1 - Nutrition Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
2 - Egas Moniz School of Health & Science, Campus Universitário, Monte de Caparica, Portugal
3 - Nutrition and Metabolism, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
4 - CINTESIS@RISE, NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
5 - Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—School of Health and Science, Monte de Caparica, Portugal
6 - Nutrition Laboratory, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
7 - EnviHeB Lab, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
8 - Endocrinology Service, Hospital Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
9 - Neonatology Unit, Department of Pediatrics, Hospital Dona Estefânia and Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
10 - CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- 6th International Congress of the Egas Moniz. Monte da Caparica, 5-7/07/2023 (Poster)
Background: In standard fortification of human milk (HM), the HM macronutrient content is assumed, and a fixed amount of a multi-nutrient fortifier is added to achieve recommended nutrient intakes. In target fortification, the HM macronutrient content is regularly measured, guiding the addition of modular macronutrient supplements to the fortified HM, to achieve the nutritional targets more precisely.
Objective: To investigate whether this addition of modular supplements, unaccompanied by mineral supplementation, predispose to metabolic bone disease.
Methods: This is a secondary analysis of a larger study of infants born with <33 weeks gestational age. Fortifications based on the assumed (Group 1) or measured (Group 2) of the HM macronutrient content were compared, using low serum phosphate levels as an indicator of metabolic bone disease, and length growth as a surrogate of bone growth.
Results: Eighty-four infants were included, 35 in Group 1 and 49 in Group 2. During the exposure period, infants of Group 2 received higher mean fat (6.1 vs. 5.3 g/kg/day, p<0.001) and carbohydrate (13.0 vs. 11.7 g/kg/day, p<0.001) intakes; additionally, they exhibited lower mean serum phosphate (5.5 vs. 6.0 mg/dL, p=0.022) and faster mean length velocity (1.06 vs. 0.89 cm/week, p=0.003).
Conclusion: These findings suggest that feeding fortified HM with extra fat and carbohydrate content, unaccompanied by mineral supplementation, promote increased bone growth, as indicated by accelerated length growth, but with insufficiently mineralized osteoid, indicated by low serum phosphate levels. Intervention studies using direct biomarkers of bone mass content and mineral density are necessary to corroborate our findings.
Palavras-Chave: bone mineralization; human milk fortification; length growth; metabolic bone disease; preterm infants