Assuntos
Leite Humano , Retinopatia da Prematuridade , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido PrematuroRESUMO
Requirements for optimal nutrition, especially for micronutrients, are not well defined for premature infants. The "reference fetus," developed by Ziegler et al,(1) has served as a model to define nutritional needs and studies designed to determine nutrient requirements. Revision of nutrient requirements and provision of optimal nutrition may lead to improved outcomes in preterm infants. Appropriate provision of nutrients also may help prevent nutritional disorders, such as metabolic bone disease and anemia. In this review, we discuss calcium, phosphorus, magnesium, vitamin D, iron, and copper, and define optimal intakes based on the available published data.
Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/fisiologia , Micronutrientes/fisiologia , Necessidades Nutricionais/fisiologia , Cálcio da Dieta/administração & dosagem , Cálcio da Dieta/metabolismo , Cobre/administração & dosagem , Cobre/fisiologia , Dieta , Suplementos Nutricionais , Humanos , Recém-Nascido , Ferro da Dieta/administração & dosagem , Ferro da Dieta/metabolismo , Magnésio/administração & dosagem , Magnésio/fisiologia , Micronutrientes/administração & dosagem , Fósforo na Dieta/administração & dosagem , Fósforo na Dieta/metabolismo , Vitamina D/administração & dosagem , Vitamina D/fisiologiaRESUMO
Preterm birth continues to contribute disproportionately to neonatal morbidity and subsequent physical and neurodevelopmental disabilities. Epidemiologic studies have described additional long-term health consequences of preterm birth such as an increased risk of hypertension and insulin resistance in adult life. It is not known whether the influence of infant and childhood growth rates and early nutrition on long-term outcomes is the same or different among preterm infants and neonates with intrauterine growth restriction. Our goal is to review the effects of fetal growth, postnatal growth, and early nutrition on long-term cardiovascular and metabolic outcomes in preterm infants. Present evidence suggests that even brief periods of relative undernutrition during a sensitive period of development have significant adverse effects on later development. Our review suggests that growth between birth and expected term and 12-18 months post-term has no significant effect on later blood pressure and metabolic syndrome, whereas reduced growth during hospitalization significantly impacts later neurodevelopment. In contrast, growth during late infancy and childhood appears to be a major determinant of later metabolic and cardiovascular well being, which suggests that nutritional interventions during this period are worthy of more study. Our review also highlights the paucity of well-designed, controlled studies in preterm infants of the effects of nutrition during hospitalization and after discharge on development, the risk of developing hypertension, or insulin resistance.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro/fisiologia , Doenças Metabólicas/prevenção & controle , Peso ao Nascer , Doenças Cardiovasculares/etiologia , Desenvolvimento Infantil/fisiologia , Feminino , Desenvolvimento Fetal , Retardo do Crescimento Fetal/fisiopatologia , Humanos , Cuidado do Lactente , Fórmulas Infantis , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Doenças do Prematuro/etiologia , Doenças Metabólicas/etiologia , Síndrome Metabólica/etiologia , Síndrome Metabólica/prevenção & controle , Leite Humano , GravidezRESUMO
OBJECTIVE: To assess the effects of a prebiotic supplement and usual calcium intake on body composition changes during pubertal growth. STUDY DESIGN: We measured anthropometry and body fat with dual-energy X-ray absorptiometry in 97 young adolescents who were randomized to receive either a daily prebiotic supplement or maltodextrin (control) for 1 year. RESULTS: Subjects who received the prebiotic supplement had a smaller increase in body mass index (BMI) compared with the control group (BMI difference 0.52 +/- 0.16 kg/m2, P = .016), BMI Z-score (difference 0.13 +/- 0.06, P = .048) and total fat mass (difference 0.84 +/- 0.36 kg, P = .022). The prebiotic group maintained their baseline BMI Z-score (0.03 +/- 0.01, paired t test, P = .30), although BMI Z-score increased significantly in the control group (0.13 +/- 0.03, P < .001). In considering subjects whose usual calcium intake was > or = 700 mg/d, those who received the prebiotic supplement had a relative change in BMI that was 0.82 kg/m2 less than control subjects (P < .01), and BMI Z-score that was 0.20 less than control subjects (P = .003). Differences tended to be maintained 1 year after supplementation was stopped. CONCLUSION: Prebiotic supplementation and avoidance of a low calcium intake can have significant effects in modulating BMI and other body composition changes during puberty.
