Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants.

Objective: To test the efficacy and safety of long-chain polyunsaturated fatty acid (LCPUFA) supplementation with gamma-linolenic acid, a precursor of arachidonic acid, and docosahexaenoic acid in preterm infants.

Study Design: Preterm (<35 weeks, < or =2000 g birth weight) infants (n=238) randomly assigned to unsupplemented or LCPUFA-supplemented formula to 9 months after term. The main outcome measure was the Bayley Mental and Psychomotor Indexes (MDI, PDI) at 18 months after term.

Growth and nutrition after discharge.

Preterm infants are frequently discharged from hospital growth retarded and show reduced growth during childhood. However, nutrition during the post-discharge period has been neglected. Randomized trials show growth benefits, particularly in boys, when nutrient-enriched diets (preterm formula or post-discharge formula) rather than term formula are fed after discharge, with effects persisting beyond the intervention period.

Neurodevelopment in children born small for gestational age: a randomized trial of nutrient-enriched versus standard formula and comparison with a reference breastfed group.

Objective: Many studies have shown that children born small for gestational age (SGA) are at a neurodevelopmental disadvantage. We have shown that nutrient enrichment of formula fed to term SGA infants improves their growth and hypothesized that it also would improve their neurodevelopmental outcome.

Design: A randomized, controlled trial of standard term-infant (n = 147) or nutrient-enriched (n = 152) formula for the first 9 months.

Is slower early growth beneficial for long-term cardiovascular health?

Background: Accelerated neonatal growth increases the later propensity to cardiovascular disease (CVD) in animals, whereas slower growth is thought to have a beneficial effect. To test this hypothesis in humans, we measured flow-mediated endothelium-dependent dilation (FMD) in a population subject to slower early growth and in healthy controls.

Methods And Results: High-resolution vascular ultrasound was used to measure the change in brachial artery diameter in response to reactive hyperemia in adolescents age 13 to 16 years who were either part of a cohort born preterm and followed up prospectively (n=216) or controls born at term (n=61).

Evaluation of air-displacement plethysmography in children aged 5-7 years using a three-component model of body composition.

The aim of the present study was to evaluate air-displacement plethysmography (ADP) in children aged 5-7 years. Body-composition measurements were obtained by ADP, (2)H dilution and anthropometry in twenty-eight children. Calculation of body volume by ADP was undertaken using adult and children's equations for predicting lung volume and surface area.

Bone densitometry in children assessed by dual x ray absorptiometry: uses and pitfalls.

The importance of bone growth and mineralisation during childhood for bone health in adult life is increasingly accepted, with both nutritional factors(1) and exercise(2) being recognised as influential for normal skeletal development. The appreciation that infancy and childhood are important periods of life for bone development has led to a need for suitable methods for monitoring bone health, both for research purposes and for clinical monitoring of individuals, and hence to an increasing use of bone densitometry in children. This review discusses the role and potential pitfalls of this technique.

Cholesterol metabolism in 8 to 12-year-old children born preterm or at term.

Unlabelled: Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease.

Aim: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term.

Factors associated with weaning in full term and preterm infants.

Background: The optimal age for the introduction of solid foods (weaning) in infants is poorly researched yet may have implications for both short and longer term health. Many parents do not comply with current guidelines.

Objective: To determine and compare the age at weaning in term appropriate size for gestational age (AGA), small for gestational age (SGA), and preterm infants, and factors associated with weaning age in these groups.

Low nutrient intake and early growth for later insulin resistance in adolescents born preterm.

Background: In animals, acceleration of neonatal growth is thought to increase the later propensity to insulin resistance and non-insulin-dependent diabetes, whereas slow growth as a consequence of undernutrition is thought to have a beneficial effect. To test this hypothesis in people, we measured fasting concentrations of 32-33 split proinsulin, a marker of insulin resistance, in adolescents born preterm who had participated in randomised intervention trials of neonatal nutrition, and in adolescents born at term.

Methods: We determined fasting 32-33 split proinsulin concentration in participants aged 13-16 years born preterm and randomised to receive a nutrient-enriched or lower-nutrient diet (n=216) or in a reference group born at term (n=61).

Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease?

Background: A high birth weight has been suggested to increase the later risk of obesity, as measured by body mass index, but, paradoxically, to decrease the later propensity to cardiovascular disease. Programming of more lean tissue rather than fat mass by a high birth weight might explain this paradox and also explain the association of birth weight with later body mass index. This concept has been inadequately tested.

Influence of leptin on arterial distensibility: a novel link between obesity and cardiovascular disease?

Background: The mechanisms by which obesity increases the risk of atherosclerotic cardiovascular disease (CVD) are poorly understood. In experimental models, leptin, a hormone produced by adipose tissue, has been shown adversely to affect vascular health. Therefore, we tested the hypothesis that high leptin concentrations are associated with lower arterial distensibility, an index of circulatory function relevant to the atherosclerotic process.

Energy requirements and body composition in stable pediatric intensive care patients receiving ventilatory support.

Energy requirements of pediatric intensive-care patients are unknown due to the difficulty of measuring total energy expenditure in free-living conditions. We investigated energy expenditure and body composition in stable pediatric intensive-care patients receiving long-term ventilatory support. Total energy expenditure and total body water were measured in 10 such patients using the doubly-labeled water method.

Double-blind, randomized trial of long-chain polyunsaturated fatty acid supplementation in formula fed to preterm infants.

Objective: We tested the hypothesis that balanced addition of long-chain polyunsaturated fatty acid (LCPUFA) to preterm formula during the first weeks of life would confer long-term neurodevelopmental advantage in a double-blind, randomized, controlled trial of preterm formula with and without preformed LCPUFA.

