Nutrition and early life programming of health:focus on preterm birth and infant feeding in relation to energy-balance and related traits in adulthood

Abstract Increasing evidence suggests that early-life exposures influence the health and wellbeing in later life. Preterm birth (before 37 weeks of gestation) is associated with an increased risk of cardiometabolic disorders in later life. This risk may be partly mediated by nutrition along the course of life. As a part of the Helsinki Study of Very Low Birth Weight Adults, the aim of the present work was to investigate the association between energy and macronutrient intake during the first weeks after preterm birth at very low birth weight (VLBW, birthweight < 1500g) and body composition and energy metabolism in adulthood (n=127). A further aim was to examine traits related to eating disorders and food and nutrient intake in young adults born early (<34 weeks of gestational age, n=191) and late (34-<37 weeks of gestational age, n=364) preterm and term-born controls (n=657) from the ESTER study and Arvo Ylppö Longitudinal study. Relatively low neonatal energy and nutrient intakes during the first weeks of life of infants born at VLBW predicted body composition and energy metabolism in adulthood. When adjusted for sex, age, gestational age and birth-weight SD score every 1g/kg/day greater early protein intake was associated with 10.4% (95% CI 2.4, 19.1) higher lean body mass (LBM) and 8.5% (0.2, 17.0) higher resting energy expenditure (REE). The ratio of REE/LBM however was 5.5% (0.8, 10.0) lower. In addition, higher protein and energy intakes predicted lower energy intake per unit of LBM in young adults. These associations were only partly mediated by early growth. Young women born early preterm reported on average healthier body image and fewer traits related to eating disorders when compared with term-born peers. However, their adherence to recommended eating guidelines was on average lower. According to the results of present work, energy balance is partly programmed by relatively small variations in the amount of protein in the diet in infancy. Among young adults born preterm, focusing on primary prevention, such as dietary counseling, is suggested.Tiivistelmä Elämän varhaisvaiheet muokkaavat terveyttä ja hyvinvointia pitkällä aikavälillä. Ennenaikaisesti (ennen 37. raskausviikkoa) syntyneillä aikuisilla on todettu olevan suurempi riski sairastua sydän- ja verisuonitauteihin verrattuna täysiaikaisina syntyneisiin ikätovereihin. Ravitsemuksella, läpi elämänkaaren, on keskeinen rooli tuon riskin muokkaajana. Tämän väitöskirjatutkimuksen tavoitteena oli selvittää osana Pikku-k-tutkimusta (n=127), miten pienipainoisina (syntymäpaino <1500g) syntyneiden keskosten elämän ensimmäisten viikkojen energian ja ravintoaineiden saanti ennustaa kehonkoostumusta ja energiankulutusta sekä energian saantia aikuisiässä. Lisäksi tavoitteena oli tutkia ESTER- tai AYLS-kohorttitutkimuksiin osallistuneiden, hyvin (<34 raskausviikolla syntyneiden, n=191) ja lievästi (34-37, n=364) keskosena syntyneiden ja täysiaikaisena syntyneiden (n=657) nuorten aikuisten syömishäiriöpiirteitä, kehonkuvaa sekä ruoan käyttöä ja ravintoaineiden saantia. Suhteellisen matala elämän ensimmäisten viikkojen aikainen energian ja ravintoaineiden saanti ennusti kehonkoostumusta ja energia-aineenvaihduntaa aikuisiässä. 1g/kg/päivä korkeampi proteiininsaanti oli yhteydessä 10,4 % (95% luottamusväli 2,4; 19,1) suurempaan rasvattomaan painoon sekä 8,5 % (0,2; 17,0) korkeampaan lepoenergiankulutukseen aikuisiässä. Lepoenergiankulutus rasvatonta painoyksikköä kohden oli kuitenkin 5,5 % (0,8; 10,0) matalampi enemmän proteiinia saaneilla keskosilla. Lisäksi korkeampi energian ja proteiininsaanti elämän ensimmäisten viikkojen aikana ennusti matalampaa energiansaantia painoyksikköä kohden aikuisiässä. Varhaisella kasvulla oli vain pieni rooli tämän yhteyden välittäjänä. Nuorilla, hyvin ennenaikaisena (ennen 34. raskausviikkoa) syntyneillä, naisilla oli vähemmän syömishäiriöihin liittyviä piirteitä ja terveellisempi kehonkuva verrattaessa heitä täysiaikaisena syntyneisiin ikätovereihin. Arvioitaessa heidän ruokavaliotaan, todettiin kuitenkin heidän syövän hieman epäterveellisemmin ikätovereihin verrattuna. Tämän väitöskirjatutkimuksen tulosten valossa varhainen puuttuminen keskosena syntyneiden lisääntyneeseen sydän- ja verisuonitautien riskiin on mahdollista kiinnittämällä huomiota varhaiseen ravitsemukseen ja varhaisen aikuisiän elintapaohjaukseen, etenkin ravitsemukseen liittyen

Early postnatal nutrition after preterm birth and cardiometabolic risk factors in young adulthood