Assuntos
Composição Corporal/fisiologia , Índice de Massa Corporal , Cálcio/administração & dosagem , Suplementos Nutricionais , Inulina/administração & dosagem , Oligossacarídeos/administração & dosagem , Adolescente , Criança , Feminino , Humanos , Masculino , Puberdade/fisiologiaRESUMO
The addition of milk and milk-based products to the diets of individuals subsisting on plant-based diets was reported to have positive effects on nutritional status and functional outcomes such as growth, morbidity, and cognition. We examined the effect of the addition of milk or yogurt on the bioavailability of zinc and iron from a plant-based rural diet. The subjects were 48 Mexican women (30.9 +/- 5.7 y) who habitually consumed a plant-based diet. The women were assigned to 1 of 3 groups: 1) the typical rural Mexican diet, 2) that diet with milk added, or 3) that diet with yogurt for 13 d. Zinc absorption was measured after extrinsically labeling meals with (67)Zn and an i.v. dose of (70)Zn; iron absorption was measured by extrinsically labeling meals with (58)Fe and a reference oral dose of (57)Fe. Including milk and yogurt in the diet increased zinc absorption by 50 and 68%, respectively (P < 0.05). The 3 groups did not differ in the percentage iron absorption. The total amount of zinc absorbed was increased (P < 0.05) by 70% when milk was added to the meal and 78% when yogurt was added. The total amount of iron absorbed did not differ among the groups. The addition of milk and yogurt to a plant-based diet high in phytate increases zinc bioavailability without affecting iron bioavailability.
Assuntos
Dieta Vegetariana , Suplementos Nutricionais , Leite , Iogurte , Zinco/metabolismo , Adulto , Animais , Disponibilidade Biológica , Estatura , Peso Corporal , Feminino , Humanos , Ferro/metabolismo , Masculino , México , População Rural , Caracteres SexuaisRESUMO
After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA, positive effects on physical growth, prevalence of anemia, and several vitamin deficiencies were observed. There was no effect on iron status, which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA. The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food. Children (n = 54) aged 2-4 y were randomly assigned to receive 44 g of the weaning food fortified with ferrous sulfate, ferrous fumarate, or reduced iron + Na(2)EDTA. Iron absorption was measured using an established double-tracer isotopic methodology. Iron absorption from ferrous sulfate (7.9 +/- 9.8%) was greater than from either ferrous fumarate (2.43 +/- 2.3%) or reduced iron + Na(2)EDTA (1.4 +/- 1.3%) (P < 0.01). The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin (s-ferritin) concentration (n = 13, r = 0.63, P = 0.01) and log-(57)Fe absorption (reference dose) (n = 14, r = -0.52, P = 0.02). Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe. The recommended daily portion of the fortified complementary food provides an average of 0.256, 0.096, 0.046 mmol (1.44, 0.54, and 0.26 mg) of absorbed iron, if fortified with sulfate, fumarate and reduced iron + Na(2)EDTA, respectively. Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2-3 y of age.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Compostos Ferrosos/farmacocinética , Ferro/metabolismo , Leite , Animais , Disponibilidade Biológica , Serviços de Saúde da Criança , Pré-Escolar , Suplementos Nutricionais , Feminino , Humanos , Masculino , México , DesmameRESUMO
OBJECTIVE: To test the hypothesis that micronutrient beverages can provide the daily iron and zinc needs of small children. STUDY DESIGN: Forty children aged 6 to 9 years were recruited (Lima, Peru). For 4 weeks, they received a daily serving of a beverage containing multiple micronutrients. Over 2 consecutive days, subjects received stable isotope-labeled servings of the beverage with and without a meal as well as an intravenous dose of zinc. Iron and zinc bioavailability were assessed using mass spectrometry. RESULTS: Iron absorption was significantly lower with a meal than without (9.8 +/- 6.7% versus 11.6 +/- 6.9%, P=.04), but zinc absorption was not (24.5 +/- 10.7% versus 22.8 +/- 7.6%, P=.2). In either case, however, a single daily serving provided most of the iron and zinc requirements for the children. CONCLUSIONS: Single daily servings of multinutrient-fortified beverages can meet much of the mineral needs for small children. Food has a small inhibitory effect on iron, but not zinc, absorption; therefore, these beverages can be efficacious even when given with a meal.