Fusch Gerhard, Fink Naomi H, Rochow Niels, Fusch Christoph
Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Department of Pediatrics, Paracelsus Medical University (PMU) Nuremberg, Nuremberg General Hospital, Nuremberg, Germany.
Mol Cell Pediatr. 2024 Oct 12;11(1):10. doi: 10.1186/s40348-024-00183-9.
In preterm infants, IV administration of fat is less well tolerated compared to intake via the enteral route, often resulting in hypertriglyceridemia. It is therefore recommended that parenteral fat intake should not exceed 3.5 to 4.0 g/kg/d whereas human milk can provide up to 8 g/kg/d. It is unknown whether such hypertriglyceridemic conditions are caused by a uniform increase of all fatty acids or it is linked to an elevation of distinct fatty acids due to an unbalanced intake. Obviously, both scenarios could potentially influence the formulation of novel lipid solutions for preterm infants. Objective of this exploratory study was to compare fatty acid profiles between a) different nutritional sources and corresponding plasma samples, b) plasma of infants fed breast milk versus those receiving lipid emulsion, and c) plasma of infants with normal versus elevated triglyceride levels.
Forty-seven preterm infants < 36 weeks of gestation were included; fatty acid profiles were measured in serum samples and corresponding nutritional sources (breast milk and lipid emulsion) using gas chromatography/mass spectrometry.
Compared to breast milk levels, plasma contained significantly lower C8:0, C10:0, C12:0, C14:0, C19:1n9, C18:3n3 (p < 0.0001). In contrast, relative abundance of C16:0, C18:0 and C20:4n6 was higher in plasma than in corresponding breast milk samples (p < 0.001) and lipid emulsion (p < 0.01). Compared to the corresponding lipid emulsion, the abundance of C18:2n6 and C18:3n3 was significantly lower in plasma (p < 0.001). Fatty acid profiles in plasma of infants fed breast milk compared to lipid emulsion were not markedly different. Hypertriglyceridemic samples showed elevated levels for C18:1n9 and C16:0 when compared with normotriglyceridemic samples.
Our study reveals that lipid levels in plasma show both depletion and enrichment of distinct fatty acids which do not seem to be closely related to dietary intake. A more detailed understanding of fatty acid flux rates is needed, like the understanding of amino acid metabolism and is supported by the finding that hypertriglyceridemia might be a state of selective fatty acid accumulation. This would allow to develop more balanced diets for intensive care and potentially improve clinical outcomes.
与经肠道摄入脂肪相比，早产儿静脉输注脂肪的耐受性较差，常导致高甘油三酯血症。因此，建议肠外脂肪摄入量不应超过3.5至4.0克/千克/天，而母乳可提供高达8克/千克/天的脂肪。目前尚不清楚这种高甘油三酯血症状态是由所有脂肪酸的均匀增加引起的，还是与因摄入不均衡导致的特定脂肪酸升高有关。显然，这两种情况都可能潜在地影响早产儿新型脂质溶液的配方。本探索性研究的目的是比较：a）不同营养来源及其相应血浆样本之间的脂肪酸谱；b）母乳喂养婴儿与接受脂质乳剂婴儿的血浆；c）甘油三酯水平正常与升高的婴儿的血浆。
纳入47名孕周小于36周的早产儿；使用气相色谱/质谱法测量血清样本及相应营养来源（母乳和脂质乳剂）中的脂肪酸谱。
与母乳水平相比，血浆中C8:0、C10:0、C12:0、C14:0、C19:1n9、C18:3n3的含量显著降低（p<0.0001）。相反，血浆中C16:0、C18:0和C20:4n6的相对丰度高于相应的母乳样本（p<0.001）和脂质乳剂（p<0.01）。与相应的脂质乳剂相比，血浆中C18:2n6和C18:3n3的丰度显著降低（p<0.001）。母乳喂养婴儿与接受脂质乳剂婴儿的血浆脂肪酸谱无明显差异。与甘油三酯正常的样本相比，高甘油三酯血症样本中C18:1n9和C16:0的水平升高。
我们的研究表明，血浆中的脂质水平显示出特定脂肪酸的消耗和富集，这似乎与饮食摄入没有密切关系。需要更详细地了解脂肪酸通量率，就像了解氨基酸代谢一样，高甘油三酯血症可能是一种选择性脂肪酸积累的状态这一发现也支持了这一点。这将有助于为重症监护制定更均衡的饮食，并有可能改善临床结果。
