Nutrient-enriched Infant Formula is

Associated with Higher Weight Gain for Low

Birth Weight Infants
Original Article : nutrition ESPGHAN dan NASPGHAN
Michelle Ngan, Ramin Durazo-Arvizu, Marc G. Weiss, and Holly Kramer
 Background
Nutrition during early beginning of life is essential for
growth, development, and long term health of low birth
weight infants.

Current recommendations for feeding low birth weight

infants are designed to mimic the weight gain of normal
.fetuses without causing metabolic stress

Intensive nutritional management is used in NICU to

encourage weight gain

Optimal growth for these premature infants usually occurs

after discharge from NICU
 Background
Optimal growth during the beginning of life is critical for
long-term growth and development of low birth weight
infants.

Failure to achieve proper physical growth in the first 12

months potentially stunt growth into childhood

Consensus recommend an extra calories and vitamin

supplements for LBW after hospital dicharge
Background
Increasing caloric
density

Nutrient-
enriched
formula

Allow smaller Contain more protein,

vitamins, and minerals than
volume standard term formulas
Background
What is the impact of nutrient-
enriched formula on infant
weight gain after hospital
discharge in non-hospital setting?
Purpose
To explore the association between weight gain
and nutrient-enriched formula among low birth
weight infants.
Hypothesis
Nutrient- enriched formulas would be associated
with higher weight gain than standard term infant
formula.
 Methods
(Study population)
Inclusion
◦ The study population (n=3548)
◦ Infants enrolled the Illinois Special Supplemental Nutrition Program for
Women, Infants and Children (WIC)
◦ Born between Jan 1, 2010 – Dec 31, 2010
◦ Low birth weight (1500-2500g).

Exclusion
◦ Infants with less than 2 follow up visits
◦ Weights outside normal parameters (+5 or -6 Z-score on the WHO
2006 growth standards) (n=418)

Total included in analysis : 3130 infants

Data were collected by the Illinois Department of Human
Services' Cornerstone data management systems.
Methods
(Infant Formula)
Formula use at baseline infant upon WIC
enrollment, which generally occurs within 2 weeks
after hospital discharge.
Formula assignments were not randomized but
determined by infant’s pediatrician.
Nutrient enriched infant formulas included in this
study were Similac Neosure by Abbott Nutrition
and Enfamil Enfacare by Mead Johnson.
Standard term infant formulas included in this
study were Enfamil Infant, Enfamil Prosobee, and
Enfamil Gentlease by Mead Johnson.
Methods
(Infants weight)
The baseline measured within 2 weeks after birth and at
every subsequent follow-up WIC visit (every 6 months)
Infant weight was measured using WIC anthropometric
guidelines
 Statistical analysis
The statistical analysis was performed using STATA
software

Categorical variables were compared using a Chi-

square test and continuous variables were compared
using an unpaired t-test.

A multilevel mixed-effects linear regression model with

random intercepts (baseline weight) was used to
determine the association between infant formulas
(nutrient enriched vs. standard term) used at baseline
Three different models in order to examine the
potential impact of covariates on the association
between nutrient enriched formula and infant weight
gain.
◦ Model 1 examined the unadjusted association
between nutrient enriched formula and infant
weight gain.
◦ Model 2 added birth weight, gender and
gestational age to Model 1.
◦ Model 3 added history of breastfeeding, exposure
to household smoking, mother’s age, mother’s pre-
pregnancy BMI, mother’s education level, and
infant’s race and ethnicity to Model 2.
 Results

Infants 1500-1999 grams birth weight: 670

Infants 2000-2499 grams birth weight: 2460
Results
 Results

Use of nutrient-enriched formula among infants 1500-2000 associated

with 481.9 gr higher weight gain than standard formula (95% CI 164.1-
799.7, P<0,05)
Use of nutrient-enriched formula among infants 2000-2500 associated
with 402 gr higher weight gain (95% CI 228-597.1, p<0.05)
Discussion
Nutrient-enriched formula compared with standard term
formula is associated with higher weight gain, (~1 lb during
first 12 months).
1500 - 1999 g birth weight group, weight gain was only
significantly higher with use of nutrient-enriched formulas
versus standard term formulas during the first 6 months and
not during 6 to 12 months after adjustment for all covariates.
Young et al

• Statistically significant higher weight gain at

12 months among infant fed nutrient-
enriched formula
• (-) subjected to bias due to methodological
weakness of existing studies
• (-) eligible clinical trials that were used in the
quantitative analysis were small
• (-) no study examined whether weight gain
differences existed among LBW infants
Cost implications
Substantial cost differences exist between standard term
formulas and nutrient-enriched formulas
No strong evidence that the estimated difference in weight
gain during the first 12 months by type of formula use will
benefit low birth weight infants long term.
Quantifying differences in weight gain by formula use may,
however, help inform nutrition recommendations for low
birth weight infants.
Strength
Large number of infants
Inclusion of infants from low-income families.
Limitation
Formula assignment was
determined by the infants’
pediatrician.
Lack of follow-up through
childhood
•Rapid weight gain during infancy is a
predictor of childhood obesity
No specific measures on
household food security,
which could have influenced
a physician’s choice of
formula for an infant
Include analyses of multiple
factors that may influence,
but some factors like medical
needs and solid food intake
were not captured.
•Doesn’t collect information on the
actual timing of solids foods
Conclusion
Nutrient-enriched formula use is associated with higher
weight gain compared with standard term formula use
among low birth weight infants enrolled in the Illinois WIC
program.
Critical
Appraisal
PICO
Patient •Low birth weight

Intervention •Nutrient-enriched formula

Control •Standard formula

Outcome •Higher weight gain