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Mohamed SA, Elsawy HM, Bazaraa HM, Ghobashy MH, El Megied MAA. Point of care ultrasonography of quadriceps femoris muscle thickness for assessing nutritional status in critically ill children. Sci Rep 2025; 15:16946. [PMID: 40374802 PMCID: PMC12081691 DOI: 10.1038/s41598-025-01205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 05/05/2025] [Indexed: 05/18/2025] Open
Abstract
Muscle wasting occurs early during critical illness. It is associated with poor PICU outcomes. Ultrasonography can detect muscle thickness in critically ill children. Study quadriceps muscle thickness to assess the nutritional status on admission and follow the muscle thickness change throughout the first week of admission in PICU using point-of-care ultrasonography. This cohort study was conducted on 55 critically ill mechanically ventilated children aged between 2 months and 14 years. Serial measurements of quadriceps muscle thickness were done by ultrasound, during the first week of admission. Quadriceps muscle thickness decreased by 16.4% over the 1st week of admission. The muscle wasting was significantly correlated with STRONGkids score, the inability to achieve target caloric requirements during the 1st week of admission, duration of ventilation, PRISM score, and mortality. Point of care ultrasonography is an easy tool for assessing PICU muscle wasting. Loss of muscle mass during the first week of PICU admission is correlated to mortality, thus it can be utilized in predicting PICU outcomes.
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Affiliation(s)
- Shereen A Mohamed
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Hanan M Elsawy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hafez M Bazaraa
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed H Ghobashy
- Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Buck CO. Utilizing preterm infant body composition assessments to guide neonatal nutrition. Curr Opin Pediatr 2025; 37:191-197. [PMID: 39831772 PMCID: PMC11882371 DOI: 10.1097/mop.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
PURPOSE OF REVIEW The use of body composition to assess the quality of infant growth may add valuable information to pediatric clinical care. Preterm infants have differences in their fat and muscle mass development compared with infants born at term, which may be related to their early nutritional exposures. This review focuses on recent studies examining early nutrition in preterm infants and related body composition outcomes in the newborn period and beyond. RECENT FINDINGS Overall, the evidence shows that early nutrient delivery in parenteral nutrition and through formula supplementation or human milk fortification is associated with increased fat-free mass or lean mass in early life. However, future research is needed to fully understand the link between these body composition changes and longitudinal outcomes in preterm infants. SUMMARY Inclusion of body composition assessments in preterm infant nutrition research is critical to understand the factors associated with differences in adiposity and lean mass development in preterm infants. Medical fragility in preterm infants limits the routine use of body composition assessment tools which are currently validated, and additional studies are needed to thoroughly assess other methods which may be more feasible to integrate into bedside routine.
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Viswanathan S, Thoene M, Alja’nini Z, Alur P, McNelis K. Body Composition in Preterm Infants: Current Insights and Emerging Perspectives. CHILDREN (BASEL, SWITZERLAND) 2025; 12:53. [PMID: 39857884 PMCID: PMC11764066 DOI: 10.3390/children12010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 12/31/2024] [Accepted: 12/31/2024] [Indexed: 01/27/2025]
Abstract
In recent years, significant advancements in respiratory and nutritional care have markedly improved the survival rates of preterm infants and enhanced long-term health outcomes. Despite these improvements, emerging research highlights the lasting impacts of early growth patterns on an individual's health trajectory. Adults born prematurely face a higher incidence of health issues related to their early birth. The American Academy of Pediatrics recommends that preterm infants should achieve growth rates similar to those of fetuses, with clinicians emphasizing nutrition delivery to help these infants reach their expected weight for gestational age. However, this approach often results in altered body composition, characterized by increased fat mass and decreased fat-free mass compared to full-term infants. Air displacement plethysmography stands out as a highly reliable method for measuring preterm body composition, while DEXA scans, despite their reliability, tend to overestimate body fat. Other methods include bioelectric impedance, isotope dilution, MRI, ultrasound, and skinfold thickness, each with its own strengths and limitations. In this paper, we aim to raise awareness among neonatal clinicians about the importance of achieving acceptable neonatal body composition. We discuss the pros and cons of different body composition measurement methods, the impact of nutrition and other factors on body composition in preterm infants, long-term follow-up data, and the potential use of body composition data to tailor nutritional interventions in NICU and post-discharge settings. This comprehensive approach is designed to optimize health outcomes for preterm newborns by focusing on their body composition from an early stage.
