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doi:10.1111/jpc.12893

ORIGINAL ARTICLE

Feasibility study: Assessing the inuence of macronutrient

intakes on preterm body composition, using air displacement
plethysmography
Gemma McLeod,1 Karen Simmer,1 Jill Sherriff,2 Elizabeth Nathan,3 Donna Geddes4 and Peter Hartmann4
1
Centre for Neonatal Research and Education, School of Paediatrics and Child Health, 3Women and Infants Research Foundation, 4School of Biomedical,
Biomolecular and Chemical Sciences, The University of Western Australia and 2School of Public Health, Curtin Health Innovation Research Institute, Curtin
University, Perth, Western Australia, Australia

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 inuences on changes in BC.
Results: Median (range) gestation and birthweight of preterm infants (n = 27) were 29 (2532) weeks and 1395 (5602148) g, respectively. The
youngest corrected gestational and postnatal ages that infants qualied 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
sufciently sensitive to detect inuences of macronutrient intake on changes in BC.
Key words: air displacement plethysmography; body composition; preterm infant; preterm nutrition.

What is already known on this topic What this paper adds

1 Australian published data reporting preterm nutrition intakes
calculated using measured macronutrient milk composition are
limited.
2 Serial body composition data are lacking in Australian-born
preterm infants.
3 Body composition measurement is important when assessing
the adequacy of nutritional intakes of preterm infants.
1 This paper provides prospective preterm nutrition intake data,
based on breast milk analysis.
2 This paper documents serial body composition measurements
using PEA POD, commencing as early as 31 weeks corrected
gestational age, in a cohort of Australian preterm infants.
3 This paper documents early pilot data that suggests the PEA POD
body composition system may be sufciently sensitive to detect
BC changes in response to alterations in preterm nutrition.

Preterm infants at an equivalent age to their term counterparts
have an altered phenotype.14 In latest guidelines, nutrient
intake recommendations other than for protein are lacking for
infants weighing less than 1000 g and achieving intrauterine
growth rates remains an elusive goal for many.5 It is difficult to
achieve the correct nutritional balance.6,7 Health consequences
of postnatal under-nutrition and/or accelerated growth are
unclear, but epidemiological and experimental animal812 and
Correspondence: Dr Gemma McLeod, Centre for Neonatal Research and
Education, School of Paediatrics and Child Health. M551, The University of
Western Australia, Subiaco, WA 6008, Australia. Fax 61 8 9340 1266; email:
gemma.mcleod@health.wa.gov.au
Conict of interest: The authors have no conict of interest to declare.
Accepted for publication 5 March 2015.
human studies1317 suggest that these outcomes may have
adverse metabolic and neuro-developmental consequences5 and
may be associated with chronic morbidities.
Body composition (BC) is an important index of nutrition
adequacy and warrants further study in preterm infants.
However, measurement methods apply different theoretical
constructs based on various assumptions; employ various ref-
erence data, algorithms and constants to derive results; and are
expressed in a variety of forms. All methods have limita-
tions.18,19 Few BC methods have been evaluated for use in
children against a four-compartment reference method, which
is relatively robust in light of inter-individual variability in the
composition of fat-free mass,20 and none has been appropri-
ately validated for BC measurement of preterm and term
infants.

