Early Enteral Administration of a Complex Lipid Emulsion Supplement Prevents Postnatal Deficits in Docosahexaenoic and Arachidonic Acids and Increases Tissue Accretion of Lipophilic Nutrients in Preterm Piglets

Abstract

Background: Preterm delivery and current nutrition strategies result in deficiencies of critical long-chain fatty acids (FAs) and lipophilic nutrients, increasing the risk of preterm morbidities. We sought to determine the efficacy of preventing postnatal deficits in FAs and lipophilic nutrients using an enteral concentrated lipid supplement in preterm piglets. Methods: Preterm piglets were fed a baseline diet devoid of arachidonic acid (AA) and docosahexaenoic acid (DHA) and randomized to enteral supplementation as follows: (1) Intralipid (IL), (2) complex lipid supplement 1 (CLS1) with an AA:DHA ratio of 0.25, or (3) CLS2 with an AA:DHA ratio of 1.2. On day 8, plasma and tissue levels of FAs and lipophilic nutrients were measured and ileum histology performed. Results: Plasma DHA levels decreased in the IL group by day 2. In contrast, DHA increased by day 2 compared with birth levels in both CLS1 and CLS2 groups. The IL and CLS1 groups demonstrated a continued decline in AA levels during the 8-day protocol, whereas AA levels in the CLS2 group on day 8 were comparable to birth levels. Preserving AA levels in the CLS2 group was associated with greater ileal villus height and muscular layer thickness. Lipophilic nutrients were effectively absorbed in plasma and tissues. Conclusions: Enteral administration of CLS1 and CLS2 demonstrated similar increases in DHA levels compared with birth levels. Only CLS2 maintained AA birth levels. Providing a concentrated complex lipid emulsion with an AA:DHA ratio > 1 is important in preventing postnatal AA deficits. (JPEN J Parenter Enteral Nutr. 2020;44:69-79)

Breast Milk Lipids and Fatty Acids in Regulating Neonatal Intestinal Development and Protecting against Intestinal Injury

“…In a preterm piglet model evaluating the effect of an enteral complex lipid emulsion containing LCPUFAs on early postnatal fatty acid levels, it was demonstrated that an ARA:DHA ratio >1.0 compared to a ratio <1.0 uniquely prevented the postnatal deficit of ARA while also demonstrating increased ileal villus height and muscular thickness compared to the control soybean-oil and ARA:DHA <1.0 groups [54]. In contrast, parenteral nutrition did not show an effect on intestinal morphology and function in preterm piglet models, suggesting postnatal intestinal adaptation is driven more by enterally administered fatty acids versus parenteral delivery [55].…”

Modification of serum fatty acids in preterm infants by parenteral lipids and enteral docosahexaenoic acid/arachidonic acid: A secondary analysis of the Mega Donna Mega trial

“…The recent ImNuT (Immature, Nutrition Therapy) trial, also enterally supplementing preterm infants with AA:DHA at 100:50 mg/kg/day, reported a small increase in the molar percent of whole blood DHA between day 2 and PMA 36 weeks but no significant effect on AA levels [ 20 ]. In both this and the ImNuT trial, the supplement was provided as pure oil, and emulsification of the fat would likely have enhanced the LCPUFA bioavailability, as demonstrated in both experimental and clinical studies [ 35 , 36 ]. Increased supplement dosing and/or improved lipid delivery may be needed to avoid infant LCPUFA shortfall.…”

Parenteral Fish-Oil Containing Lipid Emulsions Limit Initial Lipopolysaccharide-Induced Host Immune Responses in Preterm Pigs

“…Maintaining birth levels of AA is critical to neonatal development, as a postnatal decrease in AA has been associated with increased risk of neonatal morbidities such as late-onset sepsis and retinopathy of prematurity [ 4 , 13 ]. We have previously shown in a pig model that providing enteral lipid emulsions with an AA:DHA ratio > 1 maintained birth levels of AA and improved intestinal development in preterm pigs [ 39 ]. Together, these data suggest that it is not only individual fatty acids such as AA and DHA, but the ratio of these fatty acids are crucial for neonatal development.…”