Preterm infants typically experience faster growth rates than term-born infants, often doubling their weight in six to eight weeks. However, many face challenges leading to growth faltering and suboptimal neurodevelopment. To achieve optimal growth, these infants often require fortified breastmilk or high-nutrient formula. While meeting nutrition and growth targets are essential, concerns arise about rapid postnatal growth during their catch-up phase, particularly regarding increased body fat at term-corrected age, possibly increasing their risk for obesity and chronic health conditions later. However, evidence suggests that although preterm infants may have higher body fat at term-corrected age, this difference diminishes by three months corrected age, aligning more closely with term-born infants. Systematic reviews of more than 20,000 individuals observed that small for gestational age preterm infants do not have higher adiposity in childhood and adulthood; rather, they exhibit lower body mass indexes, waist circumferences, similar body and visceral fat and blood pressure compared to their appropriate for gestational age preterm-born peers. Therefore, it is reassuring that promoting early growth in preterm infants does not necessitate a trade-off when it comes to supporting long-term metabolic outcomes versus neurodevelopment. Healthcare providers should encourage a responsive feeding approach, even in preterm infants, guided by infants' physiological needs, hunger and satiety once they exhibit feeding cues. This approach respects the child's developmental needs and encourages healthy eating habits, fostering positive parent-child feeding relationships, and ultimately allowing the child to grow and develop to their full potential without compromising their long-term health outcomes.

OBJECTIVE:To evaluate the effect of age correction up to 36 months of age for growth assessments of extremely preterm (<28 weeks) and very preterm (28 to <32 weeks) infants. STUDY DESIGN:This longitudinal analysis used data from the Preterm Infant Multicenter Growth Study (2001-2014). RESULTS:1,416 children were included (Median gestational age = 27 weeks). Chronological age-based weight, height, and head circumference z-scores were consistently lower than those based on corrected age for all ages (0, 4, 8, 21 and 36 months) by up to -5.2 (95% confidence interval -5.4, -5.1) z-scores for length at term. Using chronological age, higher proportions of children were misclassified as having suboptimal growth (up to 72.9% misdiagnosed as stunted and 89.8% misdiagnosed as underweight at term). CONCLUSION:For extremely and very preterm children, age correction is required for all growth measures through 36 months of corrected age.

BACKGROUND:Experts recommend assessing preterm infant growth against fetal growth patterns. However, obtaining accurate estimates of healthy fetal growth from preterm infants is challenging as many had intrauterine faltering growth. OBJECTIVES:To improve preterm infant growth assessments by developing Fenton third-generation sex-specific preterm growth charts based on anthropometric distributions of preterm infants without abnormal fetal growth. We also aimed to evaluate the consistency of the new charts' growth velocities. DATA SOURCES:From the last search for the 2013 Fenton growth charts to November 2024, MEDLINE and EMBASE databases, grey literature, as well as US Vital statistics and iNeo Consortium. STUDY SELECTION AND DATA EXTRACTION:We followed systematic review methodology to identify population-based sex-specific anthropometric estimates of preterm cohorts without abnormal fetal growth beginning ≤ 24 weeks of gestation. Specified a priori, outcomes included newborn sex-specific estimates of birthweight, length, and head circumference. SYNTHESIS:We followed PRISMA guidelines. Literature screening and quality assessment were performed in duplicate. We harmonised weight, length, and head circumference weighted-average meta-analyses with the World Health Organization growth standard and rescaled the charts' x-axis from completed gestational weeks to exact gestational age (weeks and days). RESULTS:Seven studies from 15 countries (Australia, Brazil, Canada, China, Finland, Israel, Italy, Japan, Netherlands, New Zealand, Sweden, Switzerland, Spain, United Kingdom and United States) were included, representing 4.8 million births 22-42 weeks of gestation. 174,184 were < 30 weeks gestational age. The Fenton third-generation preterm growth charts' weights showed improved growth velocity across percentiles with consistent declines for weight, length and head circumference velocity as post-menstrual age increased. The birthweight meta-analysis curves had similar shapes to fetal ultrasound estimates. CONCLUSIONS:The Fenton third-generation preterm infant growth chart curves demonstrate improved and more uniform slopes across percentiles and closer alignment with fetal ultrasound estimates, offering a growth standard for preterm infants. PROSPERO REGISTRATION:CRD42024589756.

