Acta Pædiatrica ISSN 0803-5253

REGULAR ARTICLE

Body composition in late preterm infants in the first 10 days of life and at
full term
Elisabeth Olhager (elisabeth.olhager@skane.se), Caroline T€ornqvist
€ping, Sweden
Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linkoping University, Linko

Keywords ABSTRACT
Air displacement plethysmography, Body Aim: To investigate changes in body weight, fat-free mass, fat mass and percentage of
composition, Fat mass, Fat-free mass, Preterm
infants body fat during early life and at full-term postconceptional age (PCA) in preterm infants
born after 32 gestational weeks and before 37.
Correspondence
E Olhager, Department of Neonatology, Skane Methods: Twenty-nine late preterm infants underwent growth and body composition
University Hospital, SE-221 85 Lund, Sweden. assessment by air displacement plethysmography (ADP) at the age of 4 days and at full-
Tel: +46 46 178286 |
term PCA. In 25 of these infants, body composition was assessed three times between
Email: elisabeth.olhager@skane.se
days four and nine of life. The preterm infants were compared with 29 full-term infants,
Received
matched for gestational age, sex and body weight.
29 September 2013; revised 1 February 2014;
accepted 10 March 2014. Results: There was a significant increase in birth weight and fat-free mass between days
DOI:10.1111/apa.12632
four and nine of life. Preterm infants had significantly more body fat 382
180 g vs
287
160 g than full-term infants at full-term PCA. Preterm infants showed poor linear
growth between birth and full-term PCA.
Conclusion: Weight gain after the initial postnatal weight loss consists of gain in fat-free
mass. At full-term PCA, preterm infants were stunted. When compared with full-term new
born infants matched for body weight and gestational age, preterm infants had more body
fat and a higher percentage of body fat.

INTRODUCTION fact, almost 25% of infants admitted to neonatal units,

Preterm infants often experience early postnatal growth
failure, which is already evident at full-term postconcep-
tional age (PCA) and may be associated with a negative
long-term neurological outcome (1). Aggressive nutritional
management has been proposed to minimize later devel-
opmental delays, the goal being to achieve a postnatal
weight gain approximately equal to foetal growth rates (2).
However, rapid weight gain in early infancy has been
associated with increased risks of obesity and metabolic
syndrome later in life (3). Furthermore, it has been shown
that children who are born prematurely have an isolated
reduction in insulin sensitivity, which may be a risk factor
for type 2 diabetes mellitus (4). In recent years, there has
been increasing focus on the quality of growth in preterm
infants (5,6). Studies comparing the body composition of
preterm infants at full-term PCA with that of full-term
newborns show preterm infants are not only shorter and
lighter, but they also have more body fat and less fat-free
mass (7). This is alarming, because this pattern of growth
may correlate with impaired cognitive outcome (1,5).
Most studies of the body composition of preterm infants
have been carried out in infants born before 32 gestational
weeks (1,6,7). A study of late preterm Italian infants born
after gestational week 32, but before 37 completed gesta-
tional weeks, found rapid catch-up growth in fat mass
between birth and one-month old (8,9). In Sweden, this
group of infants represents 3–4% of all newborns and, in
making them by far the largest patient group (10). Although
these late preterm infants are relatively healthy compared
with infants born before 32 completed gestational weeks,
they have higher mortality and morbidity than full-term
newborn infants (10).
The period around birth is very important, as the first
days of postnatal life are a time of enormous change (11).
Several studies have highlighted the high-fat content in
preterm infants at full-term PCA, but little attention has
been paid to their body composition development during
the first postnatal days (12). One study reported data on the
body composition of preterm and full-term infants within
48 h of birth, stating that the proportion of body fat in late
Key notes
 Conflicting data exist regarding early and late changes
in body composition in late preterm infants.
 We found that weight gain after the initial postnatal
weight loss consisted of gain in fat-free mass and
preterm infants (n = 29) had a higher percentage of
body fat than full-term infants (n = 29).
 This pattern of growth and body composition develop-
ment may be associated with increased risks of obesity
and the metabolic syndrome in later life.

