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Race as social determinant of growth and body composition among infants born very preterm

Pediatric Research (2024)Cite this article

Abstract

Objective

Racism leads to disparities in health outcomes. Our objective was to determine if black race was independently associated with differences in fat accretion at discharge in a large cohort of very preterm infants (32 weeks of gestation or less).

Methods

De-identified demographic, anthropometric and body composition data were collected from seven neonatal units around the United States. Weight, length, and head circumference z-scores at birth and at the time of body composition assessment or hospital discharge were calculated.

Results

The median gestational age and birthweight for this cohort (n = 888) were 29 weeks [IQR, 27–30] and 1167 g [SD, 354], respectively. The study population included 53% black preterm infants. Birthweight was lower in black preterm infants compared with white infants (1112 ± 334 g vs. 1228 ± 366 g; p < 0.0001). After adjusting for birthweight, gestational age, and birthweight-for-age z-score, black preterm infants had more weight gain (adjusted mean difference: 0.5 g/kg/day; p = 0.03) but not higher BF% z-scores at hospital discharge (adjusted mean: 1.2 vs. 1.3; p = 0.14) than white infants.

Conclusions

After adjusting for covariates, black race was associated with higher weight gain velocity but not higher BF% z-scores.

Impact

  • This study presents findings from a large-scale multicenter cohort. Racial differences were observed in birth weight and the rate of weight gain; however, these differences were not associated with dissimilarities in body composition outcomes.

  • Understanding nutrition and growth outcomes across racial groups is necessary to combat racial disparities in the neonatal intensive care unit (NICU).

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Fig. 1: Flow diagram.
Fig. 2: Partial correlation between Weight Gain Velocity and Different Components of Body Composition.

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Acknowledgements

A.A.S. conceptualized and designed the study, coordinated and supervised data collection, carried out the initial analyses, drafted the initial manuscript, and critically reviewed the manuscript for important intellectual content. K.C., L.L., L.K., E.I., A.B.H., A.M., E.M.B., M.T.E., and S.R. helped design the study, supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

A.A.S. and S.R. are currently supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development under Award Numbers K23HD102554 & R01HD111016, respectively. A.B.H. is supported by funding from the National Institutes of Health under Award Numbers R01DK135602 and R01DK124614. K.C., L.L. and K.L. are supported by The David and Laura Stone Endowment for Advancement in Neonatal Medicine. K.C. is supported by funding from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers KL2TR001452 & UL1TR001450 and by the Clinical Component Core of the MUSC Digestive Disease Research Core Center (P30 DK123704 and COBRE Digestive Liver Disease Center).

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Authors and Affiliations

  1. Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Ariel A. Salas

  2. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Katherine Chetta, Laura Lach & Lakshmi Katikaneni

  3. Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Elena Itriago & Amy B. Hair

  4. Department of Pediatrics, UT Health San Antonio, San Antonio, TX, USA

    Alvaro Moreira

  5. Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Erynn M. Bergner

  6. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Mohamad T. Elabiad

  7. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Sara E. Ramel

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  1. Ariel A. Salas
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  2. Katherine Chetta
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  5. Elena Itriago
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  6. Amy B. Hair
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  10. Sara E. Ramel
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Corresponding author

Correspondence to Ariel A. Salas.

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Competing interests

K.C., L.L., L.K., E.I., A.B.H., A.M., E.M.B., M.E., and S.R. have no conflicts of interest to disclose. A.A.S. has patented an instrumented feeding bottle. A.A.S. has received honoraria from the Lockwood Group for participation in advisory board meetings. E.M.B. served as a site principal investigator for a Prolacta Biosciences-funded study from 2019 to 2023.

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Salas, A.A., Chetta, K., Lach, L. et al. Race as social determinant of growth and body composition among infants born very preterm. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03406-x

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