Breast Milk Consumption in Preterm Neonates and Cardiac Shape in Adulthood

Abstract

Background and objectives: Preterm birth relates to long-term alterations in cardiac morphology and function. Understanding whether preterm postnatal life is a tractable period of cardiovascular development that can be positively altered by nutrition is relevant to long-term outcomes. We hypothesized that being fed human breast milk during early postnatal life is beneficial to long-term cardiac structure and function in preterm-born individuals compared with infant formulas.

Methods: A total of 926 preterm-born infants originally took part in a randomized controlled trial of postnatal milk-feeding regimens between 1982 and 1985 across 5 different UK centers. Preterm-born individuals were randomly assigned to either breast milk donated by unrelated lactating women or nutrient-enriched formulas. We followed 102 individuals from this cohort: 30 of whom had been randomized to being fed exclusively human milk and 16 to being fed exclusively formula. As a comparison group, we recruited an additional 102 individuals born term to uncomplicated pregnancies. Cardiac morphology and function were assessed by MRI.

Results: Preterm-born individuals fed exclusively human milk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P < .001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01) compared with preterm-born individuals who were exclusively formula fed as infants.

Conclusions: This study provides the first evidence of a beneficial association between breast milk and cardiac morphology and function in adult life in those born preterm and supports promotion of human milk for the care of preterm infants to reduce long-term cardiovascular risk.

Trial registration: ClinicalTrials.gov NCT01487824.

Figure 1

Derivation of preterm-born study population followed up at age 23 to 28 years. A, infants receiving assigned milk as sole diet; B, infants receiving assigned milk as supplement to mother’s expressed milk.

Figure 2

Preterm-born young adults fed EHM as infants (orange) had increased left and right ventricular end-diastolic volume index (A and C), and left and right ventricular stroke volume index (B and D) compared with preterm-born young adults who were EFF as infants (blue). Term-born young adults (YAT) are shown in green. Please refer to Lewandowski et al. for an illustration and description of the modes of anatomical variation.

Figure 3

The statistical average shapes of the left ventricle are shown across each group derived from computational atlas formation. Statistical comparisons across the first 10 modes for the preterm-born young adults who were EFF (blue) and fed EHM (orange) are shown, with mode 1 being the key differentiating mode between groups (P < .001). Term-born young adults (YAT) are shown in green.