Nutrition after preterm birth and adult neurocognitive outcomes

Sara Sammallahti; Eero Kajantie; Hanna Maria Matinolli; Riikka Pyhälä; Jari Lahti; Kati Heinonen; Marius Lahti; Anu Katriina Pesonen; Johan G. Eriksson; Petteri Hovi; Anna Liisa Järvenpää; Sture Andersson; Katri Raikkonen

doi:10.1371/journal.pone.0185632

Nutrition after preterm birth and adult neurocognitive outcomes

Sara Sammallahti^*
, Eero Kajantie
, Hanna Maria Matinolli
, Riikka Pyhälä
, Jari Lahti
, Kati Heinonen
, Marius Lahti
, Anu Katriina Pesonen
, Johan G. Eriksson
, Petteri Hovi
, Anna Liisa Järvenpää
, Sture Andersson
, Katri Raikkonen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

37 Citations (Scopus)

Abstract

Background Preterm birth (<37 gestational weeks) poses a risk of poorer neurocognitive functioning. Faster growth after preterm birth predicts better cognitive abilities and can be promoted through adequate nutrition, but it remains unknown whether variations in nutrient intakes translate into long-term benefits for neurodevelopment. Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.

Original language	English
Article number	e0185632
Journal	PLoS ONE
Volume	12
Issue number	9
DOIs	https://doi.org/10.1371/journal.pone.0185632
Publication status	Published - Sept 2017
Externally published	Yes
Publication type	A1 Journal article-refereed

Funding

This study was part of the Helsinki Study of Very Low Birth Weight Adults funded by the Academy of Finland (http://www.aka.fi/), University of Helsinki Research Foundation (https://www. helsinki.fi/en/university/university-of-helsinkiresearch-foundation), the Finnish Medical Society Duodecim (http://www.duodecim.fi/english/), Finska L?kares?llskapet (http://www.fls.fi/), the Foundation for Pediatric Research in Finland (http://www.lastentautientutkimussaatio.fi/), the Finnish Special Governmental Subsidy for Health Sciences, the Jalmari and Rauha Ahokas Foundation (http://www.ahokkaansaatio.org/), the Juho Vainio Foundation (http://www. juhovainionsaatio.fi), the Emil Aaltonen Foundation (http://www.emilaaltonen.fi/), the Novo Nordisk Foundation (http://www.novonordisk.com/aboutnovo-nordisk/corporate-governance/foundation. html), the P?ivikki and Sakari Sohlberg Foundation (http://www.pss-saatio.fi/), the Signe and Ane Gyllenberg Foundation (http://gyllenbergs.fi/), the Yrj? Jahnsson Foundation (http://www.yjs.fi/), the Orion-Pharma Foundation (http://www.orion.fi/ tutkimus/orionin-tutkimussaatio/), the Sigrid Jus?lius Foundation (http://sigridjuselius.fi/), the Finnish National Graduate School of Clinical Investigation (http://www.vktk.fi/), Hope and Optimism Initiative (http://hopeoptimism.com/), the Wilhelm and Else Stockmann Foundation, and the Pediatric Graduate School, University of Helsinki (http://www.kll.helsinki.fi/tutkimus/lnktko. html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

General

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@article{e364663635604e6191b1e0a5d512bab0,

title = "Nutrition after preterm birth and adult neurocognitive outcomes",

abstract = "Background Preterm birth (<37 gestational weeks) poses a risk of poorer neurocognitive functioning. Faster growth after preterm birth predicts better cognitive abilities and can be promoted through adequate nutrition, but it remains unknown whether variations in nutrient intakes translate into long-term benefits for neurodevelopment. Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95\% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95\% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.",

author = "Sara Sammallahti and Eero Kajantie and Matinolli, \{Hanna Maria\} and Riikka Pyh{\"a}l{\"a} and Jari Lahti and Kati Heinonen and Marius Lahti and Pesonen, \{Anu Katriina\} and Eriksson, \{Johan G.\} and Petteri Hovi and J{\"a}rvenp{\"a}{\"a}, \{Anna Liisa\} and Sture Andersson and Katri Raikkonen",

