Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant

Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant Qunying Xie, Jiamei Li, Yuqi Wen, Yanyan Song, Yan Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4471555/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To investigated whether high protein intake in early life contribute to physical and mental development in preterm infants aged 0-24 months, then analyzed the association between protein intake and incidence of obesity. Methods: A total of 174 preterm infants were recruited for a cohort study related to Guangzhou High-Risk Infant, and were divided into a high protein intake group (HP, n=21) and a common protein intake group (LP, n=153) based on their average protein intake at the age of 0~6 months. Body weight, body length, and BMI and their Z-scores was calculated, and the Gesell development and infant neuropsychological examination screening were used to assess child mental development. Multivariate Linear regression models were used to assess the correlation between protein intake and physical development, and the multivariate logistic regression was used to analyze the association between protein intake and the level of mental development and the incidence of obesity. Results: The average protein intake in HP and LP group were 3.76±0.62g/kg/day and 1.67±0.49g/kg/day, respectively. The body weight, body length, BMI, and their Z-scores in the HP group was significantly lower than LP group during aged 6 to18 months. There a negatively correlation between protein intake and physical development level at aged 6~12 months. No significant association was found between protein intake and the mental development and the incidence of obesity. Conclusions: A higher protein intake in early life (0~6 th month) did not contribute to the development of physical and neuropsychological and have no effect on the incidence of obesity and Neuropsychological development in preterm infants aged 0-24 months. Protein intake Preterm infant Physical development Neuropsychological development Obesity Figures Figure 1 Figure 2 1. Background Premature babies, defined as those born before 37 weeks of gestational age, faced increased risks and challenges in physical growth[ 1 , 2 ]. According to data from WHO report in 2020, the incidence of preterm birth was approximately 12% worldwide, which not also threatened the safety at newborns[ 3 ], but also their health even at adulthood[ 4 , 5 ]. Focusing on the growth and development of premature infants can help reduce infant deaths and improve the quality of the global population[ 6 ]. Clinical nutrition intervention was widely used to compensate for preterm infants, especially babies with very low birth weight[ 7 , 8 ], such as breast milk fortifier, high energy total nutrition formula. Although some of the low-quality evidence available have shown that specific nutrients influence the physical growth and mental development of premature infants, the results are contradictory due to study of object and design. Adequate protein intake was suggested to be an important measure to help catching-up growth in preterm-born children[ 9 , 10 ], as well as neurodevelopment[ 11 ]. Median (range) protein intake from human milk were 1.37(0.88, 2.43)g/kg/day[ 12 ]. Preterm infants require higher protein intake than term infants to attain adequate growth rates base of their relatively higher protein turnover rates[ 13 ]. Preterm infants who were breastfed grow significantly slower than formula-fed infants[ 14 ], the addition of protein to breast milk helps to increase body weight, body length and head growth[ 15 ]. In the formula feeding babies, a moderate increase of protein intake improve their infant immunity[ 16 ], and contribute to a higher cardiac function parameters at two years of age[ 17 ]. Reports have found that early administration of intravenous amino acid of up to 3.6 g/kg per day was safe, well tolerated, which contributed to a positive nitrogen balance that help to improve the rate of protein synthesis[ 18 ], and the greater protein intake was associated with greater body length[ 12 ]. However, reports have found that a rapid catching-up growth in preterm babies may also lead to the increase incidence of obesity and cardiovascular disease in adulthood[ 19 ]. In addition, due to diseases such as congenital digestive tract dysplasia and mal-absorption caused by gastrointestinal disorders, a higher protein supplemented in preterm infants may in turn induced the intestinal disease[ 20 ]. What is more, an extra 1 g/kg parenteral protein intake in postnatal days 1 to 7 was associated with a 27% increased odds of cerebral palsy[ 21 ]. Thus, studies on the association of protein intake with growth and neurodevelopment in preterm infants are controversial, and more research is needed. So, we focusing on the influence of different level of early protein intake on the physical and mental development, then explored the association between protein intake and the incidence of obesity by following-up a total of 174 preterm infants randomly selected from an existing preterm cohort. Aiming to provide scientific guideline and appropriate care for preterm infants base of nutrition. 2. Methods and Materials 2.1 Participants The Guangzhou High-Risk Infant Study Cohort has been reported previously[ 22 ]. Premature infants born in Guangzhou Women and Children's Medical Center from November 2020 to June 2022 were selected who met the following inclusion criteria: (1) gestational age < 37 weeks and birth weight < 2500g; (2) Regular health care in our hospital during the infant period. After further excluding participants who were born with congenital malformations (such as congenital heart disease, digestive tract atresia, hermaphroditism) and undergoing various surgical operations and suffering from congenital metabolic diseases, a total of 174 preterm infants were included and divided into high protein intake group (HP group, n = 21, protein intake ≥ 3.0g/kg/d) and low protein intake group (LP group, n = 153, protein intake < 3.0g/kg/d) according to the average protein intake within 6 months after birth. Nutrition intake and clinical data were collected from the electronic medical record system by trained clinical research staff. 2.2 Protein calculation The amount of feeding and the source of formula were corrected monthly and the protein intake levels were calculated accurately by using nutrition assessment software based on the food diary within 6 months after corrected. During hospitalization, milk samples for neonatal were analyzed by using bedside-NIRS. None of the additional dietary except for human milk fortifier intake for subjects. All participants signed informed consent. 2.3 Anthropometric measurement The body weight, body length, BMI at 0,1,3,6,12,18 and 24 months were measured by the trained nurse, and the development in intrauterine were measured by trained physician.The formula for calculating BMI is BMI = weight (kg) /[height (m)] 2 . Parents with a BMI ≥ 24kg/m 2 were considered overweight and obesity, and infants with a BMI higher than 85% of the World Health Organization (WHO) standard for the same age were considered overweight and obesity. Z-scores of birth weight and body length were calculated using Fenton growth standard, and Z-scores of birth weight and body length were calculated using WHO standard for children aged 0–5 years. 2.4 Neuropsychological testing Children underwent neuropsychological testing, including GDS-C (Griffiths developmental assessment, GDS-C), DBAS-II (Neuropsychological Development Scale for children aged 0–6 years), and ASQ-3 (Age and developmental process questionnaire)by a trained psychological evaluator. Developmental quotient (DQ) = 100* Intellectual age/Actual age. We classify the neurointelligence development of children into the following levels according to the DQ. Table 1 The classification of the level of DQ Percentile ≥ 75% 50–75% ≥ 25 and < 50% < 25% Grade 1 2 3 4 2.5 Statistical analysis SPSS 26.0 software was used for logical check and statistical analysis of the data, and R 4.1.2 software was used for visual analysis of the data. Continuous variables were described by mean ± standard deviation (Mean ± SD), categorical variables were described by cases (n) and percentage (%). T-test and Kruskal-Wallis test were used for comparisons between the two-group of continuous variables, and χ 2 test was used for inter-group comparisons of categorical variables. A multiple linear regression model was used to assess the association between protein intake and physical growth indicators at 6, 12, 18, and 24 months of age. The model corrected for parental characteristics (maternal age, educational level, preconception BMI, and paternal education level) and infant characteristics (sex, birth weight, birth length, mode of delivery, feeding methods, intrauterine growth status and maternal health) were adjusted. Logistic regression analysis was used to explore the association between protein exposure in early life and obesity in infancy. In addition, a sensitivity analysis aim to test the robustness of the results was subsequently performed to compare protein intake only in preterm infants, excluding the full-term control group. P < 0.05 was considered statistically significant. 