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Journal of Paediatrics and Child Health 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G McLeod et al.
In the past 10 years, air displacement plethysmography (ADP)
technology has been applied to the measurement of infant BC2124
(PEA POD, COSMED USA, Concord, CA, USA). The instrument
can accommodate infants weighing between 1 and 8 kg. The
method has not been validated in preterm infants but is non-
invasive and portable, and has been evaluated in term infants
against a four-compartment BC model21 derived from Butte et
al.s25 measurements of total body water, bone mineral content
and total body potassium. As a first step, we explored the
feasibility of using the PEA POD in a cohort of hospitalised preterm
infants to assess the association between BC and nutrition.
Methods
Preterm infant BC
All infants born <33 weeks gestation at King Edward Memorial
Hospital (KEMH) in Perth, Western Australia, from 1 September
to 15 October 2007, were eligible from birth to participate in this
prospective, observational feasibility study if maternal intention
was to feed breast milk, if consent was given for milk analysis
and if mothers agreed to their infants participating in PEA POD
measurements. Infants were excluded if they were born with
congenital abnormalities or developed gastrointestinal illness.
The Ethics Committee at KEMH approved the study protocol,
and primary carers provided written informed consent prior to
study commencement.
Nutrition practice
Preterm infants were fed intravenous glucose on admission and
then either:
1 progressed to parenteral nutrition (PN) (Baxter, Glucose 20%
1 L, Baxter Primene 10% 1 L; Baxter Clinoleic 20% 1 L; Baxter
Healthcare, Canning Vale, Perth, Australia) and minimal
enteral feeds usually within 2 to 5 days of admission; or
2 if stable, progressed directly to enteral feeding.
Amino acids in parenteral nutrition and lipid were initially
infused at 0.5 g/kg/day, with stepwise daily increments until
reasonable parenteral nutrient intake targets were met.26 If
mothers own milk was unavailable, donor milk or formula was
provided.
Breast milk was fortified at 150 mL/kg/day. Initial fortification
was achieved using a commercial breast milk fortifier
(Nutriprem, Cow & Gate, Trowbridge, Wiltshire, UK; 0.8 g pro-
tein/100 mL milk) and a protein supplement (Beneprotein,
Novartis, Minneapolis, MN, USA; 0.5 g powder/100 mL milk). If
an infants fluid intake was restricted to volumes 150 mL/kg/
day, fortification was upgraded using additional protein
(Beneprotein, as previous, total 1.0 g powder/100 mL milk) and
an energy supplement (Duocal, SHS International, Liverpool,
UK; 3.0 g powder/100 mL milk). Fortification was ceased near
discharge.
Breast milk feeds and sampling
In the majority, an infants preterm milk feeds were made from
their own mothers individual and pooled collections of
expressed milk, and may have included milk expressions from
different days. On the days when supply permitted, a well-
Journal of Paediatrics and Child Health 51 (2015) 862869
2015 The Authors
Journal of Paediatrics and Child Health 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Preterm nutrition and body composition
mixed sample (13 mL) from each infants unfortified milk feed
was collected in 5 mL polypropylene vials (Disposable Products
Pty Ltd, Adelaide, South Australia, Australia) and frozen in a
commercial freezer at 20C until analysed.
Biochemical breast milk analysis
Macronutrient composition of milk feeds was determined by
routine laboratory assay in the Hartmann Human Milk Research
Laboratory at The University of Western Australia (Perth,
Western Australia, Australia).
Milk protein
The protein content of the milk feeds was determined by a
modified Bradford method27 using a commercial protein reagent
(Bio-Rad Laboratories, Richmond. CA, USA). The Bio-Rad assay
has been described previously.28,29 Human breast milk protein
standards for the Bio-Rad assay were determined by the modi-
fied Kjeldahl method, as described by Atwood and Hartmann.30
Briefly, after determining total nitrogen on a sample of milk and
non-protein nitrogen on a deproteinised sample of the milk,
protein nitrogen was calculated by subtracting the non-protein
content of deproteinised human breast milk from the total
nitrogen content of the milk.31 Protein nitrogen was then multi-
plied by the Kjeldahl protein nitrogen value of 6.25 to obtain
the true protein content of the milk.32
The detection limit of the assay was 0.7 g/L (n = 25) and the
inter-assay coefficient of variation (CV) was 3.26% (n = 25).
Milk fat
The milk fat concentration was determined by Stern and
Shapiros33 spectroscopic esterified fatty acid method, described
previously.28,29 The detection limit of the assay was 1.22 g/L (n =
21) and the inter-assay CV was 11.5% (n = 21).
Milk lactose
The concentration of lactose in the milk feeds was determined
using the modified, enzymatic spectroscopic method of Kuhn,34
as previously described.28,29 The detection limit of the assay was
0.97 g/L (n = 21) and the inter-assay CV was 3.04% (n = 21).
Milk energy
The energy content of each unfortified milk feed was calculated
using the Atwater conversion values: protein (16 kJ/g), fat
(37 kJ/g) and lactose (16 kJ/g).
Nutrient intake data
Feeding data, from 2400 h on day one until discharge, were
obtained retrospectively from the daily observation charts for
infants with 2 BC measurements, for whom milk samples
could be obtained. The macronutrient and energy intakes for
each infants feeds were calculated using milk analysis data and
the nutrient profiles of commercial products. If there was insuf-
ficient milk to always obtain a sample, the most recent macro-
nutrient composition data were used. If a breastfeed was given
and recorded as breastfeed without top-up, the amount con-
sumed during the breastfeed was estimated to be equivalent to
863
Preterm nutrition and body composition G McLeod et al.

