Abstract :
Keywords Preterm; Fortifier; Human milk; Breast milk; Body composition Highlights * No difference in body composition of preterm babies at term fed human milk versus cow milk diet * No impact on body composition of source of protein in human milk fortifier * No differences in feed tolerance, days of parenteral nutrition, exclusive breast-feeding at discharge * No difference in length of stay, core outcomes or weight gain between birth and discharge Abstract Background Preterm infants receiving a diet of exclusive human milk compared to predominantly preterm formula have lower weight and non-adipose tissue mass by term. Human milk fortification is recommended. However, it is not known if the protein source affects body composition. Aims To compare the effect of an exclusive human milk based diet (intervention) with a diet containing cow milk products (control) on body composition. Participants Infants born below 30 weeks gestation. Study design Randomised multicentre, open label, controlled trial. Infants preferentially received their own mother's milk. Infants were randomised to either an exclusive human milk diet (human milk formula to make up a shortfall in own mother's milk and human milk derived fortifier) or cow milk-based supplementation (preterm formula to make up a shortfall in own mother's milk and cow milk-based fortifier). Fortification began at an enteral intake of 150 ml/kg/day. Infants underwent whole-body magnetic resonance imaging at term. Primary outcome Body composition (adipose tissue (ATM) and non-adipose tissue mass (N-ATM)) at term. Results We randomly assigned 38 infants to intervention (n = 19) and control arms (n = 19). Primary outcomes were analysed in 15 infants in the intervention arm and 12 in the control arm. The estimates of the effect of the intervention following adjustment for length and sex, were non-significant (ATM (kg): 0.137, 95 % confidence interval (CI) -0.01, 0.29; N-ATM: -0.137; -0.01, 0.29). Conclusions We identified no clinically relevant differences in body composition in preterm babies Abbreviations ATM, adipose tissue mass; N-ATM, non-adipose tissue mass; OMM, own mother's milk; AT, adipose tissue; NNRD, National Neonatal Research Database Author Affiliation: (a) Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom (b) Chelsea and Westminster NHS Foundation Trust, United Kingdom (c) Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (d) William Harvey Hospital, Ashford, United Kingdom * Corresponding author at: Section of Neonatal Medicine, Chelsea and Westminster Campus, Imperial College London, 369 Fulham Road, London SW10 9NH, United Kingdom. Article History: Received 24 May 2022; Accepted 23 June 2022 Byline: Sabita Uthaya [s.uthaya@imperial.ac.uk] (a,b,*), Suzan Jeffries (a,b), Izabela Andrzejewska (a,b), Vimal Vasu [vimal.vasu@nhs.net] (d), Nicholas D Embleton [Nicholas.Embleton@newcastle.ac.uk] (c), Neena Modi [n.modi@imperial.ac.uk] (a,b)