RATIONALE:Inhalational exposures are associated with risk of developing interstitial lung disease (ILD), yet the relationship between specific exposures and ILD is poorly characterised. OBJECTIVE:Identify inhalational exposures associated with ILD and estimate the effects of exposures on ILD risk. METHODS:MEDLINE and EMBASE databases were searched from 1990 to 2022 to identify inhalational exposures associated with ILD diagnosis. ILDs where causality is well-established (hypersensitivity pneumonitis, pneumoconiosis) and sarcoidosis were excluded. Two independent reviewers screened abstracts with full-text review and data extraction of eligible studies. Where possible, data were pooled and multilevel meta-analysis was specified using a random effects model. Sources of heterogeneity and risk of bias were assessed. MAIN RESULTS:96 studies were included in the systematic review, representing 40 819 116 subjects (295 167 had ILD, 40 523 949 controls). For the meta-analysis, 54 studies were included (40 490 793 subjects: 273 899 ILD, 40 216 894 controls). Exposures associated with significantly increased ILD risk included smoking (OR 1.69, 95% CI 1.47 to 1.94), organic exposures (OR 1.56, 95% CI 1.12 to 2.16), metals (OR 1.52, 95% CI 1.07 to 2.16), dust (OR 1.45, 95% CI 1.20 to 1.76) and asbestos (OR 1.53, 95% CI 1.08 to 2.15). Silica and fumes had positive associations with ILD that trended towards significance. CONCLUSIONS:This systematic review and multilevel meta-analysis is the first to comprehensively assess the effect of inhalational exposures on overall risk of ILD, with multiple putative exposures identified. Future work should investigate novel occupational exposures associated with ILD, characterise the gene-environment interaction and develop preventative strategies. PROSPERO REGISTRATION NUMBER:CRD42022292908.

Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.

The developmental origins of health and disease hypothesis proposes that early exposure to adverse conditions during fetal development and early life have strong detrimental consequences on long-term health and susceptibility to chronic diseases. We conducted a systematic review to critically appraise Barker’s highest cited publications using the risk-of-bias assessment tool (ROBINS-I) and investigate effects of overadjustment by later body weight. Our findings revealed that all included studies displayed high risks of bias, with particular concerns regarding confounding (8/8), selection of reported results (8/8), classification of exposure (7/8), selection of participants (5/8) and high rates of missing data (ranged from 15 to 87%). Later body weight was over-adjusted in most (6/8) of the studies. As all studies displayed high bias risk due to confounding, missing data and overadjustment, evidence is insufficient to support causal relationships between low birthweight and adult disease, warranting caution in clinical application. Protocol registration PROSPERO CRD42023433179

BACKGROUND:Growth assessments are a pillar of public health surveillance, individual health screening, and clinical care. Normal growth is defined differently for individuals versus populations. The World Health Organization (WHO) growth standards were developed to describe the pattern of growth in healthy children without socioeconomic limitations whose mothers planned to breastfeed. The growth standards' cut-off points of ±2 standard deviations (z-scores) were defined for population assessments, based on attained size, to describe stunting and wasting at the lower end and overweight at the higher end. In a healthy population, one would expect 2.3% of the population to be above and below these cut-points. Higher child mortality rates associated with higher rates of stunting and wasting noted in observational studies validated these WHO cut-offs. There are knowledge gaps influencing the accuracy and effectiveness of growth assessments in individual children, posing challenges for health care providers. SUMMARY:The principles of assessing normal growth in children and preterm infants are reviewed, along with pitfalls to be avoided. Growth is determined by genetics and modified by the interplay with nutritional, environmental, socioeconomic, and possibly intergenerational factors. This complexity is reflected at both the population and individual level. However, normal growth in an individual has unique-specific factors so requires a comprehensive assessment. Normal growth for an individual child could be defined as the progression of changes in anthropometric measurements to achieve the individual's genetic potential. A misdiagnosis of growth faltering can occur if infants and children are assessed with one-time rather than serial measures, and if age is not corrected for prematurity. Health care provider sensitivity and cognizance when communicating about a child's size is important for parental reassurance and avoiding stigma and unnecessary pressures or restrictions around feeding.

