High Amino Acid Intake in Early Life Is Associated With Systolic but Not Diastolic Arterial Hypertension at 5 Years of Age in Children Born Very Preterm

• Published in: Journal of the American Heart Association 2024-01, Vol.13 (1), p.e032804-e032804
• Main Authors: Rozé, Jean-Christophe, Bacchetta, Justine, Lapillonne, Alexandre, Boudred, Farid, Picaud, Jean-Charles, Marchand-Martin, Laetitia, Bruel-Tessoulin, Alexandra, Harambat, Jérome, Biran, Valérie, Nuyt, Anne-Monique, Darmaun, Dominique, Ancel, Pierre-Yves
• Format: Article
• Language: English
• Subjects: amino acid intake; follow‐up; high blood pressure; Life Sciences; Original Research; preterm infants; protein intake; Santé publique et épidémiologie
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.032804

The life course of individuals born very premature is a topic of increasing concern. The association between high early amino acid intake and later high blood pressure (HBP) in preterm neonates is debated. In a national, prospective, population-based birth cohort, EPIPAGE-2 (Etude Epidémiologique sur Petits Ages Gestationnels), we assessed blood pressure at 5 years. Eligible infants were those born between 24 and 29 weeks of gestation. Infants were distributed in 2 groups of 717 infants matched on propensity score on whether or not they were exposed to high amino acid intake (>3.5 g/kg per day at day 7); 455 control term infants were also enrolled. A value ≥95th percentile of reference values for age and height defined systolic or diastolic HBP. Blood pressure at 5 years of age was assessed for 389 and 385 children in the exposed and nonexposed groups, respectively. Rates (in percent) of systolic and diastolic HBP were 18.0% (95% CI, 14.5%-22.2% , 13.3% (95% CI, 10.3%-17.0%), 8.5% (95% CI, 6.5%-11.1%), and 9.0% (95% CI, 6.6%-12.3%), 10.2% (95% CI, 7.5%-13.6%), and 5.4% (95% CI, 3.8%-7.6%) in exposed, nonexposed, and term-born groups, respectively. Exposure to high early amino acid intake and maximal serum creatinine (by 50 μmol/L) between day 3 and day 7 were 2 independent risk factors for systolic HBP (adjusted odds ratio [aOR], 1.60 [95% CI, 1.05-2.43] and aOR, 1.59 [95% CI, 1.12-2.26], respectively) but not for diastolic HBP (aOR, 0.84 [95% CI, 0.50-1.39] and aOR, 1.09 [95% CI, 0.71-1.67], respectively). After adjustment for 5-year weight score, the aOR between high early amino acid intake and systolic HBP was 1.50 [95% CI, 0.98-2.30]. These results suggest that mechanisms of childhood systolic HBP involve neonatal renal challenge by high amino acid intake or dysfunction.