that amount normally given at a scheduled feed. If a top-up was for a quadratic time component and adjustment was made for
given, the volume given was subtracted from the prescribed gestational age at birth and corrected gestational age at time of
amount and the balance taken as the amount of milk consumed test. SAS 9.1 (SAS Institute Inc, Cary, NC, USA) statistical soft-
during a breastfeed. ware was used for data analysis. All tests were two-tailed and
P-values <0.05 were considered statistically significant.
BC
An air displacement plethysmograph (PEA POD, Life Measure- Results
ment Inc (LMI), Concord, CA, USA) was employed to measure
the BC of the preterm infants. The technical design and the
Recruitment
methodology underpinning a PEA POD measurement have Forty-five of the fifty-one preterm infants born <33 weeks ges-
been described elsewhere.35,36 Briefly, the PEA POD applies the tation at KEMH during a 6-week period from 1 September 2007
classic, two-compartment BC model. Total body density is esti- met the inclusion criteria (Fig. 1). Consent was refused for six
mated from the direct measurements of body mass and volume, infants, three mothers withdrew consent and incomplete data
and gas laws and densitometry principles are applied. PEA POD for nine infants (early transfer n = 5; early discharge n = 4) were
measurements were taken according to LMIs technical instruc- not analysed. Twenty-seven preterm infants (male n = 7, Cau-
tion, using the instruments default Fomon Density Model, casian n = 21, Aboriginal n = 3, Asian n = 3) participated in the
derived from published fat-free mass density values of infants.37 study (appropriate for gestational age (AGA) n = 23; small for
Prior to each measurement, as per the manufacturers calibra-
tion protocol, quality and control procedures were conducted
using a volume phantom to ensure PEA POD stability and
volume performance. Infants were measured naked at least Infants born <33 weeks
30 min after a feed, and oil was used to flatten head-hair to King Edward Memorial Hospital
reduce surface area artefact. First BC measurements were taken 1 September to 15 October 2007
as soon as the infant was clinically and thermogenically stable n = 51
(incubator <31C), free from continuous respiratory and intra-
venous support and on bolus feeds. Saturation monitoring was
temporarily suspended for clinically stable infants who under-
went a PEA POD measurement. Final measurements were Excluded
taken near discharge or at the scheduled term follow-up clinic Death n = 4
appointment. Recumbent length (perspex length board), weight Congenital abnormality n = 1
Necrosing enterocolis n = 1
and volume measurements took approximately 10 min.
Consent denied/withdrawn n = 9
Early discharge/transfer n = 9
Anthropometric data
Infants requiring intensive care were weighed daily, either in
their incubator or with digital scales (g; SECA, Hamburg,
Germany 10/20 kg). Those in special care were weighed twice
weekly. Weight gain velocity (g/kg/day) was calculated using an Parcipants
exponential model that has been validated in preterm infants,
(1000 Ln(Wn/W1))/(Dn D1), where Ln is the natural loga- n = 27
rithm, W is the weight in grams, D is day, 1 is the beginning of
the time interval and n is the end of the time interval.38,39
Birthweight was converted to z-score using Fenton data.40

Statistical analysis
Descriptive statistics were based on either means and standard 2 body composion
deviations or medians, interquartile ranges and ranges, according measurements and milk
to data normality, for continuous data. Frequency distributions analysis
n = 20 infants
were used to summarise categorical data. Patterns of growth and (AGA n = 17; SGA n = 3)
BC parameters for preterm infants were analysed using linear Body composion
measurement at
mixed models to account for the correlation between repeated
term corrected age
measurements. Intake of carbohydrate, protein and lipid, and n = 17 infants
clinical characteristics including gender, hours on ventilation, (AGA n = 13; SGA n = 4)
(inclusive of 10 infants for
continuous positive air pressure (CPAP), supplemental oxygen, whom milk analysis was
phototherapy, number of courses of antibiotics, patent ductus performed)

arteriosus, days to full enteral feeds and days to fortified feeds

were assessed for their effect on weight gain, fat mass, fat-free
mass, length and head circumference. All models were assessed Fig. 1 Infant participation.