BACKGROUND:Concerns are prevalent about preterm infant long-term growth regarding plotting low on growth charts at discharge, stunting, underweight, high body fat and subsequent cardiometabolic morbidities. OBJECTIVES:To examine (a) longitudinal growth patterns of extremely and very preterm infants to 3 years corrected age (CA) (outcome), categorised by their birthweight for gestational age: small, appropriate and large for gestational age (SGA, AGA and LGA, respectively) (exposure); and (b) the ability of growth faltering (<-2 z-scores) to predict suboptimal cognitive scores at 3 years CA. METHODS:Post-discharge head, length, weight and weight-4-length growth patterns of the PreM Growth cohort study infants born <30 weeks and < 1500 g, who had dietitian and multi-disciplinary support before and after discharge, were plotted against the World Health Organization growth standard. Infants with brain injuries, necrotising enterocolitis and bronchopulmonary dysplasia were excluded. RESULTS:Of the included 405 infants, the proportions of infants with anthropometric measures > - 2 z-scores improved with age. The highest proportions <-2 z-scores for length (24.2%) and weight (24.0%) were at 36 gestational weeks. The proportion with small heads was low by 0 months CA (1.8%). By 3 years CA, only a few children plotted lower than -2 z-scores for length, weight-4-length and weight (<6%). After zero months CA, high weight-4-length and body mass index > + 2 z-scores were rare (2.1% at 3 years CA). Those born SGA had higher proportions with shorter heights (16.7% vs. 5.2%) and lower weights (27.8% vs. 3.5%) at 3 years CA compared to those born AGA. The ability of growth faltering to predict cognitive scores was limited (AUROC 0.42, 95% CI 0.39, 0.45 to 0.52, 95% CI 0.41, 0.63). CONCLUSIONS:Although children born <30 weeks gestation without major neonatal morbidities plot low on growth charts at 36 weeks CA most catch up to growth chart curves by 3 years CA.

Background Many interstitial lung diseases (ILDs) have clear causal relationships with environmental and occupational exposures. Exposure identification can assist with diagnosis, understanding disease pathogenesis, prognostication and prevention of disease progression and occurrence in others at risk. Despite the importance of exposure identification in ILD, there is no standardised assessment approach. Many questionnaires are in clinical and research use, yet their utility, applicability, relevance and performance characteristics are unknown.Objectives This scoping review aimed to summarise the available evidence relating to ILD exposure assessment questionnaires, identify research gaps and inform the content for a future single evidence-based ILD questionnaire.Methods A scoping review based on Arksey and O’Malley’s methodological framework was conducted. Eligibility criteria: Any questionnaire that elicited exposures specific to ILD was included. A modified COSMIN Risk of Bias Framework was used to assess quality. Sources of evidence: Relevant articles were identified from MEDLINE and EMBASE up to 23 July 2023.Results 22 exposure questionnaires were identified, including 15 generally pertaining to ILD, along with several disease-specific questionnaires for hypersensitivity pneumonitis (n=4), chronic beryllium disease, sarcoidosis and silicosis (1 questionnaire each). For most questionnaires, quality was low, whereby the methods used to determine exposure inclusion and questionnaire validation were not reported or not performed. Collectively the questionnaires covered 158 unique exposures and at-risk occupations, most commonly birds, mould/water damage, wood dust, asbestos, farming, automotive mechanic and miners. Only five questionnaires also provided free-text fields, and 13 queried qualifiers such as temporality or respiratory protection.Conclusions Designing a robust ILD-specific questionnaire should include an evidence-based and relevance-based approach to exposure derivation, with clinicians and patients involved in its development and tested to ensure relevance and feasibility.