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Affiliation(s)
- Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children’s Hospital, University of Central Florida College of Medicine, Orlando, FL 32827, USA
| | - Melissa Thoene
- Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Zaineh Alja’nini
- Division of Neonatology, Department of Pediatrics, MercyKids Children’s Hospital, University of Missouri School of Medicine, Springfield Campus, Springfield, MO 65804, USA;
| | - Pradeep Alur
- Division of Neonatology, Department of Pediatrics, Hampden Medical Center, Penn State Health, Enola, PA 17025, USA;
| | - Kera McNelis
- Division of Neonatology, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA;
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Ranger BJ, Lombardi A, Kwon S, Loeb M, Cho H, He K, Wei D, Park J. Ultrasound for assessing paediatric body composition and nutritional status: Scoping review and future directions. Acta Paediatr 2025; 114:14-23. [PMID: 39295087 PMCID: PMC11627447 DOI: 10.1111/apa.17423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/21/2024]
Abstract
AIM This scoping review aims to assess the utility of ultrasound as a prospective tool in measuring body composition and nutritional status in the paediatric population. We provide a comprehensive summary of the existing literature, identify gaps, and propose future research directions. METHODS We conducted a systematic scoping review following the PRISMA Extension for Scoping Reviews guidelines. This involved screening titles and abstracts of relevant studies, followed by a detailed full-text review and extraction of pertinent data. RESULTS We identified and synthesised 34 articles. The review revealed that while ultrasound has been used to assess body composition and bone properties in children, significant gaps remain in the literature. These include limited studies on ultrasound performance, insufficient attention to relevant sample characteristics, reliance on manual image measurements, and limited sample diversity. CONCLUSION Point-of-care ultrasound shows significant promise for assessing paediatric body composition and nutritional status. To validate and enhance its effectiveness, further research is needed. Future studies should include larger and more diverse patient cohorts and conduct longitudinal investigations to evaluate nutritional interventions. Additionally, developing artificial intelligence (AI) for standardising and automating data interpretation will be crucial in improving the accuracy and efficiency of ultrasound assessments.
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Affiliation(s)
- Bryan J. Ranger
- Department of EngineeringBoston CollegeChestnut HillMassachusettsUSA
- William F. Connell School of NursingBoston CollegeChestnut HillMassachusettsUSA
| | - Allison Lombardi
- William F. Connell School of NursingBoston CollegeChestnut HillMassachusettsUSA
| | - Susie Kwon
- William F. Connell School of NursingBoston CollegeChestnut HillMassachusettsUSA
| | - Mary Loeb
- Department of EngineeringBoston CollegeChestnut HillMassachusettsUSA
| | - Hayoung Cho
- Department of EngineeringBoston CollegeChestnut HillMassachusettsUSA
| | - Keshi He
- Department of EngineeringBoston CollegeChestnut HillMassachusettsUSA
| | - Donglai Wei
- Department of Computer ScienceBoston CollegeChestnut HillMassachusettsUSA
| | - Jinhee Park
- William F. Connell School of NursingBoston CollegeChestnut HillMassachusettsUSA
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Buck CO, Santoro KL, Shabanova V, Martin CR, Taylor SN. Establishing feasibility and reliability of subcutaneous fat measurements by ultrasound in very preterm infants. Pediatr Res 2024; 96:1724-1731. [PMID: 39069538 PMCID: PMC11772127 DOI: 10.1038/s41390-024-03439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/23/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Regional fat distribution may be a marker of metabolic health and brain growth in preterm infants. Point of care ultrasound has been used to assess regional fat in term infants but has not been used widely in preterm infants. OBJECTIVE To longitudinally quantify changes in body composition metrics using bedside ultrasound in very preterm infants. STUDY DESIGN Very preterm infants (N = 69) were enrolled after birth and body composition assessments were done through 36 completed weeks' postmenstrual age (PMA). Linear mixed effects regression was used to model change in body composition assessments over time. RESULTS There was an average increase across PMA for each body composition outcome. Biceps ultrasound subcutaneous fat (SQF) thickness increased by 0.11 mm (95% CI: 0.09, 0.13) each postmenstrual week. Triceps, subscapular, and abdominal ultrasound SQF remained constant through 28 weeks' PMA, then increased each week through 36 completed weeks' PMA. The inter-rater and intra-rater intraclass correlation coefficients for the ultrasound SQF measures ranged from 85.8 to 99.9. CONCLUSION Use of ultrasound as a novel method to assess regional fat distribution in very preterm infants is feasible and reliable. IMPACT Regional fat distribution may be a marker of metabolic health and brain growth in preterm infants. Gold standard body composition assessments may not be feasible in medically fragile very preterm infants. This study assesses longitudinally changes in regional adiposity development using bedside ultrasound techniques in a multicenter cohort of very preterm infants. Results of this study show that bedside ultrasound as a novel method to assess regional subcutaneous fat distribution and development in very preterm infants is both feasible and reliable.