©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743 737
Body composition in late preterm infants
preterm infants, assessed by dual-energy X-ray absorptiom-
etry (DEXA), was as high as 13–14% (13).
In 2004, equipment based on the air displacement
plethysmography (ADP) technique became available,
enabling accurate, quick and noninvasive assessment of
body composition in infants weighing between one and
eight kilograms (9,14,15). This technique has subsequently
been used to measure the body composition of full-term and
preterm infants. It is well accepted by parents, healthcare
staff and infants and is therefore well suited for clinical
studies. We used the ADP technique in a group of late
preterm infants to study changes in body composition
during the early postnatal period. Our first aim was to
describe changes in body weight, fat mass and fat-free mass
in such infants during the first 10 days of life. Our second
aim was to compare their body composition at full-term
PCA with corresponding values for full-term new born
infants matched for PCA, sex and weight.
MATERIALS AND METHODS
Study design
Body weight, fat-free mass and fat mass were assessed in 29
preterm infants (Group One). The infants were examined
on day four
one of life, on two additional occasions
during the first 10 days of life and at full-term PCA. Four
infants were not assessed on the following two occasions.
Values obtained at full-term PCA were compared with
those for 29 full-term newborn infants (Group Two). For
this comparison, infants were matched for sex, body weight
(
100 g) and PCA (
3 days). Infants in Group Two were
examined on day six
two of life. Figure 1 shows the
infants who participated in the study.
Preterm infants
Between February 2008 and June 2009, 166 preterm
infants, born after at least 32 gestational weeks, were
€ ping
admitted to the neonatal intensive care unit at Linko
Group 1
n = 29 preterm infants,
investigated on day four
of life
Four preterm infants were
not eligable for
investigations on
day 6 and 9 of life.
Group 1
n = 29 preterm infants Group 2
investigated att full-term n = 29 full-term infants
post conceptional age
Figure 1 Flow diagram of the infants who participated in the study.
738
€rnqvist
Olhager and To
University Hospital. Gestational age was based on the date
of the last menstrual period and ultrasound in gestational
week 11–12. Postconceptional age was calculated using
chronological age plus gestational age. Forty-one of these
infants met the following criteria: birth weight over 1500
grams, singletons, weight and length appropriate for gesta-
tional age according to Swedish growth reference values
(16), no need for respiratory support (ventilator, continued
airway pressure or extra oxygen), no need for parenteral
nutrition and no sepsis or malformation. Parents were
asked for permission for their child to participate in the
study, and permission was granted for 30 infants (29 infants
had valid results). These infants were all fed according to
current practice at the neonatal unit, which includes special
efforts to initiate and maintain maternal lactation. As most
preterm infants are unable to suck effectively, breast milk
was initially fed through a nasogastric tube. If the mother
was unable to provide breast milk, the infants were fed
formula (Pepti Junior, Mead Johnsson). On day four of life,
nine infants received formula, 13 received formula plus
their mother’s breast milk, and seven only received their
mother’s breast milk. At full-term PCA, two infants were fed
formula, four were fed formula plus breast milk, and 23 only
received breast milk. Feeding regimes were not recorded
between discharge from the unit and the day of assessment.
Full-term infants
Twenty-nine healthy full-term newborn infants were
recruited from the maternity ward at Linko € ping University
Hospital. Fourteen had participated in a previous study
(17). The infants were fed according to the guidelines of the
maternity unit, where all mothers are encouraged to
breastfeed. At the time of investigation, two infants were
formula fed, two received formula plus breast milk and 25
were completely breastfed.
Anthropometry at birth
In the delivery room, all infants were weighed without
clothing on an electronic baby scale (Tanita Corporation,
Tokyo, Japan) and their length measured by means of a
measuring board. Head circumference was measured with a
plastic measuring band.
Body composition
Body composition was assessed using an ADP system (Pea
Pod, Cosmed USA Inc., Concord, CA, USA) using software
version 3.0.1. The physical design, validation and measure-
ment procedure have been described in detail elsewhere
(15,16). The system measures body volume and body weight
and calculates body density. Body composition is then
calculated by means of a two-compartment model, assum-
ing a fat mass density of 0.9007 g/mL and using fat-free
mass density values based on data published by Fomon
et al. (18). The validity of Fomon et al.0 s estimates of fat-free
mass density in full-term newborns has recently been
confirmed (19). Values for preterm infants are based on
back-extrapolation using existing reference values for foe-
tuses of different gestational ages (20,21). A recent study has
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743
 €rnqvist
Olhager and To Body composition in late preterm infants

