Human Milk vs Formula and Bone Density in Preemies

TOPLINE:

Breastfed very preterm–born children have higher bone mineral density (BMD) at 6 years than their formula-fed peers, while fortification of human milk (HM) after hospital discharge provides no added benefit, according to a new study.

METHODOLOGY:

• A prospective follow-up study included 192 infants born very preterm (gestational age, ≤ 32 weeks) in a multicentre randomised controlled trial on post-discharge nutrition.
• Participants receiving HM were randomly assigned to receive either unfortified HM (n = 59) or fortified HM (n = 67) from hospital discharge to a corrected age of 4 months. Those not receiving HM were given preterm formula (n = 66).
• Researchers performed dual-energy x-ray absorptiometry on children at 6 years of age to establish bone mineral content and BMD, with adjustments for sex, age, and anthropometrics.
• All infants received 10 μg of vitamin D supplementation from their second week of life until 2 years of age, as recommended by the Danish Health Authority.

TAKEAWAY:

• BMD was significantly higher in breastfed children than in formula-fed children after adjusting for variables (P = .001).
• At 6 years of age, the fortified and unfortified HM groups showed no significant differences in height, weight, bone area, bone mineral content, or BMD.

IN PRACTICE:

“With respect to the objective of achieving the optimal peak bone mass, feeding HM (with or without fortification) appears to be superior to formula feeding post-discharge in very preterm–born infants,” the authors wrote.

SOURCE:

The study was led by Line H. Toftlund, Department of Neonatology, Herlev Hospital, Herlev, Denmark. It was published online on January 30, 2025, in the European Journal of Pediatrics.

LIMITATIONS:

Infants on medications, receiving parenteral nutrition, or with diseases affecting bone mineralisation were excluded, limiting the generalisability of the findings. The fortifier dose in HM was relatively low and not adjusted over time. Combining the HM-fed groups may have masked subtle effects. Variations in physical activity, calcium intake, and vitamin D status during infancy and early childhood may have influenced BMD at 6 years, but their impact was likely similar across all three groups.

DISCLOSURES:

The study was funded by the Institute of Regional Health Services Research in Southern Denmark and Sjaelland, the University of Southern Denmark, and Hans Christian Andersen Children’s Hospital, Odense, Denmark. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.