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Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - Kristin L Santoro
- Department of Neonatology, Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, MA, USA
| | | | - Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Yumani DFJ, de Jongh D, Ket JCF, Lafeber HN, van Weissenbruch MM. Body composition in preterm infants: a systematic review on measurement methods. Pediatr Res 2023; 93:1120-1140. [PMID: 35995939 DOI: 10.1038/s41390-022-02262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/20/2022] [Accepted: 07/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are several methods to measure body composition in preterm infants. Yet, there is no agreement on which method should be preferred. METHODS PubMed, Embase.com, Wiley/Cochrane Library, and Google Scholar were searched for studies that reported on the predictive value or validity of body composition measurements in preterms, up to 6 months corrected age. RESULTS Nineteen out of 1884 identified studies were included. Predictive equations based on weight and length indices, body area circumferences, skinfold thickness, bioelectrical impedance, and ultrasound did not show agreement with body composition measured with air displacement plethysmography (ADP), dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), or isotope dilution. ADP agreed well with fat mass density measured by isotope dilution (bias -0.002 g/ml, limits of agreement ±0.012 g/ml, n = 14). Fat mass percentage measured with ADP did not agree well with fat mass percentage measured by isotope dilution (limits of agreement up to ±5.8%) and the bias between measurements was up to 2.2%. DXA, MRI, and isotope dilution were not compared to another reference method in preterms. CONCLUSIONS DXA, ADP, and isotope dilution methods are considered trustworthy validated techniques. Nevertheless, this review showed that these methods may not yield comparable results. IMPACT Based on validation studies that were conducted in a limited number of study subjects, weight and length indices, body area circumferences, skinfold thickness, bioelectrical impedance, and ultrasound seem to be a poor representation of body composition in preterm infants. DXA, ADP, and isotope dilution methods are considered trustworthy and validated techniques. Nevertheless, these methods may not yield comparable results.
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Affiliation(s)
- Dana F J Yumani
- Department of Pediatrics, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Dide de Jongh
- Faculty of Science, VU University, Amsterdam, The Netherlands
- Faculty of Medical Ethics and Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Harrie N Lafeber
- Department of Pediatrics, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
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Gridneva Z, Rea A, Lai CT, Tie WJ, Kugananthan S, Warden AH, Perrella SL, Murray K, Geddes DT. Human Milk Macronutrients and Bioactive Molecules and Development of Regional Fat Depots in Western Australian Infants during the First 12 Months of Lactation. Life (Basel) 2022; 12:life12040493. [PMID: 35454985 PMCID: PMC9029383 DOI: 10.3390/life12040493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 12/19/2022] Open
Abstract
We investigated associations between intakes of human milk (HM) components (macronutrients and biologically active molecules) and regional fat depots development in healthy term infants (n = 20) across the first year of lactation. Infant limb (mid-arm and mid-thigh) lean and fat areas were assessed by ultrasound imaging at 2, 5, 9 and 12 months of age. Concentrations of HM total protein, whey protein, casein, adiponectin, leptin, lysozyme, lactoferrin, secretory IGA, total carbohydrates, lactose, HM oligosaccharides (total HMO, calculated) and infant 24-h milk intake were measured, and infant calculated daily intakes (CDI) of HM components were determined. This pilot study shows higher 24-h milk intake was associated with a larger mid-arm fat area (p = 0.024), higher breastfeeding frequency was associated with larger mid-arm (p = 0.008) and mid-thigh (p < 0.001) fat areas. Lysozyme (p = 0.001) and HMO CDI (p = 0.004) were time-dependently associated with the mid-arm fat area. Intakes of HM components and breastfeeding parameters may modulate infant limb fat depots development during the first year of age and potentially promote favorable developmental programming of infant body composition; however, further studies are needed to confirm these findings.