reported good agreement between ADP and the isotope

Table 1 Gestational age, body length, head circumference and body weight at birth
dilution technique in the when assessment of body compo-
in late premature and full-term infants
sition in preterm infants (9).
Premature infants* Full-term infants†
The method of measurement was as follows: first, a
n = 29 (14 male) n = 29 (14 male)
measuring board was used to assess the infant’s length. The
infant0 s head was placed against the top of the measuring Gestational 35.0 (1.0) 38.7 (1.2)
board and held in that position by one of the parents. The age (weeks)
examiner (CT) straightened the infant’s legs and recorded Range (33.1–36.7) (37.0–40.7)
the measurement. The infant’s body weight was then Length (cm) 46.0 (1.8) 49.2 (2.1)
recorded using an electronic scale, which is part of the Range (43–49) (46–54)
Head 31.3 (0.5) 36.2 (2.0)
Pea Pod. Subsequently, the infant was placed without
circumference (cm)
clothing in a chamber, which maintains a temperature of
Range (28–33) (35–39)
around 30°C, for about 2 min to measure body volume. Weight (g) 2443 (395) 3185 (453)
While the body volume was measured a tight cap was used Range (1685–3310) (2600–4310)
to keep the infant’s hair flat. All preterm infants except two Weight z-score‡ 0.26
0.72¶ 0.83
0.34¶
were calm during the first measurement. Two infants cried Length z-score§ 0.1
0.89¶ 0.69
0.58¶
and moved around at the start of the examination, but
Data are presented as mean (SD) and range.
subsequently settled. One of these infants did not have a
*Group One.
valid result and was excluded. During the second examina- †
Group Two.
tion, nine infants initially cried but subsequently settled. ‡
Weight-for-age z-score.
Two infants did not settle and cried throughout the §
Length-for-age z-score.
examination. Of the full-term infants, three cried and ¶
(22).
moved around during measurement. All infants were
examined by the same person (CT).

Ethical considerations
The Regional Human Research Ethics Committee in
Linko€ ping approved the study. Both parents of all infants
gave informed oral consent.
Statistics
Data were analysed using the statistical software SPSS for
Windows, version 18.0 (Chicago, IL, USA). Values are
expressed as means (
SD). Repeated ANOVA, post hoc
Tukey’s test and multiple regressions were used to identify
significant differences between groups. Means were also
compared using paired and unpaired t-tests. Significance
was accepted when p < 0.05.
infants were not examined on days six and nine. Between
birth and the first examination, the infants lost 4.4
2.5%
of their body weight. At the third examination, they had
regained their birth weight. Between the first and third
examinations, there was a significant increase (p < 0.05) in
body weight, from 2323
363 to 2392
354 grams, and
in fat-free mass, from 2176
297 to 2237
275 grams.
The average increase in body weight was 69
57 grams,
and the average increase in fat-free mass was 62
53
grams. During this period, the average change in body
fat was 0.1
1.2% and the average increase in body
fat 7.0
6.3 grams. This increase in fat mass was not
significant.