BACKGROUND Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm. OBJECTIVE The objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm. DATA SOURCES MEDLINE, EMBASE and CINAHL until October 2022. STUDY SELECTION AND DATA EXTRACTION Studies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non-SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers. SYNTHESIS We meta-analysed across studies using random-effects models and explored potential heterogeneity sources. RESULTS Thirty-nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (-0.66 kg/m2 , 95% CI -0.79, -0.53; 32 studies, I2  = 16.7, n = 30,346), waist circumference (-1.20 cm, 95% CI -2.17, -0.23; 13 studies, I2  = 19.4, n = 2061), lean mass (-2.62 kg, 95% CI -3.45, 1.80; 7 studies, I2  = 0, n = 205) and height (-3.85 cm, 95% CI -4.73, -2.96; 26 studies, I2  = 52.6, n = 4174) compared with those preterm infants born non-SGA. There were no differences between preterm SGA and preterm non-SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains. CONCLUSIONS Compared to their preterm non-SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non-SGA preterm infants.

BACKGROUNDHistorical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease.OBJECTIVESTo assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size.METHODSA database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity.RESULTSWe found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I2  = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I2  = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains.CONCLUSIONSEvidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.

Rationale: Incidental parenchymal abnormalities detected on chest computed tomography scans are termed interstitial lung abnormalities (ILAs). ILAs may represent early interstitial lung disease (ILD) and are associated with an increased risk of progressive fibrosis and mortality. The prevalence of ILAs is unknown, with heterogeneity across study populations. Objectives: Estimate the pooled prevalence of ILAs in lung cancer screening, general population-based, and at-risk familial cohorts using meta-analysis; identify variables associated with ILA risk; and characterize ILA-associated mortality. Methods: The study protocol was registered on PROSPERO (CRD42022373203), and Meta-analyses of Observational Studies in Epidemiology recommendations were followed. Relevant studies were searched on Embase and Medline. Study titles were screened and abstracts reviewed for full-text eligibility. Random effect models were used to pool prevalence estimates for specified subgroups and ILA-associated mortality risk. Risk of ILAs was estimated based on age, sex, and FVC. Quality assessment was conducted using an adapted Assessment Tool for Prevalence Studies. Measurements and Main Results: The search identified 9,536 studies, with 22 included, comprising 88,325 participants. The pooled ILA prevalence was 7% (95% confidence interval [CI], 0.01-0.13) in lung cancer screening, 7% (95% CI, 0.04-0.10) in general population, and 26% (95% CI, 0.20-0.32) in familial cohorts. Pooled mortality risk was increased in those with ILAs (odds ratio, 3.56; 95% CI, 2.19-5.81). Older age, male sex, and lower FVC% were associated with greater odds of ILA. Conclusions: Populations undergoing imaging for non-ILD indications demonstrate high ILA prevalence. Standardized reporting and follow-up of ILAs is needed, including defining those at greatest risk of progression to ILD.

We read with interest the article by Johnstone et al.1 reporting their vitamin-mineral randomized trial that found that children with attention-deficit/hyperactivity disorder (ADHD) showed global benefit over placebo by blinded clinician rating, but not by parent-report CASI-5 composite rating in a population with ADHD and irritability. Because some of the mineral dosing was in potentially toxic ranges, we sought to examine the trial findings. Given that the producing company is promoting their supplement for long-term use,2 the scientific and consumer communities might value some additional information about potential toxicity from long-term dosing.