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Affiliation(s)
- Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
- Correspondence: ; Tel.: +61-8-6488-4467
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Murdoch, WA 6150, Australia;
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
| | - Wan Jun Tie
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
| | - Sambavi Kugananthan
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
| | - Ashleigh H. Warden
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
| | - Sharon L. Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (A.H.W.); (S.L.P.); (D.T.G.)
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Gridneva Z, Rea A, Lai CT, Tie WJ, Kugananthan S, Murray K, Hartmann PE, Geddes DT. Development of Visceral and Subcutaneous-Abdominal Adipose Tissue in Breastfed Infants during First Year of Lactation. Nutrients 2021; 13:3294. [PMID: 34579170 PMCID: PMC8465271 DOI: 10.3390/nu13093294] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate relationships between infant abdominal visceral and subcutaneous adiposity and human milk (HM) components and maternal body composition (BC) during first year of lactation. Subcutaneous-abdominal depth (SAD), subcutaneous-abdominal fat area (SFA), visceral depth (VD) and preperitoneal fat area of 20 breastfed infants were assessed at 2, 5, 9 and 12 months using ultrasound. Maternal BC was determined with bioimpedance spectroscopy. HM macronutrients and bioactive components concentrations and infant 24-h milk intake were measured and calculated daily intakes (CDI) determined. Maternal adiposity associated with infant SFA (negatively at 2, 5, 12, positively at 9 months, all overall p < 0.05). 24-h milk intake positively associated with infant SAD (p = 0.007) and VD (p = 0.013). CDI of total protein (p = 0.013), total carbohydrates (p = 0.004) and lactose (p = 0.013) positively associated with SFA. Lactoferrin concentration associated with infant VD (negatively at 2, 12, positively at 5, 9 months, overall p = 0.003). CDI of HM components and maternal adiposity have differential effects on development of infant visceral and subcutaneous abdominal adiposity. Maintaining healthy maternal BC and continuing breastfeeding to 12 months and beyond may facilitate favourable BC development reducing risk of obesity.
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Affiliation(s)
- Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Murdoch, WA 6150, Australia;
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
| | - Wan Jun Tie
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
| | - Sambavi Kugananthan
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia;
| | - Peter E. Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (C.T.L.); (W.J.T.); (S.K.); (P.E.H.); (D.T.G.)
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Geddes DT, Gridneva Z, Perrella SL, Mitoulas LR, Kent JC, Stinson LF, Lai CT, Sakalidis V, Twigger AJ, Hartmann PE. 25 Years of Research in Human Lactation: From Discovery to Translation. Nutrients 2021; 13:3071. [PMID: 34578947 PMCID: PMC8465002 DOI: 10.3390/nu13093071] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023] Open
Abstract
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
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Affiliation(s)
- Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Leon Robert Mitoulas
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
- Medela, AG, Lättichstrasse 4b, 6340 Baar, Switzerland
| | - Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Lisa Faye Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | - Vanessa Sakalidis
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
| | | | - Peter Edwin Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (Z.G.); (S.L.P.); (L.R.M.); (J.C.K.); (L.F.S.); (C.T.L.); (V.S.); (P.E.H.)
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10
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Kopp T, Codipilly C, Potak D, Fishbein J, Lamport L, Kurepa D, Weinberger B. Serum ghrelin is associated with early feeding readiness but not growth in premature infants. J Neonatal Perinatal Med 2021; 15:147-154. [PMID: 33935112 DOI: 10.3233/npm-200664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Feeding tolerance among premature infants is unpredictable using clinical parameters. Ghrelin, a peptide hormone, acts on the hypothalamus to increase hunger and gut motility. It is present in fetal tissues, promotes intestinal maturation, and is secreted in milk. We hypothesized that higher serum ghrelin levels on days 0-7 are associated with improved feeding tolerance and growth in premature infants. METHODS Infants (< 1500 g birth weight, n = 36) were recruited on day (D) 0-7. Serum ghrelin was measured by ELISA on D 0-7, D 10-14, and D 24-32, and milk ghrelin in a feeding concurrent with each serum sample. Feeding tolerance was assessed as days to first and full enteral feeds. Growth was quantified as both weight and adipose and muscle deposition by ultrasound. RESULTS Mean serum ghrelin levels decreased from D 0-7 to D 24-32. Higher ghrelin levels on D 0-7 were correlated with shorter time to first enteral feeding, but not with time to full enteral feeds, rate of weight gain, or rate of accretion of muscle or adipose tissue. Milk ghrelin was not related to serum ghrelin or growth. Abdominal and suprascapular muscle and adipose increased during the first month, but weight gain correlated only with the rate of accretion of abdominal adipose. CONCLUSIONS Elevated serum ghrelin in the first days of life may contribute to gut motility and readiness to feed. Weight gain in premature infants may primarily indicate abdominal fat accumulation, suggesting that ultrasound measurement of muscle accretion is a better marker for lean body growth.