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G McLeod et al. Preterm nutrition and body composition

Table 1 Clinical characteristics Table 2 Milk macronutrient composition and total nutrient intakes

Infant cohort Mean (SD)

n = 27
Milk composition
Gestational age (weeks) 29 (2731; 2532) Protein (g/L) 16.3 (1.8)
Birthweight (g) 1395 (9801500; 5602148) Fat (g/L) 45.3 (7.4)
(z-score) 0.2 (0.40.6; 2.02.0) Lactose (g/L) 63.3 (4.0)
Birth length (cm) 39.0 (35.041.0; 31.047.0) Energy (kJ/L) 3042 (277)
(z score) 0.3 (0.40.9; 2.21.9) PER (g protein/420 kJ) 2.3 (0.3)
Birth head circumference (cm) 26.5 (2528.0; 22.031.0) Total nutritional intakes
(z-score) 0.3 (0.70.7; 2.52.2) Fluid (mL/kg/day) 150 (6)
SGA (<10th percentile at birth) 4 (15%) Energy (kJ/kg/day) 500 (43)
Male gender 7 (26%) Protein (g/kg/day) 3.4 (0.3)
Length of stay (days) 49 (3568; 2191) Fat (g/kg/day) 6.0 (1.0)
PDA [PDA, requiring Indocid] 10 (37%), [5 (50%)] Carbohydrate (g/kg/day) 12.9 (1.0)
NEC suspected 7 (26%) PER (g protein per 420 kJ) 2.9 (0.4)
Antibiotic courses 2 10 (37%)
Blood transfusion/s 13 (48%) Milk composition represents the mean composition of the averaged
Parenteral nutrition (days) 15 (1020, 629) macronutrient content of each infants unfortied milk feeds. PER,
n = 17 protein energy ratio.
Days from birth when full enteral feeds 9 (616; 135)
achieved (days)
Days from birth when feeds were 14 (721; 236)
fortied (days) weeks) and time point 2 (5.4 weeks); 16 for time point 3 (6.4
Duration of ventilation and CPAP (days) 31 (943; 250) weeks) and 12 for time point 4 (7.2 weeks).
(n = 17)
Milk composition
Data summarised as median, interquartile range, range (IQR; R) or n (%)
as appropriate. CPAP, continuous positive air pressure; NEC, necrotising Samples of milk feeds (n = 503) were collected for the 20 infants
enterocolitis; PDA, patent ductus arteriosus; SGA, small for gestational who participated in serial measurements. Sixteen mothers pro-
age. vided the milk for these feeds. The median (range) number of
milk feed samples per infant was 27 (1150) and the mean
composition of each infants averaged unfortified milk feed
composition was variable (Table 2).

gestational age (SGA) n = 4), comprising one set of triplets, two
sets of twins and 20 singletons. Nutrition intake data, compre-
hensive milk analysis and serial BC data were available for 20
infants. The clinical characteristics of the preterm infants are
summarised in Table 1.
Qualifying for a BC measurement
All infants were measured in the PEA POD at least once but up
to six times during their admission, meeting our criteria for
measurement at a range of corrected (median, interquartile
range (IQR), range) (33.6, 31.942.0 weeks) and postnatal (3.6,
1.48.4 weeks) ages. This includes the youngest infant, born at
25 weeks and 3 days, whose mother preferred to delay her
infants first PEA POD measurement until corrected-term age.
The next youngest infant, born at a gestation of 25 weeks and 6
days, was measured at 45 days of age, at a corrected age of 32
weeks and 2 days. The longest time taken by an infant was 60
days, born at 27 weeks gestation, to meet the criteria for a
measurement, at a corrected age of 35 weeks and 4 days. The
most mature infant, born at a gestation of 32 weeks and 3 days,
qualified for measurement at 25 days of age (i.e. corrected 36
weeks). Up to four measurements were used for each infant (n
= 20) who participated in serial measurements: 20 measure-
ments were available for time point 1 (mean postnatal age 4.3
Nutrition and BC
Eighty-five per cent, by volume, of the total nutrition consumed
by infants was fed enterally. The major component (88% by
volume) was breast milk. Mothers of the infants provided 93%
of the milk and the remaining portion was donor milk. Com-
bined total intakes are described in Table 2.
At a mean postnatal age of 4.3 weeks, the infants had an
unadjusted mean percentage fat mass of 7.9%. By 7.2 weeks,
their percentage fat mass had almost doubled to 14.7% (Fig. 2).
The mean (SD) rate of weight gain achieved by these infants
from birth to a postnatal age of 7 weeks was 11.5 (2.5) g/kg/day.
Mixed model regression analysis showed that total energy
(g/kg/day) and fat (g/kg/day) intake, respectively, increased fat
mass (1.6 g, 95% CI 0.02.3, P < 0.001 and 22 g, 95% CI
7.037.0, P = 0.038); however, hours on CPAP moderated their
effects (0.2 g, 95% CI 0.3 (0.1), P = 0.037 and 0.2 g,
95%CI 0.3 (0.1), P = 0.003). Fat intake (0.6, 95% CI
0.21.0, P = 0.004) was significantly associated with increased
length. Protein intake positively affected rate of weight gain
(6.6 g, 95% CI 4.09.2, P < 0.001), which tapered with increas-
ing age (P = 0.020). With the inclusion of carbohydrate in the
model, protein was also positively associated with fat-free mass
(P = 0.032). Hours on CPAP negatively affected growth and
nutrient accretion (Table 3).