Body composition development of late premature infants

RESULTS
Description of infants at birth
The body weight, length and gestational age at birth of the
late premature and full-term infants are presented in Table 1.
The gestational age at birth of the preterm infants (n = 29)
was 34.9
1.0 weeks and their birth weight 2443
395
grams. The weight-for-age z-score was 0.26
0.72 and the
length-for-age z-score was 0.1
0.90 (22).
The full-term infants (n = 29) were born in gestational
week 38.7
1.2, and their birth weight was 3185
453
grams. Their weight-for-age and length-for-age z-scores
were 0.83
0.34 and 0.69
0.58, respectively.
Body composition of late premature infants during the
first 10 days of life
The body weights, fat mass and fat-free mass of the late
preterm infants are shown in Table 2. The infants were
examined, on average, at four-, six- and nine-day old. Four
until full-term PCA
Table 3 shows the body weight, length, fat mass, fat-free
mass, fat mass index and fat-free mass index of late preterm
infants at the first measurement and at full-term PCA. The
examinations were performed when the infants were on
average four- and 25-day old. Between the two examina-
tions, there were significant increases in body weight, length
and head circumference. Fat mass increased from
153
113 to 348
181 grams, and fat mass as a percent-
age of body weight increased from 6.2
4.0 to 12.3
4.9.
Fat-free mass increased from 2182
292 to 2631
309
grams. Fat mass accretion between the first and last
examinations was 4.2
2.4 g/kg/day. The fat-free mass
index was 10.3
1.1 kg/m2 at the first examination,
increasing significantly to 11.4
1.0 kg/m2 at full-term
PCA. The corresponding figures for fat mass index were
0.7
0.5–1.7
0.7 kg/m2, with this increase also signifi-
cant (p < 0.05).

©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743 739
Body composition in late preterm infants €rnqvist
Olhager and To

Table 2 Body weight, fat mass and fat-free mass in 29 late preterm infants (four infants did not participate in examinations 2 and 3) assessed three times in the first 10 days of life
Examination Age (days) Body weight (g) Fat mass (%) Fat mass (g) Fat-free mass (g)
† †
1 4 (1) 2323 (363)* 4.9 (3.8) 150 (110) 2176 (297)*
2 6 (1) 2348 (356)* 4.4 (3.8)† 135 (110)† 2216 (293)*
3 9 (2) 2392 (354)* 4.9 (3.3)† 159 (111)† 2237 (275)*

*Significant (p < 0.05) difference between measurements 1 and 2, 1 and 3, 2 and 3.

†
No significant difference between measurements 1 and 2, 1 and 3, 2 and 3.
Data are presented as means (SD).

Table 3 Body weight, length, fat mass, fat-free mass, fat mass index and fat-free mass index in 29 late preterm infants (Group One) at first measurement and at full-term PCA
First measurement Full-term PCA p-Value* 95% CI

PCA (weeks) 35.0 (1.0) 38.7 (1.1) <0.0001 (3–4)

Age (days) 4 (1) 25 (9) <0.0001 (18–25)
Weight (g) 2333 (366) 3012 (415) <0.0001 (541–817)
Length (cm) 46 (1.9) 47 (1.9) <0.007 (1.1–2.7)
Fat mass (%) 6.2 (4.0) 12.3 (4.9) <0.0001 (4.3–8.1)
Fat mass (g) 153 (113) 384 (181) <0.0001 (166–297)
Fat-free mass (g) 2182 (292) 2631 (309) <0.0001 (361–536)
Fat mass index kg/m2 0.7 (0.5) 1.7 (0.7) <0.0001 (0.7–1.2)
Fat-free mass index kg/m2 10.3 (1.1) 11.4 (1.0) <0.05 (0.8–1.6)

PCA = postconceptional age.

Data are presented as means (SD).
*For comparison between first measurements and full-term PCA.