We have read the article by Nummela et al.1 with interest. It was suggested by the investigation that weight changes in early life were associated with later blood pressure, body mass index and waist circumference. However, overadjustment was consistently committed in the conducted statistical analyses. Overadjustment is a serious methodological issue that has been highlighted in neonatal literature, supported by evidence from studies in term and preterm children in relation to cardiometabolic outcomes.24 Despite the data being from an RCT, the current study provides an observational analysis. In observational analyses, it is important to adjust for potential confounding variables (e.g. socioeconomic (SES) variables) to ensure unbiased estimates. However, intermediate variables that fall on the causal pathway should not be treated as confounders; thus, they should not be adjusted for in regression models. In the association between birth weight and/or weight changes in infancy and later cardiometabolic outcomes, measures of body size at intermediate time points are intermediate variables. Hence, intermediate variables such as body size measures should not be included in the models to avoid bias/error. We agree with the authors about the importance of including SES in the conducted analyses given “indications that childhood socioeconomical status affects later risk for obesity and later CVD risk”. A limitation of the current study is that only parental education was included as an SES indicator, while other important SES factors were not included (e.g. maternal age, maternal marital status, or household income). Accordingly, without complete and appropriate adjustment for key confounders, conclusions about the associations of interest should be made with extra caution. Furthermore, we think it is important to highlight the multiple testing/comparisons performed in the study. For example, tables 2– 4 have 132 comparisons, of which 20% were significant. Multiple comparisons increase the probability of type I error by a considerable amount, which in turn reduces our confidence in the significant results provided.5 Given the outlined concerns about the risk of bias in the estimates provided, due to overadjustment and type I errors, we think that the readers would find it valuable if the authors provide the crude estimates for their linear regression models, and the appropriately adjusted coefficients (without overadjustment for body size variables: that is, not adjusted for baseline weight for each interval and change in length for each interval result, and with adjustments for identified confounders such as SES factors). Additionally, to account for the multiple comparisons, it would be valuable for the authors to apply a Bonferroni correction to their results. Considering the current limitations, we believe that the conclusion, as currently stated, may be misleading and is not well supported by the conducted analyses. The study results should be interpreted with caution given the present methodological issues (overadjustment and multiple comparisons).

Abstract Background Numerous studies indicated that infants born small-for-gestational-age (SGA) are at higher risk of overweight. However, the association between SGA and overweight may be due to overcontrolling for body size. This study aimed to analyze the effect of controlling for child’s weight and height in the association between SGA and overweight in children born preterm. Methods Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). The association between SGA and overweight at 36 months corrected age (CA) was analyzed using logistic regression models: 1) crude, 2) adjusted for baseline covariates, 3) adjusted for baselines covariates with additional adjustments separately for child’s weight and height at 21 months CA. Marginal structural models (MSM) with stabilized inverse probability weights were used to estimate the direct effect of SGA on overweight. Results The crude and adjusted models yielded a null association (OR, 95% CI: 0.88, 0.26-2.96; 0.95, 0.28-3.29). Adjusting for later height reversed the effect (OR, 95% CI: 2.31, 0.52-10.26), and adjusting for later weight reversed the effect and provided a significant association (OR, 95% CI: 6.60, 1.10-37.14). The MSMs with height and weight considered as mediators indicated no direct effect of SGA on overweight (OR, 95% CI: 0.83, 0.14-5.01; 0.71, 0.18-2.81). Conclusions Overcontrolling for body size can falsely induce an association between SGA and overweight. Key messages Mediators should not be treated as confounders.

Objective The objective of this study is to analyze the effect of adjusting for body measures on the association between small for gestational age (SGA) and overweight at 3 years. Study design Data were obtained from the Preterm Infant Multicenter Growth Study ( n = 1089). Logistic regression was used, to adjust for confounders with additional adjustments separately for weight and height at 21 months. Marginal structural models (MSMs) estimated the direct effect of SGA on overweight. Results The crude and adjusted for confounders models yielded null associations between SGA and overweight. Adjusting for height yielded a positive association (odds ratio (OR): 2.31, 95% CI: 0.52–10.26) and adjusting for weight provided a significantly positive association (OR: 6.60, 95% CI: 1.10–37.14). The MSMs, with height and weight held constant, provided no evidence for a direct effect of SGA on overweight (OR: 0.83, 95% CI: 0.14–5.01, OR: 0.71, 95% CI: 0.18–2.81, respectively). Conclusion Adjusting for body measures can change the association between SGA and overweight, providing spurious estimates.

Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta-analysis was to assess the association between excess body fat with recurrence, cancer-specific, and all-cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty-six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2 ) was associated with increased all-cause mortality (HR = 1.34, 95%CI = 1.12-1.59) and recurrence (HR = 1.28, 95%CI = 1.06-1.56). In sub-group analysis, associations between higher BMI and all-cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all-cause mortality among endometrial cancer survivors but not endometrial cancer-specific mortality.