Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
Pediatr Res. 2022 Feb;91(3):646-651. doi: 10.1038/s41390-021-01464-z. Epub 2021 Mar 25.
Modulation of behavior and physiology by dietary perturbations early in life can provide clues to the pathogenesis of adult diseases. We tested the hypothesis that a period of early protein supplementation modulates sympathetic nervous system activity demonstrated indirectly by an increase in active sleep state distribution in very low birth weight (VLBW) infants.
VLBW infants (n = 71) were randomized to a total parenteral nutritional regimen providing 18% of the energy intake as amino acids (AA) or a conventional regimen providing 12.5% to achieve targeted AA intakes of 4 g/kg/day (0.004 kcal/kg/day) and 3 g/kg/day (0.003 kcal/kg/day), respectively. Both groups were weaned to enteral feeding and advanced to provide similar AA intake of 4 g/kg/day (0.004 kcal/kg/day). Six-hour daytime, behavioral sleep studies were performed when the infants reached full enteral intake (165 ml/kg/day).
Infants in the high protein group spent more time in active sleep (77.2 ± 10.5% vs. 70.7 ± 11.8%), p < 0.01 and less time in quiet sleep (12.9 ± 3.4% vs. 17.7 ± 7.0%, p < 0.01) as compared to the conventional group. No group differences were observed for indeterminate sleep, awake, or crying states.
These results suggest that dietary intake may indirectly influence sympathetic nervous system activity.
Infants randomized to an early, high protein nutritional regimen spent an increased percentage of time in active sleep, supporting the hypothesis that nutrition and behavior are interactive. Furthermore, sleep states are an indirect measure of sympathetic nervous system activity, suggesting that dietary intake may influence sympathetic nervous system activity. This study highlights the importance of considering the impact of nutrition during critical periods of development in order to further understand and improve the long-term outcomes of very low birth weight infants.
生命早期饮食干扰对行为和生理的调节可以为成人疾病的发病机制提供线索。我们检验了这样一个假设，即早期蛋白质补充会改变极低出生体重（VLBW）婴儿的交感神经系统活性，这种改变可通过活跃睡眠状态分布的增加间接证明。
将 71 例 VLBW 婴儿随机分为全胃肠外营养组和常规组，前者提供 18%的能量摄入作为氨基酸（AA），后者提供 12.5%以达到目标 AA 摄入量 4 g/kg/d（0.004 kcal/kg/d）和 3 g/kg/d（0.003 kcal/kg/d）。两组均逐渐转为肠内喂养，并增加至 4 g/kg/d（0.004 kcal/kg/d）的相同 AA 摄入量。当婴儿达到全肠内摄入（165 ml/kg/d）时，进行 6 小时日间行为睡眠研究。
高蛋白组婴儿的活跃睡眠时间（77.2±10.5% vs. 70.7±11.8%，p<0.01）和安静睡眠时间（12.9±3.4% vs. 17.7±7.0%，p<0.01）均多于常规组，而两组之间的不确定睡眠、觉醒和哭泣状态无差异。
这些结果表明，饮食摄入可能间接影响交感神经系统活性。
早期高蛋白营养方案组的婴儿活跃睡眠时间百分比增加，支持了这样一种假设，即营养和行为是相互作用的。此外，睡眠状态是交感神经系统活性的间接测量指标，表明饮食摄入可能影响交感神经系统活性。这项研究强调了在生命早期关键时期考虑营养影响的重要性，以便进一步了解和改善极低出生体重婴儿的长期结局。