The z-scores for weight and length at full-term PCA were
0.62
0.75 and 0.78
0.91, respectively. These values
were significantly lower than the corresponding values at
birth, when the weight-for-age z-score was 0.26
0.72,
and the length-for-age z-score was 0.1
0.9. There was a
significant difference between the z-score at PCA and the
z-scores at birth.
Body composition of late premature infants compared
with full-term infants at similar PCA
Table 4 shows the PCA and postnatal age at measurement
together with body weight, length, fat mass, fat-free mass,
fat-free mass index and fat mass index for late preterm
infants (Group One) and full-term (Group Two) infants
measured at comparable PCA. By design, the two groups
had similar body weights, but the preterm infants were
significantly shorter, on average by 2 cm. They also had
significantly less fat-free mass than the full-term infants,
2631
309 versus 2794
329 grams. Furthermore, the
preterm infants had significantly more body fat (grams and
percentage) than the full-term infants: 382
180 versus
287
160 grams, and 12.3
4.9 versus 8.1
4.3%.
Although the average body weight of the two groups was
very similar, preterm infants had 25.3% more body fat. They
also had a significantly lower fat-free mass index (p < 0.05)
but a significantly (p < 0.003) higher fat mass index than
the full-term infants. In both groups, the majority of infants
were breastfed.
DISCUSSION
In our study of late preterm infants, we found that the
increase in body weight between days four and nine of life
was mainly due to an increase in fat-free mass. Between the
fourth day of life and full-term PCA, these infants increased
their fat mass from 153 to 384 grams, equivalent to a fat
accretion of 4.2 g/kg/day. The corresponding figure for the
reference foetus is 2–3 g/kg/day during gestational weeks
33–36 (20). During this period, the weight-for-age and
length-for-age z-scores of the late preterm infants
decreased. Furthermore, at full-term PCA, these infants
had significantly less fat-free mass than full-term newborn
infants matched for weight, sex and age.
Using ADP, this study assessed body composition
changes in late preterm infants during the first 10 postnatal
days. A previous study assessed body composition in late
preterm infants on day five but did not include further
measurements during the first 10 days (8). However, mean
body fat as a percentage of body weight was 5.7% in that
study, agreeing with our results. Furthermore, body fat as a
percentage of body weight of our preterm infants on day
four of life was consistent with reference data from the
study of Ziegler et al.(20) who showed that body fat in
foetuses of corresponding gestational ages varies between
6.3 and 8.7%. The higher percentage of body fat in late
preterm infants reported by Lapillone et al. can be
explained by the use of DEXA – a technique that has been
shown to overestimate fat mass in small infants (13,23).

