| Sumario: | <p>Objective: To investigate the impact of breast milk (BM) intake on body composition at term in very preterm infants.</p> <p>Design: Preplanned secondary analysis of the Nutritional Evaluation and Optimisation in Neonates Study, a 2-by-2 factorial randomised controlled trial of preterm parenteral nutrition (PN).</p> <p>Setting: Four National Health Service hospitals in London and South-East England.</p> <p>Patients: Infants born at - 31 weeks of gestation; infants with life-threatening congenital abnormalities and those unable to receive trial PN within 24 hours of birth were ineligible. 133 infants survived and underwent whole-body MRI at term (37–44 weeks postmenstrual age).</p> <p>Main outcome: measures Non-adipose tissue mass (non-ATM), ATM and ATM as a percentage of body weight (% ATM) at term.</p> <p>Results: Compared with the exclusively BM group (proportion of BM=100% milk, n=56), predominantly formula-fed infants (BM ≤50%, n=38) weighed 283.6 g (95% CI 121.6 to 445.6) more, had 257.4 g (139.1–375.7) more non-ATM and a greater positive weight Z-score change between birth and term. There were no significant differences in weight, non-ATM and weight Z-score change between the exclusively and predominantly BM (BM 51%–99%, n=39) groups. Compared with the exclusively BM group no significant differences were observed in ATM and %ATM in the predominantly BM and predominantly formula-fed groups.</p> <p>Conclusions: The slower weight gain of preterm infants fed BM appears to be due to a deficit in non-ATM and may reflect lower protein intake. Whether this pattern persists into childhood, is altered by BM fortification or later diet, or relates to functional outcomes, are important research questions.</p>
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