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Affiliation(s)
- T Kopp
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - C Codipilly
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - D Potak
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - J Fishbein
- Division of Biostatistics, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - L Lamport
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - D Kurepa
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - B Weinberger
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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Alja'nini Z, McNelis KM, Viswanathan S, Goddard GR, Merlino-Barr S, Collin M, Groh-Wargo S. Infant body composition assessment in the neonatal intensive care unit (NICU) using air displacement plethysmography: Strategies for implementation into clinical workflow. Clin Nutr ESPEN 2021; 43:212-222. [PMID: 34024517 DOI: 10.1016/j.clnesp.2021.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/03/2021] [Accepted: 04/10/2021] [Indexed: 11/19/2022]
Abstract
Nutritional management is integral to infant care in the neonatal intensive care unit (NICU). Recent research on body composition that specifically evaluated fat and fat-free mass has improved our understanding of infant growth and nutritional requirements. The need for body composition monitoring in infants is increasingly recognized as changes in fat mass and fat-free mass associated with early growth can impact clinical outcomes. With the availability of air displacement plethysmography (ADP) as a noninvasive method for assessing infant body composition and published normative gestational age- and sex-specific body composition curves, it is justifiable to integrate this innovation into routine clinical care. Here we describe our experiences in implementing body composition measurement using ADP in routine clinical care in different NICU settings.
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Affiliation(s)
- Zaineh Alja'nini
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA.
| | - Kera Michelle McNelis
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Perinatal Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Gillian R Goddard
- Division of Pediatric and General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Merlino-Barr
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center Affiliated with Case Western Reserve University, Cleveland, OH, USA
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Nagel E, Hickey M, Teigen L, Kuchnia A, Holm T, Earthman C, Demerath E, Ramel S. Can Ultrasound Measures of Muscle and Adipose Tissue Thickness Predict Body Composition of Premature Infants in the Neonatal Intensive Care Unit? JPEN J Parenter Enteral Nutr 2020; 45:323-330. [DOI: 10.1002/jpen.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Emily Nagel
- Department of Food Science and Nutrition University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Marie Hickey
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Levi Teigen
- Department of Gastroenterology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Adam Kuchnia
- Department of Nutritional Sciences University of Wisconsin–Madison Madison Wisconsin USA
| | - Tara Holm
- Department of Radiology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Carrie Earthman
- Department of Behavioral Health and Nutrition University of Delaware Newark Delaware USA
| | - Ellen Demerath
- School of Public Health University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Sara Ramel
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
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Nagel E, Hickey M, Teigen L, Kuchnia A, Curran K, Soumekh L, Earthman C, Demerath E, Ramel S. Clinical Application of Body Composition Methods in Premature Infants. JPEN J Parenter Enteral Nutr 2020; 44:785-795. [DOI: 10.1002/jpen.1803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Emily Nagel
- Department of Food Science and NutritionUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Marie Hickey
- Department of PediatricsUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Levi Teigen
- Department of GastroenterologyUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Adam Kuchnia
- Department of Nutritional SciencesUniversity of Wisconsin‐Madison Madison WI USA
| | - Kent Curran
- Department of PediatricsAlbany Medical Center Albany NY USA
| | - Lisa Soumekh
- School of MedicineUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | | | - Ellen Demerath
- School of Public HealthUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Sara Ramel
- Department of PediatricsUniversity of Minnesota‐Twin Cities Minneapolis MN USA
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14
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Ng KWP, Dietz AR, Johnson R, Shoykhet M, Zaidman CM. Reliability of bedside ultrasound of limb and diaphragm muscle thickness in critically ill children. Muscle Nerve 2018; 59:88-94. [PMID: 30144318 DOI: 10.1002/mus.26327] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We evaluated the reliability of measuring muscle thickness with ultrasound in limbs and diaphragms of critically ill children and determined the sensitivity of these measures to quantitate muscle atrophy over time. METHODS An expert and trained novice sonographers prospectively measured limb and diaphragm muscle thickness in 33 critically ill children. RESULTS Expert and novice intrarater and interrater reliability were similar. Intraclass correlations (ICC) and coefficients of variation (CoV) were better in limbs (ICC > 0.9; CoV 3.57%-5.40%) than in diaphragm (ICC > 0.8; CoV novice 11.88%, expert, 12.28%). Mean relative difference in all muscles was small (1%-8%). Limits of agreement of the relative difference were smaller in limb (<13%-18%) than in diaphragm (<38%) muscles. DISCUSSION Muscle thickness is reliably measured with ultrasound by trained examiners in critically ill children. Our approach detects atrophy >13% in limb and >38% in diaphragm muscles. The smaller detectable change in limb muscles is likely due to their greater thickness. Muscle Nerve 59:88-94, 2019.
