Association between preterm infant body composition in the first 3 months of life and preschool age: a cohort study.

Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500 g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3 months of life with fat-free mass and fat mass percentage at 4 to 7 years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3 months of corrected age, and at 4 to 7 years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7 years. The fat-free mass at 3 months and the gain in fat-free mass between term and 3 months showed positive associations with fat-free mass at 4 to 7 years.   Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3 months of life, a sensitive period for the risk of metabolic diseases. What is Known: • Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants. • Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome. What is New: •Fat-free mass gain in the first 3 months of corrected age is associated with fat-free mass at preschool and school ages. •The first 3 months of life is a sensitive period to the risk of metabolic diseases.

The trajectory of head circumference and neurodevelopment in very preterm newborns during the first two years of life: a cohort study.

OBJECTIVE: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. METHOD: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. RESULTS: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. CONCLUSION: Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.

Physical and social activities constraint and its effects on Body Mass Index of former Neonatal Intensive Care children.

OBJECTIVE: It is reported weight gain in children due to the confinement measures during the Covid-19 pandemic. We aimed to describe the effect of these measures on the nutritional status of former Neonatal Intensive Care Unit children. METHODS: Cross-sectional study, including former Neonatal Intensive Care Unit children. The outcome was the Body mass index (BMI). RESULTS: We enrolled 126 children (74.6 % preterm; 31 % small-for-gestational-age). Weight excess was greater in the youngest group (≤5 years: 33.8 %; >5 years: 15.2 %). Prematurity was associated with weight excess in both groups (≤5 years: p value 0.006; >5 years: p value 0.046; Pearson test). Mealtime changes, lack of physical activity, socioeconomic factors and the perinatal morbidities significantly influenced the mean BMI. Birth length Z score less than -1.28 was negatively associated with BMI, while gestational age at birth presented a positive association with BMI (linear regression model). CONCLUSIONS: The BMI increase due to the confinement measures associated with the gestational age at birth and in those born with intrauterine growth restriction is a matter of concern, as it might indicate a risk for future obesity.

Trajetória do crescimento e composição corporal das crianças nascidas menores que 32 semanas de idade gestacional ou com peso inferior a 1500 gramas até 4 a 7 anos de idade: estudo de coorte / Growth trajectory and body composition of children born under 32 weeks gestational age or weighing less than 1500 g until 4 to 7 years of age: a cohort study

Introdução: Os recém-nascidos muito pré-termo e com muito baixo peso, apresentam na idade corrigida do termo, uma menor massa livre de gordura e maior adiposidade, em relação aos nascidos a termo. O aumento da gordura corporal na idade corrigida do termo pode ser fisiológico devido a uma adaptação do recém-nascido pré-termo a vida extrauterina. Entretanto, o déficit de massa livre de gordura pode persistir ao longo da vida e reflete uma capacidade metabólica reduzida e, portanto, o maior risco de doenças metabólicas no futuro. Os estudos sobre a composição corporal na idade pré-escolar e escolar de crianças nascidas pré-termo evidenciam resultados conflitantes na literatura. Objetivo: O objetivo deste estudo foi avaliar a composição corporal e o crescimento de crianças nascidas muito pré-termo ou muito baixo peso, entre 4 e 7 anos. Esta pesquisa apresenta como objetivos específicos comparar a composição corporal e o crescimento entre crianças que nasceram pequenas e adequadas para idade gestacional e avaliar associações entre a composição corporal nos primeiros 3 meses de vida com a massa livre de gordura e percentual de gordura entre 4 e 7 anos. Métodos: Estudo de coorte de recém-nascidos menores de 32 semanas de idade gestacional ou peso inferior a 1500 g, no Instituto Nacional em Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz. Os dados antropométricos e da composição corporal, com o uso da pletismografia por deslocamento de ar, foram coletados nas idades corrigidas do termo e 3 meses, e na idade entre 4 e 7 anos. O teste t de Student e o teste qui-quadrado foram utilizados para comparar o crescimento e a composição corporal entre recém-nascidos pequenos, e adequados para idade gestacional, nas idades corrigidas do termo e 3 meses e na idade entre 4 e 7 anos. A análise de regressão linear múltipla foi realizada para avaliar as associações entre a composição corporal e o sexo masculino nos primeiros 3 meses de vida com a massa livre de gordura e o percentual de gordura na idade entre 4 e 7 anos. Para todas as análises foi considerado o nível de significância de 0,05. Resultados: Os recém-nascidos muito pré-termo, pequenos para idade gestacional, na idade corrigida do termo, apresentaram menor massa livre de gordura e massa de gordura (gramas, percentual e índices) e menor peso, comprimento e perímetro cefálico do que os nascidos adequados para idade gestacional. Aos 3 meses, a massa livre de gordura, índice de massa livre de gordura, peso e comprimento permaneceram menores no grupo dos nascidos pequenos para idade gestacional. Entre 4 e 7 anos a composição corporal e a antropometria foram similares entre os grupos. Na idade corrigida do termo, a massa livre de gordura apresentou associação positiva, e o percentual de gordura associação negativa com a massa livre de gordura aos 4 a 7 anos de idade. Aos 3 meses, a massa livre de gordura apresentou associação positiva com a massa livre de gordura na idade de 4 a 7 anos. O ganho de massa livre de gordura entre o período do termo e 3 meses também apresentou associação positiva com a massa livre de gordura aos 4 a 7 anos de idade. Conclusão: As diferenças na composição corporal observadas nos primeiros 3 meses de vida entre as crianças nascidas pré-termo pequenas e adequadas para idade gestacional, não se mantiveram entre 4 e 7 anos. A composição corporal na idade de 4 a 7 anos, apresentou associações com a massa livre de gordura nos primeiros 3 meses de idade corrigida, sendo este um período sensível para o risco de doenças metabólicas ao longo da vida. Os estudos longitudinais de longo prazo são necessários para melhor avaliar a trajetória da qualidade do crescimento das crianças nascidas muito pré-termo.

