Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Learning and Leadership for Health Care Professionals at the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden.
Clin Nutr. 2023 Jun;42(6):962-971. doi: 10.1016/j.clnu.2023.04.020. Epub 2023 Apr 17.
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.
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) units.
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, 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).
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.
ClinicalTrials.gov, identifier: NCT03201588.
早产儿存在长链多不饱和脂肪酸（LCPUFAs）不足的风险，这可能导致发病和神经发育障碍。本研究旨在确定早产儿的血清脂肪酸谱，并探讨肠内和肠外脂质来源对其的影响。
这是一项 Mega Donna Mega 研究的队列研究，对 204 名胎龄<28 周的婴儿进行随机对照试验，分别给予标准营养或每日肠内补充含有花生四烯酸（AA）：二十二碳六烯酸（DHA）（100:50mg/kg/天）的脂肪乳剂。婴儿接受含有橄榄油：大豆油（4:1）的静脉内脂肪乳剂。从出生到出生后 40 周的月经龄，对婴儿进行随访。采用气相色谱-质谱法（GC-MS）检测血清磷脂中 31 种不同脂肪酸的水平，并以相对（mol%）和绝对浓度（μmol l）单位报告。
在生命的前 13 周，较高的静脉内脂质给予导致 AA 和 DHA 与其他脂肪酸的血清比例降低（第 25 百分位数与第 75 百分位数相比，p<0.001）。肠内 AA:DHA 补充剂增加了目标脂肪酸，而对其他脂肪酸影响不大。总磷脂脂肪酸的绝对浓度在生命的最初几周迅速变化，第 3 天达到峰值，中位数（Q1-Q3）为 4452（3645-5466）μmol l，并与静脉内脂质的摄入呈正相关。总的来说，在研究期间，婴儿表现出常见的脂肪酸轨迹。然而，取决于以相对或绝对单位表示的水平，观察到脂肪酸模式的显著差异。例如，许多 LCPUFAs（包括 DHA 和 AA）的相对水平在出生后迅速下降，而其绝对浓度在生命的第一周增加。与出生时的脐血相比，DHA 的绝对水平在第 1 天至出生后第 16 周均显著升高（p<0.001）。与出生后第 4 周至整个研究期间的脐血相比，AA 的绝对产后水平较低（p<0.05）。
我们的数据表明，静脉内脂质加重了早产儿中所见的 LCPUFAs 的产后损失，并且可用于积累的血清 AA 低于宫内水平。需要进一步研究以确定极早产儿的最佳产后脂肪酸补充和谱，以促进发育和长期健康。
ClinicalTrials.gov，标识符：NCT03201588。