2.6 Study design flow chart 3. Results 3.1 General description In the baseline record, the intrauterine growth status was evaluated and the birth weight, birth length, BMI and their z score, and the feeding patterns of infants and the distribution of gender, gestational age as well as the maternal age, paternal education level, maternal BMI before pregnancy, delivery mode in the parents were obtain from our electronic medical record system. As it was description in Table 1 , an average of protein intake in HP group was 3.76 ± 0.62g/kg/day, while only 1.67 ± 0.49g/kg/day in LP group. Except for body weight and body length, there no significantly differences was found between HP and LP groups in preterm infants ( P > 0.05). The The level of neuropsychological development was assessed at the age of 6 month, and there no differences between HP group(90.68 ± 24.7) and LP group (95.19 ± 22.01) ( P > 0.05). Table 1 Baseline characteristics of the study participants Overall (n = 174) HP group (n = 21) LP group (n = 153) \(\chi\) 2 / T -value P -value Sex 3.442 0.064 Male 99 (56.9) 8 (38.1) 91 (59.5) Female 75 (43.1) 13 (61.9) 62 (40.5) Maternal age at delivery 0.022 0.883 < 32 years 102 (58.6) 12 (57.1) 90 (58.8) ≥ 32 years 72 (41.4) 9 (42.9) 63 (41.2) Education level of mother 0.857 0.620 High school degree or below 25 (14.4) 2 (9.5) 23 (15.0) College or bachelor degree 111 (63.8) 13 (61.9) 98 (64.1) Master degree or above 38 (21.8) 6 (28.6) 32 (20.9) Education level of father 0.476 0.881 High school degree or below 30 (17.2) 4 (19.0) 26 (17.0) College or bachelor degree 118 (67.9) 15 (71.4) 103 (67.3) Master degree or above 26 (14.9) 2 (9.5) 24 (15.7) Maternal BMI before pregnancy 0.118 0.731 < 24 kg/m 2 149 (85.6) 19 (90.5) 130 (85.0) ≥ 24 kg/m 2 25 (14.4) 2 (9.5) 23 (15.0) Delivery mode 1.537 0.215 Spontaneous labor 80 (46.0) 7 (33.3) 73 (47.7) Cesarean delivery 94 (54.0) 14 (66.7) 80 (52.3) Feeding patterns 7.318 0.115 Exclusive breastfeeding 27 (15.5) 3 (14.3) 24 (15.7) Formula feeding 62 (35.6) 10 (47.6) 52 (34.0) Mixed feeding 85 (48.9) 8 (38.1) 77 (50.3) Intrauterine growth status 2.075 0.150 SGA 27 15.5) 6 (28.6) 21 (13.7) AGA 147 (85.5) 15 (71.4) 132 (86.3) Gestational age (W, \(\stackrel{-}{x}\pm \text{s}\) ) 32.70 ± 2.88 31.91 ± 3.39 32.81 ± 2.80 -1.340 0.182 Birth weight (kg, \(\stackrel{-}{x}\pm \text{s}\) ) 1.78 ± 0.53 1.52 ± 0.52 1.82 ± 0.52 a -2.497 0.013 Z-score of birth weight ( \(\stackrel{-}{x}\pm \text{s}\) ) -0.42 ± 0.82 -0.71 ± 1.07 -0.38 ± 0.77 -1.357 0.188 Birth length (cm, \(\stackrel{-}{x}\pm \text{s}\) ) 41.52 ± 4.75 39.25 ± 4.62 41.89 ± 4.69 a -2.345 0.02 Z-score of birth length ( \(\stackrel{-}{x}\pm \text{s}\) ) -0.51 ± 1.09 -0.91 ± 1.21 -0.45 ± 1.06 -1.758 0.081 Protein intake (g/kg/day) 1.92 ± 0.85 3.76 ± 0.62 1.67 ± 0.49 17.643 < 0.001 DQ at the age of 6month 94.64 ± 22.36 90.68 ± 24.7 95.19 ± 22.01 -0.866 0.388 Data reported are mean ± SD and statistically analyzed by using χ2 test of SPSS software; BMI: body mass index; SGA: small for gestational age; AGA: adequate for gestational age. 3.2 Physical development between groups in preterm infants aged 0 ~ 24 months During 0 ~ 24month, the body weight increment of preterm infants in HP group, LP group was 7.44 kg, 7.99kg, respectively during 0 ~ 24month. The body length increment was 35.74 cm, 36.12 cm, respectively. As it was shown in Table 2 and Fig. 1 , The body weight in HP group was significantly lower than LP group at aged 1 to 12 months after correction ( P < 0.05). Compare with LP group, the body length at the age of 1 to 18 moth was significantly lower in HP group ( P < 0.05). Meanwhile, compared with LP group, we found a reduction of BMI in HP group preterm infants at the aged of 6 month after corrected. As it was described in Table 3 and Fig. 2 , the same trend was found in the Z-score of body weight, body length, and BMI. Table 2 Comparison of physical development indexes of preterm infants after correcting gestational age. CA (months) HP group LP group T -value P -value Weight (kg) 0 3.05 ± 0.67 3.35 ± 0.46 -1.944 0.055 1 3.91 ± 0.64 4.48 ± 0.64 aa -3.433 0.001 3 5.59 ± 0.57 6.28 ± 0.84 aa -3.032 0.003 6 7.01 ± 0.81 7.78 ± 0.98 aa -3.455 0.001 12 8.51 ± 0.87 9.28 ± 1.07 aa -2.762 0.007 18 9.64 ± 1.04 10.17 ± 1.19 -1.367 0.177 24 10.49 ± 0.94 11.34 ± 1.07 -1.788 0.084 Length (cm) 0 49.29 ± 2.52 50.44 ± 2.34 -1.531 0.129 1 52.14 ± 2.22 54.53 ± 2.52 aaa -3.721 0.000 3 59.21 ± 1.67 a 61.19 ± 2.53 aa -2.842 0.005 6 66.08 ± 1.84 ab 67.91 ± 2.56 aa -3.161 0.002 12 73.74 ± 1.90 ab 75.43 ± 2.46 a -2.610 0.010 18 79.59 ± 1.88 ab 81.80 ± 3.04 a -2.312 0.024 24 85.03 ± 2.14 86.56 ± 2.54 -1.354 0.186 BMI (kg/m 2 ) 0 12.43 ± 1.67 13.12 ± 1.15 -1.781 0.078 1 14.29 ± 1.39 15.00 ± 1.48 -1.862 0.065 3 15.90 ± 1.13 16.73 ± 1.58 -1.925 0.056 6 16.02 ± 1.36 16.83 ± 1.50 a -2.355 0.020 12 15.62 ± 1.22 16.28 ± 1.37 -1.821 0.071 CA (months) HP group LP group T -value P -value 18 15.19 ± 1.20 15.17 ± 1.28 0.051 0.960 24 14.49 ± 0.86 15.14 ± 1.34 -1.132 0.267 Data reported are mean ± SD and statistically analyzed by using T - test of SPSS software. The same letter indicates a statistically significant difference between groups ( P < 0.05). CA: Corrective month. Table 3 Comparison of z-score of physical development in preterm infants after correcting gestational age. CA (months) HP group LP group T -value P -value Weight (kg) 0 -0.6155 ± 1.40 0.06 ± 0.95 a -2.124 0.036 1 -0.711 ± 1.17 0.18 ± 1.02 aa -3.292 0.001 3 -0.71 ± 0.88 0.12 ± 1.08 aa -2.767 0.006 6 -0.68 ± 0.96 0.05 ± 1.07 aa -2.968 0.003 12 -0.82 ± 0.93 -0.13 ± 0.94 aa -2.725 0.007 18 -0.72 ± 0.91 -0.47 ± 0.95 -0.807 0.423 24 -1.04 ± 0.77 -0.38 ± 0.79 -1.857 0.073 Length (cm) 0 -0.14 ± 1.33 0.45 ± 1.22 -1.497 0.138 1 -0.96 ± 1.16 0.15 ± 1.27 aa -3.403 0.001 3 -0.61 ± 0.84 0.22 ± 1.20 a -2.526 0.013 6 -0.19 ± 0.82 0.47 ± 1.13 a -2.538 0.012 12 -0.47 ± 0.83 0.15 ± 0.99 a -2.377 0.019 18 -0.54 ± 0.59 -0.05 ± 1.07 -1.752 0.085 24 -0.44 ± 0.56 0.04 ± 0.84 -1.333 0.193 CA (months) HP group LP group T -value P -value BMI (kg/m 2 ) 0 -0.89 ± 1.41 -0.26 ± 0.92 -1.451 0.175 1 -0.32 ± 1.06 0.144 ± 1.04 -1.712 0.089 3 -0.51 ± 0.84 -0.00 ± 1.05 -1.722 0.087 6 -0.78 ± 0.97 -0.28 ± 1.04 a -2.056 0.041 12 -0.77 ± 0.94 -0.30 ± 0.98 -1.794 0.075 18 -0.57 ± 0.96 -0.70 ± 1.02 0.395 0.694 24 -1.18 ± 0.91 -0.63 ± 1.10 -1.130 0.268 Data reported are mean ± SD and statistically analyzed by using T - test of SPSS software. The same letter indicates a statistically significant difference between groups ( P < 0.05). CA: Corrective month. 3.3 Association between protein intake and physical development in preterm infants aged 6–24 months After adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length, the relationship between protein intake in early life and physical development at aged 6–24 months was analyzed by using a multiple linear regression model. As it was described in Table 4 , it showed a negatively association between protein intake and weight, length at aged 6–12 months after correction ( P < 0.05), as well as their Z- scores (Tables 5 , P < 0.05). At the age of 6 month, the higher protein intake, the lower BMI is, and we found a lower body length in HP group at the age of 18 month after corrected ( P < 0.05). Table 4 Correlation analysis between protein intake in early life and physical development indexes in preterm infants at the age of 6 ~ 24 months CA(months) Weight (kg) Length (cm) BMI (kg/m 2 ) β (95%CI) P- value β (95%CI) P -value β (95%CI) P -value 6 -0.401 (-0.562, -0.239) 0.000 -1.027 (-1.444,-0.611) 0.000 -0.376 (-0.651, -0.101) 0.008 12 -0.380 (-0.578, -0.182) 0.000 -1.037 (-1.524, -0.550) 0.000 -0.231 (-0.512, 0.051) 0.107 18 -0.004 (-0.326, 0.319) 0.982 -0.845 (-1.525, -0.165) 0.016 0.303 (-0.071, 0.678) 0.109 24 -0.474 (-1.176, 0.228) 0.163 -0.675 (0.292, -2.029) 0.292 -0.417 (-1.172, 0.337) 0.246 A multiple linear regression model was used to analyze the correlation between protein intake and physical indexes after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length. Table 5 Correlation analysis between protein intake in early life and Z-score of body weight, body length and BMI in preterm infants at the age of 6 ~ 24 months CA(months) z-score of weight z-score of length z-score of BMI β (95%CI) P- value β (95%CI) P -value β (95%CI) P -value 6 -0.456 (-0.641, -0.271) 0.000 -0.465 (-0.655, -0.275) 0.000 -0.260 (-0.454, -0.065) 0.009 12 -0.364 (-0.550, -0.178) 0.000 -0.418 (-0.615, -0.222) 0.000 -0.174 (-0.386, 0.037) 0.104 18 -0.012 (-0.293, 0.269) 0.933 -0.303 (-0.543, -0.062) 0.015 0.237 (-0.073, 0.546) 0.130 24 -0.365 (-0.928, 0.198) 0.179 -0.210 (-0.640, 0.220) 0.302 -0.363 (-1.044, 0.318) 0.262 A multiple linear regression model was used to analyze the correlation between protein intake and physical indexes after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length. 3.4 Association of protein intake and the incidence of overweight in infants aged 6 to 18 months A logistic regression analysis was carried out to analyze the association between protein intake and the incidence of obesity at aged 6–18 months after correction. During which, the covariables such as gender, maternal reproductive age, parental education level, maternal pre-pregnancy BMI, infant delivery mode, feeding mode, intrauterine growth status, gestational age, birth weight and birth length were control. As it was shown in Table 6 , our results showed that there were no associated between protein intake and the incidence of obesity in infants aged 6 to 18 months ( P > 0.05). Table 6 Multivariate logistic regression analysis of protein intake and overweight in preterm infants at the age of 6 ~ 18 months. GA (months) Groups β SE Wald P -value OR (95%CI) 6 HP group 1.00 Total LP group -3.274 1.224 7.154 0.007 0.038(0.003,0.417) 12 HP group 1.00 Total LP group -0.331 0.528 0.393 0.531 0.718(0.255,2.021) 18 HP group 1.00 Total LP group 1.017 1.690 0.363 0.547 2.766(0.101,75.852) Logistic regression analysis was used to explore the association between protein exposure in early life and obesity in infancy after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, birth weight and birth length. 