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38Background and Aim: Retinopathy of prematurity (ROP) is a disorder of the retina of low-39 birth-weight preterm infants that potentially leads to blindness. Docosahexaenoic acid 40 (DHA), a component of fish oil, is protective in experimental models. Administration of 41 fish oil as part of parenteral nutrition has shown inconsistent results. We aimed to test the 42 effect of enteral DHA to prevent ROP development and/or severity, and to reduce hospital 43 stay. 44 Methods: This was a double-blind, parallel clinical-trial. Preterm infants (n = 110; 55 per 45 group) with birth weight <1500g but >1000g were recruited in a level 3 NICU. Infants were 46 randomized to receive 75 mg of DHA/kg/day (DHA-group) or high oleic sunflower oil 47 (control-group) for 14 days by enteral feeding. The effect of DHA was evaluated on any 48 stage of ROP, severe ROP (stage ≥3) incidence, and hospital stay. Groups were compared 49 with relative risk and 95% CI, Fisher's Exact, Student's t or Mann-Whitney U tests, as 50 appropriate. Logistic regression was applied to adjust for confounders.51Results: There was no difference between the DHA and control groups in ROP risk (RR for 52 DHA= 0.79; 95% CI, 0.49-1.27, P= 0.33). However, patients who received DHA showed 53 lower risk for stage 3 ROP than controls (RR for DHA= 0.66; 95% CI, 0.44-0.99, P= 0.03). 54After adjusting for confounders, enteral DHA decreased the risk of stage 3 ROP (OR adj. = 55 0.10; 95% CI, 0.011-0.886; P= 0.04). Hospital stay was not different between groups. 56Conclusion: Enteral DHA may reduce the incidence of stage 3 ROP. 57 58

Objective:To evaluate the use of the 13C-glucose breath test (13C-GBT) for insulin resistance (IR) detection in adolescents through comparison with fasting and post-glucose stimulus surrogates.Methods:One hundred thirty-three adolescents aged between 10 and 16 years received an oral glucose load of 1.75 g per kg of body weight dissolved in 150 mL of water followed by an oral dose of 1.5 mg/kg of U-13C-Glucose, without a specific maximum dose. Blood samples were drawn at baseline and 120 minutes, while breath samples were obtained at baseline and at 30, 60, 90, 120, 150, and 180 minutes. The 13C-GBT was compared to homeostasis model assessment (HOMA) IR (≥p95 adjusted by gender and age), fasting plasma insulin (≥p90 adjusted by gender and Tanner stage), results of 2-h oral glucose tolerance test (OGTT), insulin levels (≥65 μU/mL) in order to determine the optimal cut-off point for IR diagnosis.Results:13C-GBT data, expressed as adjusted cumulative percentage of oxidized dose (A% OD), correlated inversely with fasting and post-load IR surrogates. Sexual development alters A% OD results, therefore individuals were stratified into pubescent and post-pubescent. The optimal cut-off point for the 13C-GBT in pubescent individuals was 16.3% (sensitivity=82.8% & specificity=60.6%) and 13.0% in post-pubescents (sensitivity=87.5% & specificity=63.6%), when compared to fasting plasma insulin. Similar results were observed against HOMA and 2-h OGTT insulin.Conclusion:The 13C-GBT is a practical and non-invasive method to screen for IR in adolescents with reasonable sensitivity and specificity.