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Affiliation(s)
- Kay W P Ng
- Department of Medicine, Division of Neurology, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | | | - Ryan Johnson
- Division of Critical Care Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA
| | - Michael Shoykhet
- Children's Research Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, USA
| | - Craig M Zaidman
- Department of Neurology, Neuromuscular Division, Washington University in St Louis, St Louis, Missouri, 63110, USA
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15
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Gridneva Z, Rea A, Hepworth AR, Ward LC, Lai CT, Hartmann PE, Geddes DT. Relationships between Breastfeeding Patterns and Maternal and Infant Body Composition over the First 12 Months of Lactation. Nutrients 2018; 10:E45. [PMID: 29303992 PMCID: PMC5793273 DOI: 10.3390/nu10010045] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022] Open
Abstract
Breastfeeding has been implicated in the establishment of infant appetite regulation, feeding patterns and body composition (BC). A holistic approach is required to elucidate relationships between infant and maternal BC and contributing factors, such as breastfeeding parameters. Associations between maternal and breastfed term infant BC (n = 20) and feeding parameters during first 12 months of lactation were investigated. BC was measured at 2, 5, 9 and/or 12 months postpartum with ultrasound skinfolds (US; infants only) and bioimpedance spectroscopy (infants and mothers). 24-h milk intake (MI) and feeding frequency (FFQ) were measured. Higher FFQ was associated with larger 24-h MI (p ≤ 0.003). Higher 24-h MI was associated with larger infant fat mass (FM) (US: p ≤ 0.002), greater percentage FM (US: p ≤ 0.008), greater FM index (FMI) (US: p ≤ 0.001) and lower fat-free mass index (FFMI) (US: p = 0.015). Lower FFQ was associated with both larger FFM (US: p ≤ 0.001) and FFMI (US: p < 0.001). Greater maternal adiposity was associated with smaller infant FFM measured with US (BMI: p < 0.010; %FM: p = 0.004; FMI: p < 0.011). Maternal BC was not associated with FFQ or 24-h MI. These results reinforce that early life is a critical window for infant programming and that breastfeeding may influence risk of later disease via modulation of BC.
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Affiliation(s)
- Zoya Gridneva
- School of Molecular Sciences, M310, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
| | - Alethea Rea
- Centre for Applied Statistics, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
| | - Anna R Hepworth
- School of Molecular Sciences, M310, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia.
| | - Ching T Lai
- School of Molecular Sciences, M310, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
| | - Peter E Hartmann
- School of Molecular Sciences, M310, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
| | - Donna T Geddes
- School of Molecular Sciences, M310, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
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Valla FV, Young DK, Rabilloud M, Periasami U, John M, Baudin F, Vuillerot C, Portefaix A, White D, Ridout JA, Meyer R, Gaillard Le Roux B, Javouhey E, Pathan N. Thigh Ultrasound Monitoring Identifies Decreases in Quadriceps Femoris Thickness as a Frequent Observation in Critically Ill Children. Pediatr Crit Care Med 2017; 18:e339-e347. [PMID: 28650903 DOI: 10.1097/pcc.0000000000001235] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring. DESIGN A prospective bedside observational study. SETTING Two PICUs. PATIENTS Mechanically ventilated critically ill children were 15 years and younger. INTERVENTIONS Transverse and longitudinal axis measurements of quadriceps femoris anterior thickness were undertaken using bedside ultrasound. The average of four measurement values was recorded. The location of measurement was marked for consistency within subsequent measurements by the same or another trained operator, to assess intra- and interoperator repeatability and reproducibility of the technique. Where feasible, serial measurements were undertaken until the time of extubation in a group of children with prolonged PICU stay (> 5 d). MEASUREMENTS AND MAIN RESULTS Seventy-three children were enrolled to assess intra- and interoperator ultrasound reliability. Their median (25-75 interquartile range) age and weight were 30 months (4.5-96) and 10 kg (5-23.5). In the intraoperator repeatability study, mean relative difference in quadriceps femoris muscle thickness was 0.36% ± 2.5% (lower and upper limits of agreement: -4.5/+5.2%). In the interoperator reproducibility study, intraclass correlation coefficient was 0.998. In the 17 children monitored over their PICU stay, quadriceps femoris thickness significantly decreased at day 5 by 9.8% (p = 0.006) and by 13.3% (< 0.001) at the last performed measurement. CONCLUSIONS Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.
