Department of Food & Nutrition, OSF Healthcare Saint Francis Medical Center, Peoria, IL, 61637, USA.
Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, 66106, USA.
Pediatr Res. 2024 Sep;96(4):875-883. doi: 10.1038/s41390-024-03212-5. Epub 2024 Apr 24.
We undertook this review to determine if it is plausible that choline or phosphatidylcholine (PC) deficiency is a factor in necrotizing enterocolitis (NEC) after two clinical trials found a dramatic and unexpected reduction in NEC in an experimental group provided higher PC compared to a control group. Sources and amounts of choline/PC for preterm infants are compared to the choline status of preterm infants at birth and following conventional nutritional management. The roles of choline/PC in intestinal structure, mucus, mesenteric blood flow, and the cholinergic anti-inflammatory system are summarized. Low choline/PC status is linked to prematurity/immaturity, parenteral and enteral feeding, microbial dysbiosis and hypoxia/ischemia, factors long associated with the risk of developing NEC. We conclude that low choline status exists in preterm infants provided conventional parenteral and enteral nutritional management, and that it is plausible low choline/PC status adversely affects intestinal function to set up the vicious cycle of inflammation, loss of intestinal barrier function and worsening tissue hypoxia that occurs with NEC. In conclusion, this review supports the need for randomized clinical trials to test the hypothesis that additional choline or PC provided parenterally or enterally can reduce the incidence of NEC in preterm infants. IMPACT STATEMENT: Low choline status in preterm infants who are managed by conventional nutrition is plausibly linked to the risk of developing necrotizing enterocolitis.
我们进行这项综述是为了确定在两项临床试验发现实验组提供的较高 PC 水平与对照组相比显著且意外地降低了坏死性小肠结肠炎 (NEC) 发生率后，胆碱或磷脂酰胆碱 (PC) 缺乏是否是 NEC 的一个因素。早产儿的胆碱/PC 来源和用量与早产儿出生时和接受常规营养管理后的胆碱状态进行了比较。总结了胆碱/PC 在肠道结构、粘液、肠系膜血流和胆碱能抗炎系统中的作用。低胆碱/PC 状态与早产/不成熟、肠外和肠内喂养、微生物失调和缺氧/缺血有关，这些因素长期以来与发生 NEC 的风险相关。我们得出结论，接受常规肠外和肠内营养管理的早产儿存在低胆碱状态，低胆碱/PC 状态可能会对肠道功能产生不利影响，从而引发与 NEC 相关的炎症、肠道屏障功能丧失和组织缺氧恶化的恶性循环。总之，本综述支持需要进行随机临床试验来检验以下假设：通过肠外或肠内途径补充额外的胆碱或 PC 可以降低早产儿患 NEC 的发生率。