3.5 Association of protein intake and intelligence development level at the age of 6 to 12months A multivariate logistic regression analysis was carried out to analyze the association between protein intake and the intelligence development level at the age of 6 month after corrected. As it was described in Table 7 , no significantly was found for the intelligence development level between groups ( P > 0.05). Table 7 Multivariate logistic regression analysis of protein intake and development of neuropsychological in preterm infants at the age of at 6–12 months. Grade of DQ Groups β SE Wald P -value OR (95%CI) 1 HP group LP group -20.545 0.000 0.000 0.992 1.195E-007 (0.000, 0.008) 2 HP group 1.00 LP group -0.234 0.566 0.171 0.679 0.733(0.096, 5.608) 3 HP group 1.00 LP group -0.366 0.897 0.167 0.683 0.119(0.096, 4.025) Adjust for Sex, Maternal age at delivery, Education level of mother, Education level of father, Maternal BMI before pregnancy, Delivery mode, Feeding patterns, Intrauterine growth status, Gestational age, Birth weight and Birth length. Relative to < 25% (Grade 4) 4. Discussion Protein supplement was widely used to achieve catching-up growth and neuropsychological development in preterm infants[23]. However, there is still debate about the amount of protein intake and the physical and mental development of preterm infants. A reasonable protein intake in infants requires attention and further discussion. Here, we made some new findings by exploring the effects of different dose of protein intake within 6 months on physical and mental development, as well as the incidence of obesity in preterm infants aged 0-24 months. Firstly, we found that protein intake in preterm infants was negatively associated with their physical development indexes. The infants’ weight, length, BMI, and their corresponding z scores in the HP group were significantly lower than the LP group. Actually, infants with extremely low birthweight needs at least 3~3.5 g/kg amino acid intake per day to achieve catching-up growth[24]. In our study, the HP group had an average protein intake up to 3.76g/kg per day, while the LP group had only 1.67g/kg per day. Research from Hester shown that a greater amounts of AA (3.6g/kg per day) administration did not further improve nitrogen balance compared with standard AA dose (3.0g/kg per day) plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance[25]. It seems that protein intake over 3.6g/kg per day was not conducive to the growth of premature babies. A randomized controlled trail from JAMA Pediatrics raised the conclusion that increasing the protein intake by 0.6 g/kg/d to a mean intake of 4.3 g/kg/d did not further enhance growth in very preterm infants (with a median birth weight of 1200g), indicating a ceiling effect for enteral protein intake with respect to its influence on growth[26]. Although supplement protein intake after hospital discharge may accelerated the speed of growth in the first year, there still no evidence improved later cognitive or metabolic outcomes[27]. low-quality evidence results from a meta-analysis showed that protein supplementation in breast milk may increase weight growth rate during hospitalization[28]. However, results from two trials showed negative effects of high protein intake on head growth and no effect on body composition[29, 30]. Again, there is no synergy between protein supplementation and physical development. Compared with protein intake, gestational age and birth weight were more important to influenced the physical growth of preterm mature aged 0-24 months[31, 32]. In our study, although the average gestational age from preterm infants all more than 31 weeks, the average birth weight in HP groups(1.52±0.52) significantly lower than the LP group(1.82±0.52). Our results indicate there was negative correlation between protein intake and physical growth in preterm infants. Moreover, a higher protein (more than 3.7g/kg per day) intake may further restrict the physical development of premature infants. Secondly, we found no significant association between protein intake and the incidence of obesity. Existing evidence supporting that premature babies are more likely to develop metabolic diseases such as obesity, which had about 50% body fat than term-born controls after catching-up[33]. Compared with protein intake, excessive energy supplement is the mainly factor to cause obesity in premature infants. Although the clinical treatment and the daily diet of the subjects were collect and controlled in our results, few preterm babies developed obesity in our study. indicating the factors from genetic or individual differences still account for a certain proportion in the development of physical growth and neuropsychological at preterm aged 0~24month. Finally, the absorption of protein should not be ignored too[34]. The use of probiotics to improve gut absorption may contribute to the growth and development[35], which may not have come from clinical diagnosis and treatment process base of the accessibility, so this factor was beyond our control. Compared to standard preterm formulas, protein hydrolysate formulas have a higher plasma threonine levels while lower tyrosine and phenylalanine concentrations. A clinical trial[36] indicated that whey-casein hydrolysate formulas produced a plasma amino acid pattern similar to that observed in breastfed infants. However, it is important to note that the process of hydrolyzing milk powder unavoidable lead to the loss of certain nutritional components, immune growth factors and lysine content due to technological complexities[37, 38]. Although protein content in human milk lower than special formula milk powder [39], breast milk offers unparalleled advantages in terms of amino acid composition and natural immune factors, which contribute to gut development and the establishment of beneficial bacteria. Preterm babies who born a lower body weigh less likely to be exclusive breastfeeding. Therefore, even though some infants with a lower protein intake, the higher protein absorb, and preterm who suffer severe allergies consumed milk powder with high protein concentration, their actual protein absorption may be inadequate base of their absorb in protein. In our study, it was challenges to accurately measuring the protein absorption in milk powder due to design and research expenditure of the study, further research is needed in the future. It is worth noting that preterm infants with different protein intake all achieved catch-up at 24 months of age. To sum up, our study suggested that the role of higher protein intake within 6 months in promoting physical and mental development is limited in the preterm infants age of 0~ 24 month after corrected. In addition to protein intake, individual differences such as gastrointestinal absorption function and the balance between macronutrients should not be ignored. Declarations All authors listed have contributed to the work. All authors have participated and agreed to submit the manuscript to EUROPEAN JOURNAL OF PEDIATRICS . No part of the work has been published before or is under consideration for publication elsewhere. Funding This research was supported by Guangzhou Health science and technology project (Grant No. 2021A031002, 2021) and Maternal and infant nutrition and nursing research (Grant No. 2019BINCMCF22, 2019). Author Contributions: The authors’ responsibilities were as follows: Y. Hu designed and developed the research, critically revised the manuscript and is the corresponding author. QY. Xie and JM. Li contributed to the methodology, statistical analysis and writing of the manuscript. YQ. Wen performed data cleansing and data validation, and revised the manuscript. YY. Song conducted the research, enrolled participants and collected data. All authors read and approved the final manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the local Health Department and the research ethics boards of Department of Child Health Care, Guangzhou Women and Children's Medical Center, China (trial registration ID: 2017102712). Informed consent was obtained from all individual participants included in the study. References Martín-Calvo NA-O, Goni LA-O, Tur JA-O, Martínez JA-O Low birth weight and small for gestational age are associated with complications of childhood and adolescence obesity: Systematic review and meta-analysis Crump CA-O, Sundquist J, Sundquist K Association of preterm birth with lipid disorders in early adulthood: A Swedish cohort study da Fonseca EB, Damião R, Moreira DA Preterm birth prevention Crump C K. Winkleby Ma Fau - Sundquist, J. Sundquist K Fau - Sundquist, J. Sundquist, Risk of diabetes among young adults born preterm in Sweden Crump C, Winkleby Ma Fau K, Sundquist J, Sundquist K, Fau - Sundquist J, Sundquist Risk of hypertension among young adults who were born preterm: a Swedish national study of 636,000 births Murray CJ, Lopez AD Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study Yang Q, Ayers Y, Fau - K, Chen TM, Chen Y, Fau - O'Shea TM O'Shea, Early enteral fat supplementation improves protein absorption in premature infants with an enterostomy Hellström A, Nilsson AK, Wackernagel D, Pivodic A, Vanpee M, Sjöbom U, Hellgren G, Hallberg B, Domellöf M, Klevebro S, Hellström W, Andersson M, Lund AM, Löfqvist C, Elfvin A, Sävman K, Hansen-Pupp I, Hård AL, Smith LEH, Ley D Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity: A Randomized Clinical Trial Endrinikapoulos