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Modification of serum fatty acids in preterm infants by parenteral lipids and enteral docosahexaenoic acid/arachidonic acid : A secondary analysis of the Mega Donna Mega trial

Sjöbom, Ulrika ; Andersson, Mats X. ; Pivodic, Aldina ; Lund, Anna My LU ; Vanpee, Mireille ; Hansen-Pupp, Ingrid LU orcid ; Ley, David LU ; Wackernagel, Dirk ; Sävman, Karin and Smith, Lois E.H. , et al. (2023) In Clinical Nutrition 42(6). p.962-971
Abstract

Background & aim: Preterm infants risk deficits of long-chain polyunsaturated fatty acids (LCPUFAs) that may contribute to morbidities and hamper neurodevelopment. We aimed to determine longitudinal serum fatty acid profiles in preterm infants and how the profiles are affected by enteral and parenteral lipid sources. Methods: Cohort study analyzing fatty acid data from the Mega Donna Mega study, a randomized control trial with infants born <28 weeks of gestation (n = 204) receiving standard nutrition or daily enteral lipid supplementation with arachidonic acid (AA):docosahexaenoic acid (DHA) (100:50 mg/kg/day). Infants received an intravenous lipid emulsion containing olive oil:soybean oil (4:1). Infants were followed from birth... (More)

Background & aim: Preterm infants risk deficits of long-chain polyunsaturated fatty acids (LCPUFAs) that may contribute to morbidities and hamper neurodevelopment. We aimed to determine longitudinal serum fatty acid profiles in preterm infants and how the profiles are affected by enteral and parenteral lipid sources. Methods: Cohort study analyzing fatty acid data from the Mega Donna Mega study, a randomized control trial with infants born <28 weeks of gestation (n = 204) receiving standard nutrition or daily enteral lipid supplementation with arachidonic acid (AA):docosahexaenoic acid (DHA) (100:50 mg/kg/day). Infants received an intravenous lipid emulsion containing olive oil:soybean oil (4:1). Infants were followed from birth to postmenstrual age 40 weeks. Levels of 31 different fatty acids from serum phospholipids were determined by GC–MS and reported in relative (mol%) and absolute concentration (μmol l−1) units. Results: Higher parenteral lipid administration resulted in lower serum proportion of AA and DHA relative to other fatty acids during the first 13 weeks of life (p < 0.001 for the 25th vs the 75th percentile). The enteral AA:DHA supplement increased the target fatty acids with little impact on other fatty acids. The absolute concentration of total phospholipid fatty acids changed rapidly in the first weeks of life, peaking at day 3, median (Q1-Q3) 4452 (3645–5466) μmol l−1, and was positively correlated to the intake of parenteral lipids. Overall, infants displayed common fatty acid trajectories over the study period. However, remarkable differences in fatty acid patterns were observed depending on whether levels were expressed in relative or absolute units. For example, the relative levels of many LCPUFAs, including DHA and AA, declined rapidly after birth while their absolute concentrations increased in the first week of life. For DHA, absolute levels were significantly higher compared to cord blood from day 1 until postnatal week 16 (p < 0.001). For AA, absolute postnatal levels were lower compared to cord blood from week 4 throughout the study period (p < 0.05). Conclusions: Our data show that parenteral lipids aggravate the postnatal loss of LCPUFAs seen in preterm infants and that serum AA available for accretion is below that in utero. Further research is needed to establish optimal postnatal fatty acid supplementation and profiles in extremely preterm infants to promote development and long-term health. Clinical trial registry: ClinicalTrials.gov, identifier: NCT03201588.

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Contribution to journal
publication status
published
subject
keywords
Arachidonic acid, Docosahexaenoic acid, Extremely preterm infants, Intravenous lipid emulsion, LCPUFA, Parenteral nutrition
in
Clinical Nutrition
volume
42
issue
6
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85153614408
  • pmid:37120902
ISSN
0261-5614
DOI
10.1016/j.clnu.2023.04.020
language
English
LU publication?
yes
id
2279f11b-6334-4c34-824e-c492a9767bfa
date added to LUP
2023-06-20 12:35:32
date last changed
2024-02-19 20:58:55
@article{2279f11b-6334-4c34-824e-c492a9767bfa,
  abstract     = {{<p>Background &amp; aim: Preterm infants risk deficits of long-chain polyunsaturated fatty acids (LCPUFAs) that may contribute to morbidities and hamper neurodevelopment. We aimed to determine longitudinal serum fatty acid profiles in preterm infants and how the profiles are affected by enteral and parenteral lipid sources. Methods: Cohort study analyzing fatty acid data from the Mega Donna Mega study, a randomized control trial with infants born &lt;28 weeks of gestation (n = 204) receiving standard nutrition or daily enteral lipid supplementation with arachidonic acid (AA):docosahexaenoic acid (DHA) (100:50 mg/kg/day). Infants received an intravenous lipid emulsion containing olive oil:soybean oil (4:1). Infants were followed from birth to postmenstrual age 40 weeks. Levels of 31 different fatty acids from serum phospholipids were determined by GC–MS and reported in relative (mol%) and absolute concentration (μmol l<sup>−1</sup>) units. Results: Higher parenteral lipid administration resulted in lower serum proportion of AA and DHA relative to other fatty acids during the first 13 weeks of life (p &lt; 0.001 for the 25th vs the 75th percentile). The enteral AA:DHA supplement increased the target fatty acids with little impact on other fatty acids. The absolute concentration of total phospholipid fatty acids changed rapidly in the first weeks of life, peaking at day 3, median (Q1-Q3) 4452 (3645–5466) μmol l<sup>−1</sup>, and was positively correlated to the intake of parenteral lipids. Overall, infants displayed common fatty acid trajectories over the study period. However, remarkable differences in fatty acid patterns were observed depending on whether levels were expressed in relative or absolute units. For example, the relative levels of many LCPUFAs, including DHA and AA, declined rapidly after birth while their absolute concentrations increased in the first week of life. For DHA, absolute levels were significantly higher compared to cord blood from day 1 until postnatal week 16 (p &lt; 0.001). For AA, absolute postnatal levels were lower compared to cord blood from week 4 throughout the study period (p &lt; 0.05). Conclusions: Our data show that parenteral lipids aggravate the postnatal loss of LCPUFAs seen in preterm infants and that serum AA available for accretion is below that in utero. Further research is needed to establish optimal postnatal fatty acid supplementation and profiles in extremely preterm infants to promote development and long-term health. Clinical trial registry: ClinicalTrials.gov, identifier: NCT03201588.</p>}},
  author       = {{Sjöbom, Ulrika and Andersson, Mats X. and Pivodic, Aldina and Lund, Anna My and Vanpee, Mireille and Hansen-Pupp, Ingrid and Ley, David and Wackernagel, Dirk and Sävman, Karin and Smith, Lois E.H. and Löfqvist, Chatarina and Hellström, Ann and Nilsson, Anders K.}},
  issn         = {{0261-5614}},
  keywords     = {{Arachidonic acid; Docosahexaenoic acid; Extremely preterm infants; Intravenous lipid emulsion; LCPUFA; Parenteral nutrition}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{962--971}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Nutrition}},
  title        = {{Modification of serum fatty acids in preterm infants by parenteral lipids and enteral docosahexaenoic acid/arachidonic acid : A secondary analysis of the Mega Donna Mega trial}},
  url          = {{http://dx.doi.org/10.1016/j.clnu.2023.04.020}},
  doi          = {{10.1016/j.clnu.2023.04.020}},
  volume       = {{42}},
  year         = {{2023}},
}