by Anne Eglash MD, IBCLC, FABM
Do premature infants who receive breastmilk have better cardiac outcomes as adults as compared to premature infants who receive formula?
According to a recent review of research by Dr. Adam Lewandowski on prematurity’s effects on adult heart function, at least 10% of infant births globally are premature. Studies indicate that prematurity may cause structural changes in the heart, increasing the risk of heart disease in adulthood.
A very large study among approximately 2.6 million people in Sweden between 1987-2012 demonstrated a strong association between premature birth younger than 32 weeks gestation and heart failure in children and young adults. Even though the true incidence of developing heart failure as a child or young adult is low, infants born at or under 28 weeks gestation are 17 times more likely to develop heart failure as a child or young adult as compared to infants born at or after 37 weeks gestation.
The question is whether a premature infant’s diet makes a difference with this risk. A research study published in 2016 followed 2 small cohorts of premature infants into young adulthood, 30 who were fed exclusively human milk, and 16 who were fed exclusively formula. The researchers measured blood pressure, the size of the left and right ventricles, and a few parameters of cardiac function.
What do you think researchers have found regarding the association between breastmilk feedings on blood pressure, heart structure, and heart function? Choose 1 or more:
- Both the formula fed and breastmilk fed groups of young adults born prematurely had higher blood pressures as compared to young adults who were born at or near term.
- The individuals who received exclusive breastmilk as premature infants were able to pump higher volumes of blood from the ventricles as compared to the individuals who received formula. (in other words, the exclusive breastmilk group had higher diastolic volume indices and larger stroke volumes)
- Premature-born young adults fed exclusively breastmilk had larger chest cavity diameters compared to premature-born young adults fed exclusively formula.
See the Answer
All 3 are correct
Breast Milk Consumption in Preterm Neonates and Cardiac Shape in Adulthood
Adam J. Lewandowski, Pablo Lamata, Jane M. Francis, Stefan K. Piechnik, Vanessa M. Ferreira, Henry Boardman,Stefan Neubauer, Atul Singhal, Paul Leeson, Alan Lucas
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.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
I realize that the research presented is only 1 study of 2 small cohorts of premature infants, but this is such an important issue that I wanted to bring it to light. Hopefully we will see larger well designed studies in the near future. Since at least 1 out of every 10 individuals has an elevated risk of heart disease due to prematurity, finding preventable strategies to improve outcomes is key. What could be more straightforward and available than mothers’ own milk, and donor breastmilk when additional human milk is needed?
The authors point out in their discussion that human milk has growth factors, particularly vascular endothelial growth factor, which has been shown to play an important role in the growth and development of blood vessels in premature infants. This is particularly important in lung development in premature infants. Improved vascular and lung development in premature infants given breastmilk might explain their greater chest cavity diameters as compared to formula fed infants.