AA-O, Afifah DN, Mexitalia M, Andoyo R, Hatimah I, Nuryanto N Study of the importance of protein needs for catch-up growth in Indonesian stunted children: a narrative review Martin CA-O Parenteral Protein in Extremely Preterm Infants - More Is Not Better Kim SY, Kim EK, Song H, Cheon JE, Kim BN, Kim HS, Shin SH Association of Brain Microstructure and Functional Connectivity With Cognitive Outcomes and Postnatal Growth Among Early School-Aged Children Born With Extremely Low Birth Weight Belfort M, Cherkerzian S, Bell K, Soldateli BA-OX, Cordova Ramos EA-O, Palmer CA-O, Steele T, Pepin H, Ellard D, Drouin KA-O, Inder T Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants. LID – 10.3390/nu12082249 [doi] LID – 2249 Kuschel CA, Harding JE Protein supplementation of human milk for promoting growth in preterm infants O'Connor DL, Jacobs R, - Hall JF, Hall D, Fau - R, Adamkin N, Adamkin D, Fau - Auestad M, Auestad N, Fau - Castillo WE, Castillo M, Fau - Connor SL Connor We Fau - Connor, K. Connor Sl Fau - Fitzgerald, S. Fitzgerald K Fau - Groh-Wargo, E.E. Groh-Wargo S Fau - Hartmann, J. Hartmann Ee Fau - Janowsky, A. Janowsky J Fau - Lucas, D. Lucas A Fau - Margeson, P. Margeson D Fau - Mena, M. Mena P Fau - Neuringer, G. Neuringer M Fau - Ross, L. Ross G Fau - Singer, T. Singer L Fau - Stephenson, J. Stephenson T Fau - Szabo, V. Szabo J Fau - Zemon, V. Zemon, Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula Brown JV, J.E., McGuire W Multi-nutrient fortification of human milk for preterm infants Ghosh SA-O, Iacucci M Diverse Immune Effects of Bovine Colostrum and Benefits in Human Health and Disease. LID – 10.3390/nu13113798 [doi] LID – 3798. Collell R, Closa-Monasterolo R, Ferré N, Luque V, Koletzko B, Grote VA-O, Janas R, Verduci E, Escribano J Higher protein intake increases cardiac function parameters in healthy children: metabolic programming by infant nutrition-secondary analysis from a clinical trial Harding JE, Cormack BE, Alexander T, Alsweiler JM, Bloomfield FH (2017) Advances in nutrition of the newborn infant. Lancet 389:1660–1668 Singhal A Long-Term Adverse Effects of Early Growth Acceleration or Catch-Up Growth Singhal A, Lucas A Early origins of cardiovascular disease: is there a unifying hypothesis? Tottman AC, Alsweiler JM, Bloomfield FH, Gamble GD, Jiang Y, Leung M, Poppe T, Thompson B, Wouldes TA, Harding JE Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm Hu PA-O, Han A, Hu Y, Wen Y, Liang J, Xiao W, Lin S, Song Y, Tan X, Zhao X, Dong H, Liu Q, Zhang H, Tao L, Yuan Y Cohort protocol: Guangzhou High-Risk Infant Cohort study Hossain ZA-O, Qasem WA, Friel JK, Omri AA-O Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. LID – 10.3390/nu13082755 [doi] LID – 2755. Ziegler EE Meeting the nutritional needs of the low-birth-weight infant Vlaardingerbroek H, Vermeulen Mj Fau D, Rook CHP, Rook D, van den Fau K van den Akker Ch Fau -, Dorst JL, Dorst K Fau - Wattimena, A. Wattimena Jl Fau - Vermes, H. Vermes A Fau - Schierbeek, J.B. Schierbeek H Fau - van Goudoever, J.B. van Goudoever, Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants Maas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, Peter A, Poets CF, Franz AR Effect of Increased Enteral Protein Intake on Growth in Human Milk-Fed Preterm Infants: A Randomized Clinical Trial Harding JE, Cormack BE, Alexander T, Alsweiler JM, Bloomfield FH Advances in nutrition of the newborn infant. Amissah EA, Brown J, Harding JE Protein supplementation of human milk for promoting growth in preterm infants Uthaya SA-O, Liu X, Babalis D, Doré CJ, Warwick J, Bell J, Thomas L, Ashby D, Durighel G, Ederies A, Yanez-Lopez M, Modi N Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition Morgan C, McGowan S, Fau - P, Herwitker AE, Herwitker S, Fau - Hart MA Hart Ae Fau - Turner, Turner MA Postnatal head growth in preterm infants: a randomized controlled parenteral nutrition study Ahmed A, Yang S Gestational age at birth and school performance Coathup VA-O, Boyle E, Carson C, Johnson S, Kurinzcuk JJ, Macfarlane A, Petrou S, Rivero-Arias O, Quigley MA Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study) Johnson MJ, Wootton Sa Fau AA, Leaf AA Leaf Aa Fau - Jackson, Jackson AA Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis Indrio FA-O, Neu JA-O, Pettoello-Mantovani M, Marchese F, Martini SA-O, Salatto A A.A.-O.X. Aceti, Development of the Gastrointestinal Tract in Newborns as a Challenge for an Appropriate Nutrition: A Narrative Review. LID – 10.3390/nu14071405 [doi] LID – 1405. Mihatsch WA, Franz Ar Fau J, Högel F, Högel J Fau - Pohlandt, F. Pohlandt, Hydrolyzed protein accelerates feeding advancement in very low birth weight infants Rigo J, Salle Bl Fau JC, Picaud G Picaud Jc Fau - Putet, J. Putet G Fau - Senterre, J. Senterre, Nutritional evaluation of protein hydrolysate formulas. Rutherfurd SM, Moughan PJ Effect of elevated temperature storage on the digestible reactive lysine content of unhydrolyzed- and hydrolyzed-lactose milk-based products Torres JKF, Stephani R, Tavares GM, de Carvalho AF, Costa RGB, de Almeida CER, Almeida MR, de Oliveira LFC, Schuck P, Perrone T Í, Technological aspects of lactose-hydrolyzed milk powder. Lyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health. LID – 10.3390/nu12041039 [doi] LID – 1039. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4471555","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":313755403,"identity":"6ec964cb-8825-4cf5-8796-3b6c63816e8e","order_by":0,"name":"Qunying Xie","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qunying","middleName":"","lastName":"Xie","suffix":""},{"id":313755404,"identity":"ecf1875e-28ca-40c1-b186-a3793ad435b7","order_by":1,"name":"Jiamei Li","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiamei","middleName":"","lastName":"Li","suffix":""},{"id":313755405,"identity":"f57bd20f-8457-411d-8857-98e80805baf4","order_by":2,"name":"Yuqi Wen","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuqi","middleName":"","lastName":"Wen","suffix":""},{"id":313755406,"identity":"21a30c7d-589f-43ae-9bef-90b09bf87a7d","order_by":3,"name":"Yanyan Song","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center, Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanyan","middleName":"","lastName":"Song","suffix":""},{"id":313755407,"identity":"6dae58d9-9fe8-4d41-8050-8349eef08b25","order_by":4,"name":"Yan Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBADHn75xwcfJFTUEK9FRrIhLdngwZljxGuxMTiQYyb5sIWZsFKD42cMP/PU3OExOHDGrCKxgY2Bv707Ab+WMznG0jzHnvFIHmwru5G4Q4ZB4szZDfi1HMgxkOZhO8zDd5h5243EM2wMBhK5BLScf2P8m+ffYR6GYwxmBYltzERouZFjJs3bdphH4AyLGQNRWiRvPCuznNt3mEdyBluyRMKZYzwE/cJ3PnnzjTffDtvzSzAf/PijokaOv70XvxaFAxwGTDxIAjw4lcKAfAP7A8YfBJWNglEwCkbBiAYA4UdOTlsAwA8AAAAASUVORK5CYII=","orcid":"","institution":"Guangzhou Women and Children's Medical Center, Guangzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2024-05-24 09:38:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4471555/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4471555/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58387002,"identity":"8ac30503-0b77-41af-8c3c-58eae78b98bb","added_by":"auto","created_at":"2024-06-14 18:46:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":172030,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of physical development indexes between groups at the age of 0~24 months.\u003c/p\u003e\n\u003cp\u003eA. Bodyweight; B. Body length C. BMI. Data reported are mean ± SD and statistically analyzed by using F- test of SPSS software. R 4.1.2 software was used for visual analysis of the data.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4471555/v1/7c28ff616142bd3e5817d9df.png"},{"id":58387670,"identity":"26bf280c-d0fa-403e-b177-ce29899f2778","added_by":"auto","created_at":"2024-06-14 18:54:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":150865,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Z-score of body weight, body length and BMI between groups at the age of 0~24 months.\u003c/p\u003e\n\u003cp\u003eA. Z-scores of body weight; B. Z-scores of body length; C. Z-scores of BMI. Data reported are mean ± SD and statistically analyzed by using Kruskal-Wallis test of SPSS software. R 4.1.2 software was used for visual analysis of the data.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4471555/v1/783dea1ca6aac993e9dd6fa0.png"},{"id":59810093,"identity":"02591e2d-a6ed-40a6-8491-454938c5d079","added_by":"auto","created_at":"2024-07-07 19:14:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1394498,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4471555/v1/264444b0-ab91-458c-8ed2-ad84fdf73e6d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant","fulltext":[{"header":"1. Background","content":"\u003cp\u003ePremature babies, defined as those born before 37 weeks of gestational age, faced increased risks and challenges in physical growth[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to data from WHO report in 2020, the incidence of preterm birth was approximately 12% worldwide, which not also threatened the safety at newborns[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], but also their health even at adulthood[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Focusing on the growth and development of premature infants can help reduce infant deaths and improve the quality of the global population[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical nutrition intervention was widely used to compensate for preterm infants, especially babies with very low birth weight[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], such as breast milk fortifier, high energy total nutrition formula. Although some of the low-quality evidence available have shown that specific nutrients influence the physical growth and mental development of premature infants, the results are contradictory due to study of object and design.