740 ©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743
 €rnqvist
Olhager and To
Table 4 Body weight, body length, postconceptional age and postnatal age at measurement, fat mass, fat-free mass, percentage of body fat, fat mass index and fat-free mass index
in 29 preterm infants at full-term postconceptional age (Group One) and 29 full-term infants (Group Two)
Preterm infants
Postconceptional age (weeks) 38.7 (1.1)
Postnatal age (days) 25 (9)
Body weight (g) 3012 (415)
Body length (cm) 47 (2)
Fat-free mass (g) 2631 (309)
Fat mass (g) 384 (180)
Body fat (%) 12.3 (4.9)
Fat-free mass index (kg/m2) 11.4 (1.0)
Fat mass index (kg/m2) 1.7 (0.7)
Data are presented as means (SD).
*For comparison between groups.
ADP, by contrast, has been shown to be a valid method (9).
Thus, we believe that our results are likely more accurate
than those reported by Lapillone et al. At full-term PCA,
our preterm infants had weighed less, were shorter and had
a lower percentage of body fat than preterm infants assessed
by ADP at full-term PCA (5,8). The infants in the study by
Ramel et al. contained 18.7
0.8% body fat at full-term
PCA and the corresponding figure in the study by Roggero
et al. was 16.1
4.6%, which are higher values than for our
preterm group at full-term PCA (5,8). The reasons for the
difference could be that Ramel et al.0 s study included varied
samples of preterm infants who were older, between 40 and
42 weeks gestational age, when assessed by ADP at full-
term PCA. The differences in the percentage of body fat may
reflect variations in international and inter-hospital nutri-
tional regimes. This also means that further studies of
changes in body composition in late preterm infants under
different nutritional regimes are necessary. In our study, 23
of the preterm infants and 25 of the full-term infants were
breastfed at full-term PCA. The results in this study were not
adjusted for feeding regimes. Detailed feeding regimes
between discharge and assessments were not recorded in
the preterm group. We believe that confirmation studies
using larger samples sizes and, if possible, randomization to
different feeding regimes is required. Furthermore, the full-
term infants were assessed during the first week of life and
details of feeding were not recorded. Details of feeding were
not recorded, and thus, it would not be correct to draw any
conclusion on how body composition was affected by
different feeding regimes. At the time of assessment, most of
the infants had not reached their full capacity of feeding.
Normal postnatal development in full-term infants
involves a rapid increase in total body fat after birth, and
data reported by others tend to suggest that this is also the
case for infants born prematurely (6,7,12). In Figure 2, we
present a compilation of data with additional information
on this issue. The figure presents the results of the present
study for our small full-term and preterm infants in relation
to body composition data for 209 normal-sized full-term
healthy Swedish infants studied at an average age of 1 week
(24). The preterm infants were of average weight and length
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743
Body composition in late preterm infants
Full-term infants p-Value* 95% Confidence interval
39.6 (1.2) <0.05 (0.5–1.2)
6 (2) <0.0001
3000 (452) ns
49 (2) <0.05 (0.23–2.2)
2794 (329) <0.0001 (71–196)
287 (160) <0.0001 (76–205)
8.1 (4.3) <0.0001 (2.6–5.8)
12.1 (1.2) <0.02 (0.2–1.0)
1.2 (0.6) <0.000 (0.4–1.0)
at birth but, as Figure 2 shows, they were shorter than both
small full-term and normal-sized full-term infants at full-
term PCA, suggesting that their gain in length was restricted
during the first 3 or 4 weeks of extra uterine life. Further-
more, their proportion of fat-free mass at full-term PCA was
less than that of small full-term infants and, of course, of
normal-sized full-term infants, indicating that the growth of
this body component, too, was restricted during this period.
However, preterm and normal-sized full-term infants had
similar amounts of fat, both in grams and as a percentage.
This comparison thus emphasizes that the problem for a
premature newborn is to gain sufficient fat-free mass and
length. Consequently, future efforts in this area should
attempt to specifically improve these aspects of growth.
An obvious way of improving the growth in fat-free mass
and length of premature infants is to manipulate their
nutritional intake. Our late preterm infants did not follow a
prescribed nutritional schedule and the policy of our unit is
that all infants should be breastfed at discharge, as breast
milk is regarded as the optimal food for all preterm infants.
However, it has been shown that protein-fortified feeds can
increase gains in fat-free mass (25). It remains unclear
whether this can completely correct the kind of diminished
fat-free mass at full-term PCA found in our late preterm
infants. Further studies of late preterm infants are therefore
necessary to examine the effect of such protein supplements
on growth in length and fat-free mass.
Growth patterns in early life predict subsequent disease
risks, such as type 2 diabetes and decreased insulin