Abstract Objectives: Adults born preterm at very low birthweight (VLBW; <1500 g) have a non-optimal cardiometabolic risk factor profile. Since higher protein intake during the first weeks of life predicted a healthier body composition in adulthood in our previous studies, we hypothesized that it would also predict a favorable cardiometabolic profile. Study design: The Helsinki Study of VLBW Adults includes 166 VLBW and preterm infants born between 1978 and 1985. We collected postnatal nutrition data among 125 unimpaired subjects, who attended two study visits at the mean ages of 22.5 and 25.1 years. We evaluated the effects of energy and macronutrient intakes during the first three 3-week periods of life on key cardiometabolic risk factors with multiple linear regression models. We also report results adjusted for prenatal, postnatal and adult characteristics. Results: Macronutrient and energy intakes were not associated with blood pressure, heart rate, or lipid levels in adulthood. Intakes were neither associated with fasting glucose or most other markers of glucose metabolism. An exception was that the first-three-weeks-of-life intakes predicted higher fasting insulin levels: 1 g/kg/day higher protein intake by 37.6% (95% CI: 8.0%, 75.2%), and 10 kcal/kg/day higher energy intake by 8.6% (2.6%, 14.9%), when adjusted for sex and age. These early intakes similarly predicted the adult homeostasis model assessment index. Further adjustments strengthened these findings. Conclusions: Among VLBW infants with relatively low early energy intake, early macronutrient and energy intakes were unrelated to blood pressure, lipid levels and intravenous glucose tolerance test results. Contrary to our hypothesis, a higher macronutrient intake during the first three weeks of life predicted higher fasting insulin concentration in young adulthood

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

Abstract Background: We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. Methods: In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34–<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). Results: Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: −0.2 to 0.4) years/0.2 (−0.1 to 0.4) for very or moderately/late preterm born men and −0.0 (−0.3 to 0.3)/−0.0 (−0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. Conclusions: Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term

Reaction times, learning, and executive functioning in adults born preterm

Abstract Background: This study examines cognitive functioning in adults born across the range of prematurity with appropriate or small for gestational age (SGA) birth weight compared with full-term controls. Methods: ESTER Preterm Birth Study participants without severe disabilities, comprising 133 early preterm (<34 weeks, 17% SGA), 241 late preterm (34 + 0–36 + 6 weeks, 13% SGA), and 348 full-term subjects, performed the Cogstate® test at a mean age of 23.3 (SD = 1.2) years. Subtests measured paired associate learning, psychomotor function, executive function, spatial memory efficiency, visual memory, attention, working memory, visual learning, and emotional cognition. Data were analyzed with linear regression, full models adjusted for prenatal and postnatal factors and socioeconomic position. Results: Early preterm, late preterm, and full-term participants showed similar abilities in almost all subtests. Early preterm participants had 0.6 fewer moves/10 s (95% CI: −1.0; −0.2, full model) and late preterm and SGA participants had 1.3 fewer moves/10 s (95% CI: −2.1; −0.4) than full-term controls in the Groton Maze Learning Test, indicating weaker spatial memory efficiency. Conclusions: Adults born across the range of prematurity on average lack major defects in cognitive abilities. Cognitive problems may persist to adulthood only among those born the smallest: very preterm or preterm and SGA

Food and nutrient intakes in young adults born preterm

Background Adults born preterm have higher levels of cardiometabolic risk factors than their term-born peers. Studies have suggested that at least those born smallest eat less healthily. We examined the association between early (<34 weeks) and late (34 to 36 weeks) preterm birth and diet and food preferences in adult age. Methods Participants of two cohort studies located in Finland completed a validated food frequency questionnaire(FFQ) at age 24y to assess their usual diet and the adherence to healthy eating guidelines by using a recommended diet index(RDI).182 were born early preterm, 352 late preterm and 631 were term born controls. Results Young women born early preterm scored 0.77 points (95% CI 0.03, 1.51) lower in RDI when adjusted for sex, age, parental education and early life confounders, indicating a lower quality of diet. There were no differences between young women born late preterm and controls or among men. When food groups were assessed separately, men born early preterm had lower consumption of fruits and berries than controls. Conclusions Young women born early preterm have poorer adherence to healthy eating guidelines than their peers born at term. Differences in diet may contribute to increased cardiometabolic risk among adults born early preterm

Musculoskeletal pain in adults born preterm:evidence from two birth cohort studies

Abstract Background: Individuals born preterm are at risk of later developmental problems and long‐term morbidities. There is conflicting evidence regarding musculoskeletal pain in young adulthood. We investigated the prevalence of self‐reported musculoskeletal pain in young adults born across the range of preterm birth compared with a term‐born reference group. Methods: From two Finnish birth cohorts, 184 individuals born early preterm (&lt;34 weeks), 350 late preterm (34 to &lt;37 weeks) and 641 at term completed a self‐report questionnaire of musculoskeletal pain at mean age 24.1 (SD: 1.4) years. Group differences were examined by logistic regression models adjusting for sex, age and cohort (Model 1), potential early life confounders (Model 2) and lifestyle factors related to physical (Model 3) and mental health (Model 4). Results: The late preterm group had lower odds for reporting neck pain (0.73; 95% confidence interval (CI): 0.56–0.96), which was further reduced when adjusting for early life confounders and lifestyle factors (Model 4). Odds for reporting peripheral pain were 0.69 (95% CI: 0.48–0.99, Model 4) in the early preterm group. The odds for reporting any pain, shoulder, low back or widespread pain did not differ significantly between groups, although odds for reporting widespread pain were 0.77 (95% CI: 0.58–1.03, Model 4) in the late preterm group. Conclusions: We did not find evidence of increased prevalence of musculoskeletal pain in adults born early or late preterm. In contrast, our results suggest that adults born preterm have a slightly lower risk of reporting musculoskeletal pain, also when we adjusted for lifestyle factors. Significance: Young adults born preterm do not have increased rates of musculoskeletal pain. Our findings rather suggest that these rates may be slightly lower than among those born at term