\u003c/p\u003e \u003cp\u003eAdequate protein intake was suggested to be an important measure to help catching-up growth in preterm-born children[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], as well as neurodevelopment[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Median (range) protein intake from human milk were 1.37(0.88, 2.43)g/kg/day[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Preterm infants require higher protein intake than term infants to attain adequate growth rates base of their relatively higher protein turnover rates[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Preterm infants who were breastfed grow significantly slower than formula-fed infants[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], the addition of protein to breast milk helps to increase body weight, body length and head growth[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the formula feeding babies, a moderate increase of protein intake improve their infant immunity[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and contribute to a higher cardiac function parameters at two years of age[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Reports have found that early administration of intravenous amino acid of up to 3.6 g/kg per day was safe, well tolerated, which contributed to a positive nitrogen balance that help to improve the rate of protein synthesis[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and the greater protein intake was associated with greater body length[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, reports have found that a rapid catching-up growth in preterm babies may also lead to the increase incidence of obesity and cardiovascular disease in adulthood[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, due to diseases such as congenital digestive tract dysplasia and mal-absorption caused by gastrointestinal disorders, a higher protein supplemented in preterm infants may in turn induced the intestinal disease[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. What is more, an extra 1 g/kg parenteral protein intake in postnatal days 1 to 7 was associated with a 27% increased odds of cerebral palsy[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Thus, studies on the association of protein intake with growth and neurodevelopment in preterm infants are controversial, and more research is needed. So, we focusing on the influence of different level of early protein intake on the physical and mental development, then explored the association between protein intake and the incidence of obesity by following-up a total of 174 preterm infants randomly selected from an existing preterm cohort. Aiming to provide scientific guideline and appropriate care for preterm infants base of nutrition.\u003c/p\u003e"},{"header":"2. Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eThe Guangzhou High-Risk Infant Study Cohort has been reported previously[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Premature infants born in Guangzhou Women and Children's Medical Center from November 2020 to June 2022 were selected who met the following inclusion criteria: (1) gestational age\u0026thinsp;\u0026lt;\u0026thinsp;37 weeks and birth weight\u0026thinsp;\u0026lt;\u0026thinsp;2500g; (2) Regular health care in our hospital during the infant period. After further excluding participants who were born with congenital malformations (such as congenital heart disease, digestive tract atresia, hermaphroditism) and undergoing various surgical operations and suffering from congenital metabolic diseases, a total of 174 preterm infants were included and divided into high protein intake group (HP group, n\u0026thinsp;=\u0026thinsp;21, protein intake\u0026thinsp;\u0026ge;\u0026thinsp;3.0g/kg/d) and low protein intake group (LP group, n\u0026thinsp;=\u0026thinsp;153, protein intake\u0026thinsp;\u0026lt;\u0026thinsp;3.0g/kg/d) according to the average protein intake within 6 months after birth. Nutrition intake and clinical data were collected from the electronic medical record system by trained clinical research staff.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Protein calculation\u003c/h2\u003e \u003cp\u003eThe amount of feeding and the source of formula were corrected monthly and the protein intake levels were calculated accurately by using nutrition assessment software based on the food diary within 6 months after corrected. During hospitalization, milk samples for neonatal were analyzed by using bedside-NIRS. None of the additional dietary except for human milk fortifier intake for subjects. All participants signed informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Anthropometric measurement\u003c/h2\u003e \u003cp\u003eThe body weight, body length, BMI at 0,1,3,6,12,18 and 24 months were measured by the trained nurse, and the development in intrauterine were measured by trained physician.The formula for calculating BMI is BMI\u0026thinsp;=\u0026thinsp;weight (kg) /[height (m)]\u003csup\u003e2\u003c/sup\u003e. Parents with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;24kg/m\u003csup\u003e2\u003c/sup\u003e were considered overweight and obesity, and infants with a BMI higher than 85% of the World Health Organization (WHO) standard for the same age were considered overweight and obesity. Z-scores of birth weight and body length were calculated using Fenton growth standard, and Z-scores of birth weight and body length were calculated using WHO standard for children aged 0\u0026ndash;5 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Neuropsychological testing\u003c/h2\u003e \u003cp\u003eChildren underwent neuropsychological testing, including GDS-C (Griffiths developmental assessment, GDS-C), DBAS-II (Neuropsychological Development Scale for children aged 0\u0026ndash;6 years), and ASQ-3 (Age and developmental process questionnaire)by a trained psychological evaluator.\u003c/p\u003e \u003cp\u003eDevelopmental quotient (DQ)\u0026thinsp;=\u0026thinsp;100* Intellectual age/Actual age.\u003c/p\u003e \u003cp\u003eWe classify the neurointelligence development of children into the following levels according to the DQ.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe classification of the level of DQ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercentile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;75%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u0026ndash;75%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25 and \u0026lt;\u0026thinsp;50%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 26.0 software was used for logical check and statistical analysis of the data, and R 4.1.2 software was used for visual analysis of the data. Continuous variables were described by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), categorical variables were described by cases (n) and percentage (%). T-test and Kruskal-Wallis test were used for comparisons between the two-group of continuous variables, and χ\u003csup\u003e2\u003c/sup\u003e test was used for inter-group comparisons of categorical variables. A multiple linear regression model was used to assess the association between protein intake and physical growth indicators at 6, 12, 18, and 24 months of age. The model corrected for parental characteristics (maternal age, educational level, preconception BMI, and paternal education level) and infant characteristics (sex, birth weight, birth length, mode of delivery, feeding methods, intrauterine growth status and maternal health) were adjusted. Logistic regression analysis was used to explore the association between protein exposure in early life and obesity in infancy. In addition, a sensitivity analysis aim to test the robustness of the results was subsequently performed to compare protein intake only in preterm infants, excluding the full-term control group. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Study design flow chart\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 General description\u003c/h2\u003e\n \u003cp\u003eIn the baseline record, the intrauterine growth status was evaluated and the birth weight, birth length, BMI and their z score, and the feeding patterns of infants and the distribution of gender, gestational age as well as the maternal age, paternal education level, maternal BMI before pregnancy, delivery mode in the parents were obtain from our electronic medical record system. As it was description in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, an average of protein intake in HP group was 3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62g/kg/day, while only 1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49g/kg/day in LP group. Except for body weight and body length, there no significantly differences was found between HP and LP groups in preterm infants (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The The level of neuropsychological development was assessed at the age of 6 month, and there no differences between HP group(90.68\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7) and LP group (95.19\u0026thinsp;\u0026plusmn;\u0026thinsp;22.01) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics of the study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHP group (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLP group (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\chi\\)\u003c/span\u003e\u003c/span\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/ T\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75 (43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaternal age at delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;32 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;32 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level of mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school degree or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege or bachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111 (63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level of father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school degree or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege or bachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaternal BMI before pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e149 (85.