The Early Nutrition Paradox: From Developmental Programming to Long-Term Health Outcome in Preterm and Intrauterine Growth Restricted (IUGR) Infants

<jats:p>Nutrition during early life is a critical determinant of long-term health. Preterm birth, affecting approximately 10% of deliveries worldwide, and intrauterine growth re-striction (IUGR) are major perinatal conditions associated with disrupted develop-mental programming. The Developmental Origins of Health and Disease (DOHaD) framework explains how early nutritional and environmental exposures permanently shape adult disease risk. This narrative review synthesizes epidemiological, cohort, animal, and interventional evidence on early nutrition and long-term outcomes in preterm and IUGR infants. Accelerated early growth, particularly after growth re-striction, increases the risk of metabolic syndrome components, including glucose in-tolerance, obesity, hypertension, and dyslipidemia. Preterm birth is independently as-sociated with a 53% higher risk of ischemic heart disease and with increased hyperten-sion, insulin resistance, and hyperlipidemia, whereas IUGR confers overlapping but distinct risks. Underlying mechanisms include epigenetic modification, structural or-gan deficits, hormonal reprogramming, gut-microbiome dysbiosis, and oxidative stress. Preterm infants pose a particular challenge, requiring nutrition that supports survival and neurodevelopment without amplifying later cardio-metabolic risk. The preconception and early postnatal periods, during which human milk, optimal pro-tein-energy balance, long-chain polyunsaturated fatty acids, and human-milk oligo-saccharides act, are pivotal. Individualized, evidence-based feeding strategies are needed to optimize immediate outcomes while limiting lifelong disease susceptibility.</jats:p>