Introduction: Very preterm and very low birth weight infants have less fat-free mass and higher adiposity at term corrected age, than those born at term. The increase in fat mass may be physiological due to an adaptation of the preterm newborn to extrauterine life. However, the deficit of fat-free mass may persist throughout life and reflects a reduced metabolic capacity and therefore, increasing the risk of metabolic diseases in the future. Studies on body composition at preschool and school ages of children born preterm show conflicting results in the literature. Objective: The aim of the present study was to evaluate the body composition and growth of children born very preterm and/or very low birth weight, between 4 and 7 years of age. This research presents as specific objectives the comparison of body composition and growth between children born small and adequate for gestational age and to evaluate associations between body composition in the first 3 months of life with fat-free mass and fat percentage between 4 and 7 years of age. Methods: Cohort study of infants younger than 32 weeks of gestational age or less than 1500 g, at the Instituto Nacional em Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira / Fiocruz. Anthropometric and body composition data, using air displacement plethysmography, were collected at term and 3-month corrected ages, and at 4 to 7 years of age. Student's t test and chi-square test were used to compare growth and body composition between small and appropriate for gestational age infants at term and 3-month corrected ages, and at 4 to 7 years of age. A multiple linear regression analysis was performed to evaluate the associations between body composition and male sex in the first 3 months of life with fat-free mass and fat percentage at 4 to 7 years of age. For all analyses, a significance level of 0.05 was considered. Results: The very preterm, small for gestational age infants had had lower fat-free mass and fat mass (grams, percentual and indexes), and lower weight, length, and head circumference than the appropriate for gestational age infants. At 3 months, fat-free mass, fat-free mass index, weight and length remained lower in the small for gestational age group. Between 4 and 7 years, body composition and anthropometry were similar between the groups. At term corrected age, the fat-free mass showed a positive association and the percentage of fat mass a negative association with fat-free mass at 4 to 7 years. At 3 months, fat-free mass showed a positive association with fat-free mass at ages 4 to 7 years. Also, the gain in fat-free mass between term to 3 months was positively associated with fat-free mass ate 4 to 7 years at age. Conclusion: The differences in body composition and anthropometry observed in the first 3 months of life between children born very preterm small and appropriate for gestational age, were not maintained at 4 to 7 years of age. Body composition at preschool and school age shows associations with fat-free mass and % fat mass in the first 3 months of corrected age, and this is a sensitive period for the risk of metabolic diseases. Long-term longitudinal studies are needed to better assess the trajectory of growth quality in children born very preterm.

Body composition at 4 to 7 years of age in children born <32 weeks gestational age or 1500 g: A cohort study.

BACKGROUND: Small for gestational age preterm infants show differences in body composition when compared to those appropriate for gestational age at term, which have consequences on metabolism. AIM: To compare growth and body composition of children born small and appropriate for gestational age between 4 and 7 years. METHOD: A Cohort of small and appropriate for gestational age infants <32 weeks or 1500 g were followed at term and 3 months corrected ages and at 4 to 7 years. Body composition assessment by air displacement plethysmography and anthropometry were performed at all moments. Differences between the two groups were assessed using t-student and Chi-square tests. RESULTS: Ninety-four infants were included at term (26 small and 68 appropriate for gestational age); 88 at 3 months (24 small and 64 appropriate for gestational age) and 47 between 4 and 7 years (11 small and 36 appropriate for gestational age). At term, small for gestational age infants had lower fat-free mass, fat mass, weight and length compared with those appropriate for gestational age (p < 0.001). At 3 months, fat-free mass (grams) remained lower in small for gestational age group (p < 0.001). Between 4 and 7 years, body composition and anthropometry were similar between the groups. CONCLUSION: Between 4 and 7 years, children born small and appropriate for gestational age had similar body composition. New long-term longitudinal studies are necessary to understand the influence of fat-free mass and fat mass in the first months of age on body composition throughout life.