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelivery mode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpontaneous labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCesarean delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeeding patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExclusive breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFormula feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62 (35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntrauterine growth status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e147 (85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132 (86.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGestational age (W, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm \\text{s}\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth weight (kg,\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm \\text{s}\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ-score of birth weight (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm \\text{s}\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBirth length (cm,\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm \\text{s}\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ-score of birth length (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm \\text{s}\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtein intake (g/kg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDQ at the age of 6month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.64\u0026thinsp;\u0026plusmn;\u0026thinsp;22.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.68\u0026thinsp;\u0026plusmn;\u0026thinsp;24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.19\u0026thinsp;\u0026plusmn;\u0026thinsp;22.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eData reported are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and statistically analyzed by using \u0026chi;2 test of SPSS software; BMI: body mass index; SGA: small for gestational age; AGA: adequate for gestational age.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Physical development between groups in preterm infants aged 0\u0026thinsp;~\u0026thinsp;24 months\u003c/h2\u003e\n \u003cp\u003eDuring 0\u0026thinsp;~\u0026thinsp;24month, the body weight increment of preterm infants in HP group, LP group was 7.44 kg, 7.99kg, respectively during 0\u0026thinsp;~\u0026thinsp;24month. The body length increment was 35.74 cm, 36.12 cm, respectively. As it was shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, The body weight in HP group was significantly lower than LP group at aged 1 to 12 months after correction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compare with LP group, the body length at the age of 1 to 18 moth was significantly lower in HP group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Meanwhile, compared with LP group, we found a reduction of BMI in HP group preterm infants at the aged of 6 month after corrected. As it was described in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the same trend was found in the Z-score of body weight, body length, and BMI.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of physical development indexes of preterm infants after correcting gestational age.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCA (months)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003csup\u003eaaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCA (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eData reported are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and statistically analyzed by using \u003cem\u003eT\u003c/em\u003e- test of SPSS software. The same letter indicates a statistically significant difference between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CA: Corrective month.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of z-score of physical development in preterm infants after correcting gestational age.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCA (months)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.6155\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.711\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003csup\u003eaa\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.085\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCA (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eT\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.144\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eData reported are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and statistically analyzed by using \u003cem\u003eT\u003c/em\u003e- test of SPSS software. The same letter indicates a statistically significant difference between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CA: Corrective month.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Association between protein intake and physical development in preterm infants aged 6\u0026ndash;24 months\u003c/h2\u003e\n \u003cp\u003eAfter adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length, the relationship between protein intake in early life and physical development at aged 6\u0026ndash;24 months was analyzed by using a multiple linear regression model. As it was described in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, it showed a negatively association between protein intake and weight, length at aged 6\u0026ndash;12 months after correction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as well as their Z- scores (Tables \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At the age of 6 month, the higher protein intake, the lower BMI is, and we found a lower body length in HP group at the age of 18 month after corrected (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation analysis between protein intake in early life and physical development indexes in preterm infants at the age of 6\u0026thinsp;~\u0026thinsp;24 months\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCA(months)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLength (cm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.401\u003c/p\u003e\n \u003cp\u003e(-0.562, -0.239)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.027\u003c/p\u003e\n \u003cp\u003e(-1.444,-0.611)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.376\u003c/p\u003e\n \u003cp\u003e(-0.651, -0.101)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.380\u003c/p\u003e\n \u003cp\u003e(-0.578, -0.182)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.037\u003c/p\u003e\n \u003cp\u003e(-1.524, -0.550)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.231\u003c/p\u003e\n \u003cp\u003e(-0.512, 0.051)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003cp\u003e(-0.326, 0.319)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.845\u003c/p\u003e\n \u003cp\u003e(-1.525, -0.165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003cp\u003e(-0.071, 0.678)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.474\u003c/p\u003e\n \u003cp\u003e(-1.176, 0.228)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.675\u003c/p\u003e\n \u003cp\u003e(0.292, -2.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.417\u003c/p\u003e\n \u003cp\u003e(-1.172, 0.337)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eA multiple linear regression model was used to analyze the correlation between protein intake and physical indexes after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation analysis between protein intake in early life and Z-score of body weight, body length and BMI in preterm infants at the age of 6\u0026thinsp;~\u0026thinsp;24 months\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCA(months)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ez-score of weight\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ez-score of length\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ez-score of BMI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.456\u003c/p\u003e\n \u003cp\u003e(-0.641, -0.271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.465\u003c/p\u003e\n \u003cp\u003e(-0.655, -0.275)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.260\u003c/p\u003e\n \u003cp\u003e(-0.454, -0.065)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.364\u003c/p\u003e\n \u003cp\u003e(-0.550, -0.178)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.418\u003c/p\u003e\n \u003cp\u003e(-0.615, -0.222)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.174\u003c/p\u003e\n \u003cp\u003e(-0.386, 0.037)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.012\u003c/p\u003e\n \u003cp\u003e(-0.293, 0.269)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.303\u003c/p\u003e\n \u003cp\u003e(-0.543, -0.