Methods: The participants were 195 formula-fed preterm infants (birth weight <1750 g, gestation <37 weeks) from 2 UK neonatal units and 88 breast milk-fed infants. Main outcome measures were Bayley Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 18 months and Knobloch, Passamanick and Sherrard's Developmental Screening Inventory at 9 months' corrected age.

Early nutrition and leptin concentrations in later life.

Background: Formula feeding or overweight in infancy may increase the later risk of obesity, but the mechanisms involved are uncertain. Because obesity is associated with high leptin concentrations relative to fat mass, programming of leptin concentrations may be one mechanism by which early nutrition influences later obesity.

Objective: We tested the hypothesis that high nutrient intake or formula feeding in infancy programs greater leptin concentrations relative to fat mass in later life.

Segmental bioelectrical impedance analysis in children aged 8-12 y: 2. The assessment of regional body composition and muscle mass.

Objectives: To investigate the potential of segmental bioelectrical impedance analysis (BIA) for assessing regional composition and muscle mass in children.

Design: Strengths of relationships were determined between (a) BIA indices of trunk, limbs or limb segments and (b) segment fat or fat-free mass (FFM) assessed using dual-energy X-ray absorptiometry (DXA); the extent of agreement was established between two independent models, based on DXA and BIA, of limb muscle and adipose tissue (AT) mass.

Subjects: Eighteen boys and 19 girls aged 8-12 y.

Segmental bioelectrical impedance analysis in children aged 8-12 y: 1. The assessment of whole-body composition.

Objectives: To investigate the potential of segmental bioelectrical impedance analysis (BIA) for estimating whole-body composition in children.

Design: Strengths of relationships were determined between indices of impedance or specific resistivities of body segments and reference four-component model (4-CM) assessments of body composition.

Subjects: Eighteen boys and 19 girls aged 8-12 y.

Randomized study comparing the efficacy of a novel manual breast pump with a mini-electric breast pump in mothers of term infants.

The objective of this study was to compare the efficacy of a mini-electric pump (MEP) and a novel manual breast pump (MP) designed to operate more physiologically. Sixty term breastfeeding mothers used the MP and MEP in randomized order 8 weeks postpartum, expressing for 10 minutes from each breast. Milk volume, fat content, and pattern of milk flow were measured.

Catch-up growth in small-for-gestational-age term infants: a randomized trial.

Background: Small-for-gestational-age (SGA) term infants are at risk of long-term growth deficits.

Objective: The objectives were to test the hypothesis that postnatal growth in SGA term infants can be altered by dietary intervention and to examine whether there is a critical window for nutritional programming of the growth trajectory during the first 9 mo postnatally.

Design: Healthy term (gestation > or =37 wk) infants with birth weights below the 10th centile were randomly assigned to receive standard term formula (TF; n = 147) or nutrient-enriched formula (EF; n = 152) for the first 9 mo; 175 breast-fed SGA term infants formed a reference group.

Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants.

Objectives: Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood. In a large efficacy and safety trial, we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes.

Participants And Intervention: Two hundred eighty-four infants (mean gestation: 30.

Randomized trial comparing the efficacy of a novel manual breast pump with a standard electric breast pump in mothers who delivered preterm infants.

Objective: The benefits of human milk for preterm infants are widely recognized, yet technological advances in milk expression have been slow. We compared the efficacy of a standard electric pump (EP; Egnell) used in 94% of United Kingdom neonatal units with a novel manual pump (MP; Avent ISIS) designed to operate more physiologically by simulating the infant's compressive action on the areola during breastfeeding.

Methods: We randomized 145 women who delivered infants of <35 weeks' gestation to use the MP or the EP and measured total milk volume expressed while using the randomized pump during the infant's hospital stay, pattern of milk output and creamatocrit of milk expressed during a test period in the second week, and pump characteristics by maternal questionnaire.

Birth weight, subsequent growth, and cholesterol metabolism in children 8-12 years old born preterm.

Aims: To test the hypothesis that plasma lipids, lipoproteins, and markers of cholesterol biosynthesis (lathosterol) and absorption efficiency (campesterol) in children aged 8-12 years are related to birth size and subsequent growth.

Methods: A total of 412 girls and boys weighing less than 1850 g at birth were studied. Birth weight, gestation, and weight at 18 months were recorded and followed up at 8-12 years.

Neonatal factors predicting childhood height in preterm infants: evidence for a persisting effect of early metabolic bone disease?

Objectives: Preterm infants are known to remain small during childhood. We previously found that evidence of neonatal metabolic bone disease was associated with reduced length at 18 months. We aimed to further investigate factors predicting childhood height and to test the hypothesis that evidence of early metabolic bone disease is associated with reduced later height.

Effects of size at birth, gestational age and early growth in preterm infants on glucose and insulin concentrations at 9-12 years.

Aims/hypothesis: To test the hypothesis that small size for gestation and poor postnatal growth in preterm infants is associated with higher fasting and post-load plasma glucose and insulin concentrations at 9-12 years of age.

Methods: Prospective follow-up at 9-12 years of 385 preterm children with birth weight less than 1850 g, who had anthropometry recorded at birth, 18 months and 7 years. Fasting plasma glucose, insulin, proinsulin and 32.

Whole body air displacement plethysmography compared with hydrodensitometry for body composition analysis.

Aims: To assess the acceptability and feasibility of whole body air displacement plethysmography in children and to determine its precision and agreement with hydrodensitometry, an appropriate reference method.

Methods: Age specific two component model equations were used to predict fat mass from body density in 22 children aged 8-12 years and in 10 adults for comparison of methods. Precision for each method was established from duplicate measurements.