What Are the Maternal Factors that Potentially Intervenes in the Nutritional Composition of Human Milk?

BACKGROUND: To evaluate the potential factors associated with the nutritional composition of human milk of puerperal women. METHODS: cross-sectional study, conducted between March 2016 and August 2017, with 107 women, selected in a Tertiary Health Care Tertiary Health Facility of the Unified Health System (SUS) in the Municipality of Rio de Janeiro. Data were collected two months after delivery. The dependent variable of the study was the nutritional composition of human milk. We divided the independent variables into hierarchical levels: distal (age, schooling, parity and pregestational nutritional status), intermediate (number of prenatal visits and gestational weight gain) and proximal (alcohol consumption, smoking, diabetes mellitus and hypertension). For data analysis, we applied the multiple linear regression, centered on the hierarchical model. Only the variables associated with the nutritional composition of breast milk remained in the final model at a 5% level of significance. RESULTS: The nutritional composition of human milk yielded by women with pregestational overweight, smokers and hypertensive had higher amounts of lipids and energy. Conversely, women with gestational weight gain below the recommended had lower amounts of these components. CONCLUSION: The evaluation of factors associated with the nutritional composition of human milk is extremely important to assist post-partum care practices. In this study, we observed that lipid and energy contents were associated to pregestational nutritional status, gestational weight gain, smoking and hypertension.

Do chronic noncommunicable diseases modify the macronutrient composition of human milk?

This study aims to evaluate the impact of excess body weight, diabetes mellitus, and hypertension on the nutritional composition of human milk. This cohort study was conducted at a tertiary public health unit in the city of Rio de Janeiro from March 2016 to February 2018. The data were collected in two stages (96 hours and one month after delivery). The macronutrients (carbohydrate, protein, lipid) and total energy were determined using the MIRIS® equipment. The level of significance was 5%. Higher protein content was observed in the nutritional composition of colostrum in women with diabetes mellitus. A higher protein and energy content was observed in the milk of mothers with excessive body weight. The energy content was higher in the milk of mothers with excessive body weight. Increased protein content in the human milk of women with excessive body weight or diabetes.

Influence of gestational and perinatal factors on body composition of full-term newborns / Influência de fatores gestacionais e perinatais na composição corporal de recém-nascidos a termo

Abstract Objective: To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full-term newborns. Method: This was a cross-sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre-gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air-displacement plethysmography (PeaPod® Infant Body Composition System-LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model. Results: The significant variables in the model that explained 84% of the variation in neonatal fat-free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre-gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat-free mass. Conclusion: Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.

Resumo Objetivo: Avaliar a influência de fatores gestacionais e perinatais na composição corporal e no peso de nascimento de recém-nascidos a termo. Método: Estudo transversal, dentro de uma coorte prospectiva, composto por 124 puérperas e seus recém-nascidos. Os dados incluíram: idade materna; etnia; índice de massa corpórea pré-gestacional; ganho de peso gestacional; paridade; morbidades gestacionais, (hipertensão arterial e diabetes mellitus gestacional); idade gestacional do nascimento; peso de nascimento; e sexo do recém-nascido. Os dados antropométricos e de composição corporal dos recém-nascidos foram coletados com a pletismografia por deslocamento de ar (PeaPod®). Foi aplicada a técnica de stepwise no modelo de regressão linear múltipla. Resultados: As variáveis significativas do modelo que explicou 84% da variação da massa livre de gordura neonatal foram: peso de nascimento; idade materna; sexo do recém-nascido; e idade gestacional. Para a massa de gordura corporal: peso de nascimento; sexo do recém-nascido; hipertensão arterial gestacional; diabetes gestacional; e ganho de peso gestacional. Essas variáveis explicaram 60% e 46% da massa de gordura, em gramas e percentual, respectivamente. Em relação ao peso de nascimento os fatores significativos foram: idade gestacional; IMC pré-gestacional; e ganho de peso gestacional. Os recém-nascidos do sexo feminino apresentaram maior massa de gordura corporal e os do sexo masculino maior massa livre de gordura. Conclusão: Fatores gestacionais e perinatais influenciam a composição corporal neonatal. A identificação precoce desses fatores gestacionais, que podem ser modificáveis, é necessária para prevenção de obesidade e de doenças crônicas não transmissíveis no futuro.