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003cp\u003e(-0.073, 0.546)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.365\u003c/p\u003e\n \u003cp\u003e(-0.928, 0.198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.210\u003c/p\u003e\n \u003cp\u003e(-0.640, 0.220)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.363\u003c/p\u003e\n \u003cp\u003e(-1.044, 0.318)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eA multiple linear regression model was used to analyze the correlation between protein intake and physical indexes after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, z-score of birth weight and z-score of birth length.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.4 Association of protein intake and the incidence of overweight in infants aged 6 to 18 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA logistic regression analysis was carried out to analyze the association between protein intake and the incidence of obesity at aged 6\u0026ndash;18 months after correction. During which, the covariables such as gender, maternal reproductive age, parental education level, maternal pre-pregnancy BMI, infant delivery mode, feeding mode, intrauterine growth status, gestational age, birth weight and birth length were control. As it was shown in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, our results showed that there were no associated between protein intake and the incidence of obesity in infants aged 6 to 18 months (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate logistic regression analysis of protein intake and overweight in preterm infants at the age of 6\u0026thinsp;~\u0026thinsp;18 months.\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGA (months)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal LP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.038(0.003,0.417)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal LP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.718(0.255,2.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal LP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.766(0.101,75.852)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eLogistic regression analysis was used to explore the association between protein exposure in early life and obesity in infancy after adjust for sex, maternal age at delivery, education level of mother, education level of father, maternal BMI before pregnancy, delivery mode, feeding patterns, intrauterine growth status, gestational age, birth weight and birth length.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Association of protein intake and intelligence development level at the age of 6 to 12months\u003c/h2\u003e\n \u003cp\u003eA multivariate logistic regression analysis was carried out to analyze the association between protein intake and the intelligence development level at the age of 6 month after corrected. As it was described in Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, no significantly was found for the intelligence development level between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate logistic regression analysis of protein intake and development of neuropsychological in preterm infants at the age of at 6\u0026ndash;12 months.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGrade of DQ\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-20.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.195E-007 (0.000, 0.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.733(0.096, 5.608)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLP group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.119(0.096, 4.025)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAdjust for Sex, Maternal age at delivery, Education level of mother, Education level of father, Maternal BMI before pregnancy, Delivery mode, Feeding patterns, Intrauterine growth status, Gestational age, Birth weight and Birth length. Relative to \u0026lt;\u0026thinsp;25% (Grade 4)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eProtein supplement was widely used to achieve catching-up growth and neuropsychological development in preterm infants[23]. However, there is still debate about the amount of protein intake and the physical and mental development of preterm infants. A reasonable protein intake in infants requires attention and further discussion. Here, we made some new findings by exploring the effects of different dose of protein intake within 6 months on physical and mental development, as well as the incidence of obesity in preterm infants aged 0-24 months.\u003c/p\u003e\n\u003cp\u003eFirstly, we found that protein intake in preterm infants was negatively associated with their physical development indexes. The infants\u0026rsquo; weight, length, BMI, and their corresponding z scores in the HP group were significantly lower than the LP group. Actually, infants with extremely low birthweight needs at least 3~3.5 g/kg amino acid intake per day to achieve catching-up growth[24]. In our study, the HP group had an average protein intake up to 3.76g/kg per day, while the LP group had only 1.67g/kg per day. Research from \u003cem\u003eHester \u003c/em\u003eshown that a greater amounts of AA (3.6g/kg per day) administration did not further improve nitrogen balance compared with standard AA dose (3.0g/kg per day) plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance[25]. It seems that protein intake over 3.6g/kg per day was not conducive to the growth of premature babies. A randomized controlled trail from \u003cem\u003eJAMA Pediatrics\u003c/em\u003e raised the conclusion that increasing the protein intake by 0.6 g/kg/d to a mean intake of 4.3 g/kg/d did not further enhance growth in very preterm infants (with a median birth weight of 1200g), indicating a ceiling effect for enteral protein intake with respect to its influence on growth[26]. Although supplement protein intake after hospital discharge may accelerated the speed of growth in the first year, there still no evidence improved later cognitive or metabolic outcomes[27]. low-quality evidence results from a meta-analysis showed that protein supplementation in breast milk may increase weight growth rate during hospitalization[28]. However, results from two trials showed negative effects of high protein intake on head growth and no effect on body composition[29, 30]. Again, there is no synergy between protein supplementation and physical development. Compared with protein intake, gestational age and birth weight were more important to influenced the physical growth of preterm mature aged 0-24 months[31, 32]. In our study, although the average gestational age from preterm infants all more than 31 weeks, the average birth weight in HP groups(1.52\u0026plusmn;0.52) significantly lower than the LP group(1.82\u0026plusmn;0.52). Our results indicate there was negative correlation between protein intake and physical growth in preterm infants. Moreover, a higher protein (more than 3.7g/kg per day) intake may further restrict the physical development of premature infants.\u003c/p\u003e\n\u003cp\u003eSecondly, we found no significant association between protein intake and the incidence of obesity. Existing evidence supporting that premature babies are more likely to develop metabolic diseases such as obesity, which had about 50% body fat than term-born controls after catching-up[33]. Compared with protein intake, excessive energy supplement is the mainly factor to cause obesity in premature infants. Although the clinical treatment and the daily diet of the subjects were collect and controlled in our results, few preterm babies developed obesity in our study. indicating the factors from genetic or individual differences still account for a certain proportion in the development of physical growth and neuropsychological at preterm aged 0~24month. \u003c/p\u003e\n\u003cp\u003eFinally, the absorption of protein should not be ignored too[34]. The use of probiotics to improve gut absorption may contribute to the growth and development[35], which may not have come from clinical diagnosis and treatment process base of the accessibility, so this factor was beyond our control. Compared to standard preterm formulas, protein hydrolysate formulas have a higher plasma threonine levels while lower tyrosine and phenylalanine concentrations. A clinical trial[36] indicated that whey-casein hydrolysate formulas produced a plasma amino acid pattern similar to that observed in breastfed infants. However, it is important to note that the process of hydrolyzing milk powder unavoidable lead to the loss of certain nutritional components, immune growth factors and lysine content due to technological complexities[37, 38]. Although protein content in human milk lower than special formula milk powder [39], breast milk offers unparalleled advantages in terms of amino acid composition and natural immune factors, which contribute to gut development and the establishment of beneficial bacteria. Preterm babies who born a lower body weigh less likely to be exclusive breastfeeding. Therefore, even though some infants with a lower protein intake, the higher protein absorb, and preterm who suffer severe allergies consumed milk powder with high protein concentration, their actual protein absorption may be inadequate base of their absorb in protein. In our study, it was challenges to accurately measuring the protein absorption in milk powder due to design and research expenditure of the study, further research is needed in the future. It is worth noting that preterm infants with different protein intake all achieved catch-up at 24 months of age. \u003c/p\u003e\n\u003cp\u003eTo sum up, our study suggested that the role of higher protein intake within 6 months in promoting physical and mental development is limited in the preterm infants age of 0~ 24 month after corrected. In addition to protein intake, individual differences such as gastrointestinal absorption function and the balance between macronutrients should not be ignored.