note = "Funding Information: This study was part of the Helsinki Study of Very Low Birth Weight Adults funded by the Academy of Finland (http://www.aka.fi/), University of Helsinki Research Foundation (https://www. helsinki.fi/en/university/university-of-helsinkiresearch-foundation), the Finnish Medical Society Duodecim (http://www.duodecim.fi/english/), Finska L?kares?llskapet (http://www.fls.fi/), the Foundation for Pediatric Research in Finland (http://www.lastentautientutkimussaatio.fi/), the Finnish Special Governmental Subsidy for Health Sciences, the Jalmari and Rauha Ahokas Foundation (http://www.ahokkaansaatio.org/), the Juho Vainio Foundation (http://www. juhovainionsaatio.fi), the Emil Aaltonen Foundation (http://www.emilaaltonen.fi/), the Novo Nordisk Foundation (http://www.novonordisk.com/aboutnovo-nordisk/corporate-governance/foundation. html), the P?ivikki and Sakari Sohlberg Foundation (http://www.pss-saatio.fi/), the Signe and Ane Gyllenberg Foundation (http://gyllenbergs.fi/), the Yrj? Jahnsson Foundation (http://www.yjs.fi/), the Orion-Pharma Foundation (http://www.orion.fi/ tutkimus/orionin-tutkimussaatio/), the Sigrid Jus?lius Foundation (http://sigridjuselius.fi/), the Finnish National Graduate School of Clinical Investigation (http://www.vktk.fi/), Hope and Optimism Initiative (http://hopeoptimism.com/), the Wilhelm and Else Stockmann Foundation, and the Pediatric Graduate School, University of Helsinki (http://www.kll.helsinki.fi/tutkimus/lnktko. html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2017 Sammallahti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2017",

month = sep,

doi = "10.1371/journal.pone.0185632",

language = "English",

volume = "12",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "9",

}

TY - JOUR

T1 - Nutrition after preterm birth and adult neurocognitive outcomes

AU - Sammallahti, Sara

AU - Kajantie, Eero

AU - Matinolli, Hanna Maria

AU - Pyhälä, Riikka

AU - Lahti, Jari

AU - Heinonen, Kati

AU - Lahti, Marius

AU - Pesonen, Anu Katriina

AU - Eriksson, Johan G.

AU - Hovi, Petteri

AU - Järvenpää, Anna Liisa

AU - Andersson, Sture

AU - Raikkonen, Katri

N1 - Funding Information: This study was part of the Helsinki Study of Very Low Birth Weight Adults funded by the Academy of Finland (http://www.aka.fi/), University of Helsinki Research Foundation (https://www. helsinki.fi/en/university/university-of-helsinkiresearch-foundation), the Finnish Medical Society Duodecim (http://www.duodecim.fi/english/), Finska L?kares?llskapet (http://www.fls.fi/), the Foundation for Pediatric Research in Finland (http://www.lastentautientutkimussaatio.fi/), the Finnish Special Governmental Subsidy for Health Sciences, the Jalmari and Rauha Ahokas Foundation (http://www.ahokkaansaatio.org/), the Juho Vainio Foundation (http://www. juhovainionsaatio.fi), the Emil Aaltonen Foundation (http://www.emilaaltonen.fi/), the Novo Nordisk Foundation (http://www.novonordisk.com/aboutnovo-nordisk/corporate-governance/foundation. html), the P?ivikki and Sakari Sohlberg Foundation (http://www.pss-saatio.fi/), the Signe and Ane Gyllenberg Foundation (http://gyllenbergs.fi/), the Yrj? Jahnsson Foundation (http://www.yjs.fi/), the Orion-Pharma Foundation (http://www.orion.fi/ tutkimus/orionin-tutkimussaatio/), the Sigrid Jus?lius Foundation (http://sigridjuselius.fi/), the Finnish National Graduate School of Clinical Investigation (http://www.vktk.fi/), Hope and Optimism Initiative (http://hopeoptimism.com/), the Wilhelm and Else Stockmann Foundation, and the Pediatric Graduate School, University of Helsinki (http://www.kll.helsinki.fi/tutkimus/lnktko. html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2017 Sammallahti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2017/9

Y1 - 2017/9

N2 - Background Preterm birth (<37 gestational weeks) poses a risk of poorer neurocognitive functioning. Faster growth after preterm birth predicts better cognitive abilities and can be promoted through adequate nutrition, but it remains unknown whether variations in nutrient intakes translate into long-term benefits for neurodevelopment. Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.

AB - Background Preterm birth (<37 gestational weeks) poses a risk of poorer neurocognitive functioning. Faster growth after preterm birth predicts better cognitive abilities and can be promoted through adequate nutrition, but it remains unknown whether variations in nutrient intakes translate into long-term benefits for neurodevelopment. Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.

U2 - 10.1371/journal.pone.0185632

DO - 10.1371/journal.pone.0185632

M3 - Article

C2 - 28957424

AN - SCOPUS:85032917811

SN - 1932-6203

VL - 12

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e0185632

ER -

Nutrition after preterm birth and adult neurocognitive outcomes

Abstract

Funding

UN SDGs

ASJC Scopus subject areas

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