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Journal of Paediatrics and Child Health 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Preterm nutrition and body composition
Fig. 2 Unadjusted serial changes in mean (SD) fat and fat-free mass of hospitalised preterm infants. Twenty measurements were available for time point 1
(mean postnatal age 4.3 weeks) and time point 2 (5.4 weeks); 16 for time point 3 (6.4 weeks); and 12 for time point 4 (7.2 weeks).
Preterm versus term BC
The median (range) weight, length and BC data of the 17
preterm infants (SGA n = 4) measured in the PEA POD at
corrected term-age were as follows: Weight 2696 (15964549)
g, percentile 10th (084), z-score 1.3 (3.41.0); length 47.6
(41.254.8) cm, percentile 9th (080th), z-score 1.3 (3.0
0.9); fat mass 414 (2401227) g and %fat mass 15.4 (1233)%.
Seven preterm infants had weights below the 10th percentile at
term measurement.
Discussion
This feasibility study is the first in Australia to utilise breast milk
anlaysis data, and the PEA POD, to assess the influence of
macronutrient intakes on serial changes in preterm BC.
Calculated mean protein and energy intakes were below
those recommended to achieve growth targets.26,41 Regression
modelling showed that carbohydrate synergistically combined
with protein to increase fat free mass. The postulated mecha-
nism for this synergy is through the action of insulin.42 Insulin
acts through signalling pathways to stimulate the translocation
of the glucose transporter, Glut4, in skeletal muscle, thereby
promoting uptake of glucose.43 Insulin also inhibits muscle
proteolysis and promotes uptake of the branched chain amino
acids, leucine, iso-leucine and valine into muscle, and appears
to play a regulatory role in muscle protein metabolism.44 Inter-
estingly, fat intake promoted an increase in length, perhaps
through provision of an alternative energy source, thus
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Journal of Paediatrics and Child Health 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
G McLeod et al.
sparing protein for growth. Fat and energy intakes, but not
protein, were both associated with increasing fat mass.
Notably, CPAP appeared to reduce all parameters of an infants
growth, perhaps because the work of breathing is relatively
labour intensive on CPAP, compared with ventilation and the
normal work of breathing. At corrected-term age, the preterm
infants in this study had similar BC to other preterm infants,
but were lighter, shorter and fatter than their term peers45,46
(Table 4).
The capacity to measure infants in the PEA POD was con-
strained by: (i) the age at which infants met the criteria for a
measurement, which was influenced by clinical stability and
prematurity; and (ii) the length of an infants stay and attend-
ance at the corrected-term age follow-up clinic. These factors
are difficult to control. The measurement protocol used in this
study was appropriate for hospitalised preterm infants. Infants
were measured as soon as the criteria for measurement were
met; however, immaturity, chronic lung disease, feeding intol-
erance and late-onset sepsis can extend the requirement for a
temperature-controlled environment, respiratory support,
intravenous access and continuous feeds, delaying the time to
first measurement. Small infants in this study were at risk of
becoming cold when weight and length measurements were
being taken, prior to measuring their body volume in the test
chamber, where the temperature of the circulating air is main-
tained constant by the PEA POD system at 31C. In retrospect,
undressing the infant and taking the length measurement under
the warmth of a radiant heater would assist in keeping infants
warm just prior to taking the measurement.
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G McLeod et al. Preterm nutrition and body composition