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Affiliation(s)
- Frederic V Valla
- 1Pediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 2Physiotherapy Department, Addenbrooke's Hospital, Cambridge, United Kingdom. 3Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France. 4Université Lyon 1, Villeurbanne, France. 5CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France. 6Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. 7Pediatric Neurology and Rehabilitation Unit, Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France. 8EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU-Lyon, Bron, France. 9Department Paediatrics, Imperial College London, St. Mary's Campus, London, United Kingdom. 10Pediatric Intensive Care Unit, Réanimation Pédiatrique, Hôpital Mère enfants, CHU de Nantes, Nantes cedex, France. 11Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 12Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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Ashton JJ, Johnson MJ, Pond J, Crowley P, Dimitrov BD, Pearson F, Beattie RM. Assessing the growth of preterm infants using detailed anthropometry. Acta Paediatr 2017; 106:889-896. [PMID: 28240375 DOI: 10.1111/apa.13804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM Preterm infants display altered body composition compared to term infants, and weight gain is a crude indicator body composition. Childhood mid-upper arm circumference (MUAC) is a measure of nutritional status. This study investigates MUAC and mid-thigh circumference (MTC) to monitor growth in preterm infants. METHODS Preterm infants (<30-week gestation) were recruited. MUAC, MTC, weight, length and head circumference (HC) were measured at recruitment and weekly intervals until discharge. Descriptive, correlation and regression analyses were used. RESULTS Ninety-three infants were recruited. Median measurement duration was eight weeks (1-19). Median gestational age was 27 weeks (23-29). Analysis by curve estimation displayed a mean increase of 2.58 mm/week (left MUAC) (p ≤ 0.0001), 2.56 mm/week (right MUAC) (p ≤ 0.0001), 4.16 mm/week (left MTC) (p ≤ 0.0001), 4.20 mm/week (right MTC) (p ≤ 0.0001). Coefficients of determination (R2 ) were calculated using a growth regression model for MUAC and MTC (0.866-0.917); measures were comparable to growth modelling of weight (0.913), length (0.945) and HC (0.928). High concordance between left and right MUAC and MTC generated a Pearson's correlation coefficient of 0.999 (MUAC) (p ≤ 0.001) and 0.994 (MTC) (p ≤ 0.001). CONCLUSION Data demonstrate the potential utility of MUAC and MTC as additional measures of growth in preterm infants that are reproducible over time. There is potential to gain insights to improve lean-mass accretion in preterm infants.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark J. Johnson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Jenny Pond
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Philippa Crowley
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Borislav D. Dimitrov
- Primary Care and Population Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - Freya Pearson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
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Determinants of body composition in breastfed infants using bioimpedance spectroscopy and ultrasound skinfolds-methods comparison. Pediatr Res 2017; 81:423-433. [PMID: 27828939 DOI: 10.1038/pr.2016.235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/30/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurate, noninvasive, and inexpensive methods are required to measure infant body composition. Ultrasound (US) and bioimpedance spectroscopy (BIS) have been validated in adults and introduced in pediatric populations. The aim of this study was to evaluate the performance of both methods in determining percentage fat mass (%FM) in breastfed infants. METHODS %FM of 2, 5, 9, and 12 mo-old healthy, breastfed term infants (n = 58) was calculated using BIS-derived total body water equations and skinfold equations then compared with reference models. Skinfolds were measured with US at two and four sites (biceps, suprailiac and/or triceps, and subscapular). RESULTS %FM differed widely within and between methods, with the degree of variation affected by infant age/sex. Not a single method/equation was consistent with the distributions of appropriate reference values for all age/sex groups. Moderate number of matches with references values (13-24 out of 36) was seen for both types of equations. High number of matches (25-36) was seen for US skinfold-based equations. %FM values calculated from US and BIS were not significantly different (P = 0.35). CONCLUSION Both BIS and US are practical for predicting %FM in infants. BIS calculations are highly dependent upon an appropriate set of validated age-matched equations.