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll authors listed have contributed to the work. All authors have participated and agreed to submit the manuscript to \u003cem\u003eEUROPEAN JOURNAL OF PEDIATRICS\u003c/em\u003e . No part of the work has been published before or is under consideration for publication elsewhere.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by Guangzhou Health science and technology project (Grant No. 2021A031002, 2021) and Maternal and infant nutrition and nursing research (Grant No. 2019BINCMCF22, 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026rsquo; responsibilities were as follows: \u003cstrong\u003e\u003cem\u003eY. Hu\u003c/em\u003e\u003c/strong\u003e designed and developed the research, critically revised the manuscript and is the corresponding author. \u003cstrong\u003e\u003cem\u003eQY. Xie and JM. Li\u0026nbsp;\u003c/em\u003e\u003c/strong\u003econtributed to the methodology, statistical analysis and writing of the manuscript. \u003cstrong\u003e\u003cem\u003eYQ. Wen\u003c/em\u003e\u003c/strong\u003e performed data cleansing and data validation, and revised the manuscript. \u003cstrong\u003e\u003cem\u003eYY. Song\u003c/em\u003e\u003c/strong\u003e conducted the research, enrolled participants and collected data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the local Health Department and the research ethics boards of Department of Child Health Care, Guangzhou Women and Children\u0026apos;s Medical Center, China (trial registration ID: 2017102712). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMart\u0026iacute;n-Calvo NA-O, Goni LA-O, Tur JA-O, Mart\u0026iacute;nez JA-O Low birth weight and small for gestational age are associated with complications of childhood and adolescence obesity: Systematic review and meta-analysis\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrump CA-O, Sundquist J, Sundquist K Association of preterm birth with lipid disorders in early adulthood: A Swedish cohort study\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eda Fonseca EB, Dami\u0026atilde;o R, Moreira DA Preterm birth prevention\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrump C K. Winkleby Ma Fau - Sundquist, J. Sundquist K Fau - Sundquist, J. 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Lancet 389:1660\u0026ndash;1668\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinghal A Long-Term Adverse Effects of Early Growth Acceleration or Catch-Up Growth\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinghal A, Lucas A Early origins of cardiovascular disease: is there a unifying hypothesis?\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTottman AC, Alsweiler JM, Bloomfield FH, Gamble GD, Jiang Y, Leung M, Poppe T, Thompson B, Wouldes TA, Harding JE Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu PA-O, Han A, Hu Y, Wen Y, Liang J, Xiao W, Lin S, Song Y, Tan X, Zhao X, Dong H, Liu Q, Zhang H, Tao L, Yuan Y Cohort protocol: Guangzhou High-Risk Infant Cohort study\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossain ZA-O, Qasem WA, Friel JK, Omri AA-O Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. LID \u0026ndash;\u0026thinsp;10.3390/nu13082755 [doi] LID \u0026ndash;\u0026thinsp;2755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZiegler EE Meeting the nutritional needs of the low-birth-weight infant\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVlaardingerbroek H, Vermeulen Mj Fau D, Rook CHP, Rook D, van den Fau K van den Akker Ch Fau -, Dorst JL, Dorst K Fau - Wattimena, A. Wattimena Jl Fau - Vermes, H. Vermes A Fau - Schierbeek, J.B. Schierbeek H Fau - van Goudoever, J.B. van Goudoever, Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, Peter A, Poets CF, Franz AR Effect of Increased Enteral Protein Intake on Growth in Human Milk-Fed Preterm Infants: A Randomized Clinical Trial\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarding JE, Cormack BE, Alexander T, Alsweiler JM, Bloomfield FH Advances in nutrition of the newborn infant.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmissah EA, Brown J, Harding JE Protein supplementation of human milk for promoting growth in preterm infants\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUthaya SA-O, Liu X, Babalis D, Dor\u0026eacute; CJ, Warwick J, Bell J, Thomas L, Ashby D, Durighel G, Ederies A, Yanez-Lopez M, Modi N Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan C, McGowan S, Fau - P, Herwitker AE, Herwitker S, Fau - Hart MA Hart Ae Fau - Turner, Turner MA Postnatal head growth in preterm infants: a randomized controlled parenteral nutrition study\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed A, Yang S Gestational age at birth and school performance\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoathup VA-O, Boyle E, Carson C, Johnson S, Kurinzcuk JJ, Macfarlane A, Petrou S, Rivero-Arias O, Quigley MA Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson MJ, Wootton Sa Fau AA, Leaf AA Leaf Aa Fau - Jackson, Jackson AA Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndrio FA-O, Neu JA-O, Pettoello-Mantovani M, Marchese F, Martini SA-O, Salatto A A.A.-O.X. Aceti, Development of the Gastrointestinal Tract in Newborns as a Challenge for an Appropriate Nutrition: A Narrative Review. LID \u0026ndash;\u0026thinsp;10.3390/nu14071405 [doi] LID \u0026ndash;\u0026thinsp;1405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMihatsch WA, Franz Ar Fau J, H\u0026ouml;gel F, H\u0026ouml;gel J Fau - Pohlandt, F. Pohlandt, Hydrolyzed protein accelerates feeding advancement in very low birth weight infants\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRigo J, Salle Bl Fau JC, Picaud G Picaud Jc Fau - Putet, J. Putet G Fau - Senterre, J. Senterre, Nutritional evaluation of protein hydrolysate formulas.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRutherfurd SM, Moughan PJ Effect of elevated temperature storage on the digestible reactive lysine content of unhydrolyzed- and hydrolyzed-lactose milk-based products\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres JKF, Stephani R, Tavares GM, de Carvalho AF, Costa RGB, de Almeida CER, Almeida MR, de Oliveira LFC, Schuck P, Perrone T \u0026Iacute;, Technological aspects of lactose-hydrolyzed milk powder.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health. LID \u0026ndash;\u0026thinsp;10.3390/nu12041039 [doi] LID \u0026ndash;\u0026thinsp;1039.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Protein intake, Preterm infant, Physical development, Neuropsychological development, Obesity","lastPublishedDoi":"10.21203/rs.3.rs-4471555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4471555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To investigated whether high protein intake in early life contribute to physical and mental development in preterm infants aged 0-24 months, then analyzed the association between protein intake and incidence of obesity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 174 preterm infants were recruited for a cohort study related to Guangzhou High-Risk Infant, and were divided into a high protein intake group (HP, n=21) and a common protein intake group (LP, n=153) based on their average protein intake at the age of 0~6\u003csup\u003e \u003c/sup\u003emonths. Body weight, body length, and BMI and their Z-scores was calculated, and the Gesell development and infant neuropsychological examination screening were used to assess child mental development. Multivariate Linear regression models were used to assess the correlation between protein intake and physical development, and the\u0026nbsp;multivariate logistic regression was used to analyze the association between protein intake and the level of mental development and the incidence of obesity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The average protein intake in HP and LP group were 3.76±0.62g/kg/day and 1.67±0.49g/kg/day, respectively. The body weight, body length, BMI, and their Z-scores in the HP group was significantly lower than LP group during aged 6 to18 months. There a negatively correlation between protein intake and physical development level at aged 6~12 months. No significant association was found between protein intake and the mental development and the incidence of obesity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e A higher protein intake in early life (0~6\u003csup\u003eth\u003c/sup\u003e month) did not contribute to the development of physical and neuropsychological and have no effect on the incidence of obesity and Neuropsychological development in preterm infants aged 0-24 months.\u003c/p\u003e","manuscriptTitle":"Effects of early life protein intake on physical and neuropsychological development of preterm infants aged 0-24 month：a longitudinal cohort study of High-Risk Infant","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-14 18:46:32","doi":"10.21203/rs.3.rs-4471555/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e86c08b4-9170-4420-b285-45127c20cb49","owner":[],"postedDate":"June 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-07T19:06:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-14 18:46:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4471555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4471555","identity":"rs-4471555","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}