Table 3 Growth and nutrition models

Growth outcome (n = 20) Estimate 95% CI P-value

Fat mass (g) with protein, fat and carbohydrate

Protein (g/kg/day) 19.1 21.1 to 59.3 0.392
Carbohydrate (g/kg/day) 17.6 0.634.6 0.103
Lipid (g/kg/day) 22.0 7.037.0 0.038
Continuous positive airway pressure (h) 0.2 0.3 to 0.1 0.003
Fat-free mass (g) with protein, fat and carbohydrate
Protein (g/kg/day) 178.1 15.5340.7 0.032
Carbohydrate (g/kg/day) 68.7 151.1 to 13.7 0.101
Continuous positive airway pressure (h) 0.7 1.1 to 0.3 0.004
Fat mass (g) and total energy (kJ)
Total energy (kJ/kg/day) 1.6 0.92.3 <0.001
Phototherapy (h) 0.9 1.6 to 0.2 0.026
Continuous positive airway pressure (h) 0.2 0.3 to 0.1 0.037
Percentage fat mass and total PER (g protein:420 kJ)
Total PER 1.1 2.4 to 4.6 0.549
Continuous positive airway pressure (h) 0.011 0.016 to 0.004 0.006
Weight gain (g/kg/day) and protein, fat and carbohydrate
Protein (g/kg/day) 6.6 4.09.2 <0.001
Carbohydrate (g/kg/day) 0.8 0.2 to 1.8 0.124
Lipid (g/kg/day) 0.9 0.1 to 1.9 0.076
Enteral PER 0.09 0.16 to 0.04 0.013
Length (cm wk1) and protein, fat and carbohydrate
Protein (g/kg/day) 0.4 0.7 to 1.5 0.537
Carbohydrate (g/kg/day) 0.4 0.9 to 0.1 0.091
Lipid (g/kg/day) 0.6 0.21.0 0.004
Continuous positive airway pressure (h) 0.006 0.012 to 0.008 <0.001

All measurements were corrected for gestational age and corrected gestational age. Growth models were analysed using Linear Mixed Model Analysis.
Estimates are estimates for mean effect. For example, for every 1 g fat/kg/day, there was an average increase of 22 g of fat mass. PER, protein energy ratio.

Table 4 Body composition of infants measured with the PEA POD

Preterm Term P-value

n Weight cGA (week) Fat mass FM n Weight GA (week) Fat mass FM

SGA n (%) (g) PN-age (day) (g) (%) (SGA) (g) PN-age (day) (g) (%)
Male n (%) (male %)

This study 17 2809 (715) 39 (1.8) weeks 485 (258) 16.7 (5.0)
4 (24%) 70 (24) days
5 (29%)
Roggero et al.2 110 2460 (450) 40 (1.2) weeks Not 14.8 (4.4) 87 3192 (486) 39 (1.15) weeks 8.9 (3.7) <0.000
61 (55%) reported 3 (0.5) days
50 (45%)
Roggero et al.45 23 2980 (460) 39.2 (1.3) weeks 260 (120) 8.7 (3.1)
(female) 3 days
(male) 17 2910 (260) 39.2 (1.3) weeks 290 (90) 8.9 (2.8)
3 days
Carberry 45 3593 (392) 40 (1.2) 336 (153) 9.7 (3.9)
et al.46 25 (56%) 2.1 (0.9) days

cGA, corrected gestational age; GA, gestational age; PN, age postnatal age; weight, corrected age and postnatal age is at time of measurement. Data
represented mean (SD). P-values relate to %FM of preterm versus term infants.
The mean gestational age for a cohort of 59 infants was reported, inclusive of the 23 female and 17 male infants studied.

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Journal of Paediatrics and Child Health 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Preterm nutrition and body composition
The PEA POD was found to be a safe and efficient method of
measuring BC of preterm infants. The method appears sensitive
to assessing the influence of macronutrient and total energy
intakes on changes in composition of growth. Given that protein
intakes and protein energy ratios (PER) were below recom-
mended targets,26,41 it is perhaps predictable that adiposity esti-
mates of preterm infants in this study were found to be greater
than those reported of term infants at an equivalent age.
However, this method needs further independent evaluation
against a four-compartment BC model to assess the precision
and accuracy of the PEA POD measurement in the preterm
infant population. In addition, there should be continued
endeavours to develop complementary BC measurement
methods that have the capacity to assess preterm BC from birth.
To this end, ultrasound may prove useful. Ultrasound is a non-
invasive and portable diagnostic tool commonly used in the
neonatal intensive care setting. It has been used at the preterm
infants bedside from birth to capture serial images of adipose
and muscle tissue accretion and appears sensitive in assessing
the influence of nutritional intakes on composition of preterm
growth.47
Acknowledgements
The authors would like to express their thanks and appreciation
to the families and infants who participated in the study; and to
the medical and nursing staff, King Edward Memorial Hospital;
and to The Women and Infants Research Foundation; and
Medela, AG, Switzerland.
Gemma McLeod gratefully acknowledges the Scholarship
provided by Australian Rotary Health, The Rotary Club of
Thornlie and The University of Western Australia and travel
funding provided by The Post Graduate Medical Research Fund,
King Edward Memorial Hospital.
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