sensitivity. Intrauterine growth restriction is a risk factor
for such diseases, but rapid postnatal weight gain is also
independently associated with an increased risk of devel-
oping metabolic syndrome (3,4). These aspects of the
relationship between early growth and later disease risk
have been discussed by Wells, who introduced the concepts
of metabolic load and metabolic capacity (3). A high body
fat content may represent a metabolic load and metabolic
capacity. Metabolic capacity is defined as organ develop-
ment that occurs early in life and metabolic load as the
subsequent growth. Disease risk is predicted to be greatest
when there is large disparity between metabolic capacity
741
Body composition in late preterm infants
Body weight (g)
3500
50
Body fat
Fat free mass
3000
40
2500
30
2000
1500
20
1000
10
500
0
TN TS P TN
Figure 2 Figure 2 shows the body weight (g), fat mass (g), length (cm) and body fat (%) of 209 average-size, full-term Swedish infants at an average of 1 week of age
(term normal = TN) (24), plus the small full-term infants (term small = TS, group III) and late preterm infants of the present study (preterm = PT, group II).
and metabolic load. A high body fat content may represent
a metabolic load, while a low content of fat-free mass may
be detrimental in terms of metabolic capacity. A low fat-free
mass index in relation to body length squared has been
found to be an independent risk factor for premature death
in adults (26). At full-term PCA, our late premature infants
had a lower fat-free mass index and a higher fat mass index
ratio than full-term infants. We do not know if these
observations are of any significance for future health, but it
is without doubt warranted to consider such infants‘ body
composition characteristics suboptimal.
The infants in our study were younger (4 days
1), when
examined by ADP, than those in the validity study by
Roggero et al. (9). Another study reported invalid results
when small full-term infants are measured soon after birth
(27). This could indicate that measurement accuracy soon
after birth and later differs for small infants. It has, however,
been shown that the ADP is robust to minor changes in fat-
free mass hydration in full-term infants (28). In preterm
infants, adaptation to extra uterine life takes longer com-
pared with full-term infants (11). ADP values are affected by
lung volume and fluctuation in hydration. Therefore, our
preterm infants were assessed on day four, when most late
742
€rnqvist
Olhager and To
Length (cm) Body fat (%)
12
10
8
6
4
2
TS P TN TS P
preterm infants have adapted to extra uterine life (11).
Calculation of the percentage of body fat is based on
measurements of body density, assuming a constant density
of fat mass and fat-free mass. However, in fat-free mass the
amount of water, the so-called hydration factor, is an
important determiner of fat-free mass density. The hydra-
tion factor is known for full-term newborns but not for
preterm infants (19). Thus, to increase the validity of ADP
for preterm infants, studies on the degree of hydration
factor would be recommended.
Several maternal factors, such as smoking, parity, pre-
eclampsia, maternal body mass index, diabetes and level of
education, have been shown to affect the outcome of a
mother’s offspring (29). Placental dysfunction is strongly
associated with preterm birth and growth restriction, and
high maternal body mass index and diabetes are associated
with increased growth (30). In our study, maternal factors
were not recorded and the presented data were not adjusted
for maternal factors. As preterm birth is often caused by
maternal factors, there is reason to believe that the intrauter-
ine growth of the preterm infants in our study was affected.
The rapid postnatal growth in fat mass could be an effect of
intrauterine growth restriction caused by maternal factors.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. 737–743
 €rnqvist
Olhager and To
In conclusion, we showed that in late preterm infants the
weight gained after the initial postnatal weight loss mainly
consisted of a gain in fat-free mass. At full-term PCA,
however, growth in length and fat-free mass was restricted in
these infants. Accretion of body fat, on the other hand, was
comparable with that of healthy newborn infants of average
size. Furthermore, in relation to their length, preterm infants
were fatter. This pattern of growth and body composition is
a concern, as it may be associated with increased risks of
obesity and metabolic syndrome later in life.
ACKNOWLEDGEMENTS
We wish express our thanks to the infants who participated
in this study and the staff at the Neonatal Intensive Care
Unit in Linko € ping. We also wish to thank Mats Fredriksson
for statistical advice. We are further grateful to Professor
Elisabet Forsum, Britt Eriksson and Pontus Henriksson for
generously allowing us to use their material.
COMPETING INTERESTS
The authors do not have any conflicts of interest.
ROLE OF FUNDING SOURCE
€
The project was funded by Ostergo€ tland County Council
and the Samariten Foundation.
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