Gestational weight gain and body composition of full-term newborns and infants: a cohort study.

BACKGROUND: The association between gestational weight gain and neonatal body composition has been inconsistent, exposing the need for further research. The aim of this study was to evaluate whether gestational weight gain influences the body composition of full-term newborns and infants up to 4 months old. METHODS: A cohort study was performed with 124 participants divided into categories of gestational weight gain according to the 2009 Institute of Medicine guidelines. The anthropometric and body composition data of newborns and infants acquired using air displacement plethysmography (PeaPod®) were collected at 96 h, 1 month, 2 months and 4 months of life. In the statistical analysis, the chi-square test was used to analyze categorical variables, and ANOVA was used to analyze numerical variables. Univariate analysis was performed, and the absolute and relative frequencies of the categorical variables, as well as mean and standard deviation of the numerical variables, were obtained. Bivariate analysis was performed for the categories of gestational weight gain and gestational and neonatal characteristics. When adjustments to gestational hypertension, gestational diabetes, and pregestational body mass index (BMI) were analyzed by linear regression, gestational weight gain remained a significant variable for newborn percent fat mass. For all analyses, a significance level of 5% was adopted. RESULTS: Gestational weight gain was adequate in 33.8% of the participants, excessive in 41.1% and insufficient in 25%. Women with excessive weight gain had higher pregestational BMIs and a higher incidence of gestational hypertension. Their newborns had a higher body mass, body fat mass in grams and percent fat mass than the infants born to mothers with adequate or insufficient gestational weight gain. No significant differences were observed in body composition at 1, 2 and 4 months of life during infant follow-up. CONCLUSION: Excessive gestational weight gain may alter the body composition of newborns at birth. Further studies are required to better evaluate infant follow-up. TRIAL REGISTRATION: Clinical Trial Registry: NCT00875251 on April 3, 2009.

Influence of gestational and perinatal factors on body composition of full-term newborns.

OBJECTIVE: To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full-term newborns. METHOD: This was a cross-sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre-gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air-displacement plethysmography (PeaPod® Infant Body Composition System-LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model. RESULTS: The significant variables in the model that explained 84% of the variation in neonatal fat-free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre-gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat-free mass. CONCLUSION: Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.

Zika virus infection in pregnancy and infant growth, body composition in the first three months of life: a cohort study.

The implications of Zika Virus exposure in pregnancy for early infant growth remains poorly described. The main goal of this study is to compare the growth, body composition, and feeding modality of infants in the first three months of life by prenatal Zika Virus exposure status. We selected an analytical cohort of 115 infants born without microcephaly, comprising 56 infants with qRT-PCR confirmed exposure to ZIKV during gestation and 59 infants born to women with presumptively no evidence of ZIKV in pregnancy. Infants were evaluated at birth, 1 and 3 months of age in terms of anthropometrics, body composition All the results were adjusted by maternal age, maternal BMI and gestational age. We observe no differences between anthropometric measurements at birth. Mothers in exposed group showed higher BMI. At 1 month and 3 months of age there were differences in mid arm circumference, arm muscle circumference and fat free mass. Weight and length was less in the ZIKV exposed in pregnancy infants and statistically different at 3 month of age. The findings of this investigation provide new evidence that ZIKV exposure in pregnancy may be associated with differences in body composition.

Growth and body composition of preterm infants less than or equal to 32 weeks: Cohort study.

BACKGROUND: Extremely preterm infants with weights less than the 10th percentile at discharge have a fat-free mass deficit. AIM: To analyze the relationship of weight Z-scores less than -2SD at term age with fat-free mass and fat mass at term age and at 1 and 3 months of corrected age in very preterm infants. STUDY DESIGN: COHORT STUDY: Subjects: Sixty-six preterm infants born before or at 32 weeks gestation with birth weight equal or greater than the 10th percentile for age were included at term age. They were classified according to weight Z-score as either: "term (-)" (n = 18) if weight Z-scores were less -2SD or "term (+)" (n = 48) if the weight Z-scores were equal or greater than -2SD at term age. OUTCOME MEASURES: Growth and body composition by an air displacement plethysmography system and bioimpedance were assessed at term age and 1 and 3 months of corrected age. RESULTS: Lower fat-free mass persisted up to 3 months in the "term (-)" group [4137 g (645) vs 4592 g (707), p < .01]. Fat mass was lower in the "term (-)" group at term and at 1 month but was similar at 3 months of corrected age [1295 g (774) vs 1477 g (782), p = .109]. Weight, length and head circumference Z-scores were lower in the "term (-)" group compared to those in the "term (+)" group. CONCLUSIONS: The lean tissue deficits were maintained in the "term (-)" group while the differences in body fat percentage were not.