Division of Neonatology, University Children's Hospital, Ernst-Moritz-Arndt University, D-17475 Greifswald, Germany.
Clin Nutr. 2010 Feb;29(1):94-9. doi: 10.1016/j.clnu.2009.07.002. Epub 2009 Aug 8.
Actual recommendations in preterm infants limit parenteral fat intake to 3-4 g/kg/d. This is based on clinical studies where fat administration was adjusted to achieve levels close to those recommended in adults for atherosclerosis prevention. Data about lipid profiles of breast fed preterm infants who may have fat intakes of up to 7 g/kg/d and could serve as reference are not available.
To establish full lipid profiles in healthy fully breast fed preterm infants and to test the hypothesis that breast milk fat intake leads to serum triglycerides higher than those achieved under full parenteral fat administration.
Serum triglycerides, cholesterol, VLDL, LDL, HDL (all pre- and postprandial), as well as triglycerides in breast milk were measured in 65 healthy, fully breast fed, stable growing preterm infants stratified in 500 g intervals (mean gestational age: 31+/-4 weeks, birth weight: 1500+/-600 g, age at study: 25+/-16 d).
Median fat intake was 7.0 g/kg/d (interquartile range: 5.8;8.1) and led to the following serum levels: triglycerides 0.9 (0.6;1.1), cholesterol 3.1 (2.6;3.5), VLDL 0.5 (0.3;0.6), LDL 1.3 (1.1;1.6), HDL 1.1 (0.8;1.4)mmol/L. Small for gestational age infants showed higher triglycerides (p=0.005). Triglycerides (r2=0.08, p=0.023), postprandial triglyceride increase (r2=0.21, p<0.001), cholesterol (r2=0.16, p<0.001) and HDL (r2=0.16, p<0.001) were correlated with weight at study.
Though higher by a factor of two, fat intake by breast milk leads to considerably lower lipid levels when compared to published values obtained under parenteral fat intake. Results suggest that either fat absorption is reduced in preterm infants, or the composition of breast milk supports a lower profile of fat levels when compared to commercially available parenteral fat emulsions.
早产儿的实际推荐意见限制了其肠外脂肪摄入量为 3-4 g/kg/d。这是基于临床研究的，其中脂肪的给予量被调整以达到接近预防动脉粥样硬化的成人推荐水平。关于母乳喂养的早产儿的脂质谱的数据，他们的脂肪摄入量可能高达 7 g/kg/d，可以作为参考，但目前尚不可用。
建立健康的完全母乳喂养的早产儿的完整脂质谱，并验证这样一个假设，即母乳脂肪摄入会导致血清甘油三酯高于完全肠外脂肪给药所达到的水平。
65 名健康、完全母乳喂养、稳定生长的早产儿被分层为 500g 间隔（平均胎龄：31+/-4 周，出生体重：1500+/-600g，研究时的年龄：25+/-16 天），测量了他们的血清甘油三酯、胆固醇、VLDL、LDL、HDL（所有空腹和餐后）以及母乳中的甘油三酯。
中位脂肪摄入量为 7.0 g/kg/d（四分位间距：5.8；8.1），导致以下血清水平：甘油三酯 0.9（0.6；1.1）mmol/L，胆固醇 3.1（2.6；3.5）mmol/L，VLDL 0.5（0.3；0.6）mmol/L，LDL 1.3（1.1；1.6）mmol/L，HDL 1.1（0.8；1.4）mmol/L。小于胎龄儿的甘油三酯水平较高（p=0.005）。甘油三酯（r2=0.08，p=0.023）、餐后甘油三酯增加（r2=0.21，p<0.001）、胆固醇（r2=0.16，p<0.001）和 HDL（r2=0.16，p<0.001）与研究时的体重相关。
尽管母乳喂养的脂肪摄入量比肠外脂肪摄入量高出两倍，但与已发表的数值相比，其脂质水平要低得多。结果表明，在早产儿中，脂肪吸收减少，或者母乳的成分与商业上可获得的肠外脂肪乳剂相比，支持较低的脂肪水平特征。
