Abstract
BackgroundArachidonic (ARA) and docosahexaenoic acid (DHA) are constitutive to membrane phospholipids, and essential for brain and overall development. ARA/DHA pools in term infants (TI) are built during the third trimester, stored as adipose tissue triglycerides and predominantly distributed via plasma phosphatidylcholine (PC). In preterm infants (PTI), placental ARA/DHA supply is replaced by linoleic-acid (LA)-enriched nutrition. This study aimed to investigate the impact of PTI nutrition, compared to placental supply, on fatty acid composition in adipose tissue and blood.MethodsProspective observational study (4/2017–3/2019) in 12 PTI and 3 PTI with enterostomy (PTI/E) (gestational age (GA) < 32 weeks) with surgical intervention at term (± 6 weeks) and 14 TI (GA ≥ 34 weeks, surgical intervention < 2 weeks postnatally). PTI/E were analyzed descriptively only. PC and triglyceride fatty acids were analyzed with tandem mass spectrometry and gas chromatography, respectively. Results were compared between TI and PTI with Wilcoxon Test and shown as median [25th percentile–75th percentile] mol%.ResultsPTI had less ARA in adipose tissue TG (0.77[0.67–0.87]% vs. 1.04[0.95–1.14]%, p = 0.0003) and plasma PC (20.7[18.7–22.8]% vs. 28.3[22.7–33.5]%, p = 0.011) than TI. PTI also had less DHA in adipose tissue TG (0.6[0.4–0.8]% vs. 1.1[0.8–1.4]%, p = 0.006) and plasma PC (6.4[5.6–7.1]% vs. 8.4[7.8–13.1]%, p = 0.002). LA was increased in PTI’s adipose tissue TG (10.0[8.8–12.3]% vs. 3.0[2.5–3.6]%, p < 0.0001) and plasma PC (48.4[44.6–49.6]% vs. 30.6[24.9–35.6]%, p = 0.0002). Similar differences were observed in erythrocyte PC.ConclusionIn PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development.
Highlights
Long-chain polyunsaturated fatty acids (LC-PUFA) are important components of glycerophospholipids like phosphatidylcholine (PC) and phosphatidylethanolamine (PE), the main phospholipids in plasma membranes and lipoproteins [1]
Because synthesis during rapid fetal and neonatal growth is not sufficient for developmental requirements, these fatty acids are largely supplied during the third trimester via the placenta, and more than 90% of docosahexaenoic acid (DHA) and ARA accretion is deposited in adipose tissue triglycerides (TG) [11]
This study investigated the effects of the untimely switch from selective trans-placental fatty acid supply to the fetus to parenteral and enteral nutrition of preterm infants (PTI) and PTI with enterostomy (PTI/E)
Summary
Long-chain polyunsaturated fatty acids (LC-PUFA) are important components of glycerophospholipids like phosphatidylcholine (PC) and phosphatidylethanolamine (PE), the main phospholipids in plasma membranes and lipoproteins [1]. Docosahexaenoic (DHA = C22:6 N–3) and arachidonic acid (ARA = C20:4 N–6) are the major LC-PUFA, and are essential for overall organ and cerebral development and homeostasis. Their alterations in preterm infants are associated with neonatal morbidity [2]. Conclusion In PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development
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