39 Dietary proteins and IGF I levels in preterm infants 2 Conclusions Altogether preterm and small for gestational age infants are at risk for impaired growth and a suboptimal body composition, making them prone to risk factors for the metabolic syndrome. Low early postnatal IGF I levels seem to be at the origin of this problem. Increased early dietary protein intake has shown to improve growth and body composition in infancy. However it is yet to be elucidated whether this trend persists in later life, thus calling for long-term follow-up studies. Higher IGF I levels and increased dietary protein intake have been found to also improve neurodevelopmental outcome of preterm infants. Evidence supports a trophic role of IGF I in the development of the central nervous system. So far signs of a direct mechanism which limits damage from hypoxic-ischemic and inflammatory insults have only been found in experimental studies. However it is plausible that improved neuronal processing due to higher IGF I levels and an increased dietary protein intake may play a role in preterm infants. Since IGF I levels are related to dietary protein intake it would be valuable to investigate whether a nutritional intervention could improve the long-term outcome of preterm infants by optimizing IGF I levels as well as optimally using the potential of IGF I. It may be argued whether initial IGF I levels are sufficient or should be further increased by increasing nutrient intake in the early postnatal period. On the other hand nutrient intake might have to be reduced once IGF I reaches the level where it’s trophic and neurodevelopment enhancing potential becomes effective, creating a more favourable setting for further development. Moreover, assessment of the optimal protein/energy ratio in this period may be a key to improve metabolic programming and studies on specific amino acids could ameliorate dietary advices. In addition it has to be questioned whether IGF I administration to preterm infants could offer a potential future therapeutic intervention. Altogether the above illustrates the important gap of knowledge in potential causal pathways between dietary protein intake, IGF I levels and longterm outcomes of preterm infants that needs to be explored in future research.
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