. We also report results adjusted for prenatal, postnatal and adult characteristics.ResultsMacronutrient and energy intakes were not associated with blood pressure, heart rate, or lipid levels in adulthood. Intakes were neither associated with fasting glucose or most other markers of glucose metabolism. An exception was that the first-three-weeks-of-life intakes predicted higher fasting insulin levels: 1 g/kg/day higher protein intake by 37.6% (95% CI: 8.0%, 75.2%), and 10 kcal/kg/day higher energy intake by 8.6% (2.6%, 14.9%), when adjusted for sex and age. These early intakes similarly predicted the adult homeostasis model assessment index. Further adjustments strengthened these findings.ConclusionsAmong VLBW infants with relatively low early energy intake, early macronutrient and energy intakes were unrelated to blood pressure, lipid levels and intravenous glucose tolerance test results. Contrary to our hypothesis, a higher macronutrient intake during the first three weeks of life predicted higher fasting insulin concentration in young adulthood.

Macronutrient Supplements in Preterm and Small-for-Gestational-Age Animals: A Systematic Review and Meta-analysis

“…We found no association overall between early macronutrient supplementation and other metabolic outcomes including serum lipids (triglycerides and total cholesterol), fat mass index, HOMA-IR, insulin sensitivity, fasting insulin concentrations, fasting plasma glucose concentrations, and mean arterial, systolic or diastolic blood pressure in animals born small. Although our findings are from limited data, they are consistent with studies of human cohorts born preterm that found no associations between higher protein and energy intakes and serum lipids (triglycerides, HDL cholesterol, and cholesterol) in adults 40 and systolic or diastolic blood pressure in adolescents 41 . Similarly, at 6 years, a follow-up study of 239 preterm infants randomised to fortified vs. unfortified human milk and preterm formula vs.unfortified human milk, also found no differences in mean arterial, systolic or diastolic blood pressure, and no differences in fat mass index between the groups, although there was a significant increase in fat-free mass index in the unfortified breastmilk group 42 .…”

Prematurity and body composition at 6, 18, and 30 years of age: Pelotas (Brazil) 2004, 1993, and 1982 birth cohorts

“…Through metabolic changes, including reduced insulin sensitivity, preterm birth may increase the risk of adult obesity and noncommunicable diseases, such as diabetes mellitus, arterial hypertension, and coronary heart disease. Studies also suggest that such changes are different in males and females [ 13 , 14 ].…”

The mediation effect of anthropometry and physical fitness on the relationship between birthweight and basal metabolic rate in children

“…A previous study observed that BW adjusted for age and FFM was inversely associated with BMR (r = −0.12; P < 0.01) in adulthood 15 . Recently, it was observed that the low consumption of energy, protein and fat during the first three weeks of life can predict adult body composition and BMR 16 . As the main predictor of BMR is the FFM, a lower lean tissue mass may be implicated within the reduction of BMR and in body fat accumulation 17 .…”