The Relationship of Early Body Composition Changes and 1 year Neurodevelopment in VLBW Preterm InfantsSARA RAMEL, MD 1 , HEATHER GRAY, MPH2 , ELLEN W DEMERATH, PhD3

1 Department of Pediatrics, University of Minnesota, Minneapolis, MN, 2 Department of Maternal Fetal Medicine, University of Minnesota, Minneapolis, MN and 3 Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

Disclosure: I presented a 2015 Educational Webinar for Mead Johnson Nutrition

Results

SAMPLE: 34 appropriate for gestational age very low birth weight (VLBW )(<1500g) preterm infantsMEASURES: Body composition (fat mass, fat free mass and percent body fat) using air-displacement plethysmography (Pea Pod, COSMED USA) were measured weekly from birth to discharge (once stable enough to tolerate RA for 5 minutes). Data were also gathered on several clinical markers of illness. Total hospital caloric and protein deficits were calculated by taking the total amounts received throughout hospitalization and subtracting it from a calculated goal of 120 kcal/kg/day and 3.5 g of protein/kg/day, respectively. Neurodevelopment was tested using the Bayley Scales of Infant Development-III at 12 months CA. STATISTICAL ANALYSIS: Linear mixed effects models were used to test subject-specific changes in FFM from birth to discharge as predictors of Bayley scores (SAS v9.3). Potential confounders were included if they improved the models (higher R2 and lower AIC).

Background

Methods

Objective

Table 1. Descriptive characteristics

To investigate the relationship between early body composition changes and neurodevelopment at 1 year CA.

Summary & ConclusionsFat-free mass is an important biomarker of brain development and should be monitored closely throughout early life in very low birth weight preterm infants

Increased fat mass gains during hospitalization do not improve neurodevelopmental scores and may increase later metabolic risk

Additional research into strategies which increase fat-free mass gains without further increasing fat mass are needed to inform the nutritional and clinical management of VLBW preterm infants.

Increased fat-free mass gains prior to hospital discharge are associated with improved neurodevelopment at 12 months CA Even after controlling for important confounders, an additional

gain of 10 grams/per week of fat-free mass is associated with increased motor and cognitive scores by 2-3 points when measured at 12 months CA

Fat-free mass may be an important biomarker of brain development

More research into nutritional and non-nutritional interventions aimed at specifically increasing early fat-free mass gains is needed to improve long-term outcomes for VLBW preterm infants

Increased fat mass gains prior to hospital discharge are not associated with neurodevelopment at 12 months CA Early and rapid fat mass gains may be associated with

increased risk for later obesity and metabolic syndrome without additional neurodevelopmental benefit

Long-term studies investigating the associations between early body composition on both metabolic and neurodevelopmental outcomes are needed

Discussion

Table 3. Association of fat mass (g/wk) from birth to discharge and Bayley Scales of Infant Development-III scores at 12moCA

Table 2. Association of fat-free mass (g/wk) from birth to discharge and Bayley Scales of Infant Development-III scores at 12moCA

Preterm infants have less fat free mass and increased relative adiposity at term corrected gestational age (CA).

Early alterations in body composition may increase later risk for obesity and components of metabolic syndrome.

Increased weight gain during hospitalization and increased linear growth throughout the first year are associated with improved neurodevelopmental outcomes.