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Comparing different methods of human breast milk fortification using measured v. assumed macronutrient composition to target reference growth: a randomised controlled trial. Br J Nutr 2015; 115:431-9. [PMID: 26627899 DOI: 10.1017/s0007114515004614] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The variable content of human breast milk suggests that its routine fortification may result in sub-optimal nutritional intakes and growth. In a pragmatic trial, we randomised infants born below 30 weeks of gestation to either the intervention (Igp) of fortifying milk on measured composition according to birth weight criteria and postmenstrual age (PMA) or our routine practice (RPgp) of fortifying on assumed milk composition to target 3·8-4·4 g protein/kg per d and 545-629 kJ/kg per d. Milk composition was measured using the MIRIS® Human Milk Analyser. Percentage fat mass (%FM) was measured using PEA POD (COSMED). The effects of macronutrient intakes and clinical variables on growth were assessed using mixed model analysis. Mean measured protein content (1·6 g/100 ml) was higher than the assumed value (1·4 g/100 ml), often leading to lower amounts of fortifier added to the milk of intervention infants. At discharge (Igp v. RPgp), total protein (3·2 (SD 0·3) v. 3·4 (SD 0·4) g; P=0·067) and energy (456 (SD 39) v. 481 (SD 48) kJ; P=0·079) intakes from all nutrition sources, weight gain velocity (11·4 (SD 1·4) v. 12·1 (SD 1·6) g/kg per d; P=0·135) and %FM (13·7 (SD 3·6) v.13·6 (SD 3·5) %; P=0·984) did not significantly differ between groups. A protein intake >3·4 g/kg per d reduced %FM by 2%. Nutrition and growth was not improved by targeting milk fortification according to birth weight criteria and PMA using measured milk composition, compared with routine practice. Targeting fortification on measured composition is labour intensive, requiring frequent milk sampling and precision measuring equipment, perhaps reasons for its limited practice. Guidance around safe upper levels of milk fortification is needed.
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McLeod G, Simmer K, Sherriff J, Nathan E, Geddes D, Hartmann P. Feasibility study: Assessing the influence of macronutrient intakes on preterm body composition, using air displacement plethysmography. J Paediatr Child Health 2015; 51:862-9. [PMID: 25873446 DOI: 10.1111/jpc.12893] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
AIM Preterm nutrition guidelines target nutrient accretion and growth at intrauterine rates, yet at term equivalent age, the phenotype of the preterm infant differs from that of term infants. Monitoring early changes in preterm body composition (BC) in response to macronutrient intakes may facilitate our understanding of how best to meet preterm nutrition and growth targets. METHOD Macronutrient intakes based on milk analysis were calculated from birth for infants born <33 weeks gestation. BC was measured in the PEA POD when infants were thermodynamically stable, free of intravenous lines and independent of respiratory support. Subsequent BC measurements were taken at least fortnightly until term age. Regression analysis was used to assess macronutrient influences on changes in BC. RESULTS Median (range) gestation and birthweight of preterm infants (n = 27) were 29 (25-32) weeks and 1395 (560-2148) g, respectively. The youngest corrected gestational and postnatal ages that infants qualified for a PEA POD measurement were 31.86 and 1.43 weeks, respectively. Fat and total energy intakes were positively associated with increasing fat mass. Protein (with carbohydrate) intake was positively associated with increasing fat-free mass. CONCLUSION Preterm infants can be measured in the PEA POD as early as 31 weeks corrected gestational age and the method appears sufficiently sensitive to detect influences of macronutrient intake on changes in BC.
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Affiliation(s)
- Gemma McLeod
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jill Sherriff
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth Nathan
- Women and Infants' Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Donna Geddes
- School of Biomedical, Biomolecular and Chemical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Hartmann
- School of Biomedical, Biomolecular and Chemical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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